Posts for category: Dental Procedures
Wearing braces isn't just for teenagers — straightening teeth can be just as viable a need when you're an adult. For example, it may be necessary to first move teeth away from an empty tooth socket before you obtain a dental implant or other restoration.
But braces could have complications, especially if you have periodontal (gum) disease. These infections caused by plaque, a thin film of bacteria and food particles, inflame and weaken gum tissues and erode supporting bone. It can be treated and brought under control — but keeping it under control requires daily brushing and flossing, along with frequent office cleanings and checkups.
Braces can make this more difficult: it's harder to brush and floss effectively through the hardware of brackets and wires, which can give plaque a chance to build up. Patients susceptible to gum disease are more likely to have re-infections while wearing braces. The hardware can also cause enamel to come in prolonged contact with acid, which can dissolve its mineral content and open the door to tooth decay.
Clear aligners are an alternative to braces that can accomplish tooth movement while minimizing infection flare-ups for people with gum disease. Aligners are a series of customized clear plastic trays worn over the teeth, with each succeeding tray incrementally moving the teeth further than the preceding one. After wearing one tray for a specified time period, you then switch to the next tray. The teeth gradually move to the desired new position over the course of the aligner series.
This option is especially advantageous for gum disease patients because the trays can be removed temporarily for brushing and flossing. There are also other benefits: we can hide a missing tooth space with a temporary false tooth attached to the aligner; and, they're nearly invisible so it won't be obvious to others you're undergoing orthodontic treatment.
Not all orthodontic situations benefit from this alternative, while some cases may call for a combination approach between aligners and braces. But in the right setting, clear aligners are a good choice for not only obtaining better teeth position, but also helping you avoid a new encounter with dental disease.
Losing permanent teeth is never good — unlike primary teeth, no natural replacements wait in the wings. But the good news is you have a number of options for replacing them with life-like prosthetic (false) teeth.
Today's premier choice is dental implants, preferred by dentists and patients alike for their durability and life-likeness. But because of their cost when replacing multiple teeth, many people opt for traditional dentures. And now dentures are easier to wear and maintain thanks to new, advanced materials and designs.
Still, there's one major area where implants have the definite edge over dentures — long-term bone health. Older bone cells die and dissolve (resorb), replaced then by newly formed cells. Teeth help perpetuate this cycle through the forces generated when we chew that travel through the roots to stimulate the formation of new bone.
But because this stimulation through a tooth ends when it's lost, new bone beneath the empty socket may not keep up with the resorption rate of older bone. As a result, you could lose as much as a quarter of normal bone width in just the first year after losing a tooth.
This bone loss will continue to accumulate even if you wear dentures, which can't replicate the bone growth stimulation of natural teeth. What's more, the constant pressure on the bony ridge of the gums can accelerate bone loss. Eventually, the firm, comfortable fit you first had with your dentures will become looser and less comfortable with the shrinking bone volume.
Implants, on the other hand, can stop bone loss and may even reverse it. This is because the titanium metal of an implant has a special affinity with bone cells that readily grow and adhere to it. This creates the anchorage responsible for the implant's durability, but it's also healthy for the bone.
Of course, this doesn't have to be a binary choice between the two restorations thanks to a new hybrid advancement that combines implants with dentures. We can install as few as two implants to support a removable denture. You'll enjoy greater stability, fit and durability with your dentures, while also improving bone health through the implants.
So before you decide on a dental restoration, be sure to discuss with us your implant options. Your oral health and appearance could benefit immensely.
If you would like more information on dental restoration, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”
So, you’ve just acquired an attractive restoration with dental implants. You may be thinking at least with these teeth you won’t have to worry about dental disease.
Think again. While the implants and their porcelain crowns are impervious to decay the surrounding gums and bone are still vulnerable to infection. In fact, you could be at risk for a specific type of periodontal (gum) disease called peri-implantitis (inflammation around the implant).
Bacterial plaque, the thin bio-film most responsible for gum disease, can build up on implant crowns just as it does on natural tooth surfaces. If it isn’t removed with daily brushing and flossing and regular dental cleanings the bacteria can trigger an infection in the gums.
Besides weakening gum tissues, gum disease can also cause bone loss, of critical importance to dental implants. An implant depends on the bone they’re inserted in to hold them in place. If the bone around an implant becomes infected it could begin to be lost or dissolve (resorb), which could lead to loss of the implant.
That’s why it’s critical to keep the natural tissue structures supporting your implants infection-free. Not only is daily hygiene a must, but your implants and any remaining natural teeth should undergo professional cleaning at least twice a year or more if your dentist recommends it.
Cleanings involving implants will also be a bit different from natural teeth. While the dental materials used in the crown and implant post are quite durable, regular cleaning instruments can scratch them. Although tiny, these scratches can become hiding places for bacteria and increase your risk of infection.
To avoid this, your hygienist will use instruments (known as scalers and curettes) usually made of plastics or resins rather than metal. The hygienist may still use metal instruments on your remaining natural teeth because their enamel can tolerate metal without becoming scratched creating a smoother surface.
While keeping implants clean can sometimes be a challenge, it’s not impossible. Implants on average have a long-term success rate above 95%. With both you and your dentist caring and maintaining these state-of-the-art restorations, you may be able to enjoy them for decades.
If you would like more information on caring for dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implant Maintenance: Implant Teeth must be Cleaned Differently.”
Modern dental care wouldn’t be the same without x-rays. Since dentists began capturing x-ray images a century ago to detect beginning tooth decay, billions of teeth have been preserved.
“Catching it early” is the key to staying ahead of this aggressive bacterial infection. Once it breaks through the protective defenses of tooth enamel, it can advance toward the center of the tooth, the pulp, damaging dentin as it goes. While we can effectively stop it at this point with a root canal treatment, it’s better for the tooth’s long-term health to detect and treat any decay early on with a less-invasive filling or other treatment method.
X-ray imaging helps make that possible, revealing decay much easier than we can see with the unaided eye. And while we can often detect decay in front teeth by visual examination or by using very bright lighting, that’s not as easy with the less accessible back teeth. For those teeth we use a special x-ray technique known as the bitewing.
The name comes from the small frame used to hold the film. It’s held in place in the mouth by the patient biting down on small tabs or “wings” extending from the frame. The x-ray beam travels through the outer cheek and teeth to the film being held in the frame on the back side of the teeth. When exposed, we’ll be able to view the interior of these back teeth: a set of four bitewings gives us a full view of all the upper and lower molars and pre-molars on each side of the jaws.
Like other forms of radiation energy, too much or too frequent exposures to x-rays can lead to serious health problems. But bitewing x-rays carry little risk to health. That’s because they fit well with the ALARA principle, meaning “As Low As Reasonably Achievable,” which helps guide our use of x-rays. Patients receive a fraction of the radiation exposure from routine bitewing x-rays than they receive annually from the natural environment.
Without bitewing x-rays and other diagnostic methods, the chances are high that tooth decay or other dental problems can go undetected in their early stages. Using this important tool can help us head off major damage before it occurs.
If you would like more information on the role of x-rays in dental care, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bitewing X-Rays: A Routine Part of Your Dental Exam.”
If you've lost a tooth, you have a number of options for replacing it. Perhaps the best choice in terms of lifelikeness and durability is a dental implant.
All implants have the same basic architecture: a titanium metal post imbedded in the jawbone to replace the root; and an abutment, a metal collar that links the post with a lifelike porcelain crown. But implants can vary in how the crown attaches to the abutment and post — either cemented to the abutment or screwed through the abutment to the post.
Either method will permanently secure the crown to the implant. But there are advantages and disadvantages for each.
A screw-retained crown may better facilitate any future repair that might be needed. For a skilled dentist it's a simple matter of removing the screw and then the crown from the abutment. There's less risk of damage to the implant during repairs or crown replacement. Many dentists also prefer screws for crowns placed at the same time they're installing the implant post (a procedure called immediate loading).
The screw access hole, however, could pose a cosmetic problem. Although we can cover it over with tooth-colored filling, it may still be noticeable and unattractive especially for a tooth visible when you smile (in the smile zone). There's also the possibility the porcelain around the access hole could chip.
By contrast, cemented crowns have a smooth, unbroken surface and are aesthetically ideal for smile zone teeth. But the cement could interact poorly with gum and bone tissue in some patients, causing inflammation and possible bone loss.
And unlike screw-retained crowns, cemented crowns are difficult to remove for implant repair. We may have to drill through the crown to access the screw between the abutment and the post, and then repair it cosmetically if we use the same crown. Again, the final result may not be quite as visually appealing.
In the end, it will depend on the implant's location, how your body reacts to the cement or your dentist's preference. In either case, though, you'll have a tooth replacement that's functional, life-like and able to endure for many years to come.
If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “How Crowns Attach to Implants.”