Posts for: December, 2013
If you've recently had a dental implant placed, congratulations! You have made a good investment in your smile that should last for a lifetime — if you take proper care of it. This is easy to do with a good oral hygiene routine and regular professional cleanings. Here are some important things to keep in mind about implant care:
- Implants can last as long as teeth. A dental implant made of titanium will fuse to the bone surrounding it and function just like a natural tooth. It is a highly successful method of tooth replacement that succeeds more than 95% of the time.
- Implants and natural teeth attach to surrounding bone and gums very differently. A natural tooth does not actually fuse to the bone that surrounds it. Instead, it is held in place by a periodontal ligament (“peri” – around; “odont” – tooth) made up of tiny fibers that insert into the bone on one side and into the tooth on the other. Farther up, these collagen fibers attach the tooth to the gum tissue. Implants and the crowns that go on top of them are not anchored to the gum in this way. An understanding of this biology is important for maintaining good periodontal health when implants are present. We will go over this with you so can care for your implants correctly.
- Infection is the enemy. Bacterial infection is a concern with both natural teeth and implant-supported teeth. A bacterial biofilm (plaque) builds up daily on implant teeth, just as it does on natural teeth. If it is not regularly cleared away, various oral infections can develop. In the case of natural teeth, this might result in tooth decay, gum disease, and the loss of tooth-supporting bone. Implants can't decay, but they can be threatened by a rapidly progressing infection known as peri-implantits (“peri” – around; implant “itis” – inflammation), which can lead to a well-like or dish-shaped loss of bone around the implant. The implant can become loose as greater amounts of bone is lost.
- Good oral hygiene is as important as ever. Daily removal of bacterial biofilm is key to preventing peri-implantitis. You'll want to make sure you brush your teeth twice daily with a soft brush and fluoride toothpaste, and floss gently at least once per day.
- Your dental hygienist has an important role to play. Professional cleanings here at our dental office are also still as necessary as ever, if not more so. Dental hygienists have special instruments they use to clean areas around your implant that can't be reached by your brush or floss — without scratching the surfaces of your implant components.
Tooth decay and other oral diseases aren’t the only dangers your teeth face — accidental injuries also pose a risk. Fortunately, much can be done to save injured teeth, if you act quickly.
Dental injuries where part of the enamel crown has chipped off are the most common. Even if only one tooth appears damaged, adjacent teeth and bone might also have been damaged internally. Most chip injuries can be repaired either by reattaching the broken crown or with a tooth-colored filling or veneer. If the damage has extended into the inner tooth pulp then a root canal treatment might ultimately be necessary.
Teeth that have been knocked loose from normal alignment (dislodged) or where the entire tooth with its root has separated from the socket (avulsed) are rare but severe when they occur. It’s imperative to see a dentist as soon as possible — even more than five minutes’ of elapsed time can drastically reduce the tooth’s survivability. Dislodged teeth are usually splinted to adjacent teeth for several weeks; we would then carefully monitor the healing process and intervene with endodontic treatment (focused on the tooth’s interior) should something unfavorable occur.
With the possible exception of a primary (baby) tooth, an avulsed tooth should be placed back in the socket as soon as possible. This can be done by someone on scene, as long as the tooth is handled gently, the root not touched, and the tooth rinsed with cold, clean water if it has become dirty. If no one is available to do this, the tooth should be placed in milk to avoid drying out the root, and the patient and tooth transported to a dentist immediately. Once in the socket, the treatment is similar as for a dislodged tooth with splinting and careful watching.
The damaged tooth should be checked regularly. Your body’s defense mechanism could still reject it, so there’s a danger the root could be eaten away, or resorbed. Some forms of resorption can’t be treated — the aim then is to preserve the natural tooth for as long as possible, and then replace it with a life-like restoration to regain form and function.
If you would like more information on the treatment of injured teeth, 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 “Trauma & Nerve Damage to Teeth.”
As life spans have increased over the last century so has the importance of maintaining good oral health. Teeth are such a critical component in good nutrition and disease protection, it’s important we do all we can to preserve them for a lifetime.
Through advances in dentistry and oral hygiene, two of teeth’s greatest enemies, dental caries (tooth decay) and periodontal (gum) disease, are not only quite treatable but even preventable. The fact remains, though, that like the rest of our body, our teeth are still subject to aging. The irreplaceable outer layer known as enamel is especially susceptible to wear over time.
The normal wearing down of teeth occurs because of occlusal (bite) activity. As our upper and lower teeth interact with each other through constant biting and chewing activities, some of the enamel surface naturally wears away as we age. Our biggest concern shouldn’t be the wear itself but the rate of wear — whether it’s exceeded the normal range.
Habits that increase the frequency and rate of biting forces are the most common reason for excessive enamel erosion. Such habits include excessive tooth-to-tooth contact as when we clench or grind our teeth and tooth-to-foreign object, the chronic habit of holding hard objects (nails, pencils, pins, etc.) tightly between the teeth. Many of these habits are a response to psychological stress that can even carry over into our sleep.
The key is to minimize these effects on the normal process of wear, and to protect teeth for as long as possible. How to accomplish that goal depends on your individual circumstance: treatments could include such things as orthodontics to correct bite problems that contribute to abnormal wear, considering restoring worn teeth with new crowns or fillings, or reducing grinding or clenching with nocturnal mouth guards or some form of stress-relief therapy.
In cases where abnormal wear has passed the point where it doesn’t make sense to repair your natural teeth, all is not lost — restorations such as dental implants can help restore lost function and inhibit further erosion. Advances over the last thirty years in restoration techniques can, in effect, extend a new lease on life for your teeth. What’s more, we can also restore form — to bring back that smile from your younger years.
If you would like more information on tooth erosion and aging, 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 and Why Teeth Wear.”
Dental implants have come a long way since their introduction thirty years ago. Unlike their predecessors, today’s implants come in various shapes and sizes that can meet the precise needs of individual patients. Crown attachment has also developed some variety.
The actual implant is a titanium post surgically imbedded in the jawbone to replace the original tooth root. The restoration crown, the visible part of the implant system that resembles natural tooth, is affixed to the implant post. There are two basic methods to attach the crown: cement it to an abutment that has been installed in the implant; or screw it into the implant with a retaining screw from the underside of the crown. In the latter case, the abutment has been built into the crown.
While either method provides years of effective service, one method may work better than the other depending on the circumstance. Screw-retained crowns require no cement and are more easily removed than cemented crowns if it becomes necessary. On the other hand, the screw access hole can be visible, although the area can be filled with a tooth-colored filling; and although rare, chips near the access hole can occur. Occasionally the screw may become loose, but tightening or replacing the retaining screw is a simple matter because of the access hole.
A cemented crown looks more like a natural tooth and so is more useful in situations where cosmetics are a factor. The cement, however, can cause inflammation and contribute to bone loss in some patients when excess cement gets below the gums. Unlike a screw-retained crown, removal is more difficult and limited.
As a rule, screw-retained crowns are normally used in areas where the screw hole is not conspicuous, such as for posterior (back) teeth. They’re also more desirable than cemented when the implant is permanently crowned at the same time it’s surgically implanted, a process called “immediate loading.”
Which method of crown attachment is best for you? That depends on the implant location and other factors we would explore during a thorough pre-implant exam. Either way, the end result will be a life-like replica of your natural teeth, and a restored, vibrant smile.
If you would like more information on crown attachment to 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 “How Crowns Attach to Implants.”