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Compared to other dental restorations—a few of which have been around for over a century—implants are a relatively recent development. But even though it's just now entering its fourth decade, recent advances have catapulted implant therapy well beyond where it began.
That's due mainly to digital technology. Two examples of this, computed tomography (CT) and 3-D printing, are increasing the accuracy and efficiency of implant placement.
Properly placing an implant is one of the most important elements in achieving a natural and attractive result. But finding the best location is often difficult due to a lack of suitable bone volume, the patient's bite or the proximity of anatomical structures like nerves and blood vessels. CT imaging, especially Cone Beam CT scanners (CBCT), is helping to make implant placement planning easier.
Unlike the static, two-dimensional views of standard x-rays, CBCT takes hundreds of images and digitally blends them together to create a virtual 3-D model of the patient's jaw and face. Dentists can view this highly detailed model on a computer monitor from various vantage points and better identify possible obstructions. With better information about what "lies beneath," they can more accurately pinpoint the best implant site.
Creating the ideal plan is one thing—successfully implementing it is another. Dentists often create a surgical guide that helps them drill in precisely the right positions during surgery. The guide, which resembles a mouthguard, fits over the gums and contains marker locations for drilling.
Many dentists are now using 3-D printing to create these surgical guides. A 3-D printer turns a digital model of the guide based on measurements of the patient's mouth and proposed implant locations into an actual physical object "printed out" layer by layer of special polymer material. The end product can be more precise than guides created by other means.
These and other technological developments are helping implant therapy rise to a new level of success. With the resulting increase in accuracy, efficiency and less treatment time, tomorrow's implant patients will be the ultimate beneficiaries.
If you would like more information on restoring missing teeth 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 “How Technology Aids Dental Implant Therapy.”
At the first-ever Players Weekend in August 2017, Major League Baseball players wore jerseys with their nicknames on the back. One player — Cleveland Indians shortstop, Francisco Lindor — picked the perfect moniker to express his cheerful, fun-loving nature: “Mr. Smile.” And Lindor gave fans plenty to smile about when he belted a 2-run homer into the stands while wearing his new jersey!
Lindor has explained that he believes smiling is an important part of connecting with fans and teammates alike: “I’ve never been a fan of the guy that makes a great play and then acts like he’s done it 10,000 times — smile, man! We’ve got to enjoy the game.”
We think Lindor is right: Smiling is a great way to generate good will. And it feels great too… as long as you have a smile that’s healthy, and that looks as good as you want it to. But what if you don’t? Here are some things we can do at the dental office to help you enjoy smiling again:
Routine Professional Cleanings & Exams. This is a great place to start on the road toward a healthy, beautiful smile. Even if you are conscientious about brushing and flossing at home, you won’t be able to remove all of the disease-causing dental plaque that can hide beneath the gum line, especially if it has hardened into tartar, but we can do it easily in the office. Then, after a thorough dental exam, we can identify any problems that may be affecting your ability to smile freely, such as tooth decay, gum disease, or cosmetic dental issues.
Cosmetic Dental Treatments. If your oral health is good but your smile is not as bright as you’d like it to be, we can discuss a number of cosmetic dental treatments that can help. These range from conservative procedures such as professional teeth whitening and bonding to more dramatic procedures like porcelain veneers or crowns.
Tooth Replacement. Many people hide their smiles because they are embarrassed by a gap from a missing tooth. That’s a shame, because there are several excellent tooth-replacement options in a variety of price ranges. These include partial and full dentures, bridgework, and dental implants. So don’t let a missing tooth stop you from being Mr. (or Ms.) Smile!
If you’d like more information about oral health or cosmetic dentistry, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Beautiful Smiles by Design” and “The Impact of a Smile Makeover.”
In the realm of restorative dentistry, dental implants are king. A dental implant can replace a tooth with a permanent, life-like restoration with a solid reputation for durability.
Implants are also known for one other quality — variety. Not all implants are alike, and they have varied applications for use. Available in various shapes and sizes, they can be used for a single tooth or as part of a multiple tooth bridge or overdenture. And while their basic architecture is the same, you also have two options for how the permanent crown (the visible tooth portion) attaches to the implant: screwed or cemented.
A screw attachment can securely fasten a crown to an implant without the need for cement; it also allows for easy removal for repair or replacement should the crown become damaged or worn. On the other hand, it could pose a cosmetic problem — even though the access hole for the screw may be covered with a tooth-colored filling, it could still be distinguishable from the rest of the crown. There’s also a slight risk of the crown chipping around the access hole.
A crown cemented to the implant won’t have this cosmetic issue with an access hole, and will look just like a natural tooth. But unlike a screwed crown, removing a cemented crown can be more difficult. The cement may also cause gum inflammation and potential bone loss in sensitive patients.
The condition of your mouth, the type of implant you’re receiving and other circumstances will all factor into determining which method is best for you. If we’re “immediately loading” the crown (meaning we’re affixing a temporary crown to the implant immediately after placement in the jaw), then the screw method may be more advantageous. Aesthetically speaking, though, a cemented crown may be a better option in terms of final smile appearance.
But whichever method is used, you’ll still benefit from what implants do best — help you regain the function lost from a missing tooth and change your smile for the better.
If you would like more information on your options 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 “How Crowns Attach to Implants.”
For those of you who missed it, Remote Area Medical (RAM) is a non-profit organization that travels from city to city providing free medical and dental care to any and everyone who is willing to wait in line for it. People can get x-rays, vision care, triage, dentistry, and medical screening. They have come to Sacramento in the past but this was my first experience volunteering with them and I want to share details about how fantastic it was. So, if you're interested, please read on and also visit the RAM California website at http://www.ram-ca.org/.
Cynthia and I arrived at Cal Expo on Sunday morning a little after 6am. It was still dark outside and as we walked into the large exposition building we passed a long line of patients waiting outside, most of whom arrived the night before. We checked in and it was off to work right away. The entire floor was filled with an array of dental chairs, tables stacked with disposables and materials, x-ray machines, and sterilization equipment. It was also filled with tired patients, many in pain, and eager dentists, hygienists, surgeons, and assistants. "Let's get going", Cynthia and I said as we gathered materials and our first patient.
As you can see in this picture, there were tables and dental chairs set up and behind them were the groups of patients waiting to be seen. We walked up and asked for the next person in line, introduced ourselves, found out what was bothering them most and treated 1 or 2 teeth before starting again. We learned that our patients had already been in line for hours and had sat through screening, received pertinent x-rays, and waited again to see a doctor. For a few, they were already at RAM the day before to get medical care and had returned again to have their mouth looked at. Most of our patients had jobs but no benefits. I could tell that they were grateful for the free care but also scared and reluctant, just as most patients are about getting anesthetic and being poked and prodded by someone they just met moments ago. They knew nothing about my credentials, where I went to school, how many years I've been in practice, or how good I am at my job. They put all of their faith in me solely because this was their one shot to get out of pain, remove infection, or rebuild a broken tooth. Come Monday, the clinic would move on and it will be several months before it returns.
I was amazed at the diversity in the nine patients I treated that day. Among them were a young landscaper, a property manager, and single father of five children, a woman who was laid off and is now returning to nursing school, and a 23 year old mother with two young children she's working to support. After doing a filling on Jesse, a 22 year old man I strongly encouraged him to get right back in line to remove three broken down and infected teeth in his upper right quadrant. He politely declined, saying that he had to work the next day and wasn't prepared to be in pain. In fact, the floor director walked by and said they already tried to put him in the surgery line but he doesn't want to. But I wasn't ready to give up. I explained the infection that was visible on his x-ray and what kind of pain he could expect to feel in the near future. "And then what will you do?", I asked. "The care is FREE!", I emphasized. "I know you are so tired and you've been in line for a day. But there are excellent doctors here. You will see a surgeon who is ready to take on these teeth and make you feel better." I am happy to report that Jesse stuck it out and got back in line. And I knew we had done the right thing by not giving up on him.
The mere chance to talk with these patients while they were getting numb would have made the day worth it on its own. Many dental problems are preventable with proper nutrition and home care, which we are all aware is not always well-practiced in the U.S. My mission was to make sure every patient knew what could have caused their problems and how they could prevent their return. If they left with those tools and followed through with them, then our time was well spent. Our young mother of two Erika, has a 3 year old and an 8 month old. I felt such relief having the chance to tell her how she should be caring for her kids' mouths, and educating her on the correct way to give juice and a balanced diet. Just a few small tips can go such a long way. Informing her that tooth decay is caused by bacteria that she can transfer to them through straws and spoons may make her think twice before sharing what's been in her mouth with them. She seemed so grateful for the advise and I felt good thinking her children can avoid the same problems she's having.
Debbie, seen in the picture to the right, hopped in our chair and pointed to her front teeth, saying "Fix these please". Most of her upper teeth were broken down from decay and she said she could no longer stand to look in the mirror. As she got numb, I asked her if she regularly drinks sodas, energy drinks, or juice. She said no but I went ahead and discussed how those items typically cause decay on the front teeth as they pass through. I made the recommendation that she limit those beverages but also drink them through a straw so they bypass the teeth and go straight to the back of the mouth. I also explained to her that my cosmetic materials were limited in this setting so she may not look like a "supermodel" when I'm done but I would do my very best. Debbie dozed off during the procedure and when she awoke I assured her she hadn't snored. Naturally, she wanted to look in the mirror but I couldn't locate one. So, we pulled out the trusty cell phone and took a picture of her teeth to show her. Well, she may not be a supermodel but she felt enough like a model to tell me she had lied to me and she does drink a lot of soda. She was so grateful for having her teeth fixed that she vowed to cut it off so that she could take care of the work we had done. That moment is one of the best I've had as a dentist.
Cynthia also went out of her way to make our patients at ease. She translated everything I said for our Spanish speaking patients so that they could truly understand what was happening and what to expect. And as the day came to a close, she made sure one patient got a signature from the head dentist to return the following morning and go to the front of the line to complete here care. This didn't surprise me at all, of course, because this is what I see from her everyday. But it made me so happy that these people weren't just getting their teeth fixed. Rather, they were being cared for. They could tell they were in good hands and that really put them at ease.
When all was said and done 12 hours after we had arrived, I felt I had been given a gift by being allowed this experience. Sure, I was exhausted and my body was hurting. Cynthia had stood on her feet all day because she didn't have an assistant's chair. But we had zero complaints. All I had to do was show up and provide my services. Anyone can volunteer but not everyone is a dentist, doctor, nurse, hygienist, or medical assistant. These people needed care and it is part of our profession to help others. That is, after all, what I wrote on my dental school application. I want to help people and I really felt I did on this day. But they also helped me. And when RAM returns to Sacramento you bet you will find me there.
Spring is just around the corner and I got my urge to clean house a little early. I've been doing a lot here and there to streamline things in the office and make the patient and professional experiences smooth and effective for everyone. I find that if I take an hour once a month to look around the office and see what I can change then we will always be evolving and never becoming stagnant.
With that in mind, I made some additions to the practice that I've been thinking about for quite a while now. The first is an Intraoral Camera. This small camera fits into the mouth and allows me to easily and comfortably take photos of teeth and tissue. The benefit here is that I can have a visual record of what various conditions look like and how they change over time, rather than relying on written descriptions and memory. Additionally, all of the things I spend time diligently describing to patients may be easier for them to see for themselves, making diagnosis and treatment explanations simpler and more assuring for patients. Finally, the images can be e-mailed to specialists and patients easily, making communication a breeze. And rest assured that I will take these images at no charge, as I have always done for my photos.
The other bit of technology that's benefiting my patients these days is a new light that attaches to my loupes (magnifying lenses). I have always worn the loupes in order to see more detail on the teeth than I can with the naked eye. Now this powerful fiber optic light will enhance my visibility even more with the benefit of removing use of the overhead light that shines down on you while you are in the chair. This will also increase efficiency and detailed accuracy of procedures in areas that previously were difficult to make well-lit. And again, there is no cost to my patients for this added upgrade to the practice.
I'm proud of the fact that I am continuing my mission of providing the best care along with the most comfort, education, and ease for my patients. I look forward to sharing these new enhancements with you all.