The best method for permanently replacing a missing tooth is with a dental implant. But did you know that there are two main techniques for placing implants? Implants can be placed either using a one stage or a two stage surgical technique, and as their names suggests, one is performed in one step while the other requires a second surgery.

With a one-stage procedure, a healing abutment is placed at the time of surgery. An abutment is a connector that attaches the implant from the bone into the mouth and which protrudes through the gum tissues. Following a 3 to 6 month healing period in which the implant fuses to the bone, a crown is then placed on the implant restoring the immediate appearance of a healthy, normal tooth. One-stage implant systems are generally used when the bone quality is good, guaranteeing good initial implant stability. They are also used when cosmetics is not a concern, such as the back areas of the mouth.

Under special conditions an implant can be placed and a crown placed on top of it at the same time. However, this is a very special circumstance requiring ideal conditions and surgical experience as well as crown fabrication know-how. It is generally safer and wiser not to subject an implant to biting forces until it is fully healed and integrated with the supporting bone.

A two-stage procedure is typically used for replacing teeth where there is no immediate need for a cosmetic solution and when more of a margin of safety is required. With this approach, the implant(s) are placed into the jawbone and the gum tissues cover them. They are not exposed to the mouth, but stay buried and left to heal. Once healed, a second surgery is performed to attach an abutment for securing the crown in place. This approach is used when there is poorer bone quality or quantity. This may make it necessary to regenerate bone around the implant at the time of its placement. There may also be other health considerations dictating that a two-stage approach may be indicated.

Depending on your individual situation and medical status, our implant team will determine which approach is best for you. To learn more about these two procedures, read the Dear Doctor article, “Staging Surgery In Implant Dentistry.” You are also welcome to contact us to discuss your questions or to schedule an appointment.

Anytime you have a tooth that does not erupt (surface) correctly but rather stays submerged below the gum you have a problem. Sometimes this situation can cause significant pain, while other times it can be totally pain-free. When this occurs to a wisdom tooth (third molar), you have what is commonly referred to as an impacted wisdom tooth. This generally occurs when there is insufficient room in the mouth, and the wisdom tooth “impacts” or butts up against an adjacent tooth.

Third molars come in typically between the ages of 17 and 25, when a moderate amount of “wisdom” is supposedly achieved. Most people have four wisdom teeth; however, it is possible to have more or less. The key to not having issues generally depends upon one main factor: having adequate space for them to grow and erupt into proper position.

The most common consequence of having an impacted wisdom tooth is gum (periodontal) disease and damage to adjacent healthy teeth. This makes removing the impacted tooth so important. Another problem with impacted wisdom teeth is that they can affect other adjacent structures like gum, bone, nerves, blood vessels and sinuses. They can also become cystic, a condition in which the submerged tooth is surrounded by a closed sac or membrane that can cause possible infection and loss of bone.

We stress the importance of routine dental exams between the ages of 17 and 25 to catch problems with wisdom teeth before they start. The best time to remove a wisdom tooth is when it is not causing problems and the sooner and younger you are the better!

To learn more about the symptoms and treatment options of impacted wisdom teeth, continue reading the Dear Doctor magazine article “Wisdom Teeth.” Or, you can contact us today to schedule an appointment to discuss your questions.

You didn't have your teeth straightened as a child. Is it too late, or should you have orthodontic treatment now as an adult?

Orthodontics is a sub-specialty of dentistry devoted to the study and treatment of improper bites, or malocclusions. Orthodontic treatment has the goal of slowly applying pressure to teeth in a way that moves them into proper alignment in your mouth.

Recommendations are for children to have their teeth assessed for orthodontic treatment before the age of seven. The whole process can be done more easily while their teeth are coming in and their jaws are still growing.

However, if your teeth are overcrowded, you have an overbite or an underbite, or your teeth are misaligned in other ways, it is never too late. If you “missed the boat” on orthodontic treatment before, here are seven reasons to consider doing it now.

1. Orthodontic treatment brings teeth, lips and face into proportion, resulting in a beautiful smile.
2. An attractive smile contributes to self-esteem, self-confidence and better self-image.
3. Because of improved self-esteem, you may see improved social and career success.
4. Teeth that are in proper alignment will function and wear better over the years as you age.
5. Properly aligned teeth are easier to keep clean, making you less prone to periodontal (gum) disease.
6. If you have any missing teeth that need to be replaced, this can be done more effectively if your remaining teeth are put into their correct spacing and position first.
7. Current options for treatment include fixed appliances (traditional braces) in which bands and brackets are bonded to the teeth and wires are threaded through them — or as an adult you may be able to use removable clear aligners. These consist of a series of nearly invisible computer-generated clear plastic trays that progressively move the teeth into better alignment.

Take the first step: call our office for an orthodontic evaluation. Having orthodontic treatment as an adult may be just the thing to give you an attitude boost as you move forward in your life.

Contact us today to schedule an appointment to discuss your questions about teeth straightening. You can also learn more by reading the Dear Doctor magazine article “Why Straighten Teeth?”

Time to tune up the brightness on your teeth? Here are six modern methods of whitening and brightening your smile.

• In-office “power” bleaching under the supervision of my staff and me is recommended if your teeth are badly stained, or if you are about to have veneers or crowns made. It's quick, safe, and effective. Gels containing high concentrations of bleach are applied to your teeth in our office, often with the enhancement by heat and light to make them act faster. Results show teeth becoming up to ten shades lighter in about an hour.
• “Take home” whitening solutions and trays are designed to fit your mouth and can also be provided by my office. The technique is easy to perform and is less expensive than in-office power whitening system, although it takes longer to see the same results. General recommendations are for 30 minute applications twice a day. You can usually see a change after two to four sessions. This requires patience, because it is important not to exceed recommended exposure in order to avoid damage to your teeth, gums, and the inside skin of your mouth. After two weeks of use, teeth can be expected to be about eight shades lighter.
• Whitening strips look like clear Band-Aids that are applied to the tooth surfaces. They should be worn twice a day for 30 minutes each time, for seven days. On average, they claim to lighten teeth more than three shades. They take about two weeks to work at 30 minutes per day.
• “Paint on” or “Brush on” whitening formulas are also available. These are gels that are painted onto the teeth every night at bedtime, for two weeks. Some claim that this line of home whitening can whiten teeth two to five shades. These gels may make your mouth feel goopy, but they are relatively inexpensive. Some gels come with a small brush to scrub them onto the teeth.
• Over-the-counter “mouth-tray” whiteners use mouth trays that are not designed for your particular mouth, so they may not fit well and may be messy or uncomfortable. They are filled with gel and worn 45 minutes a day for one week. On average, teeth become two shades whiter.
• Whitening gum is a relatively new product. It requires chewing two pieces for at least 20 minutes, four times a day, to see an effect.

Contact us today to schedule an appointment to discuss your questions about tooth bleaching. You can also learn more by reading the Dear Doctor magazine article “Teeth Whitening.”

If you've lost one or more of your teeth due to tooth decay, trauma, gum disease or a failed root canal, there are a variety of ways that our office can help you to restore your smile and increase your confidence. Crowns, conventional bridges and dentures aren't your only options for replacing missing teeth. Dental implants, surgically placed below the gums, are another alternative for replacing missing teeth.

Getting Started: If you would like to explore the option of having dental implants to replace one or more teeth, you will first need a comprehensive exam. The ideal candidate for implants is in good general and oral health. Adequate bone in your jaw is needed to support an implant. Smokers and those with uncontrolled chronic diseases like diabetes may not be good candidates for dental implants because healing may be impaired or slow. In addition, dental implants aren't appropriate for children or teens until their jaw growth is complete.

The Process: Dental implant surgery can be performed in our office using either a local or general anesthetic. The implants actually replace tooth roots; they are placed into the bone surgically. Generally made of commercially pure titanium, this metal has the remarkable ability to fuse with the bone as it heals forming a union known as osseointegration (“osseo” – bone; “integration” – to fuse with). This process takes two to six months depending upon many factors of which bone quality is the most important.

The next step is to place an abutment (a small connector) which attaches the implant to the crown. The crown is the part of the tooth that is normally seen in the mouth above the gums.

Assessment of your individual situation and deciding if dental implants are right for you takes knowledge and experience. Contact us today to schedule an appointment to discuss any questions you may have regarding dental implants. Read more about this topic in the Dear Doctor magazine article “Dental Implants: Options for Replacing Missing Teeth.”