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Implant or Bridge? How to Decide (Part 1)

Implant or Bridge? How to Decide (Part 1)

by | Mar 30, 2014 | Bridge, Dentistry, Implant, Medical Issues, Tooth Loss, Tooth Replacements

We hope we will never lose a single tooth.  Unfortunately, it happens sometimes.  We can lose a tooth for many reasons. I won’t delve into them in this article.  The purpose here is to help you to decide between a bridge and an implant, in the event that you have to make that choice.

Just so we are clear: No two situations are completely alike. I have neither seen nor evaluated your case and am simply discussing general principles. You should always consult a comp

etent and licensed professional to assess your specific circumstance before making a decision that will affect both your health and finances. Nevertheless, here you are.  Either a tooth has been compromised and is lost already, or it is about to be extracted. If the idea of dental implants has crossed your mind, your dentist first has to determine whether you are a good candidate for the implants. The criteria can be broken down into three broad categories:

  1. Do you have any medical issues that may prevent successful placement of an implant?
  2. Do you have sufficient bone?
  3. Will your existing bite allow it?

So let’s get into it:

1. Medical Issues. Health conditions that could prevent an implant being placed may include, but are not limited to:

  • Diabetes
  • Recent heart attack or stroke
  • Immunosuppression
  • Drug abuse
  • Active treatment of malignancy
  • Intravenous bisphosphonate use

You should disclose anything you think could be a matter of concern with your dentist.  The success rate with dental implants is very high, but careful case selection is the key to success.

2. Sufficient Bone. Again, this needs to be determined by the implant surgeon. Your bone needs to be high enough and wide enough to accommodate the implant. If it isn’t, you may still qualify for a dental implant, but will likely require an additional procedure called bone grafting. Your dentist or implant specialist will determine your specific needs.

3. Your Bite. What does the bite have to do with anything?  There was a tooth there to begin with, right? Both implants – and natural teeth – survive longer when your teeth and jaw are in harmony. If your bite has collapsed – meaning the upper jaw and lower jaws are now too close to each other – there may not be enough room to place an implant without orthodontic (braces), or surgical, intervention.

Starting to sound a bit complicated?  Don’t worry, in most cases, the dentist can tell you pretty quickly if he feels implants will work for you. Sometimes, he needs additional screening tools to make the final call but, if he does, he’ll let you know that too.

Loose Denture Solution

Loose Denture Solution

by | Mar 2, 2013 | Dentistry

A New Standard of Care?

Do you suffer from a loose lower denture or have a family member who is having a rough time wearing their denture?

Unfortunately, this is a common problem. When all of the lower teeth are missing, little remains to stabilize or retain the denture.

An upper denture actually creates some suction on the roof of the mouth and will generally hold well. Not so, with the lower denture. First of all, the tongue has a tendency to displace it and because the surface area that the denture rests upon is generally narrow – there is little surface tension to hold it in place.

Many denture wearers have to rely on adhesives to keep their dentures from flopping around while they speak or eat. In a number of cases, even these adhesives fall short of their objective. Not to mention the fact that many patients find the adhesives unpalatable and some concerns have been recently raised about zinc sensitivities and copper de

ficiencies associated with these products.

Eating with full lower dentures can become difficult or even painful. Patients often opt not to wear their lower dentures at all out of frustration or embarrassment. Unfortunately, this can make it difficult to eat certain foods that are needed for good nutrition and health.

Numerous remedies have been forwarded to solve the problem in addition to adhesives. For example, relines can create an improved fit but they still don’t overcome the inherent problems described above. Then, there are dentures that are designed to look like they have octopus suction cups on the bottom, dentures with valves to suck out the air that gets under them, and dentures that have little “wings” on them that hold the denture down by the weight of the tongue.

Probably the greatest advance in denture stability, however, has been the development of dental implants. If a person has enough bone that is of good quality (not too soft) to accept implants, little comes close to these to provide both retention and stability for a loose lower denture. Also, much of the pain associated with dentures moving around and creating sore gums is eliminated because the denture is actually supported by the implants.

But what if you have been told you are not a candidate for conventional implants because of insufficient bone? Countless patients have still been able to benefit from mini-implants.

These are extremely small (1.8 mm diameter) implants that can be used for critically needed support purposes. Mini-implants can and do serve as long-term devices. In fact, some have been successfully functioning in patients for decades.

Because they are so narrow, they can typically be inserted directly through the overlying gum tissue into the bone underneath. This means that the procedure is generally much more comfortable for the patient because (in most cases) there is no need to surgically cut open the gum tissue – routinely required for standard implant cases. As a result, post-operative patient irritation and soreness is significantly reduced.

It should be mentioned that no implant system is fool-proof or has any guarantee of longevity. Such factors as poor oral hygiene, poor health, stress-inducing habits such as tooth grinding and clenching, smoking, poor health, osteoporosis, medications, and lack of follow-up care can all lead to potential failure of the implants. Compared to conventional implants, however, the cost of replacement is generally much smaller and with less bone loss and gum deterioration. Failures involving mini-implants are not unheard of, but are generally quite rare.

As you might expect fees vary from doctor to doctor and by geographic location. Generally, though, the fees tend to be a lot lower than for conventional implants – with similar results, less discomfort and much shorter waiting times. The best way to address the cost issue is to have an open and honest discussion about what fees may arise with the dentist of your choice.

Many dentists now consider an implant-stabilized lower denture the new “standard of care.” By choosing this option you are deciding upon an improved way of life that is free of so many of the heartaches and discomforts associated with loose, painful and ill-fitting dentures. Because people need to use their teeth each and every day of their lives, that’s worth a great deal.

YouTube Video Available by Clicking HERE

Dental Implants

Dental Implants

by | Feb 3, 2013 | Uncategorized

Strong, beautiful, and discreet.

Chances are that you have met someone with a dental implant and didn’t even know it. Completely natural looking, they have saved countless beautiful smiles. Dental implants are on the leading edge of technology and use special biomaterials – and they can be placed in only one or two office visits!

Dental Implant You may be a candidate for dental implants. In our office, we coordinate treatment with a periodontist who handles the first step of the procedure.

Implants are basically artificial tooth roots which anchor to surrounding bone and to which replacement teeth are attached.

The periodontist handles the first part of the procedure, which is placing the tooth root. Once that step is completed, I complete the second step which involves making the replacement tooth.

Permanent replacement teeth can be made translucent like natural enamel and are framed by your natural gum tissue.

Implants are long-lasting and reliable – and actually, quite cost effective. The cost to replace a single tooth with an implant is comparable to making a dental bridge. But, unless you’re 125 years old, most bridges will have to be replaced after several years. (Five to fifteen is the national average.) Implant crowns can last considerably longer because there is no natural tooth structure beneath them that can decay and if the crown comes loose, it is usually just a matter of re-cementing the crown.

Implants can replace one tooth, rebuild an entire jaw of missing teeth, or be used to secure dentures.

Replacing Dentures

Replacing Dentures

by | Mar 9, 2012 | Cavities, Cavity, Periodontal Disease, Tooth Decay, Toothache

In an ideal world we wouldn’t get cavities, have gum problems, or ever lose a tooth.  Perhaps, the world might not be ideal, even then, but at least we wouldn’t have those problems.

Unfortunately, it is a fact of life that many people do lose their teeth – either to tooth decay or periodontal disease – and then require tooth replacements.  Despite the growing popularity and acceptance of dental implants as prosthetic tooth substitutes, removable dentures still constitute the most common solution to missing teeth.

If a person still has some natural teeth, they may get what we term a “removable partial denture.”    If they have lost all of their teeth, typically they will get a full denture.  A commonly observed problem, however, is that once the dentures are made, patients tend to wear them far beyond the point where the denture continues to function well.  A little background regarding the problem with dentures may help clarify why this is so:

Some people think that if they get rid of all of their teeth and get dentures they will finally see an end to their dental problems.  This is far from reality.  Actually, what happens is that patients simply trade one set of dental problems for another.  While many patients will tell you that they eat just fine with their dentures, it has probably been so long since they had their real teeth, they have forgotten what it is like to eat normally.

What are some of the disadvantages of wearing dentures?

  •  You lose up to 50% of your biting force.
  •  A full upper denture covers your palate and interferes with your ability to taste your food.
  •  Dentures can move when you eat, speak, cough, or sneeze.
  •  Food accumulates around your dentures after a meal.
  •  Sore spots can develop when the hard denture rubs against your gums.
  •  Patients with an active gag reflex may not be able to even wear a denture without feeling as though they will gag.
  •  Multiple relines of the denture may be required as the shape of your mouth changes.  This can happen as a result of gaining or losing weight, or as a result of bone shrinkage and aging.
  •  Atrophy of the upper or lower jaws can make it impossible to develop suction with the denture.

How long do they last?  

This is an interesting question, because it is not unusual to encounter patients who tell you their denture was made twenty or even thirty years ago.  Believe me, at that point, they are seldom good-looking dentures!  But it underscores something about denture wear that is not well understood.

Once a denture is made and, assuming it fits well at the time of delivery, most patients expect – and can experience – good retention and stability.

But the key point is – once made – the dentures don’t change.  Yet your mouth can – and often does. New medications can also cause your mouth to become dry, leading to irritation and sore spots.  Osteoporosis could lead to shrinkage of the jaw.  Despite these changes, many patients attempt to make up for new problems with denture adhesives.  Unfortunately, this can open the door to even more irritation, and denture creams containing zinc have even been linked to other health problems such as numbness, tingling and muscle weakness.

While relines can assist with these changes and correct the fit of your denture to improve retention, many patients would do well to consider re-making their dentures after about five years to seven years.  In my experience, waiting too long beyond that time period can make the transition to a new denture more difficult.

200 Year-Old Denture

When the change is minimal, such as one might expect after about five years, the transition is generally quite easy.  It also helps to have a spare denture for those “oops!” moments.  Over the years, I have experienced patients dropping dentures into the sink while cleaning them, accidentally dropping them into garbage disposals, having dogs and cats chew them, and more.  Patients will bite into hard objects and break a tooth, they take them out at night and sometimes sit on them, they get stepped on – and one, believe it or not, was even stolen!  That was simply too strange a story to recount here.

If your denture is over five years old, talk to your dentist about whether it is time to reline or remake your denture.  You will be glad you did.