Posts for: May, 2018

SurgicallyAccessingSinusescanHelpGrowNewBoneforImplants

Dental implants are by far the best way to replace missing teeth. But they do more than improve your smile: they can restore your ability to eat, chew and talk properly, especially if the teeth replaced are in the back of your mouth. What’s more, they can improve the entire look of your face by restoring facial height and cheek support lost because of the missing teeth.

There is, however, one obstacle to overcome before receiving dental implants — a lack of sufficient bone at the implant site. Bone loss usually occurs when teeth have been missing for some time. This is because when we chew the forces generated by the teeth stimulate continual bone growth to make up for older bone that has dissolved (resorbed). This stimulation doesn’t occur after teeth are lost, which slows the rate of bone growth. Over time the amount of healthy bone diminishes.

Without enough bone for support, implants can’t be placed properly. Fortunately, some of the bone can be regenerated through techniques that place bone grafting material at the site to stimulate and serve as a scaffold for new bone.  The new bone will eventually replace the graft.

For missing upper back teeth with bone loss, we can take advantage of facial anatomy to grow the bone needed for implants. This area of the face is where the maxillary sinuses, air spaces lined with a tissue membrane, are located on either side just above the upper jaw. After determining their exact size and location through detailed x-ray imaging, we can surgically access the area inside the mouth just above the missing teeth.

The sinus cavity is an area where bone growth can occur by placing a bone graft between the floor of the sinus and the sinus membrane. Sometimes bone growth enhancers are used to stimulate and speed up regeneration. The procedure can usually be performed with local anesthesia (much like a routine tooth filling), with only mild discomfort afterward for a few days managed by an anti-inflammatory drug like ibuprofen and a decongestant for sinus swelling.

After six to seven months, we re-evaluate the area to see if sufficient bone has returned for implant surgery. If so, you will be well on your way to achieving a new look and better function through dental implants.

If you would like more information on building new bone through sinus surgery, 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 “Sinus Surgery.”


StoppingToothDecayCouldRequireRootCanalTreatment

It’s absolutely critical to stop tooth decay and repair any damage to tooth structure. Hopefully, we’ve caught it early in the enamel and dentin where we’re able to repair any holes or “cavities” that might have developed by filling them.

But what if the decay has crept deeper into the interior of the tooth? In this case, you’re at a much higher risk of eventually losing the tooth. If the decay has spread into the bone, a root canal treatment is usually your best option.

The first sign that decay has invaded the pulp, the innermost layer of the tooth, and the root canals may be a severe toothache. It’s different from the wince of pain or discomfort caused by sensitivity to temperature or pressure. Inner decay pain is constant and often excruciating. This is because the infection is attacking the nerves bundled within the pulp chamber.

The pain can last for several days, and then suddenly stop altogether. No pain is good news, right? Wrong — the pain has stopped because the infected nerves have finally died and can no longer signal the brain. The infection, though, is very much alive and will continue to advance toward the root where the damage may eventually cause you to lose the tooth.

A root canal treatment removes decay in the pulp chamber and canals. We first drill an access hole to enter the pulp chamber. Once inside, we use special instruments to completely remove all tissue and disinfect the empty chamber. We then fill the chamber and root canals with a special filling and seal the access hole to prevent further decay. A few weeks later we install a custom crown to protect the tooth further.

If you have a toothache, or you’ve had one that suddenly went away, you should schedule an appointment for a dental examination as soon as possible: this is the only way to accurately determine the cause of the pain. If a root canal is deemed necessary, the sooner we perform it, the less chance the infection will cause you to lose your tooth.

If you would like more information on root canal treatment, 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 “Signs and Symptoms of a Future Root Canal.”


By Iris L. Shields, DDS
May 10, 2018
Category: Dental Procedures
Tags: dental implants  
3PossibleTimingScenariosforGettingYourNewImplant

If you have a problem tooth we’ve recommended removing, those “Tooth in one day” ads—a tooth removed and an implant placed at the same time—might start to pique your interest. But there are a few factors we must consider first to determine if this procedure is right for you. Depending on your mouth’s health conditions, you may need to wait a little while between tooth extraction and implantation.

Here are 3 timing scenarios for receiving your implant after tooth removal, depending on your oral health.

Immediately. The “tooth in one day” scenario can be much to your liking, but it could also be tricky in achieving the best results. For one, the implant may fit too loosely—the bone around the socket might first need to heal and fill in or undergo grafting to stimulate regeneration. In other words, immediate implant placement usually requires enough supporting bone and an intact socket. Bone grafting around the implant is usually needed as well.

After gum healing.  Sufficient gum coverage is also necessary for a successful outcome even if the bone appears adequate. To guard against gum shrinkage that could unattractively expose too much of the implant, we may need to delay implant placement for about 4 to 8 weeks to allow sufficient gum healing and sealing of the extraction wound. Allowing the gums to heal can help ensure there’s enough gum tissue to cover and protect the implant once it’s placed.

After bone healing. As we’ve implied, implants need an adequate amount of supporting bone for best results. When there isn’t enough, we might place a bone graft (often immediately after tooth extraction) that will serve as a scaffold for new bone to grow upon. Depending on the degree of bone loss, we may wait until some of the bone has regenerated (about 2 to 4 months) and then allow the natural process of bone cells growing and adhering to the implant (osseointegration) to complete the needed bone growth. If bone loss is extensive, we may need to wait until full healing in 4 to 6 months to encourage the most stable outcome.

If you would like more information on the process of obtaining 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 “Implant Timelines for Replacing Missing Teeth.”




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