Besides their life-likeness, implants are also prized for their high success rate. More than ninety-five percent of implants continue to function effectively after ten years.
Implants’ advanced technology explains some of their reliability and longevity—they’re as close to natural teeth as we’re now able to achieve. But their impressive success rate also owes to the detailed protocols that dentists follow to install them. One critical part of these protocols is ensuring a patient has enough bone in their jaw to support and precisely situate the implant for the best functional and aesthetic outcome.
Unfortunately, there are situations where a patient doesn’t have enough bone to achieve a satisfactory result. This often happens if there’s been months or years between losing the tooth and considering an implant. The reason why relates to the nature of bone as living tissue.
Like other cellular tissues in the body, bone has a life cycle: Older, worn-out cells die and are absorbed by the body, and new cells form to replace them. The growth cycle in the jaw receives stimulation from the forces generated when we chew, which travel up through the teeth to the bone.
However, this stimulation stops after tooth loss for the related area of bone, which can slow new bone growth. Over time, the volume and density of the bone around a missing tooth gradually decreases, enough eventually to make an implant impractical.
Insufficient bone volume, though, doesn’t necessarily mean an implant is out of the question. We may be able to address the problem by attempting to regenerate the bone through grafting. This is a procedure in which we insert graft material into the affected area of the jawbone. The graft then becomes a scaffold upon which bone cells can grow. After several months, we may have enough regenerated bone to support an implant.
If there’s been too much bone loss, we may still need to consider another form of restoration. But if we can successfully build up the bone around your missing tooth, this premier restoration for replacing lost teeth could become a reality for you.
Dental cleanings are an important part of regular dental office visits. Performed by a dental hygienist or dentist, cleanings serve two purposes: to remove bacterial plaque and calculus (hardened deposits of plaque) from tooth surfaces missed during daily brushing and flossing; and to remove stains that can dull your smile.
There are different degrees of cleaning, including root planing that removes plaque and calculus deep below the gum line, usually for patients affected by periodontal (gum) disease. For patients in good oral health, the basic cleaning approach is known as prophylaxis, a term derived from the Greek for guarding or preventing beforehand. The techniques used in a prophylaxis remove both “coronal” (tooth surfaces visible above the gum line) plaque and staining, providing both therapeutic and cosmetic benefits.
A typical prophylaxis includes a procedure known as scaling. Hygienists use special instruments known as scalers to remove plaque and calculus by hand, or an ultrasonic device that vibrates plaque loose and is flushed away with water. The procedure removes that rough coating you often feel as you rub your tongue against your teeth, leaving the tooth surfaces feeling smooth.
Tooth polishing is a subsequent procedure to scaling that also removes plaque and surface stains. Polishing is carried out with a motorized instrument with a rubber cup in which a polishing (or “prophy”) paste is contained. The hygienist moves the rapidly rotating cup filled with the paste over the tooth surface to remove plaque and stains. The end result is a highly smooth surface and a much shinier appearance.
People with dental insurance plans are often concerned tooth polishing may be viewed strictly as a cosmetic procedure, and thus not fully qualify for benefits. This should not be the case if coded properly: tooth polishing is part of the overall prophylaxis to remove plaque and staining. The primary purpose is therapeutic and preventive; the cosmetic effect is a by-product. Most dental plans will cover one or two prophylaxes (scaling and tooth polishing) a year, but there are variations so individuals should check their plans.
If you would like more information on dental cleaning, 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 “Tooth Polishing.”
On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.
“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”
Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.
Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.
A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.
Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.
So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.
If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”
Think dental implants only replace individual teeth? Think again—this premier technology can also support other kinds of restorations to provide better stability and comfort. And, they also help improve bone health when incorporated with any type of tooth replacement options, especially dentures.
Although traditional dentures have enjoyed a long, successful history as a tooth replacement solution, they can interfere with bone health. That’s because regular dentures fit in the mouth by resting on the bony ridges of the jaw, which has implications for the bone.
As living tissue, bone goes through a growth cycle with older bone cells dying and dissolving and newer cells forming to take their place. The teeth play a role in this growth cycle — the forces generated when we chew travel up through the teeth and help stimulate bone growth. When teeth go missing, however, so does this stimulus.
Traditional dentures can’t replace this missing stimulus. In fact, the constant pressure of dentures on the jaw may even accelerate bone loss. A sign this is happening occurs when the dentures’ once tight fit begins to loosen and they become uncomfortable to wear.
Implant-supported dentures can help eliminate this problem. We first surgically place a few implants in the jaw, the number determined by which jaw (the lower requires less) and whether the denture is removable or fixed. If removable, the denture has connective points that match the implant locations — you simply connect them with the implants. If fixed, the denture is screwed into the implants to hold it in place.
So, how does this help bone health? For one, the denture no longer puts as much pressure on the jaw ridges—the main support comes from the implants. And, the implants themselves encourage bone stimulation: The titanium in the implant has a special affinity with bone cells that naturally grow and adhere to its metal surface. This natural integration between implant and bone can stop bone loss and may even help reverse it.
If you’re interested in implant-supported dentures, you’ll first need to undergo a full dental exam with your dentist. These restorations aren’t appropriate for all dental situations. But, if they can work for you, you may be able to enjoy the benefits of an implant-supported restoration.
If you would like more information on 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.”
You would love to replace a troubled tooth with a dental implant. But you have one nagging concern: you also have diabetes. Could that keep you from getting an implant?
The answer, unfortunately, is yes, it might: the effect diabetes can have on the body could affect an implant's success and longevity. The key word, though, is might—it's not inevitable you'll encounter these obstacles with your implant.
Diabetes is a group of metabolic diseases that interfere with the normal levels of blood glucose, a natural sugar that is the energy source for the body's cells. Normally, the pancreas produces a hormone called insulin as needed to regulate glucose in the bloodstream. A diabetic, though either can't produce insulin or not enough, or the body doesn't respond to the insulin that is produced.
And while the condition can often be managed through diet, exercise, medication or supplemental insulin, there can still be complications like slow wound healing. High glucose can damage blood vessels, causing them to deliver less nutrients and antibodies to various parts of the body like the eyes, fingers and toes, or the kidneys. It can also affect the gums and their ability to heal.
Another possible complication from diabetes is with the body's inflammatory response. This is triggered whenever tissues in the body are diseased or injured, sealing them off from damaging the rest of the body. The response, however, can become chronic in diabetics, which could damage otherwise healthy tissues.
Both of these complications can disrupt the process for getting an implant. Like other surgical procedures, implantation disrupts the gum tissues. They will need to heal; likewise, the implant itself must integrate fully with the bone in which it's inserted. Both healing and bone integration might be impeded by slow wound healing and chronic inflammation.
Again, it might. In reality, as a number of studies comparing implant outcomes between diabetics and non-diabetics has shown, there is little difference in the success rate, provided the diabetes is under control. Diabetics with well-managed glucose can have success rates above 95%, well within the normal range.
An implant restoration is a decision you should make with your dentist. But if you're doing a good job managing your diabetes, your chances of a successful outcome are good.
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