ADVANCED PROCEDURES

CROWNS

Crowns are full coverage restorations that are used to cover a tooth that is likely to break, or is too broken down to be restored with a filling. They are most commonly done after root canal treatment, or when a large filling wears out. The larger the hole made by a cavity that has to be treated, the more likely a crown will be needed. Even after a filling is put in a large cavity, a tooth is more likely to break. Keep in mind that the jaw muscles are the strongest in the human body. Teeth are subjected to tremendous pressures. Crowns ride over the weakened tooth, providing strength and protecting the tooth against breakage. A broken or cracked tooth is a far more serious matter and much more difficult to treat. Crowns prevent this, as well as making for a nice smile.

It takes two appointments to restore a tooth with a crown. In the first any decay is removed from the tooth and it is shaped to accept the crown. Then an impression is made of the tooth for use in fabricating a crown. Between the two visits the crown is made, usually of high-strength porcelain over gold alloy, all ceramic material, or gold. During this time a temporary crown is worn. In the second visit this temporary is removed. Then the permanent crown is adjusted as needed and then cemented in place.

DENTURES

There are different types of dentures, but they share their common function. They replace teeth that have become loose or been lost due to bone loss. When bone loss around the roots of teeth is great enough to loosen them or let them fall out, it's time for dentures. Relax. No one enjoys losing their natural teeth, but you can still eat and talk regularly.

The entire mouth is examined and a determination is made as to which teeth will have to be removed, and which will remain. The loose teeth are then extracted. Dentures are fitted to go over or around whatever teeth remain in the mouth, depending on the type. There is an adjustment period after dentures are placed in the mouth, and it can take some getting used to. But once accustomed to the dentures, all the normal functionality and appearance return and one just carries on as usual. Often implants can used to further stabilize the dentures.

IMPLANTS 

WHAT ARE DENTAL IMPLANTS?

Dental implants are metal post that are surgically placed in the bone under your gums. During a healing period, the bone grows around the implant. Then a replacement tooth, or crown, is attached to the metal post, giving you a restoration that is a lot like your natural tooth. Implants also can be used to secure bridges and dentures when more than one tooth is missing.

WHAT ARE THE ADVANTAGES OF DENTAL IMPLANTS?

Because implants fuse to the jawbone and offer a secure base for the replacement teeth, some patients find this a comfortable option in restoring their smile. In many cases, implant-supported teeth may look and feel more like natural teeth.

CAN ANYONE HAVE IMPLANTS?

Healthy gums and bone are necessary to support dental implants. Patients who want to have implants must commit to a meticulous oral hygiene routine, including flossing, brushing and regular dental visits to help protect the supporting tissues from any disease. Because dental implant placement is a surgical procedure, candidate must be in good overall health. Successful fusion of the bone to the implant requires good periodontal health, so people with a higher risk of experiencing gum disease-such as those with diabetes or those who smoke-might not be good candidates.

WHAT ELSE SHOULD I KNOW?

Talk to your dentist about whether you are a candidate for dental implants, and learn more about the details of the procedure specific to your case. After fully discussing the benefits and risks, you may want to contact your dental benefit provider to determine whether implant placement and restoration is covered by your dental insurance plan. If so, ask how much of the estimated cost will be covered.

You might also want to talk to your dentist about the length of time the procedure may require. In many instances, implant placement involves more than one surgery, and the healing period for each surgery may be several weeks (your dentist usually can provide you with a denture or temporary bridge during this period). In some complicated cases, the whole process can take more than a year, so you would need to be patient and dedicated to good oral health.

THE IMPLANT PROCESS

Treatment generally is a three-part process that takes several months.

• In the first step, the dentist surgically places the implant in the jaw, with the top pf the implant slightly above the top of the bone. A screw is inserted into the implant to prevent gum tissue and other debris from entering. The gum then is secured over the implant. The implant will remain covered for approximately three to six months while it fuses with the bone, a process called “osseointegration”. There may be some swelling, tenderness or both for a few days after the surgery, so pain medication usually is prescribed to alleviate the discomfort. A diet of soft foods, cold foods and warm soup often is recommended during the healing process.

• In the second step, the implant is uncovered and the dentist attached an extension, called a post, to the implant. The gum tissue is allowed to heal around the post. Some implants require a second surgical procedure in which a post is attached to connect the replacement teeth. With other implants, the implant and post are a single unit placed in the mouth during the initial surgery. Once healed, the implant and post can serve as the foundation for the new tooth.

• In the third and final step, the dentist makes a crown, which has a size, shape,color and fit that will blend with your other teeth. Once completed, the crown is attached to the implant post.

ROOT CANAL TREATMENT

Root canal treatment (also referred to as root canal therapy or endodontic therapy) is made necessary when a cavity is allowed, through neglect, to reach all the way to this pulp. (Regular cleanings and checkups prevent and detect problems early) Sometimes deep restorations or trauma to a tooth may cause the nerve to be damaged to the point it needs root canal therapy, also. Once this occurs the pulp becomes infected, and can even extend through the root tip and begin to eat away at the surrounding bone (this is an abscess). By the time the pulp is infected it must be treated, and cannot heal on its own. It can even weaken the entire immune system. This is dangerous, not to mention very painful. Symptoms that the pulp has become infected may include sensitivity to hot/cold or sweets, pain, swelling, pain to biting or pressure, and a bad taste in the mouth. Sometimes, however, no symptoms are apparent and the person is unaware of any problem until a checkup.

A root canal is then performed to clean out the infected tooth pulp, and disinfect the canals of the tooth. The only other treatment would be to extract the tooth. Once the infection is resolved, the canal(s) are filled in to prevent any further infection. Usually a core build-up and crown is recommended for restoring a tooth that has had root canal therapy.

BRIDGES

This is an option for filling the space created by a missing tooth. It is formed to look like the missing tooth, and it takes its place in the mouth. The sides of a bridge use the two surrounding teeth for support, hence the name. A bridge replaces the missing tooth, both functionally and cosmetically. Bridge work is as much an art as it is an exact science. The materials used may be gold alloys, porcelain bonded to metal alloy, or all ceramic material. The choice of material depends on requirements for strength, wear, and/or esthetics.

It is important that a missing tooth be replaced as soon as possible for several reasons. If not treated the teeth surrounding the gap begin to shift inward, creating a whole chain reaction of bad things. Teeth use their neighbors for support, and, with one missing, they start to "fall." As this worsens the bite changes in response to the pressure. This can eventually result in problems with the entire jaw, e.g. TMJ. The surrounding teeth deteriorate and it is just a matter of time before they, too, are lost. Gum disease becomes a serious problem, with the difficulty of treatment increasing as the neglect continues.

TMJ TREATMENTS

TMJ stands for temporal-mandibular joint. Temporal, as in temple area of skull; mandibular as in mandible, or lower jaw; joint as in it's where the head and jaw meet. Problems in this joint may be caused by a misalignment of the teeth, trauma, or excess muscle tension. Aside from the two bones that meet there, cartilage buffers them and five muscles are involved in the area. If something goes wrong a good deal of trouble can result.

Problems in this area can cause:

• Headaches
• Earaches
• Trouble/soreness in opening and closing the mouth
• Clicking or popping of the jaw
• Pain in the jaw muscles
• Soreness in the area, sometimes extending to the face

Dental treatments for the condition can include replacing missing teeth, moving teeth, adjusting the bite, filling gaps between teeth, etc. There is no one solution that is right for all cases. Sometimes a plastic mouthpiece is used to prevent clenching or grinding that is contributing to the problem. If untreated and taken to extremes, surgery may be required to repair a badly damaged joint.