Posts for category: Dental Procedures
Restoring a smile with implants involves more than the surgical procedure itself. We must also take into consideration the quality of the bone they’re placed into and the gums that will surround them — the “canvas” that showcases your new beautiful smile.
Bone — not only at the missing tooth site but supporting neighboring teeth as well — is the foundation for a successful implant. Without an adequate amount of bone, we can’t place an implant to achieve a final life-like appearance. Inadequate bone can be a problem if the tooth has been missing for awhile — without the stimulation of biting forces from the tooth, the bone can shrink gradually over time. Periodontal (gum) disease and other dental conditions can also cause bone loss.
The health of your gums — as well as the tissue type you’ve inherited from your parents, thin or thick — can also determine how natural the implant crown looks as it emerges from them. If they’ve receded due to gum disease they may not regenerate sufficiently, making your teeth longer-looking or leaving the triangular bit of gum tissue between the teeth, the papillae, noticeably missing. If you’ve inherited thin tissue gums, you’re also more susceptible to gum recession and there’s less margin for error during implant surgery.
There are some things we can do to minimize these problems. Tooth removal to make room for the new implant needs to be done carefully with as little tissue trauma as possible; it’s also helpful to place grafting material in the empty socket immediately after extraction, especially if there’s going to be a time gap before implant placement. If bone loss has already occurred, we can also use similar grafting techniques to rebuild the bone.
Likewise we need to take special care during implant surgery when dealing with thin or diseased gums. With the latter, it’s usually necessary to bring the gum disease under control and allow the gums to heal first. In extreme cases, cosmetic gum surgery may also help restore lost tissues and create a more natural look between the gums and the implant crown.
Creating a natural appearance with implants is a blend of technical skill and artistic insight. Keeping the balance between all these factors will produce a smile you’ll be proud to show.
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 “Matching Teeth & Implants.”
Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.
In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.
Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.
Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.
If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.
The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.
Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.
The Golden Globes ceremony is a night when Hollywood stars shine their brightest. At the recent red-carpet event, leading man Viggo Mortensen had plenty to smile about: Green Book, the movie in which he co-starred, picked up the award for Best Motion Picture—Musical or Comedy. But fans looking at the veteran actor's big smile today might not realize that it once looked very different. A few years ago, an accident during the filming of The Two Towers took a major chip out of Mortensen's front tooth!
That might be OK for some movies (think The Hangover or Dumb and Dumber)—but it's not so great for everyday life. Fortunately, Mortensen visited a dentist promptly, and now his smile is picture-perfect. How was that accomplished? He didn't say…but generally, the best treatment for a chipped tooth depends on how much of the tooth's structure is missing.
If the tooth has only a small chip or crack, it's often possible to restore it via cosmetic bonding. This procedure can be done right in the dental office, frequently in a single visit. Here's how it works: First the tooth is cleaned and prepared, and then a tooth-colored resin is applied to the area being restored. After it is cured (hardened) with a special light, additional layers may be applied to build up the missing structure. When properly cared for, a tooth restored this way can look good for several years.
For a longer-lasting restoration, veneers may be recommended. These are wafer-thin shells made of durable material (most often porcelain) that cover the front (visible) surfaces of teeth. Strong and lifelike, veneers can match the exact color of your natural teeth—or give you the bright, high-wattage smile you've always wanted. No wonder they're so popular in Hollywood! Because veneers are custom-made for you, getting them may require several office visits.
If a chip or crack extends to the inner pulp of the tooth, a root canal procedure will be needed to keep the tooth from becoming infected—a situation that could have serious consequences. But you shouldn't fear a root canal! The procedure generally causes no more discomfort than filling a cavity (though it takes a little longer), and it can help save teeth that would otherwise be lost. After a root canal, a crown (cap) is generally needed to restore the visible part of the tooth.
When a damaged tooth can't be restored, it needs to be extracted (removed) and replaced. Today's best option for tooth replacement is a dental implant—a small, screw-shaped post inserted into the bone of your jaw that anchors a lifelike, fully functional crown. Implants require very little special care and can look great for many years, making them a top choice for tooth replacement
If you have questions about chipped or damaged teeth, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Artistic Repair Of Front Teeth With Composite Resin” and “Porcelain Veneers.”
There are good reasons, for both health and appearance, to replace a missing tooth with a dental implant or similar restoration as soon as is practical. The bone around a tooth socket diminishes the longer it remains empty, up to 25% the first year. And, of course, your smile is less attractive, especially with a highly visible tooth.
If it’s your teenager, though, you may need to wait on a permanent restoration because their jaws are still developing. An implant placed before completion of jaw development could eventually appear out of alignment with neighboring teeth.
Our biggest concern is protecting bone health at the site of the missing tooth. We can do this and encourage growth by placing bone grafts (processed minerals from another donor) that serve as scaffolds on which surrounding bone can grow. Grafts usually dissolve (resorb) over time, but the rate of resorption can be slowed for a younger patient in need of long-term bone growth.
Planned orthodontic treatment can usually go on as scheduled. The orthodontist may accommodate the tooth loss by adding a temporary tooth within the braces or other device that matches the color and shape of the patient’s natural teeth. The orthodontist will also take care to maintain the empty space for a future implant or other restoration.
A dental implant is considered the best option for a missing tooth, not only for its life-like appearance and durability, but also its ability to encourage bone maintenance. Timing, though, is essential for teenagers. As it grows, the upper jaw will tend to move forward and down. Natural teeth move with this growth; implants, though, are attached differently and won’t move with the jawbone. While the other teeth around them move, the implants can appear to shrink back resulting in an unattractive smile appearance. So waiting until the jaw has finished growing is important.
For most people, jaw growth finishes by age twenty-one for men, women usually faster, but each person is different. The dentist’s expertise and experience, coupled with comparisons of adult family members’ facial appearances, will help determine the right time to undertake a permanent restoration for the best outcome both for health and a permanent, attractive smile.
If you would like more information on treating teenagers with missing teeth, please contact us to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants for Teenagers.”
While tooth loss can occur at any age, replacing one in a younger patient requires a different approach than for someone older. It’s actually better to hold off on a permanent restoration like a dental implant if the person is still in their teens.
This is because a teenager’s jaws won’t finish developing until after nineteen or in their early twenties. An implant set in the jawbone before then could end up out of alignment, making it appear out of place — and it also may not function properly. A temporary replacement improves form and function for now and leaves the door open for a permanent solution later.
The two most common choices for teens are a removable partial denture (RPD) or a bonded fixed bridge. RPDs consist of a plastic gum-colored base with an attached prosthetic (false) tooth matching the missing tooth’s type, shape and jaw position. Most dentists recommend an acrylic base for teens for its durability (although they should still be careful biting into something hard).
The fixed bridge option is not similar to one used commonly with adult teeth, as the adult version requires permanent alteration of the teeth on either side of the missing tooth to support the bridge. The version for teens, known as a “bonded” or “Maryland bridge,” uses tiny tabs of dental material bonded to the back of the false tooth with the extended portion then bonded to the back of the adjacent supporting teeth.
While bonded bridges don’t permanently alter healthy teeth, they also can’t withstand the same level of biting forces as a traditional bridge used for adults. The big drawback is if the bonding breaks free a new bonded bridge will likely be necessary with additional cost for the replacement.
The bridge option generally costs more than an RPD, but buys the most time and is most comfortable before installing a permanent restoration. Depending on your teen’s age and your financial ability, you may find it the most ideal — though not every teen is a good candidate. That will depend on how their bite, teeth-grinding habits or the health of surrounding gums might impact the bridge’s stability and durability.
A complete dental exam, then, is the first step toward determining which options are feasible. From there we can discuss the best choice that matches your teen’s long-term health, as well as your finances.