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People often put a premium on appearance when deciding whether or not to replace a missing tooth. There’s more motivation to replace one in the “smile zone,” where the teeth are more visible, than one that’s not.

But even if your missing tooth is in the back out of sight, there are still good reasons to replace it. That’s because even one lost tooth can have a cascading ill effect on other teeth, the underlying bone or eventually your entire facial structure.

The chief problems caused by a missing tooth occur first with the bone. The act of chewing generates pressure around the teeth. The teeth transmit this pressure through the roots to the bone, which stimulates the bone to grow and remain strong in support of the teeth. When you lose a tooth, the bone no longer receives this growth stimulation.

In time, the replacement rate for older bone cells will slow down and cause the bone volume to decrease. It’s possible to detect a change just months after losing a tooth: you can lose an estimated 25% of bone width in the first year.

As the bone diminishes, the jaw loses height and then more width. The gum tissues will also gradually decrease. As a result you may not be able to chew or even speak as well as you once could. Depending on the number of teeth you’ve lost, the foundational portion of the jawbone — the basal bone — may also decline. The distance between nose and chin may decrease and the cheeks sink in. Without bone support in the rear, the bite can collapse and push the teeth forward out of their normal position.

The best way to avoid this debilitating spiral is to replace a tooth as soon as practical. There are many options, but perhaps the best choice is a dental implant: not only will it provide a life-like appearance, but its affinity with bone will stop bone loss and even encourage new growth.

So, don’t neglect replacing that “invisible” tooth if it’s lost. Your mouth and ultimately your appearance will be better for it.

If you would like more information on tooth loss and restoration 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 “The Hidden Consequences of Losing Teeth.”

Dental implants are known for their durability as well as life-like beauty. Thanks to their unique construction and ability to integrate with bone, they have a very high success rate and can last for decades.

But while they’re less problematic than other restorations, we still can’t “set them and forget them.” While the implants themselves aren’t susceptible to disease, the supporting gums, bone and adjacent teeth are. If you want them to last as long as possible, you’ll need to care for them and the rest of your mouth through daily oral hygiene and semi-annual office cleanings.

With that said, there are a few differences in how we perform hygiene tasks with implants. This is due to the way in which they attach to the jaw, as the titanium post is inserted directly into the bone. Natural teeth, on the other hand, are held in place by the periodontal ligament, a strong connective tissue that lies between the teeth and bone. The ligament holds the teeth firmly in place while also allowing minute tooth movement in response to changes in the mouth.

The ligament also has an ample blood supply that assists with fighting infection that may arise in the tooth and its supporting gums. Without this extra source of defense, infections that arise around an implant can grow quickly into a condition known as peri-implantitis and lead to rapid bone loss that could cause the implant to fail.

That’s why you and your hygienist must be ever vigilant to the buildup of plaque, the bacterial film that gives rise to dental disease, around implants and adjacent teeth. This includes removing plaque buildup from implant surfaces, although your hygienist will use tools (scalers or curettes) made of plastic or resin rather than traditional metal to avoid scratching the implant’s dental material. They’ll likewise use nylon or plastic tips with ultrasonic equipment (which uses high vibration to loosen plaque) and lower power settings with water irrigation devices.

Keeping infection at bay with effective hygiene is the number one maintenance goal with dental implants. Doing your part along with your hygienist will help you get the most of this investment in your smile.

If you would like more information on oral hygiene with 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 Maintenance.”

Everyone has to face the music at some time — even John Lydon, former lead singer of The Sex Pistols, arguably England’s best known punk rock band. The 59-year old musician was once better known by his stage name, Johnny Rotten — a brash reference to the visibly degraded state of his teeth. But in the decades since his band broke up, Lydon’s lifelong deficiency in dental hygiene had begun to cause him serious problems.

In recent years, Lydon has had several dental surgeries — including one to resolve two serious abscesses in his mouth, which left him with stitches in his gums and a temporary speech impediment. Photos show that he also had missing teeth, which, sources say, he opted to replace with dental implants.

For Lydon (and many others in the same situation) that’s likely to be an excellent choice. Dental implants are the gold standard for tooth replacement today, for some very good reasons. The most natural-looking of all tooth replacements, implants also have a higher success rate than any other method: over 95 percent. They can be used to replace one tooth, several teeth, or an entire arch (top or bottom row) of teeth. And with only routine care, they can last for the rest of your life.

Like natural teeth, dental implants get support from the bone in your jaw. The implant itself — a screw-like titanium post — is inserted into the jaw in a minor surgical operation. The lifelike, visible part of the tooth — the crown — is attached to the implant by a sturdy connector called an abutment. In time, the titanium metal of the implant actually becomes fused with the living bone tissue. This not only provides a solid anchorage for the prosthetic, but it also prevents bone loss at the site of the missing tooth — which is something neither bridgework nor dentures can do.

It’s true that implants may have a higher initial cost than other tooth replacement methods; in the long run, however, they may prove more economical. Over time, the cost of repeated dental treatments and periodic replacement of shorter-lived tooth restorations (not to mention lost time and discomfort) can easily exceed the expense of implants.

That’s a lesson John Lydon has learned. “A lot of ill health came from neglecting my teeth,” he told a newspaper reporter. “I felt sick all the time, and I decided to do something about it… I’ve had all kinds of abscesses, jaw surgery. It costs money and is very painful. So Johnny says: ‘Get your brush!’”

We couldn’t agree more. But if brushing isn’t enough, it may be time to consider dental implants. If you would like more information about dental implants, please call our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Dental Implants” and “Save a Tooth or Get an Implant?”

In real life he was a hard-charging basketball player through high school and college. In TV and the movies, he has gone head-to-head with serial killers, assorted bad guys… even mysterious paranormal forces. So would you believe that David Duchovny, who played Agent Fox Mulder in The X-Files and starred in countless other large and small-screen productions, lost his front teeth… in an elevator accident?

“I was running for the elevator at my high school when the door shut on my arm,” he explained. “The next thing I knew, I was waking up in the hospital. I had fainted, fallen on my face, and knocked out my two front teeth.” Looking at Duchovny now, you’d never know his front teeth weren’t natural. But that’s not “movie magic” — it’s the art and science of modern dentistry.

How do dentists go about replacing lost teeth with natural-looking prosthetics? Today, there are two widely used tooth replacement procedures: dental implants and bridgework. When a natural tooth can’t be saved — due to advanced decay, periodontal disease, or an accident like Duchovny’s — these methods offer good looking, fully functional replacements. So what’s the difference between the two? Essentially, it’s a matter of how the replacement teeth are supported.

With state-of-the-art dental implants, support for the replacement tooth (or teeth) comes from small titanium inserts, which are implanted directly into the bone of the jaw. In time these become fused with the bone itself, providing a solid anchorage. What’s more, they actually help prevent the bone loss that naturally occurs after tooth loss. The crowns — lifelike replacements for the visible part of the tooth — are securely attached to the implants via special connectors called abutments.

In traditional bridgework, the existing natural teeth on either side of a gap are used to support the replacement crowns that “bridge” the gap. Here’s how it works: A one-piece unit is custom-fabricated, consisting of prosthetic crowns to replace missing teeth, plus caps to cover the adjacent (abutment) teeth on each side. Those abutment teeth must be shaped so the caps can fit over them; this is done by carefully removing some of the outer tooth material. Then the whole bridge unit is securely cemented in place.

While both systems have been used successfully for decades, bridgework is now being gradually supplanted by implants. That’s because dental implants don’t have any negative impact on nearby healthy teeth, while bridgework requires that abutment teeth be shaped for crowns, and puts additional stresses on them. Dental implants also generally last far longer than bridges — the rest of your life, if given proper care. However, they are initially more expensive (though they may prove more economical in the long run), and not everyone is a candidate for the minor surgery they require.

Which method is best for you? Don’t try using paranormal powers to find out: Come in and talk to us. If you would like more information about tooth replacement, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Crowns & Bridgework,” and “Dental Implants.”

Dental implants are widely recognized as the best tooth replacement option available. For most people, though, it’s a long process: after a tooth is extracted the socket is allowed to heal and fill in with new bone before implant surgery: that can take anywhere from two to five months. Afterward, there’s usually a two– to three–month period after the implant is placed before the permanent crown (the visible tooth) can be attached.

Without adequate bone present the implant’s long-term stability might be compromised. Furthermore, the implant’s durability is dependent upon bone growth around and attaching to its titanium post after surgery in a process known as osseo-integration. These two considerations indeed serve a critical function in the implant’s ultimate success.

In recent years, however, a variation to this traditional implant process has emerged that allows for immediate implantation right after extraction. Besides combining extraction and implantation into one surgical procedure, immediate implants minimize the disruption to a person’s appearance (especially with visibly prominent front teeth) when combined with a provisional crown.

Immediate implants joined together that replace a full arch of teeth can receive biting forces and succeed. Individual implants that replace single teeth, however, won’t work in all situations and must be undertaken with care to ensure long-term success. Because there may be less available bone, the implant must fit snugly within the socket to maintain as secure a hold as possible. The surgeon must also take care not to damage too much of the gum and bone tissue when extracting the tooth, which could affect both the integrity of the implant and its appearance in the gum line.

Temporary crowns may be attached during the implant surgery, but they’re installed for appearance’ sake only. For individual crowns, they must be designed not to make contact with the teeth on the opposing jaw to avoid generating biting forces that will cause the implant to fail and stop the bone-healing process that occurs with osseo–integration.

If you’re considering dental implants, it’s important to discuss with us which type of procedure, traditional or immediate, would be best for you, and only after a comprehensive examination of your mouth and jaw structure. Regardless of the approach, our goal is to provide you with a smile-transforming restoration that will last for many years to come.

If you would like more information on the dental implant process, 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 Implants.”

Implants are highly regarded by both dentists and patients for their versatility and durability. But it’s their life-like appearance that “seals the deal” as the restoration of choice — not only mimicking an individual tooth, but emerging from the gum line and blending indistinguishably with other teeth in color and symmetry.

To achieve this result, we must consider a few factors beforehand, particularly the amount of bone available at the intended implant site. An implant requires a certain amount of bone to properly position it for the most natural crown appearance. The bone present around adjacent teeth can also affect your appearance: in the absence of adequate bone the papillae, triangular shaped gum tissue between teeth, may not regenerate properly between the implant and the natural teeth. This can leave a noticeable void, what dentists call “black hole disease.”

Bone loss is a significant problem particularly after tooth loss. It’s quite possible for you to lose a quarter of the bone’s width in the first year after tooth loss. To avoid this, we often use bone grafting techniques immediately after extraction to lessen bone loss; if it’s already occurred we may be able to use similar reconstructive techniques to rebuild and encourage renewed bone growth. In the end, though, if there remains a significant level of bone loss it may be necessary to consider another option for tooth replacement other than implants.

The thickness of your gum tissue, a genetic trait, can also have an impact on the implant’s ultimate appearance. Thicker gum tissues are generally more resilient and easier to work with surgically. Thinner gum tissues are more susceptible to recession and tend to be more translucent, which could cause the underlying metal implant to be visible. Thus, working with thinner gum tissues requires a more delicate approach when trying to achieve a visually appealing result.

All these factors must be balanced, from implantation to final crown placement. But with careful planning and attention to detail throughout the process, many of these issues can be overcome to produce a satisfying result — a new and appealing smile.

If you would like more information on the aesthetics of 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 “Matching Teeth & Implants.”

Some patients who wear dentures face a kind of Catch-22: their denture fit may have loosened and become uncomfortable over time due to continued bone loss, yet the same bone loss prevents them from obtaining dental implants, a superior tooth replacement system to dentures.

But there may be a solution to this dilemma that combines the stability of implants with a removable denture. A set of smaller diameter implants — “mini-implants” — can support a removable denture with less bone than required by a conventional implant.

Like all living tissue, bone has a life cycle: after a period of growth, the older bone dissolves and is absorbed by the body, a process known as resorption. The forces generated when we bite or chew are transmitted by the teeth to the jawbones, which stimulates new bone formation to replace the resorbed bone. When the teeth are lost, however, the stimulation is lost too; without it, resorption will eventually outpace bone growth and repair, causing the bone mass to shrink.

Removable dentures also can’t supply the missing stimulation — bone loss continues as if the dentures weren’t there; and due to the compressive forces of a denture, bone loss accelerates. As the jawbone structure used to originally form the denture’s fit eventually shrinks, the denture becomes loose and difficult to wear. It’s possible to adjust to the new jaw contours by relining the dentures with new material or creating a new set of dentures that match the current bone mass. Without adequate bone, fixed crowns or bridges anchored by conventional implants may also be out of the picture.

On the other hand, mini-implants with their smaller diameter need less bone than the traditional implant. A few strategically placed within the jaw are strong and stable enough to support a removable denture. One other advantage: these mini-implants can be installed in one visit with local anesthesia and usually without the need for incisions or stitches.

If you would like more information on dentures supported by mini-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 “The ‘Great’ Mini-Implant.”

Dental implants provide a number of advantages as a tooth replacement system, like durability and imperviousness to decay or gum disease. Bone naturally grows and attaches to the titanium posts, strengthening the attachment over time, and they don’t cause damage to adjacent teeth. Best of all, an implant and its crown’s life-like appearance can rejuvenate a person’s smile, transforming their appearance and self-image.

But it takes time to complete treatment with dental implants — months of healing and sufficient bone growth to anchor the implant before affixing the permanent crown. If the natural tooth requires extraction first, this may add another step — and more healing time — to the process.

In recent years, though, patients who meet certain criteria are able to shorten the time after a tooth extraction with “immediate” implants. In this case, rather than waiting for the socket to heal following a tooth extraction, the implant is placed directly into the socket immediately after the extraction. Immediate implants thus combine tooth extraction and implantation into one procedure.

For the best results, the extraction must be done very carefully to avoid as little damage as possible to surrounding tissue and bone. It’s also important for the implant to be completely immobilized within the bone with no movement at all. It will stabilize further as bone growth (or ossification) occurs over time.

It’s also possible to attach a provisional crown to the immediate implant for aesthetic purposes. This isn’t the permanent crown that will be affixed after bone growth around the implant; for that reason it’s made in such a way that it doesn’t contact its counterpart tooth in the opposing jaw. Although the implant is completely immobilized mechanically, it’s still not ready for the full forces of normal biting and chewing. After two to three months, the implant should be fully integrated with the surrounding bone and ready for the permanent crown.

Immediate implants are best for the more visible front teeth that encounter less biting force than back teeth. The technique not only reduces healing time, but enables patients to gain an “immediate” aesthetic benefit — and something worth smiling about.

If you would like more information on immediate implants or other dental implant 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 “Immediate Implants.”