Dental implant technology has advanced at such an astounding rate in recent years that you can now walk into a dentist's office with a problem tooth and out the same day with a new one. Unfortunately, not all dental situations allow for this possibility.
For example, you might be considering an implant many years after losing a tooth. But there's a potential problem: there might not be enough supporting bone. While an implant might still be possible, inadequate bone complicates the matter.
Because implants are essentially tooth root replacements, they require a certain amount of bone for stability and the best attractive outcome. As a general rule, implants need to be surrounded by at least 1.5-2.0 millimeters of healthy bone to support an implant. But you might not have enough if your tooth has been missing for awhile, regardless if you have or haven't worn dentures or other restorations.
That's because bone has a life cycle in which older cells die and newer ones form to take their place. As we chew or bite, the force generated travels up through the teeth to the bone to stimulate this new growth. Without a tooth the bone doesn't receive this stimulus, which can slow the growth rate. Over time the affected bone can lose its volume and density.
If we find you've experienced loss to the point your bone won't support an implant, that doesn't automatically mean this popular restoration is out of the picture. But it will require us first performing a procedure known as augmentation or bone grafting to help rejuvenate some of the lost bone.
With grafting, we place processed bone grafting material in the jaw through a minor surgical procedure to form a scaffold for new bone to grow upon. After several months this can result in several millimeters of new growth maintaining the width of the underlying bone, which in turn may be able to support an implant.
Bone grafting is quite common, often performed at the same time as tooth extraction if there's going to be a time lag before installing an implant. Even if performed later, though, it can successfully rejuvenate lost bone and make it possible for you to take advantage of durable, life-like implants.
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 “Dental Implants after Previous Tooth Loss.”
For whatever reason, you’ve put off replacing a missing tooth for awhile. Now you want to fill that empty gap in your smile with a dental implant restoration.
But if your tooth’s been missing for a long time, there could be a problem with space. This is because the teeth on either side of the space may have gradually drifted into it, leaving no room for the implant. You could need orthodontic work first to return these teeth to their proper position.
We could use braces, metal orthodontic devices with wires threaded through brackets bonded to the teeth that are then anchored, usually to back teeth. The orthodontist uses elastics or springs as well as possibly incrementally tightening of the wire against the anchors. These techniques create pressure or tension on the teeth for the desired direction of movement. The teeth’s natural mechanism for movement does the rest.
But while effective, braces can be quite noticeable, an embarrassing thought for many adults having to wear them over several months of treatment. But there may be an alternative: clear aligners, a succession of slightly different plastic trays usually worn in two-week intervals. Sequentially wearing each tray gradually moves the teeth to their desired positions.
Though not appropriate for all bite situations, clear aligners have a number of benefits when they can be used. They’re nearly invisible to others and can be removed for hygiene tasks or rare special occasions. What’s more, the orthodontist may attach a temporary prosthetic (false) tooth to the trays to camouflage the missing space during treatment.
There’s one other issue you may have to deal with: if your tooth loss was related to periodontal (gum) disease, the gums and underlying bone may be in poor condition. In fact, substantial bone loss could rule out an implant altogether. But we may be able to remedy both gum and bone deficiencies through grafting or plastic surgery. It may be possible to regenerate enough bone to support the implant; and surgically repairing your gums will help ensure the implant appears natural.
If you have problems like these, don’t give up on your restoration goal just yet. With some orthodontic and dental work ahead of time, we may still be able to make implants a reality for you.
Dentures in one form or another have been around for centuries. Although dental implants have earned a well-deserved prominence of late, the denture still remains a viable tooth replacement option.
What's more, dentures aren't reserved for total tooth loss only. Even if you've lost just a few of your teeth, we can fit you with a removable partial denture (RPD). Although mainly considered a temporary solution for missing teeth, some people depend on an RPD for many years due to finances or other issues.
The traditional RPD consists of a rigid acrylic plastic base that resembles gum tissue supported by a metal framework, with prosthetic (false) teeth precisely placed to fill the space of the missing teeth. They're held in place with metal clasps that extend from the metal framework to fit over the remaining natural teeth.
Although they're an effective restoration, traditional RPDs have a few drawbacks. Some people find them uncomfortable to wear or have an allergy to the acrylic plastic. They also have a propensity to stain from beverages like tea, coffee or wine.
But there's a more recent version called a flexible RPD that addresses these and other concerns. It's made of a pliable nylon that's durable, yet comfortable to wear. Rather than metal clasps, they're secured in place with thin, finger-like nylon extensions that fit into the small, natural depressions in the crowns of the teeth around the gum line.
Flexible RPDs are also highly adaptable to appear life-like in many situations. We can fashion the nylon base to cover areas around natural teeth where the gums may have receded due to gum disease.
They do, however, have a few downsides. Unlike traditional dentures, they're difficult to reline or repair. Like any oral appliance, they can suffer from wear and neglect, so you must properly clean and maintain them. And, like any RPD their best role is as a temporary bridge rather than a permanent restoration.
In the meantime, though, you can count on a flexible RPD to restore your ability to eat and speak proficiently, as well as smile with confidence. It's a great affordable way to address a few missing teeth.
If you would like more information on dentures as a restoration option, 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 “Flexible Partial Dentures.”
Proponents of legalized marijuana have won phenomenal gains over the last decade. Despite the federal government's continuing criminalization of the drug, several states including California, Colorado and Massachusetts, have voted to legalize its recreational use.
Most people are aware of the social and political controversies the marijuana legalization movement stirs. But there's another side to this roiling issue: the health effects of marijuana, particularly for your teeth and gums. What may be lost beneath the more exciting headlines about ballot initiatives is the growing evidence that habitual marijuana use may increase the risk and severity of periodontal (gum) disease.
Gum disease is a bacterial infection caused by dental plaque, a thin film of bacteria and food particles that accumulates on teeth. The spreading infection triggers inflammation, a normal bodily response to disease that's ordinarily beneficial. But if the inflammation becomes chronic it weakens the gums' attachment to the teeth. This can create voids or periodontal pockets of infection around the teeth. The disease can eventually damage the underlying bone, which could accelerate tooth loss.
Poor oral hygiene is the biggest factor for an increased risk of gum disease; thinner gum tissue (an inherited condition or related to poor tooth position) is another factor, as well as lifestyle habits like tobacco use or excessive alcohol consumption. Add marijuana to the list: there's now some evidence that its use increases the risk for more severe periodontal pockets if the disease occurs.
In a recent study, researchers with the Columbia University College of Dental Medicine reviewed statistics on the care for nearly 2,000 adult patients; a quarter of those in the study were frequent marijuana users. The marijuana users proportionately had deeper periodontal pocket occurrences than the rest of the patients in the study that didn't use the drug.
The study doesn't say that marijuana causes periodontal (gum) disease. But it does suggest that marijuana use might increase its severity. As with other substances and practices in our society, marijuana use comes with a caveat: it may be legal where you live, but it may not necessarily be good for your health.
If you would like more information on the effects of marijuana use on your oral health, 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 “As More States Legalize Marijuana, Link to Gum Disease is a Concern.”
Those unattractive teeth you see in the mirror are what are standing between you and a truly beautiful smile. If only you could make them go away.
In a way, you can do just that—with dental veneers. For the past three decades dentists have been covering the imperfections of problem teeth with these thin layers of porcelain. What's more, they're usually less involved and expensive than other restorations.
Veneers work best on teeth with moderate flaws like chipping, heavy staining or wearing, or slight misalignments like crookedness or gaps. The dental porcelain used is a ceramic material that so closely mimics the color and translucence of natural teeth it often takes a trained eye to notice any difference.
The first step to getting veneers is to plan your new look with a full examination and a diagnostic mock-up, a temporary application of tooth-colored filling materials applied directly to the teeth. This gives you and your dentist a better visual idea of how veneers will look on your teeth, and to make any adjustments ahead of time. A dental lab will use these findings to create your custom veneers.
In the meantime we'll prepare your teeth to accommodate your veneers. Although they're usually only 0.3 to 0.7 millimeters thick, veneers can still appear bulky when placed straight on the teeth. To adjust for their width we usually must remove some of the teeth's surface enamel so the veneers look more natural. Because enamel can't be replaced, the removal permanently alters the teeth and will require some form of restoration from then on.
When the veneers are ready we'll attach them with special cement so they'll form an almost seamless bond with the teeth. You'll then be able to use them just as before—but with a little caution. Although quite durable, veneers can break under too much force, so avoid biting on hard objects like ice, hard candy or nuts. And be sure you practice good dental care on your veneered teeth with daily brushing and regular dental cleanings and checkups.
The end result, though, is well worth the upkeep. Porcelain veneers can rejuvenate your smile and provide you a new level of confidence for years to come.
If you would like more information on porcelain veneers, 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 “Porcelain Veneers: Your Smile—Better than Ever.”
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