Richard Winter, D.D.S. and Bruce Winter, D.D.S.

1. Upgradeable Dentistry - Part I

   Read the article written by Dr. Richard Winter about Upgradeable Dentistry.

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1. Upgradeable Dentistry - Part II

   Read Part II

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1. Upgradeable Dentistry - Part III

   Read Part III

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1. Upgradeable Dentistry - Part IV

   Read Part IV

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1. Compromised Foundations Require Confident Conversation

   The loss of bone as a result of tooth loss, disuse atrophy, and attrition can result in physiological and psychological atrophy. This case study serves as a reminder of how conventional treatment planning can lead to deep depression and emotional distress.

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1. Upgradeable Dentistry - Implants

   Treatment planning is a complex discipline that can be confusing and multifaceted. Dentists are often unprepared to discuss complex “upgrade” paths with their patients due to their own incomplete understanding of current implant treatment options and their associated costs.

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1. Ask the Dentist

   Dr. Winter answers a question from a reader about his problems with his lower bridge and not being able to pronounce S's.

   Dear Dr. Winter,
   
   I recently had my lower 6 teeth (all in the front of jaw) crowned with temporary crowns. A temporary bridge was made and applied. I am having trouble speaking words with “S's.” I have had the bridge with all the crowns filed down twice but still can't speak words with S's. Is this normal? Will my permanent teeth be less bulky (all will be single teeth) and will I be able to speak better?
   
   Dear Nick, this is obviously a question your dentist needs to discuss with you. I can’t give you any specific answer to your question as I haven’t met you seen your initial teeth or bite or performed a thorough examination on you! The dentist is performing your treatment, understands what your starting point was and the reason for your new crowns. So you should discuss your concerns, and the dentist should either be able to work with you to recreate the "s" sound prior to delivering your new crowns or they should discuss the reasons why changes may need to occur that could change your speech. Some of these reasons could be to decrease trauma to the opposing teeth, improve your bite, or to change the crowding that may have been present (Any of these could change your speech).
   
   Often, teeth positions are changed with crowns to form a different esthetic or functional result. In these instances you may need to give your speech time to "acclimate" to the changes. If your speech cannot be improved upon, then the temporaries should be changed until they are acceptable to you. This new temporary should be a prototype or "blue print"' for the laboratory to follow in creating the height, width, shape and emergence angles of your new crowns. If the dentist feels the bulkiness of the crowns is because they are in 1 piece as a bridge and this bulk is changing the air flow through the teeth or the way your tongue bounces off the teeth, then perhaps they can separate them into 6 individual temporaries to match the 6 individual crowns you will be receiving to see if that alone can improve your speech. Either way, it is important to work things out before you have the permanent crowns cemented as they can be difficult to remove and can create trauma to the remaining tooth structure if removed after cementation. In most instances they will need to be cut off to be removed which would require remaking them at a substantial cost to the patient (if approved for cementation) or the dentist.
   
   While dentists can adjust your temporaries multiple times, if the edges of the teeth are in a different position then the “s” position or the closest speaking space between your upper and lower teeth could be off very slightly. In some instances we need to add to the temporaries in the front and reduce them in the back to make them come a bit closer to the upper teeth to create the "s" sound more sharply. Lastly, your speech may be so close that only you can tell it’s different! In that case you must trust the judgment of the dentist to make the subtle changes in porcelain to get it just right.
   
   We invite all of our readers to call us at 414-375-4930 for your complimentary consultation regarding your crowns, bridges or implant restorations. If you mention this column your comprehensive exam and x-ray visit is discounted! We offer interest free financing for up to two years and you can find out more by going to "prevent worse" on our websites. We always try and help people stay within their budgets while pursuing the finest dental options.

1. Question: Non-Carious Cervical Lesions: Does Occlusion Affect Their Formation and Treatment?

   Inside Dentistry poses a question to various dentists, including Dr. Richard Winter: Non-carious cervical lesions: Does occlusion affect their formation and treatment?

   Dr. Winter's Response:
   

   For the restorative dentist, NCCLs raise a red flag as we try to ascertain whether these lesions are caused by corrosion, abrasion, attrition, occlusal traumatism (abfraction), or some combination of these individual causes. These lesions are multi-factorial in nature and are difficult to study in vitro. Tooth wear can occur at the cervical area from cyclic occlusal loading, and studies have shown that enamel fractures occur at the CEJ after 200,000 cycles or approximately two and a half months of chewing. The introduction of abrasive elements and changes in pH can contribute to further dissolution of tooth structure.

   A second cause of wear can be found with eccentric forces such as premature contacts, bruxism, and clenching. These stressors can be force multipliers that add to the odontolytic effects. Thirdly, we look at abrasion as a cause of tooth structure loss and we can see how poor brushing technique, hard bristles, and parafunctional habits can lead to loss of tooth structure. Most of us have probably had patient who think that straight baking soda is better than toothpaste.

   Lastly, corrosion (formerly called erosion) has been discussed as a source of tooth structure dissolution both from exogenous sources, such as sucking lemon drops, or endogenously, such as with GERD or bulimia, resulting in gastric acid reflux that can lead to NCCLs.

   In my practice, I will assess these lesions by evaluating these components. I will identify a patient’s habits, medications (which can be acidic or corrosive or could contribute to decreased saliva), and other corrosive exogenous sources such as soda habits and candy.

   Then I will perform a thorough occlusal analysis to evaluate whether there are parafunctional habits such as nocturnal bruxism or occlusal prematurities and excursive interferences resulting in fremitus.

   After treating the lesion directly, occlusal adjustment may be performed. Equilibration will centralize and equalize contacts, decrease fremitus and excursive interference, and, whenever possible, create canine-protected occlusion.

   Mouthguards and splints are fabricated and used to optimize occlusal constructs and decrease force factors on the stomatognathic system prior to finalization of the patient’s treatment plan.

1. Caring for the Edentulous Patient

   In a series of Dentistry Today articles that began in June 2009, Richard Winter, DDS, MAGD, lays out his concept of “upgradeable dentistry,” which provides for a diligent continuum of care as patients gradually progress from removable prosthodontics to implants.

   In a series of Dentistry Today articles that began in June 2009, Richard Winter, DDS, MAGD, lays out his concept of “upgradeable dentistry,” which provides for a diligent continuum of care as patients gradually progress from removable prosthodontics to implants. His approach, he believes, builds in excellence at every level by taking a full measure of each patient, which provides the basis for long-term success and patient satisfaction. Financial considerations are one part of a paradigm that helps to “more fully educate dentists and patients about the many levels of dentistry that are not always discussed in appropriate detail due to insurance limitations, time constraints, and preconceptions about patient desires,” he says. “Patients aren’t always treated with the dignity and respect they deserve with regard to their dental treatment options. Upgradeable dentistry is a concept that allows people the dignity to choose options that will improve their oral health in a sequential fashion, based on their emotional, financial, and personal readiness.”
   
   Full and partial dentures are considered “provisional” prostheses in Dr. Winter’s practice, yet he also goes to “great lengths” on denture fabrication and fitting to create prototype restorations that serve as the foundation for any future implant-based treatment. Dr. Winter moves forward on dentures with each patient only after lengthy communication on the consequences of bone loss and prolonged denture wear as well as information on the range of upgrade options available over time.
   
   The underlying lesson, says Dr. Winter, is that dentistry is a “dynamic process” rather than a “static event.” “Patients who are allowed to remain engaged in their ongoing care through continual upgrades will provide an economic benefit to a dental practice while creating a huge dental benefit for the patient,” he says. “This is realized, in part, through increased masticatory forces; improved esthetics, phonetics, and function; and social satisfaction, to name just a few factors.”

1. General Dentistry as a Specialty

   Read the article by Dr. Richard Winter about General Dentistry as a Specialty

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1. Cosmetic Nightmare! Composite Success!

   In restorative dentistry, we are introduced to a plethora of conditions that can leave us perplexed. Not all conditions lend themselves to an ideal treatment methodology. While our goal is to always perform textbook treatment, situations arise that call for flexible treatment planning.

1. Behind the Scenes: A Guide To Implant Success

Richard Winter, D.D.S., M.A.G.D., F.A.D.I., D.I.C.O.I., F.I.C.D.

Fellowship and Mastership Award Academy of General Dentistry
Fellowship Academy of Dentistry International
Fellowship, Mastership (Implant Prosthetic Section) and Diplomate International Congress of Oral Implantologists
Fellowship International College of Dentists

A 1988 University of Minnesota graduate, Dr. Richard Winter has a passion for modern dentistry and thrives on the challenges of the dental treatment needs of his patients that require leading edge applications of advanced dental procedures and use of state-of-the-art dental components and materials.

Dr. Winter's personal and professional commitment to remaining abreast of and going beyond traditional standards in creative dentistry is evidenced in numerous post graduate training programs.

Dr. Richard is a Master with and active Board Member of the esteemed Academy of General Dentistry. He is also a graduate of the Misch Implant Institute of Implant Prosthetics. Dr. Richard also participated in a mini-residency program with Nobel Biocare's Branemark Implant systems.

Dr. Richard is a frequent guest speaker and lecturer at local schools, discussing both current standards of modern dentistry and the ongoing developments within the general field of advanced dental sciences and technologies.

Outside of his active practice, Dr. Winter is a Black Belt in TaeKwonDo, and an instructor in Jeet Kune Do as well as a Thai Boxing enthusiast. He is a professional judge of Kickboxing and Mixed Martial Arts and is certified by the Nevada State Athletic Commision to judge these events in Las Vegas.

Dr. Richard has been married for over 20 years to wife Jackie and has a daughter, Ariel, who loves dancing and a son, Eli, who is Dr. Richard's "superhero."

Professional Affiliations

American Dental Association
Greater Milwaukee Dental Association
Wisconsin Dental Association
Chicago Dental Society
Alpha Omega Dental Fraternity
Master - Academy of General Dentistry (MAGD)
Academy of General Dentistry - Board Member
American Academy of Implant Dentistry
Fellow, Master (Implant and Prosthetic Section), and Diplomate - International Congress of Oral Implantologists
International College of Dentists
Academy of Dentists International
Alpha Omega Dental Fraternity
Wisconsin Academy of General Dentistry - Board Member
International Consultant for Dental Health Library

Education

1980-1984 B.S. Zoology University of Wisconsin Madison
1984-1988 D.D.S. Doctor of Dental Surgery - University of Minnesota School of Dentistry
2004 Fellowship Academy of General Dentistry
2007 Fellowship Academy of Dentistry International
2008 Mastership Academy of General Dentistry
May 11, 2009 Fellowship Award International Congress of Oral Implantologists
August 27th, 2009 Mastership Award International Congress of Oral Implantologists
Oct. 8, 2010 Fellowship International College of Dentists


Dental courses totaling over 2000 hours of continuing education in 16 subspecialties of General Dentistry

Graduate of the Misch International Implant Institute Prosthetic and Surgical Continuums, including Advanced Block Grafting and Cadaver modules. December 2008.

Two, two-year courses in Orthodontics through SWOS Straight Wire Orthodontic Studies and Waldemar Brehm and Carapezza Orthodontics

Courses in Implantology, Esthetics, Full Mouth Rehabilitation, Periodontics, Pedodontics, Special needs, Operative Dentistry, Endodontics, Oral Surgery, Advanced Prosthodontics - full list available upon request.

Bruce Winter, D.D.S.

A 1982 graduate of Marquette University, Dr. Winter is a third generation dentist. Dr. Morris Paschen (grandfather) and Dr. Charles Winter (father) established the family tradition of providing full service dentistry. His father retired about eight years after Dr. Bruce Winter joined the practice. We continue to treat a number of patients that began their initial treatment programs with grandfather Dr. Paschen.

Dr. Winter, one of four brothers, is married to his wife Susan. Son Jeremy is a student at University of Wisconsin at Madison while daughter Andrea is a student at Nicolet High School. Misty, a proud member of the Winter's family, is a Bishon-poo.

Professional Affiliations

American Dental Association
Greater Milwaukee Dental Association
Wisconsin Dental Association
Chicago Dental Society
Alpha Omega Dental Fraternity

Cosmetic Dentistry

• Smile Makeover
• Composite Fillings
• Porcelain Veneers
• Tooth Whitening
• Invisalign
• Orthodontics
• Snap-on-Smiles
• Kor Super Deep Whitening

Restorative Dentistry

• Dental Bonding
• One Day Dental Implants
• Mini Implants
• Inlay Restorations
• Onlay Restorations
• Composite Fillings
• Crowns (Caps)
• Dentures & Partial Dentures
• Fixed Bridges
• Root Canal Therapy
• One Day Teeth
• Tooth Enamel Damage
• Tetracycline Stain Treatment
• Full Mouth Reconstruction
• Diastema Repair
• Acid Damage

Oral Surgery

• Bone Grafting
• Maxilla Reconstruction
• Gum Recontouring - Crown Lengthening
• Structural Face Lift
• Tooth Contouring and Reshaping
• Cosmetic Gum Surgery

Periodontal Treatment

• Diagnosis
• Treatment
• Maintenance