Dental implants have quickly become the restoration of choice for two basic reasons: they effectively restore the lost function of missing teeth and simultaneously rejuvenate the smile with their life-like appearance.
Achieving a life-like appearance, however, isn’t always a simple matter. A restoration in what we dentists call the “Smile Zone” (the upper front area that displays both teeth and the gum line when you smile) requires careful planning and technique to ensure they appear as life-like as possible.
Our first concern is whether there’s enough bone to fully anchor an implant. Bone is a living, dynamic tissue that goes through cycles of dissolving (resorption) and growth. The normal forces of biting and chewing transmit through healthy teeth and stimulate growth in the bone. When the teeth are missing and no longer transmit this pressure, the bone will eventually resorb only and not grow.
Adjacent teeth could also be affected with bone loss if the extraction was difficult and a bone graft was not placed into the extraction socket to preserve bone. This not only puts adjacent teeth at risk of gum and bone loss but can also have implications for the final smile appearance. This bone also supports the triangular tissue between teeth known as papillae which give teeth their arched appearance. If the bone isn’t adequate, there’s less hope that the papillae will regenerate.
With these concerns it’s very important to consider how the implant and crown emerges from the gums in the Smile Zone. Recent developments in implant design are helping in this regard. The design change of the top of the implant re-orients the gum tissues in relation to the implant from vertical to horizontal, which dentists call “platform switching.” This provides greater stabilization where bone mass is limited, and helps create a more aesthetically pleasing result. There are also other techniques, such as surgical tissue grafting of the papillae that can further enhance the final appearance.
Although creating a natural, life-like appearance in the Smile Zone is difficult, it’s not impossible. It’s important first to undergo a complete dental examination and profile, where we can advise you on your best options to achieve a beautiful smile.
If you would like more information on the relation of implants to the aesthetics of your smile, 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 “Implant Aesthetics.”
Dentists go to great lengths to save an adult permanent tooth. Even though restoration technology is incredibly advanced, none can completely replace the biological function of natural teeth. Treating a diseased tooth to preserve it is a high priority in dentistry.
It would seem, though, that a child’s primary (baby) tooth might not warrant the same treatment. Since the tooth eventually detaches from the jaw to make way for a permanent tooth, why save it?
It is worth the effort, because primary teeth provide more than a chewing function: they also serve as guides for their permanent successors. When they’re lost prematurely, the permanent teeth may not come in correctly, leading to a malocclusion (poor bite). Other areas of development, like speech and dental bone growth, may suffer as well from the longer time gap between the premature loss and the permanent tooth eruption.
Saving an infected primary tooth should be considered, especially if significant time remains in its lifespan. Due to differences between primary and permanent teeth, though, the treatment approach isn’t the same. For example, the body gradually absorbs the roots of a primary tooth (a process called resorption) as the permanent tooth beneath erupts applying pressure to the primary roots (this is what enables its eventual detachment). Dentists must factor this process into their diagnosis and treatment plan for a primary tooth.
The level of treatment may vary depending on how deep the infection has advanced. If the decay is limited to the tooth’s outer layers and only partially affects the pulp, the innermost layer of the tooth, a dentist may remove as much soft decay as possible, apply an antibacterial agent for any remaining hardened infection, and then restore the tooth with filling materials.
For deeper infection, the dentist may remove some or all of the pulp, disinfect and clean the area, and then fill and seal the empty space with a filling. A filling material like zinc oxide/eugenol paste should be used that’s capable of resorption by the body to coincide with the natural root resorption. After treatment, the tooth should continue to be monitored for changes in appearance or gum swelling, just in case the infection returns or advances.
Although it may seem counterintuitive, treating a primary tooth as you would its successor is worth the effort. Your child will reap the health benefits, both now and long after the primary tooth is gone.
If you would like more information on endodontic treatment for children, 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 “Root Canal Treatment for Children’s Teeth.”
We all know that dentistry can do amazing things these days to give you the smile you've always dreamed of. With the latest cosmetic and restorative dental techniques, it is possible to achieve amazingly natural-looking results. But how do we map out the best route to a better smile? And how do we know that the results will hold up over time?
Every individual has a unique set of conditions in his or her mouth and it is our job to figure out how you have come to your present state, dentally speaking. We need to correct or at least manage any factors that could risk the success of your treatment. These risk factors fall into four basic categories:
Periodontal Risk — This involves the condition of the structures that support your teeth, including your gum and bone tissue. It's important to establish good periodontal health before we perform any restorative or cosmetic procedures.
Biomechanical Risk — This has to do with the structural integrity of your teeth. We will look at whether any tooth structure has been lost due to decay, and take steps to reduce your susceptibility to decay if necessary.
Functional Risk — This relates to your bite: how your teeth, muscles and jaw joints are functioning. For example, do you have excessive tooth wear or joint pain? If so, you are at a higher risk in this category and we need to figure out why.
Aesthetic Risk — This is the most subjective of the categories as beauty is in the eye of the beholder. Still, if you display a lot of your teeth and gums when you smile, any issues you have (gum recession, for example) will be that much more visible and affect your smile more. We will have to take this into account when we plan your treatment.
Only when we have determined how best to minimize your risk in all four of these categories can we restore or enhance your smile in a way that will not only look great but also last as long as possible.
Young children are like sponges, soaking up patterns of behavior they will later apply in many circumstances throughout life. In this learning process, they often look to family members for guidance. Some good habits, like saying “please” and “thank you,” can be taught verbally. Others are best learned by example.
Developing good habits early will benefit your children for a lifetime — especially where their health is concerned. Fortunately, it isn't hard to instill good oral hygiene behavior in a young child; for example, most all children are successfully taught to brush their teeth at an early age. What follows are some tips that might not be as obvious, but will help your children build healthy routines for maintaining optimum oral hygiene.
1) Teach your children how to check the cleanliness of their own teeth.
How? By running their tongue over the tooth surfaces! If the teeth feel nice and smooth, they're likely to be clean, too. Remember to give kids a soft brush, and tell them to use gentle strokes in brushing.
2) Avoid transferring your own oral bacteria to your children.
Children aren't born with decay-producing bacteria — they get them from others! That's why sharing baby's spoon or licking a pacifier clean aren't really good ideas. (Neither is pre-chewing a baby's food, despite what some birds and celebrities do. Trust us on this.)
3) Set an example of healthy eating habits for your children.
Follow common-sense guidelines (like those in www.choosemyplate.gov) for maintaining a balanced diet, eating plenty of vegetables and whole grains, drinking lots of water and getting moderate exercise.
4) Limit sugary treats to mealtimes, not snack times — if you allow them at all.
Oral bacteria utilize sugar for energy and when they metabolize it, they produce harmful acids. These acids attack the teeth and cause decay. The more sugar, the higher potential for stronger acids. Saliva helps neutralize these acids — but not if sugar is constantly present in the mouth. Try to limit sugary treats to mealtimes, and serve a healthier snack between meals.
5) Encourage your children to stop sucking thumbs and pacifiers by age 3.
Thumb sucking is a normal, comforting habit that may begin in the womb. Most kids stop on their own between ages 2 and 4. But long-term sucking on fingers or a pacifier can lead to tooth and jaw-development problems. We can help you find ways to gently encourage children to stop when it's time.
If you would like more information about instilling good oral hygiene habits in children, 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 to Help Your Child Develop the Best Habits for Oral Health.”
Regardless of culture, the smile is a universal gesture of friendship and openness, and an important communication tool in your social and career relationships. But what if you’re not comfortable with your smile because of misaligned, damaged or missing teeth? That could have a dampening effect on your interactions with people and your own self-confidence.
Cosmetic dentistry can change all that — we have an arsenal of treatments that can rejuvenate your smile. We must first, though, develop a design plan, often involving multiple dental disciplines. It will definitely involve you — your desires, expectations and choices.
It begins with a thought-provoking discussion with our office. Generalities — “I want a beautiful smile” — aren’t enough. Effective planning begins with a clear perspective about your teeth: What do you like or dislike about them? If you could change anything, what would it be? These initial discussions help us specify your expectations.
While the initial discussion envisions the future, the next step focuses on the present — the current condition of your teeth, mouth and entire facial structure. This requires a comprehensive examination to identify any health issues like tooth decay, periodontal gum disease or bone loss. We must also take in the “big picture,” like the shape of your face, out-of-balance features (asymmetries), skin complexion, eye shape and color, or the form and posture of your lips.
Considering all these factors, we then develop a treatment plan with specifics on how to achieve the desired transformation. We will offer our prognosis for what we believe is achievable and maintainable for your specific situation. Here we provide various models, perhaps even including computer simulation, to depict your future smile. In the end, we create a workable plan that meets both reality and your expectations.
With the design plan completed, we can then harness all the techniques and materials available to achieve it. These range from less invasive procedures like whitening, tooth reshaping, cosmetic bonding or porcelain veneers, to more involved restorations like crowns, bridgework or dental implants. In some cases, orthodontics may be necessary to correct bad bites or other malformations of your oral structures.
Smile design ensures we’re employing the right techniques for your particular situation. It all serves the end goal — a new smile that can transform your life.
If you would like more information on smile design, 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 “Beautiful Smiles by Design.”
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