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Posts for category: Dental Procedures

By George Debbaneh, DDS
May 16, 2019
Category: Dental Procedures
Tags: dental implants  
KnowtheRisksandBenefitsforSame-DayToothReplacement

While there’s usually a period of months between implant placement and the permanent crown, a new technique known as same-day tooth replacement installs both the implant and a temporary crown during the same visit. But be advised — it does have its risks and isn’t for everyone.

Successful same-day replacements require special attention during the three phases for implants: the removal (extraction) of the existing tooth; placement of the implant in the bone; and attachment of the crown, the visible tooth, to the implant. The tooth extraction lays the foundation for the entire process; the extraction procedure must be performed carefully to avoid undue damage to the socket. In addition, if infection or disease has compromised the site, an implant may not be possible immediately.

The implant must then be placed in the bone so that it’s stable and immovable. All implants stabilize with time as the bone grows and adheres to them, but we need greater stability for a same-day tooth replacement when an extraction is performed.

Our last consideration is positioning the implant so that the attached crown blends in naturally with the surrounding gum tissue and adjacent teeth. We must place it at the proper depth below the gum tissues so that the crown appears to emerge from them in the proper tooth length.

Taking extra care during all these phases, including the angle of crown attachment, will increase our chances of success. We still run a risk of implant damage or failure, however, from biting forces before the implant fully integrates with the bone. This means avoiding chewy foods and other situations that might increase the force on the implant. We may also use a temporary crown that’s slightly shorter than adjacent teeth so it won’t make full contact with the opposing tooth.

If you’d like to know if you’re a good candidate for a same-day tooth replacement, see us for a detailed examination. After reviewing your needs, we’ll be able to discuss with you the risks and benefits for a new look in one day.

If you would like more information on same-day tooth replacement, 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 “Same-Day Tooth Replacement with Dental Implants.”

By George Debbaneh, DDS
April 06, 2019
Category: Dental Procedures
Tags: partial denture  
CantAffordDentalImplantsConsiderPartialDentures

We’ve come a long way in our ability to restore missing teeth. Today’s top choice is dental implants, prized not only for their close resemblance to real teeth but also their durability.

The rise of implants, though, hasn’t put older restorative methods out to pasture—many continue to offer patients a viable and affordable choice for tooth replacement. One example is the removable partial denture (RPD).

Once quite common, RPDs’ popularity has only slightly diminished with the advent of implants. They’re a fair option in terms of dental function and appearance, and much less expensive than implants or fixed bridges.

Similar to a full denture—a removable appliance that replaces all the teeth on a dental arch—a RPD can replace multiple missing teeth in a variety of configurations. A traditional RPD is usually constructed of vitallium, a lightweight but strong metal alloy, which allows for a very thin and comfortable frame. It’s covered in a gum-colored resin or plastic with prosthetic (false) teeth precisely set at the missing teeth’s locations. The appliance stays in place through a series of clasps that attach to the remaining teeth.

¬†Each RPD is custom-made to fit a patient’s mouth contours and the locations and patterns of the missing teeth. The top design goal for each individual RPD is to minimize any rocking movement during chewing; achieving that goal will depend not only on how many teeth are missing and where, but also what type of teeth are being replaced. For example, teeth missing from the back would require a different support design than teeth missing from the side or front.

RPDs’ biggest benefits are comfortable fit, effective dental function and good appearance. However, their means of attachment can create difficulties keeping remaining teeth clean of disease-causing bacterial plaque. Furthermore, an ill-fitting or unstable RPD could damage or even loosen natural teeth. It’s therefore essential for wearers to diligently practice daily hygiene (including cleaning the RPD) and undergo regular fit monitoring with their dentist.

Even with these constraints, a RPD can do an acceptable job providing dental function. What’s more, it can definitely improve your smile.

If you would like more information on options for dental restoration, 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 “Removable Partial Dentures: Still a Viable Tooth-Replacement Alternative.”

ThoughnotAlwaysSeenitsStillImportanttoReplaceaMissingBackTooth

Your front teeth are the stars of your smile — so it makes perfect sense to replace them if they’re missing. But is it really necessary to replace a largely unseen back tooth with an implant or bridgework?

The answer is an unequivocal yes. Your individual teeth are an interactive part of a dynamic mechanism that enables you to eat, speak and smile. They’re highly adaptable and can move incrementally to accommodate mouth changes — especially when one of them is lost.

Back teeth not only help us chew food efficiently, they also ease some of the pressure from front teeth as we chew. Our efficiency while chewing suffers when they’re missing; other teeth will wear faster and tend to move out of position, “drifting” into the space left by the missing tooth. And without their stimulation during chewing, new bone may grow at a slower rate to replace older bone, reducing bone volume over time.

So, whether visible or not, replacing a back tooth is the best course to take to prevent these adverse consequences. Your two best options are fixed bridgework or dental implants, each with their own advantages and disadvantages.

Bridgework has been the traditional method for replacing one or a few missing teeth: they’re long-lasting if cared for properly, have a life-like appearance that blends well with other teeth and are a good option when implants aren’t. But they require extensive altering of the anchor teeth (those used on either side of the bridge to secure it) and they’re highly prone for trapping food between them and the gums, increasing the risk of disease.

Dental implants are easily maintained and their installation doesn’t affect adjacent teeth as with a bridge. They’re also durable with a 95% success rate after ten years. On the other hand, the installation process can take several months and visits, and they require a certain amount of bone mass for proper placement and so aren’t ideal for certain patients.

Regardless of its location, if you have a missing tooth or one that may need to be removed, you should visit us for a complete examination. From there we can tell you how your mouth has been impacted by the missing tooth and which replacement option is best for you.

If you would like more information on tooth replacement options, 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 “Replacing Back Teeth.”

By George Debbaneh, DDS
January 26, 2019
Category: Dental Procedures
Tags: dental implants   dentures  
Implant-SupportedDenturesCouldBoostYourJawboneHealth

People have depended on dentures for generations—and they still do. That's because they work, both in restoring dental function and a smile marred by missing teeth.

But they have one major drawback related to bone health. That's because living bone has a life cycle: as older cells die, new ones form to take their place. The pressure generated when we chew stimulates this growth. But when this stimulus goes missing along with the teeth, the cell replacement rate slows and bone volume and density gradually diminishes.

Traditional dentures can't transmit this chewing pressure stimulus. And because they rest directly on the gum ridges, they can adversely affect the underlying bone and actually accelerate bone loss.

But implant technology potentially solves this bone loss problem with dentures by using implants rather than the gums to support them. It's a two-fold benefit: first, the implants relieve much of the irritation to the gums and bone caused by traditional dentures. Primarily, though, the implants themselves can slow or even stop continuing bone loss.

Most implants are made of titanium, not only because it's compatible with the body, but also because it has an affinity with bone. Over time bone cells grow on the titanium post imbedded in the jawbone. This process not only creates stability and durability, it can improve bone health.

In recent years dentists have incorporated implants with dentures to create two exciting treatment options. With one option, the dentist installs two or more implants in the jaw, to which a specially fitted removable denture can be attached. You would still have the ease of removing the denture for cleaning, while gaining greater stability and a reduced risk of bone loss.

The other option is a fixed denture (or bridge) attached permanently to implants. For this option, a patient's jawbone must be adequate and healthy enough to support at least four to six implants. A fixed denture is also often costlier and more complex than a removable denture, but it can feel more like real teeth. It also promotes better bone health too.

Although both options are more expensive than traditional dentures, they can pay dividends for long-term dental health. Implants could help you enjoy your new dentures and resulting smile for a long time to come.

If you would like more information on dental implant-supported restorations, 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 “Overdentures & Fixed Dentures.”

GoodBoneHealthEssentialforObtainingTeethinOneDayImplants

You've seen ads for “Teeth in One Day” that promise immediate implant placement at the same time you have the problem tooth removed. But this presumes the gums and underlying bone are healthy and able to support and protect the implant. If that's not the case, it may be ill-advised to place an implant on the same day.

Even with immediate placement, there will be a small degree of bone and gum opening or space around the implant after it's placed into the socket. This can often be remedied by placing a bone graft and sometimes a gum graft when we install the implant. It's also possible for natural healing to gradually fill in the space, but we'll need to monitor the site carefully for several weeks.

On the other hand, if we detect significant bone loss (or strongly suspect it will occur), immediate placement may not be an option — there's not enough bone or it's too weak to support an implant. In this case, it's necessary to wait on placement and focus on improving the bone health and quantity, beginning when we remove the old tooth and place a bone graft.

After completing the extraction, we typically place a bone graft in the empty socket. The graft will become a “scaffold” for new bone cells to grow upon. We may then allow about two to four months for new bone to partially replenish the area and then place the implant. The bone will continue to regenerate as it grows and attaches to the titanium implant to create a solid attachment.

If the site, however, still appears fragile even after partial bone growth, we may opt to wait another two to four months before attempting placement. From a long-term perspective, this is the best scenario for ensuring a durable foundation for the implant. It also allows for a socket severely compromised by disease to heal more thoroughly.

To determine which of these placement scenarios is best for you, we'll first need to conduct a thorough dental examination. From there we'll be in a better position to discuss the right implant timeline for your situation. Our main goal is to ensure we can securely place your implant in just the right position to achieve the most successful and attractive result.

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 “Implant Timelines for Replacing Missing Teeth.”