Posts for category: Dental Procedures
Losing a tooth from disease or accident can be traumatic. The good news, though, is that it can be replaced with a life-like replica that restores your smile. One of the most popular and durable solutions is a dental implant, which replaces not only the root of the tooth but the crown as well.
But there's a possible wrinkle with implants — for accurate placement there must be a sufficient amount of bone around it. This could be a problem if you've been missing the tooth for sometime: without the stimulus provided by a tooth as you chew, older bone cells aren't replaced at an adequate rate. The bone volume gradually diminishes, as up to 25% of its normal width can be lost during the first year after tooth loss. A traumatic injury can damage underlying bone to an even greater extent.
There is a possible solution, but it will require the services of other specialists, particularly a periodontist trained in gum and bone structure. The first step is a complete examination of the mouth to gauge the true extent of any bone loss. While x-rays play a crucial role, a CT scan in particular provides a three-dimensional view of the jaw and more detail on any bone loss.
With a more accurate bone loss picture, we can then set about actually creating new bone through grafting procedures. One such technique is called a ridge augmentation: after opening the gum tissues, we place the bone graft within a barrier membrane to protect it. Over time the bone will grow replacing both the grafting material and membrane structure.
Once we have enough regenerated bone, we can then perform dental implant surgery. There are two options: a “one-stage” procedure in which a temporary crown is placed on the implant immediately after surgery; or a “two-stage” in which we place the gum tissue over the implant to protect it as it heals and bone grows and attaches to it. In cases of pre-surgical bone grafting, it's usually best to go with the two-stage procedure for maximum protection while the bone strengthens around it.
Necessary preparation of the bone for a future dental implant takes time. But the extra effort will pay off with a new smile you'll be proud to display.
Orthodontic braces are a familiar sight, especially among tweens and teens: metal brackets and wires attached to the front of the teeth for all to see. Now imagine the opposite: much the same hardware, but now positioned out of sight on the back of the teeth.
It's not your imagination: It's the latest development in orthodontic technology called lingual braces. Developed simultaneously by two orthodontists in Japan and Beverly Hills, these appliances are placed on the tongue or “lingual” side of the teeth rather than the traditional labial or “lip-side.”
Generally, lingual braces can correct any bite problem labial braces can. The difference lies in how each method does its job: Traditional braces exert pressure or “push” against the teeth, while lingual braces “pull” the teeth into better alignment.
So, why choose lingual over labial? For one, they're “invisible” to others: all the hardware is on the backside of the teeth, out of sight. They're also not as readily exposed to blunt force facial trauma, which can damage traditional braces (a driving impetus for the Japanese doctor to develop them for his martial arts patients, and his American counterpart for a law enforcement patient working in a rough area).
Patients may also prefer lingual braces over removable clear aligners, another popular tooth-movement option. Fixed lingual braces achieve the same quality of “invisibility” as removable aligners, but without the inconvenience of removing them as patients must with aligners for eating, snacking or cleaning.
They can, however, be costly, running 15-35% more than labial braces. Patients may also have difficulty adjusting to them because they can affect speech and tongue comfort. However, any discomfort and initial regret with choosing lingual braces tends to fade as most patients grow more accustomed to them after a week or so.
There's one other “perk” to lingual braces—unlike patients with traditional braces who have to wait for their removal to see the finished bite correction, patients with lingual braces get an unobstructed view of their progress all during wear. That can definitely boost morale during the long treatment period!
Lingual braces haven't been around long, so not every orthodontist offers them. But the list is growing, and there soon may be a provider near you for this new teeth-straightening alternative.
If you would like more information on lingual braces, 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 “Lingual Braces: A Truly Invisible Way to Straighten Teeth.”
The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.
The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.
Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.
Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.
After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.
Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.
If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”
One in 700 babies are born each year with a cleft lip, a cleft palate or both. Besides its devastating emotional and social impact, this common birth defect can also jeopardize a child's long-term health. Fortunately, incredible progress has occurred in the last half century repairing cleft defects. Today's children with these birth defects often enter adulthood with a normal appearance and better overall health.
A cleft is a gap in the mouth or face that typically forms during early pregnancy. It often affects the upper lip, the soft and hard palates, the nose or (rarely) the cheek and eye areas. Clefts can form in one or more structures, on one side of the face or on both. Why they form isn't fully understood, but they seem connected to a mother's vitamin deficiencies or to mother-fetus exposure to toxic substances or infections.
Before the 1950s there was little that could be done to repair clefts. That changed with a monumental discovery by Dr. Ralph Millard, a U.S. Navy surgeon stationed in Korea: Reviewing cleft photos, Dr. Millard realized the “missing” tissue wasn't missing—only misplaced. He developed the first technique to utilize this misplaced tissue to repair the cleft.
Today, skilled surgical teams have improved on Dr. Millard's efforts to not only repair the clefts but also restore balance and symmetry to the face. These teams are composed of various oral and dental specialties, including general dentists who care for the patient's teeth and prevent disease during the long repair process.
Cleft repairs are usually done in stages, beginning with initial lip repair around 3-6 months of age and, if necessary, palate repair around 6-12 months. Depending on the nature and degree of the cleft, subsequent surgeries might be needed throughout childhood to “polish” the original repairs, as well as cosmetic dental work like implants, crowns or bridgework.
In addition to the surgical team's skill and artistry, cleft repair also requires courage, strength and perseverance from patients and their parents, and support from extended family and friends. The end result, though, can be truly amazing and well worth the challenging road to get there.
If you would like more information on repairing cleft birth defects, 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 “Cleft Lip & Cleft Palate.”
Sometimes, looking at old pictures can really bring memories back to life. Just ask Stefani Germanotta—the pop diva better known as Lady Gaga. In one scene from the recent documentary Five Foot Two, as family members sort through headshots from her teen years, her father proclaims: "Here, this proves she had braces!"
"If I had kept that gap, then I would have even more problems with Madonna," Lady Gaga replies, referencing an ongoing feud between the two musical celebrities.
The photos of Gaga's teenage smile reveal that the singer of hits like "Born This Way" once had a noticeable gap (which dentists call a diastema) between her front teeth. This condition is common in children, but often becomes less conspicuous with age. It isn't necessarily a problem: Lots of well-known people have extra space in their smiles, including ex-football player and TV host Michael Strahan, actress Anna Paquin…and fellow pop superstar Madonna. It hasn't hurt any of their careers.
Yet others would prefer a smile without the gap. Fortunately, diastema in children is generally not difficult to fix. One of the easiest ways to do so is with traditional braces or clear aligners. These orthodontic appliances, usually worn for a period of months, can actually move the teeth into positions that look more pleasing in the smile and function better in the bite. For many people, orthodontic treatment is a part of their emergence from adolescence into adulthood.
Braces and aligners, along with other specialized orthodontic appliances, can also remedy many bite problems besides diastema. They can correct misaligned teeth and spacing irregularities, fix overbites and underbites, and take care of numerous other types of malocclusions (bite problems).
The American Association of Orthodontists recommends that kids get screened for orthodontic problems at age 7. Even if an issue is found, most won't get treatment at this age—but in some instances, it's possible that early intervention can save a great deal of time, money and effort later. For example, while the jaw is still developing, its growth can be guided with special appliances that can make future orthodontic treatment go quicker and easier.
Yet orthodontics isn't just for children—adults can wear braces too! As long as teeth and gums are healthy, there's no upper age limit on orthodontic treatment. Instead of traditional silver braces, many adults choose tooth-colored braces or clear aligners to complement their more professional appearance.
So if your child is at the age where screening is recommended—or if you're unhappy with your own smile—ask us whether orthodontics could help. But if you get into a rivalry with Madonna…you're on your own.
If you have questions about orthodontic treatment, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Magic of Orthodontics” and “Orthodontics For The Older Adult.”