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By Howard D. Klein, DMD
August 12, 2020
Category: Dental Procedures
Tags: dental implants  
ImplantSurgeryASafeandRoutineProcedure

Unlike other tooth replacement options, dental implants require a surgical procedure. But don't let your imagination run wild — the procedure is relatively minor and easy for most people to undergo.

Implants are unique among restorations because they replace a tooth's root. A metal titanium post, substituting for the root, must be surgically placed into the jawbone. While the procedure itself is simple and no more involved than a tooth extraction, it does require careful attention to detail before, during and afterward.

Our first step is to examine the target site with x-rays (often CT scanning) to pinpoint the best location for placement. This is critical because where we place the implant will have a huge bearing on how attractive and natural the implant finally appears. From this evaluation we frequently create a surgical guide.

Surgery begins with a local anesthesia to completely numb the site. You will feel no pain during the procedure and only minimal discomfort for a few days afterward. We then make small incisions in the gums to access the bone and create a small channel or hole.

Using the surgical guide, we then initiate a drilling sequence that gradually increases the size of the channel until it's the size and shape of the implant post. One thing we must do at this point is take our time: we use gentle pressure and water-cooling to avoid overheating and damaging the bone.

Once we're finished with drilling we remove the implant from its sterile packaging and imbed it directly into the prepared channel. It's then a matter of verifying the location with x-rays and then closing the gum tissue with self-absorbing sutures if necessary.

Most patients only need mild pain medication like aspirin or ibuprofen to manage discomfort afterwards. You won't even notice it in a week or less. After several weeks in which the bone grows and adheres to the implant (a process called osseointegration), you'll be ready for the final step, attaching the life-like porcelain crown to the implant.

Although the process can take several weeks to months, your discomfort should be minimal at any stage. In the end, your patience will be rewarded with a new, more attractive smile.

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 “Dental Implant Surgery.”

DakotaJohnsonandHerMissingToothGapSparksOnlineDebate

Celebrities’ controversial actions and opinions frequently spark fiery debates on social media. But actress Dakota Johnson lit a match to online platforms in a seemingly innocent way—through orthodontics.

This summer she appeared at the premier of her film The Peanut Butter Falcon missing the trademark gap between her front teeth. Interestingly, it happened a little differently than you might think: Her orthodontist removed a permanent retainer attached to the back of her teeth, and the gap closed on its own.

Tooth gaps are otherwise routinely closed with braces or other forms of orthodontics. But, as the back and forth that ensued over Johnson’s new look shows, a number of people don’t think that’s a good idea: It’s not just a gap—it’s your gap, a part of your own uniqueness.

Someone who might be sympathetic to that viewpoint is Michael Strahan, a host on Good Morning America. Right after the former football star began his NFL career, he strongly considered closing the noticeable gap between his two front teeth. In the end, though, he opted to keep it, deciding it was a defining part of his appearance.

But consider another point of view: If it truly is your gap (or whatever other quirky smile “defect” you may have), you can do whatever you want with it—it really is your choice. And, on that score, you have options.

You can have a significant gap closed with orthodontics or, if it’s only a slight gap or other defect, you can improve your appearance with the help of porcelain veneers or crowns. You can also preserve a perceived flaw even while undergoing cosmetic enhancements or restorations. Implant-supported replacement teeth, for example, can be fashioned to retain unique features of your former smile like a tooth gap.

If you’re considering a “smile makeover,” we’ll blend your expectations and desires into the design plans for your future smile. In the case of something unique like a tooth gap, we’ll work closely with dental technicians to create restorations that either include or exclude the gap or other characteristics as you wish.

Regardless of the debate raging on social media, the final arbiter of what a smile should look like is the person wearing it. Our goal is to make sure your new smile reflects the real you.

If you would like more information about cosmetically enhancing your smile, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Space Between Front Teeth” and “The Impact of a Smile Makeover.”

By Howard D. Klein, DMD
June 13, 2020
Category: Dental Procedures
Tags: dental implant  
YourGumsandBoneNeedtoBeHealthyBeforeGettingImplants

If you've been dealing with a tooth that needs to be removed—or it's already missing—you may be looking to replace it with a dental implant. And it's a great choice: No other restoration can provide the appearance and function of a real tooth like an implant.

You and your smile are ready for it. The question is, though, are your gums and underlying bone ready? These dental structures play a critical role in an implant's stability and eventual appearance. A problem with them may make placing an implant difficult if not impossible.

An implant requires around 2.0 millimeters of bone thickness surrounding the implant surface for adequate support and to minimize the chances of gum recession. But tooth loss often leads to bone loss that can drop its thickness below this threshold. This can make placing an implant problematic.

Fortunately, though, we may be able to address the lack of sufficient bone through bone grafting. By placing grafting material within the empty socket, we create a scaffold for new bone cells to grow upon. Over time this subsequent growth may be enough to maintain an adequate thickness of bone for an implant to be placed.

The gums may also pose a problem if they've shrunk back or receded from their normal positions, as often happens because of gum disease (which may also have precipitated the tooth loss). Again, grafting procedures can help ensure there's adequate gum coverage for the implant. And healthier gums may also help protect the underlying bone from loss.

There are several techniques for placing gum tissue grafts, depending on how much recession has taken place. One procedure in particular is often used in conjunction with implant placement. A small layer of synthetic collagen material or gum tissue referred to as pa dermal apron is included with the implant when its placed. Settling into the bone socket, this apron helps thicken the gum tissues, as well as preserve the underlying bone.

During your preliminary exams, we'll assess your bone and gum health to determine if we should take any steps like these to improve them. It may add some time to the implant process, but the end result will be well worth it.

If you would like more information on 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 “Immediate Dental Implants.”

YouCanHaveaStraighterSmile-JustLiketheQueenofEngland

The monarchs of the world experience the same health issues as their subjects—but they often tend to be hush-hush about it. Recently, though, the normally reticent Queen Elizabeth II let some young dental patients in on a lesser known fact about Her Majesty's teeth.

While touring a new dental hospital, the queen told some children being fitted for braces that she too “had wires” once upon a time. She also said, “I think it's worth it in the end.”

The queen isn't the only member of the House of Windsor to need help with a poor bite. Both Princes William and Harry have worn braces, as have other members of the royal family. A propensity for overbites, underbites and other malocclusions (poor bites) can indeed pass down through families, whether of noble or common lineage.

Fortunately, there are many ways to correct congenital malocclusions, depending on their type and severity. Here are 3 of them.

Braces and clear aligners. Braces are the tried and true way to straighten misaligned teeth, while the clear aligner method—removable plastic mouth trays—is the relative “new kid on the block.” Braces are indeed effective for a wide range of malocclusions, but their wires and brackets make it difficult to brush and floss, and they're not particularly attractive. Clear aligners solve both of these issues, though they may not handle more complex malocclusions as well as braces.

Palatal expanders. When the upper jaw develops too narrowly, a malocclusion may result from teeth crowding into too small a space. But before the upper jaw bones fuse together in late childhood, orthodontists can fit a device called a palatal expander inside the upper teeth, which exerts gentle outward pressure on the teeth. This encourages more bone growth in the center to widen the jaw and help prevent a difficult malocclusion from forming.

Specialized braces for impacted teeth. An impacted tooth, which remains partially or completely hidden in the gums, can impede dental health, function and appearance. But we may be able to coax some impacted teeth like the front canines into full eruption. This requires a special orthodontic technique in which a bracket is surgically attached to the impacted tooth's crown. A chain connected to the bracket is then looped over other orthodontic hardware to gradually pull the tooth down where it should be.

Although some techniques like palatal expanders are best undertaken in early dental development, people of any age and reasonably good health can have a problem bite corrected with other methods. If you are among those who benefit from orthodontics, you'll have something in common with the Sovereign of the British Isles: a healthy, attractive and straighter smile.

If you would like more information about orthodontic treatment options, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “The Magic of Orthodontics.”

By Howard D. Klein, DMD
May 24, 2020
Category: Dental Procedures
Tags: tooth pain  
WhyandHowtoSaveaDiseasedTooth

Let's say you have a diseased tooth you think might be on its last leg. It might be possible to save it, perhaps with a significant investment of time and money. On the other hand, you could have it replaced with a life-like dental implant.

That seems like a no-brainer, especially since implants are as close as we have to natural teeth. But you might want to take a second look at salvaging your tooth—as wonderful as implants are, they can't beat the real thing.

Our teeth, gums and jaws form an intricate oral system: Each part supports the others for optimum function and health. Rescuing a troubled tooth could be the best way to preserve that function, and replacing it, even with a dental implant, a less satisfying option.

How we save it will depend on what's threatening it, like advanced tooth decay. Caused by bacterial acid that creates a cavity in enamel and underlying dentin, decay can quickly spread into the tooth's pulp and root canals, and eventually threaten the supporting bone.

We may be able to stop decay and save the tooth with a root canal treatment. During this procedure, we remove diseased tissue from the pulp and root canals through a drilled access hole, and then fill the empty spaces. We then seal the access and later crown the tooth to protect it against future infection.

A second common threat is periodontal (gum) disease. Bacteria in dental plaque infect the outer gums and, like tooth decay, the infection quickly spreads deeper into the root and bone. The disease weakens gum attachments to affected teeth, hastening their demise.

To treat gum disease, we manually remove built-up plaque and tartar (hardened plaque). This deprives the infecting bacteria of their primary food source and “starves” the infection. Depending on the disease's advancement, this might take several cleaning sessions and possible gum surgery to access deep pockets of infection around the root.

Because both of these treatment modalities can be quite in-depth, we'll need to assess the survivability of the tooth. The tooth could be too far gone and not worth the effort and expense to save it. If there is a reasonable chance, though, a rescue attempt for your troubled tooth might be the right option.

If you would like more information on whether to save or replace a tooth, 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 “Save a Tooth or Get an Implant?