Posts for: March, 2020
You probably can’t remember a time without your teeth — and can’t imagine life without them. But now it’s a reality: one by one your teeth have become casualties in a long-standing war with dental disease until now they’re all lost.
Total tooth loss (edentulism) can be difficult in more ways than the loss of function — it can be psychologically traumatic as you must now transition from natural teeth to dentures or other restorations. To add to the stress, you probably won’t be able to obtain your permanent restoration immediately because the extraction sites must heal.
To help you with this transition and provide a means for you to have teeth during the healing period, we may fit you with an appliance known as an immediate denture. With these temporary teeth replacements, you can maintain your smile appearance, chew food and speak unimpaired.
Initially, immediate dentures should fit well, but over time your gums will tend to shrink as they heal. This can loosen the dentures’ fit and make them uncomfortable to wear. If the healing process is still ongoing and you still need to wear the immediate dentures, they can be relined with more denture material to fine-tune the fit.
At some point, though, we must consider creating a new, permanent set of dentures. When your mouth is fully healed, we can make a more accurate impression that we can then use to construct your new set. There are also other options, such as using dental implants to support a denture or a fixed bridge. This option will only be possible, however, if you have sufficient bone available to fully support it, which we might also be able to augment with grafting.
Immediate dentures serve a worthwhile purpose, but only for a temporary period. We’ll be happy to discuss all your options with you to help you find the right permanent solution that fits both your mouth’s condition and your financial ability.
If you would like more information on transitioning to teeth 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 “Immediate Dentures.”
Somewhere around age 6, your child’s primary (baby) teeth will begin to give way to their permanent set. If all goes well, you’ll notice all the front teeth erupting in the right position: the top teeth slightly overlapping the bottom and all coming in without crowding.
Sometimes, though, the process doesn’t occur as it should and a bad bite (malocclusion) may develop. You can get a head start on treatment if you know what to look for. Here are a few problems for which you should see a dentist — or more likely an orthodontist — for a thorough evaluation.
Spacing problems. Teeth should normally come in right next to each other without a noticeable gap. But if you notice excessive space between the permanent front teeth especially, this may be an indication there’s a discrepancy in size between the teeth and the jaws. At the other end of the spectrum, if teeth on the same arch appear to overlap each other, this indicates crowding in which there’s not enough space for the teeth to erupt properly.
Bad bites. Malocclusions can take different forms. In an underbite, the front bottom teeth bite in front of the upper teeth. If there’s a noticeable gap between the upper and lower teeth when the jaws are closed, this is known as an open bite. Front teeth biting too far down over the lower teeth is a deep bite and could even include biting into the soft tissue of the hard palate. Cross bites can occur in either the front or back teeth: if in the front, some of the lower teeth will bite in front of the upper; if in the back, some of the lower teeth bite outside the upper rather than normally on the inside.
Abnormal eruptions. You should also be alert for protusions, in which the upper teeth or the jaw appears to be too far forward, or retrusions, in which the lower teeth or jaw appears to be too far back. You should also be concerned if permanent teeth erupt far from their normal position — this is especially likely if the primary tooth was also out of position, or was lost prematurely or not in the right order.
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.”