Posts for: September, 2014
Our “baby” teeth begin appearing around six months of age — by age 10 or 13, they’ve largely been replaced by our permanent teeth. Though their lifespan is relatively short, baby teeth play an important role in our dental development. In fact, saving a damaged baby tooth is an extremely important treatment goal even though they will be eventually lost.
Baby teeth perform a number of functions as our mouth and facial structure develops during our formative years (infancy to early adulthood). Besides providing a means to chew food, baby teeth aid speech by providing contact points for the tongue while speaking. They help us relate to others socially through smiling and other facial gestures. And, in relation to our long-term development, they serve as both guides and “placeholders” for our permanent teeth until they’re ready to erupt.
Thus, a permanent tooth’s development could be stymied if its counterpart baby tooth is lost prematurely. It could come in misaligned or not erupt fully if adjacent teeth have drifted into the open space. The resulting malocclusion (bad bite) could require long-term orthodontic treatment with higher costs than treatments to save the baby tooth and avoid the misalignment.
There are various treatments to prevent and save at-risk baby teeth. Even a badly decayed tooth might be saved with a pulpotomy, a similar treatment to a root canal but less invasive. This is often followed with a stainless steel crown to cover the remaining tooth and restore some of its form and function.
If it’s not feasible to save a baby tooth, we may recommend installing a space maintainer that prevents other teeth from drifting into the resulting space until the permanent tooth is ready to erupt. This orthodontic appliance usually consists of a metal band cemented to an adjacent tooth with an attached stiff wire loop that extends across the gap and rests against the tooth on the other side. Although effective, space maintainers can break or become dislodged, require extra monitoring and are often cosmetically unappealing.
In any event, the primary goal should be to save a baby tooth, if possible. Doing so will prevent more serious long-term problems for permanent teeth.
Martha Stewart has built a flourishing career by showcasing the things she’s designed and made — like floral arrangements, crafts, and even home renovations. Just recently, she was showing off her latest restoration project: a new dental bridge. In fact, she live-tweeted the procedure from her dentist’s office… and she even included pictures of the bridgework before it was placed on her teeth!
OK, it’s a departure from paper crafts and home-made pillows… but why not? We can’t help feeling that there’s just as much craftsmanship — even artistry — in dental bridgework as there is in many other custom-made items. If you learn a little more about what goes into making and placing bridgework, perhaps you’ll understand why we feel that way.
Bridgework is one good solution to the problem of missing teeth (another is dental implants). A fixed bridge is anchored to existing teeth on either side of the gap left by missing teeth, and it uses those healthy teeth to support one or more lifelike replacement teeth. How does it work?
Fabricated as a single unit, the bridge consists of one or more crowns (caps) on either end that will be bonded or cemented to the existing teeth, plus a number of prosthetic teeth in the middle. The solid attachment of the crowns to the healthy teeth keeps the bridge in place; they support the artificial teeth in between, and let them function properly in the bite.
Here’s where some of the artistry comes in: Every piece of bridgework is custom-made for each individual patient. It matches not only their dental anatomy, but also the shape and shade of their natural teeth. Most bridges are made in dental laboratories from models of an individual’s teeth — but some dental offices have their own mini-labs, capable of fabricating quality bridgework quickly and accurately. No matter where they are made, lifelike and perfect-fitting bridges reflect the craftsmanship of skilled lab technicians using high-tech equipment.
Once it is made, bridgework must be properly placed on your teeth. That’s another job that requires a combination of art and science — and it’s one we’re experts at. From creating accurate models of your mouth to making sure the new bridge works well with your bite, we take pride in the work we do… and it shows in your smile.
If you would like more information about dental bridges, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Fixed vs. Removable Bridges” and “Dental Implants vs. Bridgework.”
A crown is an effective way to save a tooth and restore its form and function. These life-like “caps” that fit over and are permanently attached to teeth have been used for decades with good results.
For this type of restoration to be effective, though, there must be enough of the natural tooth remaining above the gum line for the crown to “grab on to.” This poses a problem if the tooth has broken or decayed too close to the gum tissue.
Fortunately, there is a way to expose more of the remaining tooth for applying a crown. Known as crown lengthening, this surgical procedure is also used for “gummy” smiles, where normal tooth length is obscured by excess gum tissue that makes the teeth appear shorter.
We begin the procedure by first numbing the tooth and gum area with a local anesthetic. We then make tiny incisions inside the gum line on both the tongue and cheek side of the tooth to create a small flap. With this area below the gum line now open to view, we then determine whether we need to remove excess gum tissue or a small amount of bone around the tooth to expose more of the tooth itself. We then position the opened gum tissue against the bone and tooth at the appropriate height to create an aesthetic result.
You shouldn’t experience any discomfort during the procedure, which usually takes about sixty minutes for a single tooth area (which needs to involve at least three teeth for proper blending of the tissues). The pressures and vibrations from equipment, as well as any post-procedure discomfort, are similar to what you would encounter with a tooth filling. After the gum tissue has healed (about six to eight weeks), we are then able to fit and attach a crown onto the extended area.
Crown lengthening a small area may result in an uneven appearance if you’re dealing within the aesthetic zone. One option in this case is to consider undergoing orthodontic treatment first to correct the potential discrepancy that may result from surgery. After orthodontics, we can perform crown lengthening on just the affected tooth and still achieve an even smile.
Crown lengthening is just one of many tools we have to achieve tooth restorations for difficult situations. Using this technique, we can increase your chances of achieving both renewed tooth function and a more beautiful smile.
If you would like more information on crown lengthening, 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 “Saving Broken Teeth.”
Dental implants are now the gold standard for tooth replacement. Why? Because not only do they offer the longest-lasting method of restoring missing teeth, but they also help mitigate one of the greatest problems associated with tooth loss — the loss of underlying bone structure. While standard dental implants have been around since the 1970s, mini-implants are a smaller version of the same technology that have recently come into their own. Here are a few things you should know about them.
Mini-implants rely on the same structure and principles as their larger relatives.
Like standard implants, mini-implants are screw-shaped devices made of titanium which are set into the bone of the jaw. Put in place permanently, they become fixed to the bone itself, which grows around and fuses to the implant. Or, they can be used as temporary anchors for the attachment of other dental work.
Mini-implants are a great option for attaching lower overdentures.
Overdentures (implant-retained dentures) are now considered the standard of care for people who have lost all of their teeth in one or both jaws. But the undesired movement of lower dentures has been a perennial problem for many denture wearers. One key use of mini-implants is to anchor overdentures to the lower jaw. Just two mini-implants provide the stability needed to attach a set of lower dentures sturdily, giving the denture wearer increased dental function — and a restored sense of confidence.
Mini-implants offer some real benefits in orthodontics.
TADS (Temporary Anchorage Devices), another type of mini-implants, are finding increasing use alongside of orthodontic appliances (braces). Braces move teeth by placing small forces on them, which are transmitted by a wire. The wire must be anchored at a “fixed” point: usually, other teeth; but it may cause these teeth to move as well! TADS offer an anchorage point that's truly immovable. They help to speed up orthodontic treatment, and give more accurate control as well.
Placing mini-implants is a relatively simple process.
It's an office procedure done by an experienced clinician, normally under local anesthesia. Most patients tolerate the procedure very well, experiencing only minor discomfort. In some cases, a single two-hour visit is all that's needed for implant placement, and the patient can go home and eat a steak afterward!
Mini-implants may be more economical than you think.
These smaller cousins of standard implants are often easier to place. They save treatment time, and, if you're a denture wearer, they may be compatible with your existing dentures. If your dental situation could benefit from using mini-implants, you should give them serious consideration.
If you would like more information about mini-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 articles “Implant Overdentures for the Lower Jaw,” “The Great Mini-Implant,” and “What are TADS?”
A dental implant can permanently restore the form and function of a missing natural tooth. But there’s an important prerequisite for this smile-transforming therapy — you must have enough bone remaining at the implant site to securely anchor the implant and ensure proper crown placement for the most natural looking result.
Patients who don’t meet this prerequisite may need to consider other restorative options. In some cases, however, we may be able to encourage sufficient bone growth to support an implantation through a technique called bone grafting.
Bone grafting involves opening the gum tissues at the intended implant site to expose the underlying bone. We then place the grafting material (usually a processed material) around the bone, sometimes with collagen membranes that serve as subterranean band-aids to guide bone growth. In most cases, the graft is actually a scaffold for the natural bone to grow upon; the natural bone will eventually replace the graft material. The procedure is normally performed with local anesthesia to minimize discomfort.
While bone grafting is a fairly routine procedure, it shouldn’t be undertaken unless there’s a firm prognosis it can successfully support a future implant. We must therefore determine if anything else in your oral health would disqualify you as an implant candidate, even if sufficient bone existed or not. We must also determine if there’s enough remaining bone currently at the site to even attach a bone graft.
Once we’re satisfied that bone grafting would be both possible and helpful, we must then consider what type of grafting material to use. If we’re only replacing one tooth we may choose to use an autograft, bone material taken from another area of your own body. Although autografts have advantages because of their regeneration ability, it does involve creating another surgical site within the body. In most cases we may use processed materials, for example allografts, material that originates from another human being; xenografts, taken from another species of animal; or synthetic (man-made) materials. Regardless of the source, these materials are first processed to be safe for human use.
If successful, the regeneration process will result in enough new bone structure to make dental implants a reality. Your mouth will be healthier — and your resulting smile will be more beautiful than ever.
If you would like more information on bone grafting, 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 “Can Dentists Rebuild Bone?”