So you tell your dentist your gums bleed when you brush. Or your hygienist, during a routine cleaning, finds a gum pocket. Which dental professional should treat your gum disease? Your dentist? The hygienist? What about a periodontist? The fact is that most dentists and hygienists are extremely capable of treating early gum disease and periodontal pockets...and they should tackle these problems.
When do these problems require intervention by a specialist? This question is best answered by the generalist. They often refer patients to periodontists (gum specialists) when pocket depths and bone loss appear excessive to what is considered the “norm.” Young people with advanced periodontal disease tend to be referred sooner than older patients whose disease has taken decades to form and no tooth appears in jeopardy of being lost.
What about the others? Patients with modest bone loss and/or deep gum pockets that don’t hurt? Do they require the skills of a periodontist? (Dental specialists are required to take three years of advanced training beyond dental school). The best way for a patient to get the best treatment is to, perhaps, simply ask how the would treat your condition if you were a family member.
Tuesday, August 24, 2010
Monday, August 16, 2010
Ridge Splitting: Ridge Augmentation Without Grafts or Membranes
Ridge Augmentation is a commonplace procedure to rebuild bone lost when teeth are removed.
Note the concavity caused by removing a tooth
The goal of implant treatment is not only to successful insert the implant and fabricate a crown on it so the patient can function in comfort, but to missing bone, gum tissue, and to have the implant “emerge” out of the bone like a natural tooth.
The expanded ridge restores the missing bone and gum tissue.
demonstrates the post-operative result after an implant has been inserted, the atrophic ridge expanded by a ridge splitting technique, and the crown is inserted.
The goal is to make the implant crown, including its supporting tissues, indistinguishable from a natural tooth and its tissues. In this case, the implant crown is on the right.
In most cases with severe alveolar bone loss, a procedure – known as ridge augmentation – is commonly performed to increase the width of the atrophic ridge by using bone grafts and a membrane. The healing time for this prodecure is roughly six months. This long healing time delays the time when the final restoration can be fabricated and inserted, and it is costly. An alternative is to expand the ridge via a special technique that reduces the healing time, is less costly, and yields a predictable, lasting result.
Another example of ridge splitting that helps to restore lost tissues caused by the removal of a tooth can be seen.
Note the “dished in” or caved in appearance caused by the removal of the left central incisor.
Notice how the lost tissues have been restored via ridge splitting, recreating normal root anatomy, normal gingival architecture, and an esthetic crown.
demonstrate an atrophic ridge. Without performing some form of bone enhancement, the implant would be inserted in an unfavorable position. Biting forces could be deleterious and oral hygiene measures could be difficult. Esthetics would be severely compromised. Under most circumstances, dental surgeons try to correct this defect with a ridge augmentation procedure that utilizes expensive materials and takes a long time to heal. An alternative, known as ridge splitting, enables the skilled clinician to expand the ridge and, at the same time, insert a dental implant without the need for either bone graft material or a membrane known as GBR or Guided Bone Regeneration technique.
Note the compressed ridge where the tooth is missing. If the implant is inserted in this bone, without changing its width, the implant will be too palatal and out of alignment.
demonstrates how the ridge is expanded and a space opened wide enough to insert a dental implant.
demonstrates the bone flap created by the ridge splitting and the implant being inserted.
Thisi is a cross-sectional 3D image of the implant after 3 months of healing. Notice that the “bone flap” has healed and remains present.
While ridge augmentation and GBR is acceptable and well-documented technique, ridge splitting accomplishes the same goals of recreating both lost hard and soft tissues without using expensive materials or taking a long time to heal. While technique sensitive, ridge splitting is atraumatic and simpler for the patient, with a predictable outcome.
*These images are from author’s previous practice.
Note the concavity caused by removing a tooth
The goal of implant treatment is not only to successful insert the implant and fabricate a crown on it so the patient can function in comfort, but to missing bone, gum tissue, and to have the implant “emerge” out of the bone like a natural tooth.
The expanded ridge restores the missing bone and gum tissue.
demonstrates the post-operative result after an implant has been inserted, the atrophic ridge expanded by a ridge splitting technique, and the crown is inserted.
The goal is to make the implant crown, including its supporting tissues, indistinguishable from a natural tooth and its tissues. In this case, the implant crown is on the right.
In most cases with severe alveolar bone loss, a procedure – known as ridge augmentation – is commonly performed to increase the width of the atrophic ridge by using bone grafts and a membrane. The healing time for this prodecure is roughly six months. This long healing time delays the time when the final restoration can be fabricated and inserted, and it is costly. An alternative is to expand the ridge via a special technique that reduces the healing time, is less costly, and yields a predictable, lasting result.
Another example of ridge splitting that helps to restore lost tissues caused by the removal of a tooth can be seen.
Note the “dished in” or caved in appearance caused by the removal of the left central incisor.
Notice how the lost tissues have been restored via ridge splitting, recreating normal root anatomy, normal gingival architecture, and an esthetic crown.
demonstrate an atrophic ridge. Without performing some form of bone enhancement, the implant would be inserted in an unfavorable position. Biting forces could be deleterious and oral hygiene measures could be difficult. Esthetics would be severely compromised. Under most circumstances, dental surgeons try to correct this defect with a ridge augmentation procedure that utilizes expensive materials and takes a long time to heal. An alternative, known as ridge splitting, enables the skilled clinician to expand the ridge and, at the same time, insert a dental implant without the need for either bone graft material or a membrane known as GBR or Guided Bone Regeneration technique.
Note the compressed ridge where the tooth is missing. If the implant is inserted in this bone, without changing its width, the implant will be too palatal and out of alignment.
demonstrates how the ridge is expanded and a space opened wide enough to insert a dental implant.
demonstrates the bone flap created by the ridge splitting and the implant being inserted.
Thisi is a cross-sectional 3D image of the implant after 3 months of healing. Notice that the “bone flap” has healed and remains present.
While ridge augmentation and GBR is acceptable and well-documented technique, ridge splitting accomplishes the same goals of recreating both lost hard and soft tissues without using expensive materials or taking a long time to heal. While technique sensitive, ridge splitting is atraumatic and simpler for the patient, with a predictable outcome.
*These images are from author’s previous practice.
Monday, August 9, 2010
Bleeding gums: are you concerned? You should be!
Bleeding gums are not normal. If your gums bleed, it means there’s a problem lurking; you could have gum pockets or even bone loss. When it gets this bad, it’s called “periodontitis.” One way to know is to make certain your dentist or hygienist uses a millimeter ruler (periodontal probe), that measures the amount the gums have separated from your teeth. Even if your gums are not bleeding, you could have severe periodontitis that puts you at risk factor for heart problems, strokes, respiratory diseases, and more. A diagnosis of bleeding gums or periodontal (periodontitis) disease does not mean all is lost. Gum pockets can be treated a number of ways that include scraping (known as scaling and root planing), to gum surgery often referred to as flap or osseous surgery. An alternative to surgical treatment of periodontal problems is using a laser (Periolase). This procedure ablates, sterilizes, and seals deep pockets to promote healing. This is known as the LANAP laser gum surgery.
Bleeding gums is a sign of a problem that needs to be addressed. The next time you visit your dentist, make certain he or she uses a periodontal probe and explains, in exact terms, how healthy or unhealthy your gums really are. Your life may depend on it.
Bleeding gums is a sign of a problem that needs to be addressed. The next time you visit your dentist, make certain he or she uses a periodontal probe and explains, in exact terms, how healthy or unhealthy your gums really are. Your life may depend on it.
Thursday, August 5, 2010
Extract and Implant vs. Crown Lengthening
The decision-making process as to when to save a compromised tooth as opposed to extracting it has been influenced by the predictable success of dental implants. Factors considered in saving a tooth include whether there is enough structure left to support a crown; is the decay or tooth fracture so deep as to require a root canal or osseous surgery; is retreatment of a previously done root canal required; does bone need to be removed in order to make a proper-fitting crown; and what is the dental status of the adjacent teeth?
The following case typifies how these and other factors help the patient and treating dentist decide on the best treatment course for a problem tooth.
A 25 yr old female presented with a post-and-core fractured at the bone level on tooth #29 (Fig 1). The crown could no longer be attached, the root canal filling was incomplete, and the adjacent tooth (#28) had no restoration.
figre 1 : The tooth structure is at the bone level.
To save the tooth, bone needed to be removed (crown-lengthening) in order to gain enough root structure to fabricate a properly fitting crown. Weighing the many treatment steps and risks necessary to save this tooth – removing the post to retreat the root canal or performing a root-end surgery known as an apicoectomy, removing bone, and fabricating a restoration that has an unfavorable crown-to-root ratio, it was decided to extract the tooth and insert a dental implant.
Figure 2. Tooth removed.
Figure 2 demonstrates the tooth removed and a direction indicator to help determine the implant placement. The osteotomy site was prepared and a NobelBiocare Active implant inserted into the site (Fig 3).
Figure 3. Implant in place.
In this case, it was determined that the best treatment for a 25 year-old patient was not engage in the multiple risks to save the tooth that would leave the patient the patient with a compromised tooth. This treatment choice resulted in preserving bone, not damaging the adjacent teeth by making a bridge, and being able to insert a dental implant at the time the tooth was extracted in order to provide the most predictable and lasting treatment for a severely compromised tooth.
The following case typifies how these and other factors help the patient and treating dentist decide on the best treatment course for a problem tooth.
A 25 yr old female presented with a post-and-core fractured at the bone level on tooth #29 (Fig 1). The crown could no longer be attached, the root canal filling was incomplete, and the adjacent tooth (#28) had no restoration.
figre 1 : The tooth structure is at the bone level.
To save the tooth, bone needed to be removed (crown-lengthening) in order to gain enough root structure to fabricate a properly fitting crown. Weighing the many treatment steps and risks necessary to save this tooth – removing the post to retreat the root canal or performing a root-end surgery known as an apicoectomy, removing bone, and fabricating a restoration that has an unfavorable crown-to-root ratio, it was decided to extract the tooth and insert a dental implant.
Figure 2. Tooth removed.
Figure 2 demonstrates the tooth removed and a direction indicator to help determine the implant placement. The osteotomy site was prepared and a NobelBiocare Active implant inserted into the site (Fig 3).
Figure 3. Implant in place.
In this case, it was determined that the best treatment for a 25 year-old patient was not engage in the multiple risks to save the tooth that would leave the patient the patient with a compromised tooth. This treatment choice resulted in preserving bone, not damaging the adjacent teeth by making a bridge, and being able to insert a dental implant at the time the tooth was extracted in order to provide the most predictable and lasting treatment for a severely compromised tooth.
Monday, August 2, 2010
Sinus Grafts of the Maxilla: An Alternative Technique Using Osteotomes
An osteotome sinus lift reduces the need for a traditional maxillary sinus graft and avoids using bone graft material while enabling a dental implant to be inserted into atrophic bone. This surgery heals faster than a sinus graft and enables the crown or bridge to be applied to the implant sooner than with other traditional methods.
Sinus grafts for the maxillary posterior are recommended when there is too little bone under these sinus cavities to insert a dental implant. When this occurs, some form of treatment is necessary to increase bone volume. While sinus grafts, sometimes called sinus lifts, are safe, predictable, and are a valuable treatment approach, extra time (six-to-nine months) is needed for forming new bone, not to mention the expense, potential complications, and the use of foreign bone graft material. There is an alternative to sinus grafts that permits implants to be inserted in atrophic bone: the osteotome lift.
Diagrams of an Osteotome Technique
The black area above the stippled bone represents the sinus cavity. There is not enough bone to insert an implant.
The initial hole stops short of the sinus floor.
An osteotome pushes through the bone.
The osteotome advances, infracturing the sinus floor without penetrating through the sinus membrane.
The osteotome reaches 10 mm.
The dental implant is inserted.
Sinus grafts for the maxillary posterior are recommended when there is too little bone under these sinus cavities to insert a dental implant. When this occurs, some form of treatment is necessary to increase bone volume. While sinus grafts, sometimes called sinus lifts, are safe, predictable, and are a valuable treatment approach, extra time (six-to-nine months) is needed for forming new bone, not to mention the expense, potential complications, and the use of foreign bone graft material. There is an alternative to sinus grafts that permits implants to be inserted in atrophic bone: the osteotome lift.
Diagrams of an Osteotome Technique
The black area above the stippled bone represents the sinus cavity. There is not enough bone to insert an implant.
The initial hole stops short of the sinus floor.
An osteotome pushes through the bone.
The osteotome advances, infracturing the sinus floor without penetrating through the sinus membrane.
The osteotome reaches 10 mm.
The dental implant is inserted.
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