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.

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.”

It is always good to be prepared before you have any dental or medical procedure. Make sure that you are informed and know what to expect to make you as comfortable as possible. We recommend that you have a list of questions with you to ask us during your consultation. If we inform you that you need a crown, consider asking any or all of the following questions:

• Am I a good candidate for a crown?
• Can you do a computer-generated mock-up of my new smile with crowns? (This question is only applicable if the crown is for a front or visible tooth.)
• Is there a way that I can “test-drive” my new smile and crown(s) before making them permanent?
• How long will the entire process take from my first appointment through completion?
• What are the risks, benefits and alternatives associated with the type of crown(s) you are recommending?
• Is there any discomfort associated with crown procedures?
• Will I need or receive any type of sedation when you prepare (drill) the tooth or teeth for a crown?
• Is what you are recommending commonly done?
• Can you show me some before and after photos of cases that you have done?
• How much will my crown(s) cost?
• Will my insurance cover all or a portion of the cost?
• How long can I expect my crown(s) to last?
• Will there be any maintenance required with my crown(s)?

To learn more about crowns, read the Dear Doctor article, “Porcelain Crowns & Veneers.” Or you can contact us today to discuss your situation and schedule a consultation.

Some of the most popular smile enhancers on the market today are both over-the-counter (OTC) and professional teeth whitening products. And while studies indicate that bleaching can successfully achieve noticeable increases in whitening of stained teeth, there are some facts you need to know about these products and the results that they can deliver.

• Nearly all bleaching products contain the same basic ingredient, carbamide peroxide or its breakdown product, hydrogen peroxide. However, the products our office uses to professionally whiten your teeth are much stronger without compromising the health and safety of your teeth, gums, and mouth.
• OTC bleaches typically contain no more that 10% carbamide peroxide while professional bleaches can contain between 15% and 35%. And to make professional bleaching even more effective, we may use them in combination with specialized lights or lasers.
• Bleaching is NOT a permanent solution and thus results will diminish over time. The “fade rate” begins to occur 6 to 12 months after treatment.
• While you can't avoid the fading process, you can extend your bleaching results by avoiding foods and drinks that stain your teeth, such as red wine, red (tomato-based) sauces, coffee, tea, sodas/colas, and blueberries to name a few.
• Another method for extending your results is to use a straw when drinking beverages that can stain your teeth so that the liquid does not come in contact with your teeth.
• If you have visible crowns and/or veneers mixed with your natural front teeth, it may be quite difficult for you to bleach your natural teeth so that they perfectly match your veneers or crowns. Remember, tooth whitening is not effective on crowns, veneers, bridgework, or any type of artificial tooth.
• One of the most common side effects of whitening teeth is tooth sensitivity and irritation of the gum tissues. They both are usually temporary and often occur when you start bleaching; however, they generally subside after a few days.

Overall, bleaching your teeth is an effective way to brighten your smile with minimal side effects. If it is something you are interested in pursuing, talk it over with us first — even if you plan to use OTC products — so that you have a clear understanding about your specific options and projected outcomes. Or, learn more by reading the Dear Doctor article, “Teeth Whitening: Brighter, Lighter, Whiter....”