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Posts for category: Dental Procedures

By Michele Solis DDS.
September 10, 2020
Category: Dental Procedures
Tags: missing teeth  
3WaysWeCanImproveaSmileAffectedbyUnformedTeeth

On the way to adulthood, permanent teeth steadily erupt until, if all goes normally, you have a full set of teeth. Sometimes, though, one or more teeth may fail to form. This not only can affect your dental health, but it could also diminish your smile.

For example, if the lateral incisors on either side of the central incisors (the two teeth front and center) don't develop, it could create a smile that's “not quite right.” But we can vastly improve such a smile in one of three unique ways.

The first is to fill the resulting gap through canine substitution. This is an orthodontic method in which we use braces to move the pointed canine teeth, which normally position on the other side of the missing laterals, closer to the central incisors. This choice is determined by the size of the canine teeth. If they are slim in width, they can be re-shaped to make them appear more like a lateral incisor, and the gums possibly reshaped as well around them through cosmetic surgery.

We can also install a dental bridge, an appliance that fills the missing lateral space with prosthetic teeth. A traditional bridge requires the teeth on either side of the gap to be reduced in size, which becomes a permanent alteration to accommodate these crowns. This is a disadvantage in a young person.  We can also use a “bonded bridge” which uses adhesives to attach extended pieces (or “wings”) of dental material from either side of the prosthetic tooth to one or more supporting teeth.  These wings are behind the permanent teeth.  Though not as durable as a traditional bridge, it does avoid altering the support teeth.

Finally, we can replace the missing teeth with dental implants. In this method, we install titanium metal posts into the jawbone at the missing tooth locations and then attach a life-like crown to each one. Implants may be more costly than other restorative methods and can take several months to complete. But they are life-like, highly durable, and don't require any alteration to other teeth. A disadvantage is that you should wait until at least 19 years of age to consider this option.  What many people do is use a temporary solution until the proper age to do a dental implant.

Each of these methods have their advantages and disadvantages, which should be thoroughly reviewed in consultation with your dentist. And each may also require other dental work, such as initial orthodontics to open adequate space for a restoration. But any of these methods for correcting a missing lateral tooth can be effective and help restore both a healthier mouth and a more attractive smile.

If you would like more information on treating congenital dental defects, 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 “When Permanent Teeth Don't Grow.”

ImplantsMakeDenturesMoreSecureComfortableandBone-Friendly

Even in the 21st Century, losing most or all of your teeth is still an unfortunate possibility. Many in this circumstance turn to dentures, as their great-grandparents did, to restore their teeth. But today's dentures are much different from those of past generations—and dental implants are a big reason why.

The basic denture is made of a gum-colored, acrylic base with artificial teeth attached. The base is precisely made to fit snugly and comfortably on the patient's individual gum and jaw structure, as the bony ridges of the gums provide the overall support for the denture.

Implants improve on this through two possible approaches. A removable denture can be fitted with a metal frame that firmly connects with implants embedded in the jaw. Alternatively, a denture can be permanently attached to implants with screws. Each way has its pros and cons, but both have two decided advantages over traditional dentures.

First, because implants rather than the gums provide their main support, implant-denture hybrids are often more secure and comfortable than traditional dentures. As a result, patients may enjoy greater confidence while eating or speaking wearing an implant-based denture.

They may also improve bone health rather than diminish it like standard dentures. This is because the forces generated when chewing and eating travel from the teeth to the jawbone and stimulate new bone cell growth to replace older cells. We lose this stimulation when we lose teeth, leading to slower bone cell replacement and eventually less overall bone volume.

Traditional dentures not only don't restore this stimulation, they can also accelerate bone loss as they rub against the bony ridges of the gums. Implants, on the other hand, can help slow or stop bone loss. The titanium in the imbedded post attracts bone cells, which then grow and adhere to the implant surface. Over time, this can increase the amount of bone attachment and help stymie any further loss.

An implant-supported denture is more expensive than a standard denture, but far less than replacing each individual tooth with an implant. If you want the affordability of dentures with the added benefits of implants, this option may be worth your consideration.

If you would like more information on implant-supported restorations, 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 “Overdentures & Fixed Dentures.”

WisdomTeethCanStillbeaProblemfortheWorldsYoungestBillionaire

According to Forbes Magazine, Kylie Jenner is the world's youngest billionaire at age 22. Daughter of Caitlyn (Bruce) Jenner and Kris Jenner, Kylie is the founder and owner of the highly successful Kylie Cosmetics, and a rising celebrity in her own right. But even this busy CEO couldn't avoid an experience many young people her age go through each year: having her wisdom teeth removed.

At around 10 million removals each year, wisdom teeth extraction is the most common surgical procedure performed by oral surgeons. Also called the third molars, the wisdom teeth are in the back corners of the jaws, top and bottom. Most people have four of them, but some have more, some have fewer, and some never have any. They're typically the last permanent teeth to come in, usually between ages 17 and 25.

And therein lies the problem with wisdom teeth: Many times, they're coming in late on a jaw already crowded with teeth. Their eruption can cause these other teeth to move out of normal alignment, or the wisdom teeth themselves may not fully erupt and remain fully or partially within the gums (a condition called impaction). All of this can have a ripple effect, decreasing dental function and increasing disease risk.

As Kylie Jenner has just experienced, they're often removed when problems with bite or instances of diseases like tooth decay or gum disease begin to show. But not just when problems show: It's also been a common practice to remove them earlier in a kind of “preemptive strike” against dental dysfunction. But this practice of early wisdom teeth extraction has its critics. The main contention is that early extractions aren't really necessary from a medical or dental standpoint, and so patients are unduly exposed to surgical risks. Although negative outcomes are very rare, any surgical procedure carries some risk.

Over the last few years, a kind of middle ground consensus has developed among dentists on how to deal with wisdom teeth in younger patients. What has emerged is a “watch and wait” approach: Don't advise extraction unless there is clear evidence of developing problems. Instead, continue to monitor a young patient's dental development to see that it's progressing normally.

Taking this approach can lead to fewer early wisdom teeth extractions, which are postponed to a later time or even indefinitely. The key is to always do what's best for a patient's current development and future dental health.

Still, removing wisdom teeth remains a sound practice when necessary. Whether for a high school or college student or the CEO of a large company, wisdom teeth extraction can boost overall dental health and development.

If you would like more information about wisdom teeth and their impact on dental health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Wisdom Teeth: To Be or Not to Be?

By Michele Solis DDS.
June 22, 2020
Category: Dental Procedures
Tags: crowns  
NewCrownsGiveBothDurabilityandBeautytoProblemTeeth

Repairing a decayed tooth may be as simple as removing the damaged tooth material and filling the void. Many filling materials can now match the color of a tooth, so the dental work is hardly noticeable.

Sometimes, though, the decay is too extensive or we've treated the tooth several times and it won't support another filling. If the tooth is still viable, we may be able to cover it with a custom crown.

Also known as a cap, a crown fits over and is securely affixed to the tooth with bonding material or cement. Crowns have been used for decades to restore teeth, but the materials they're made of have changed with time.

The original crowns were made of metal, usually gold or silver. They were strong and could hold up well to the daily forces produced by chewing or biting. They did, however, visually stand out and came to be regarded as unattractive. There were porcelain materials available that could closely mimic the life-likeness of teeth, but they could be weak and brittle.

Dentists came up with a hybrid crown that could supply strength as well as an attractive appearance. These were composed of two parts: an inner metal frame for strength overlaid with porcelain for appearance. These fused crowns were the most popular until the mid-2000s.

About that time, newer forms of porcelain came on the market that were not only attractive, but also durable. Although caution should still be taken when biting something hard, they've proven to stand up well to biting forces. Fused porcelain to metal is still in use, but usually for back teeth where biting forces are higher and the crown won't be as noticeable as on front teeth.

Crowns can also address cosmetic issues with chipped, fractured or excessively worn teeth. But with any crown you should be aware that much of the original tooth material must be removed to accommodate the fit. The altered tooth will require a crown or other restoration from then on. Crowns must also be custom-made by a dental technician in a process that can take weeks.

Still, the process can be well worth it. With proper care and maintenance, a crown could serve you and your smile well for many years to come.

If you would like more information on crowns and other restoration options, 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 “Crowns & Bridgework.”

NotAllCrownsareAlikeKnowtheDifferencestoGettheLookyouWant

If you're in need of a crown to cover a damaged tooth, you have a lot of options. But before you choose, you need to know what you want. Would you be happy with an affordable, well-fitting crown that holds up well and allows you to chew comfortably? Or are you interested in a more expensive one that also provides the most attractive result?

Crowns have been a mainstay in dentistry for generations. The first were made of metals like gold or silver — durable and effective but not very attractive.

In time, a ceramic material known as dental porcelain began to make its appearance in crowns. Dental porcelain could be fashioned to resemble the color and texture of natural teeth, but it had a significant drawback: it could be brittle and subject to shattering under chewing pressure.

This problem was somewhat addressed with the innovation of a crown with a metal substructure fused with an outer layer of porcelain. These porcelain-fused-to-metal (PFM) crowns combined the best advantages of both materials: strength and life-likeness. Up until around the mid-2000s, PFM made up over 80% of crowns.

But later porcelains continued to improve in strength, beginning in 1993 with the introduction of a Lucite-reinforced material. Newer formulations like lithium disilicate or zirconium oxide (now considered the strongest porcelain) have made all-porcelain crowns a viable option. Today, an estimated 60% of new crowns are all-porcelain.

From an appearance standpoint, all-porcelain crowns achieve the best results. The most realistic crown can be costly — not because of the material but the level of artistry required. A skilled dental technician will spend several hours, including brushing on as many as fifteen coats of liquid porcelain to the crown, to achieve the most life-like outcome. Your insurance plan, if you have one, will most likely not pay as high a percentage for that type of crown.

In the end, it's your decision as to what type of crown you wish to have. We'll help you weigh your options and decide what's best for you and your budget.

If you would like more information on crown options, please contact us or schedule an appointment for a consultation.