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.
Category Archives: Dentistry
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.
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.
Pulpitis
Ouch!
Ever woken up to a toothache? Chances are it was caused by pulpitis, an inflammation of the dental pulp, a collection of nerves and blood vessels inside your tooth. A mild pulpitis can cause symptoms of cold sensitivity. If the condition is allowed to progress, then it can lead to lots of pain and suffering. The most common cause of pulpitis is decay. Bacteria can get down inside a cavity and form acids and toxins that can injure the pulp (nerve). If allowed to continue unchecked, it can lead to much discomfort and to pulpal death. Another cause of pulpitis can be exposed roots. Normally a tooth has an enamel coating, but if the gums begin to recede, then cementum and dentin can be exposed. Dentin has microscopic tubules that lead to the nerve. Bacteria can get into these tubules and can cause sensitivity. For temporary relief of pulpitis until you can get to a dentist, the best thing is an anti-inflammatory such as Ibuprofen. Pharmacies may have toothache drops which have oil of cloves in it or temporary filling material (zinc oxide and eugenol) to plug the hole. Once at the dental office, if decay is the cause of the pulpitis, then the dentist many times can simply remove it and place a filling. If the pulpitis is due to receded gums, then the dentist can apply a desensitizing agent on the root surface to help alleviate the pain.
Periapical X-Rays
A periapical x-ray is a closeup of a particular tooth or teeth. If your dentist recommends one, by all means, have him take it. I recommend periapical x-rays to my patients anytime they say that they are having pain in a particular area, if there is deep decay in a tooth or if there is a problem or defect that is apparent on a bitewing x-ray (the x-ray that is used to detect cavities and gum disease) but cannot be seen in it’s entirety. When viewing a periapical x-ray, the dentist will look at the bone around the root, the height of the bone for periodontal (gum) defects, intactness of the root and for any other pathology (disease process) that could be visible. If a darker area exists on the x-ray around the tip of the root, then that could mean that there is a dead nerve inside the tooth. Dark areas up the side of the root could mean a possible root fracture. Dark areas at the crest of the bone (the portion closest to the crown of the tooth, i.e. the part of the tooth that you see) is usually an indication of bone loss due to gum disease. Pathological conditions can show up as either light or dark areas. This could be indicative of a tumor or cyst. That’s why it is so important to allow your dentist to take a periapical x-ray if he recommends it.