Once an implant has had time to heal and an abutment (the metal post that protrudes through the gums) has been placed, it is now time to make the implant look and function like a tooth. Depending on how many teeth need to be replaced and how many implants are present will determine how the area will be restored. For a single tooth, it’s just a matter of constructing a conventional crown (cap). For a section of missing teeth, a row of teeth can be made and screwed into the abutments. For patients who are needing all of their teeth in a particular arch (upper or lower) replaced, there are a number of options available. If two implants are placed, then the abutments can be placed that have little balls that look like trailer hitches. Then “O” rings are placed inside the denture to allow it to snap onto the implant abutments. Although this setup doesn’t hold the denture in rigidly, it does keep it from shifting laterally, greatly improving function. If four or more abutments are present, then special clips can be placed in the denture that can hold the denture in fairly firmly. The denture can then be unclipped to allow for easy cleaning underneath. The other alternative is to screw the denture directly to the abutments. This way, the denture is rigidly held in place and is as close to having one’s natural teeth.
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Dental Implant Abutments
Once an implant has healed for a few months it is ready to restore. The implant has healed undisturbed for a number of months under the gums. At this point, the implant must be uncovered. It’s a simple procedure that can be done under a local anesthetic and results in only minimal gum soreness that can be eased with an anti-inflammatory such as ibuprofen. A healing cap is placed over the exposed implant so that the gums can heal around the area. Now it’s time to choose an abutment. An abutment is a post that attaches to the implant and protrudes through the gums. This provides a platform for a crown (cap) to be attached to the implant. If the implant was able to be placed in the bone relatively straight compared to the adjacent teeth, then a standard abutment can be placed on the same day. Otherwise, an impression (mold) of the mouth must be taken and a custom abutment would need to be constructed at a lab. The abutment is placed by tightening a screw to a specified torque. The implant is now ready to restore into a new tooth.
Bone Grafts For Dental Implants
Dental implants need a minimum amount of bone to be sturdy enough to handle the stresses of biting and chewing. For those patients who lack adequate bone in areas where they have lost teeth, not all hope is lost. We now have very successful bone grafting techniques that can add enough bone to allow placement of an implant. In the back of the upper arch lies the maxillary sinus. It is not unusual to be short of bone in this area. A technique is now available where a small window of bone is removed and the membrane that lines the sinus cavity is raised up and bone graft material is placed in the resulting space. After a few months, new bone will grow in replacing the graft material. Then, the area is good to go for placing an implant. On a front teeth, when a tooth is removed, the bone tends to sink in when it heals. This makes it difficult at best to get a good cosmetic result around the gum line. By cutting out a block of cortical bone (the smooth hard bone on the outside of the jaw) from far back in the jaw bone and placing it over the defect, the sunken area can be corrected within a few months and will be ready to place the implant.
Clear Orthodontic Brackets
There is a lot of talk these days about “invisible braces” and for good reason. For selected cases, they work great. They can be removed to eat and to brush and floss. However, these type of “braces” do not work on many cases because of the complexity of the case. The invisible braces do not allow for fine control of tooth movement and some movements such as raising a tooth from it’s socket or doing a lot of rotation cannot be done with that method. Many adults and even some teens avoid orthodontic treatment because of the 
“metal mouth” stigma. For those who are not candidates for invisible braces, there is still hope to get their teeth straightened without having to wear a silver smile. Clear brackets are placed on the teeth as an alternative to the metal ones. These are made of an extremely hard, ceramic material. A metal wire still needs to be used, however, that is so thin that it is not very perceptible from a conversational distance. The ceramic brackets can be more difficult to work with and some orthodontists will charge more due to that. They can especially be problematic treatment wise when torque is placed on them and they can tend to crack due to their brittle nature. But if the only other acceptable treatment is no treatment, the clear braces are certainly a very acceptable alternative.
Placement of Dental Implants
Once the gum tissue has been reflected away from the bone, the surgeon can drill on the bone all day without any discomfort, only vibration because there are no nerve endings in the bone. To place an implant, there must be adequate bone to hold the titanium cylinder. Now 3D x-rays are available to accurately measure the amount of bone and to avoid major structures such as nerves and sinuses. An incision is made in the gums, then the gums are pulled back to give the surgeon full visibility of bone. A hole is drilled into the bone and then the titanium implant is screwed right into the bone. The gums are sutured back into place and the implant is left under the gums undisturbed for a number of months. This allows the bone to grow directly around the implant, a process called osseointegration. Finally, once the implant site has fully healed, the implant can be uncovered and restored to a new tooth.
Metal Allergies In Dentistry
Metal allergies to dental materials can cause the need to change the way different conditions are treated. There are a number of metals used in dentistry: gold, silver, mercury, nickel, titanium, chromium, cobalt. Any one of these metals can cause an allergic reaction in a susceptible individual. The good news is that true metal allergies, except for nickel, are extremely rare. Gold is used in crowns, silver and mercury are used in fillings, titanium in implants, and chromium/cobalt is used in partial dentures. The main symptom of metal allergy is contact dermatitis marked by a localized redness in the area where the metal contacts the mucosal tissue. The solution to the problem is to change out the dental work to a non-metallic alternative. For crowns, there are all porcelain types that can be made. Amalgam fillings can be replaced with composite (tooth colored) filling material. A chromium/cobalt metal framework of a particular denture can be redone in all acrylic (plastic). Titanium implants can be removed and a partial denture constructed to replace teeth. Even though metal allergies are not common, they can be very aggravating if you are one the affected ones. At least there are viable alternatives for restoring and replacing teeth.
Digital Dental X-Rays Part II
We recently added a digital x-ray system to our office. It has been a very welcome addition. With it, we bought a computer for each treatment room. We are now able to take the x-rays and blow them up to the size of the computer screen. No more squinting through a magnifying glass to search for little cavities. The images can also be rotated or enhanced. The images’s contrast can be sharpened to make previously undetected cavities jump out on the screen. With the larger images on the screen, it is much easier to explain to the patient about the need for a particular dental treatment. Although the pages are stored digitally and backed up regularly, we still print a “hard copy”. Having that copy in hand has saved us during times when the server was down. With the x-rays stored on the server, they can be viewed at the touch of a button. They can also be emailed to specialists or to insurance companies. Technology allows life to keep getting easier.
Invisible Braces (Invisalign®)
Invisalign Aligner
Invisible braces (such as Invisalign®) are a fantastic way to straighten one’s teeth. There is no “metal mouth” look. People can’t even tell that you are having orthodontics done. You can take the aligner out to eat so there are no restrictions of sticky or hard foods. You can also take them out to brush and floss your teeth. Oral hygiene is so much easier to do without all of the nooks and crannies to negotiate around with the brush. No more smiling with a big wad of lettuce hanging from your teeth. The process is started by making precise molds of the person’s teeth. A lab makes a 3-D computer image of the mold and a technician manipulates the teeth in tiny increments until the final result is achieved. A clear, thin, plastic aligner is contructed for every incremental step. As each aligner is worn, the teeth are slowly moved to their intended positions.
Invisible braces are not for everyone. They have a difficult time raising teeth out of the sockets, a movement called extrusion. They will also not be able to treat a tooth that is severly rotated. Teens can be treated with this method, however, all of the 2nd molars (12 year old molars) have to be fully erupted. With all of that being said, for patients who are candidates fo invisible braces, it can be an extremely satisfying experience.
Digital Dental X-Rays
We finally added digital x-rays to our office. It was a big expense but it was well worth it. Digital x-rays have been available for a number of years, however, the quality didn’t come close to film. With the recent advances in technology, the number of megapixels available now can match good quality x-ray film. There are two types of digital x-rays. One system uses a phosphor plate in place of the film, the other uses a direct sensor just like the light sensor in your digital camera. The phosphor plate must be sent through a scanner which is then processed by a computer which inherently causes a delay in viewing the resulting radiograph. 
The sensor type provides almost instantaneous feedback due to to it’s direct connection to the computer, however, the sensor is quite bulky and can be uncomfortable. We chose the phosphor plate system due to it’s sensor (it’s thinner than regular x-ray film) for the ultimate comfort for our patients. The radiation dosage that is needed to obtain good radiographs is less than that of film and there is no messy chemicals to fool with during processing.
What To Do If Your Child’s Tooth Is Knocked Out
Having your child run to you, mouth bleeding and holding their front tooth in their hand can be a very disconcerting thing. The key is-don’t panic. There are methods to save the tooth, but you must not delay. Time is of the essence. Your first thought is to clean the tooth since it came from the dirty ground. Make certain that you DON’T CLEAN THE TOOTH! It can rinsed with salt water or milk. If these aren’t available, then tap water will do. Saliva works great since there are bacteria fighting antibodies in it. It is best to replace the tooth back into the socket within 20 minutes of the injury. This would be best done by a dentist, but that is not always possible since most injuries happen during off-hours and even then, by the time the child hands you his tooth, you are probably close to the 20 minute mark already. That means you will need to be the one to reinsert the tooth. This is not the time to be squeamish. Your cool, calm actions can mean the difference between your child enjoying a beautiful smile or a lifetime of maintaining replacements. First, have your child vigorously swish with water to remove any blood clots that may have formed in the socket. 
Next is crunch time. Take the previously rinsed tooth and quickly and firmly insert the tooth back into the socket. This will probably bring stars and a few tears to your child’s eyes, but you’ve got to remember-it’s tough love. Once the tooth is back in the socket, have your child close their teeth together to make sure that it doesn’t interfere with the bite, then you can ajdust the alignment as needed. A dentist would be best seen within 24 hours for follow up care.