For a predictable outcome, a dental implant should be placed as soon as the bone and gum tissues following a tooth extraction have healed. But what happens if the tooth has been missing for months or years? You might then run the risk of not having enough bone to properly place an implant.
This can happen because of a disruption in the growth cycle of living bone tissue. As older bone cells dissolve (resorption), new bone develops to take its place. This is a dynamic process, as the amount and exact location of the new growth is in response to changes in the mouth, particularly from forces generated by the teeth as we chew. If, however, this stimulation transmitted to the bone no longer occurs because the tooth is missing, the bone will tend to dissolve over time.
In fact, within the first year after a tooth loss the associated bone can lose as much as a quarter of its normal width. This is why we typically place bone grafting material in an empty socket at the same time as we extract the tooth. This encourages bone growth during the healing period in anticipation of installing a dental implant or a fixed bridge. If, however, the bone has diminished to less than required for a dental implant, we must then use techniques to encourage new bone growth to support a future implant.
One such technique for restoring bone in the back of the upper jaw is to surgically access the area through the maxillary sinus (a membrane-lined air space within the bone structure of the face) positioned just over the jawbone to place grafting material. During surgery performed usually with local anesthesia, the surgeon accesses the sinus cavity, lifts the tissue membrane up from the sinus floor and applies the grafting material on top of the bone. Eventually, the new bone growth will replace the grafting material.
If successful, the new bone growth will be sufficient to support an implant. Thanks to this renewed growth, you’ll soon be able to enjoy better function and a transformed smile provided by your new implant.
If you would like more information on forming new bone for implants through sinus surgery, 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 “Sinus Surgery.”
Boston Bruins defenseman Zdeno Chara had a rough Stanley Cup final against the St. Louis Blues this past June. Not only did the Bruins ultimately lose the championship, but Chara took a deflected puck shot to the face in Game Four that broke his jaw.
With the NHL season now over, the 42-year-old Bruins captain continues to mend from his injury that required extensive treatment. His experience highlights how jaw fractures and related dental damage are an unfortunate hazard in hockey—not only for pros like Chara, but also for an estimated half million U.S. amateurs, many in youth leagues.
Ice hockey isn't the only sport with this injury potential: Basketball, football (now gearing up with summer training) and even baseball players are also at risk. That's why appropriate protective gear like helmets and face shields are key to preventing injury.
For any contact sport, that protection should also include a mouthguard to absorb hard contact forces that could damage the mouth, teeth and gums. The best guards (and the most comfortable fit) are custom-made by a dentist based on impressions made of the individual's mouth.
But even with adequate protection, an injury can still happen. Here's what you should do if your child has an injury to their jaw, mouth or teeth.
Recognize signs of a broken jaw. A broken jaw can result in severe pain, swelling, difficulty speaking, numbness in the chin or lower lip or the teeth not seeming to fit together properly. You may also notice bleeding in the mouth, as well as bruising under the tongue or a cut in the ear canal resulting from jawbone movement during the fracture. Get immediate medical attention if you notice any of these signs.
Take quick action for a knocked-out tooth. A tooth knocked completely out of its socket is a severe dental injury. But you may be able to ultimately save the tooth by promptly taking the following steps: (1) find the tooth and pick it up without touching the root end, (2) rinse it off, (3) place it back in its socket with firm pressure, and (4) see a dentist as soon as possible.
Seek dental care. Besides the injuries already mentioned, you should also see a dentist for any moderate to severe trauma to the mouth, teeth and gums. Leading the list: any injury that results in tooth chipping, looseness or movement out of alignment.
Even a top athlete like Zdeno Chara isn't immune to injury. Take steps then to protect your amateur athlete from a dental or facial injury.
If you would like more information about dealing with sports-related dental injuries, please contact us or schedule an appointment for a consultation. To learn more, read the Dear Doctor magazine articles “Athletic Mouthguards” and “The Field-Side Guide to Dental Injuries.”
Your mouth is a lot like the Wild West — home to millions of bacteria and other microbes, some of which are definitely not “the good guys.” But your teeth are well-protected from these hostile forces and their acidic waste products: with enamel shielding the visible part of your tooth, your gums protect the parts you can’t see.
As effective as they are, though, your gums aren’t invincible: their greatest threat is periodontal (gum) disease. This bacterial infection arises from plaque, a thin film of bacteria and food particles accumulating on teeth due to inadequate brushing and flossing.
The infected tissues soon become inflamed (red and swollen), a natural defensive response from the immune system. The longer they’re inflamed, however, the more likely they’ll begin detaching from the teeth. The gums may eventually shrink back or recede from the teeth, often causing them to appear “longer” because more of the tooth is now exposed to view.
Gum recession doesn’t bode well for your teeth’s survival: the exposed tooth and underlying bone can become even more susceptible to infection and damage. In the end, you could lose your tooth and portions of the supporting bone.
Treatment depends on the severity of the gum recession. In mild to moderate cases, we may only need to perform the standard gum disease treatment of removing plaque and calculus from all gum and tooth surfaces (including below the gum line) with special instruments. This helps reduce the infection and allow the gums to heal and re-establish attachment with the tooth. In more advanced cases, though, the recession may be so extensive we’ll need to graft donor tissue to the area using one of a variety of surgical techniques.
Although the right treatment plan can help restore your gum health, there’s another approach that’s even better — preventing gum disease in the first place. You can reduce your disease risk by practicing daily brushing and flossing and visiting your dentist regularly or when you see symptoms like gum swelling or bleeding. Taking care of your gums won’t just save your smile — it might also save your teeth.
If you would like more information on diagnosing and treating gum disease, 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 “Gum Recession.”
Seven out of ten Americans are missing at least one tooth due to decay, periodontal (gum) disease or injury. Unfortunately, the consequences go far beyond a missing tooth — the loss of even one could set in motion a cascade of problems.
Perhaps the most damaging of these problems is bone loss. Like other living tissue, bone has a life cycle — older cells dissolve (resorb) into the body and are replaced by fresher cells. This growth cycle in the jawbone receives stimulation from forces generated by teeth when we chew or bite. If a tooth is no longer present to provide this stimulation, the affected bone cells won’t regenerate at a healthy rate. Over time this causes the volume of bone to diminish, as much as 25% the first year after tooth loss.
The void left by a missing tooth can also adversely affect remaining teeth. Teeth are held in place by a tough but elastic tissue known as the periodontal ligament that lies between the tooth and the bone. The ligament enables teeth to move gradually in response to mouth changes so that the teeth remain tightly aligned with each other. When there’s a gap from a missing tooth, this tendency will cause the teeth on either side to move (or “drift”) toward the open space. Although a natural phenomena, it can result in a malocclusion (poor bite).
That’s why it’s important to replace a missing tooth with a life-like replica — not just for appearance’s sake, but also to improve function and prevent the rise of these other problems. While many options exist (from removable dentures to fixed bridges) the choice most preferred by dentists and patients is the dental implant.
An implant replaces the tooth root as well as the crown, because it’s imbedded securely into the jawbone. Because of a natural affinity with titanium, the principal metal used in implants, bone cells will grow to its surface. Not only will this anchor the implant more securely, it will slow or even stop bone loss.
If you have a missing tooth, you should visit us as soon as possible to consider your options for a replacement. A new tooth will help stop even greater problems from occurring.
If you would like more information on effects and treatment of tooth loss, 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 “The Hidden Consequences of Losing Teeth.”
Even in the 21st Century, losing most or all of your teeth is still an unfortunate possibility. Many in this circumstance turn to dentures, as their great-grandparents did, to restore their teeth. But today's dentures are much different from those of past generations—and dental implants are a big reason why.
The basic denture is made of a gum-colored, acrylic base with artificial teeth attached. The base is precisely made to fit snugly and comfortably on the patient's individual gum and jaw structure, as the bony ridges of the gums provide the overall support for the denture.
Implants improve on this through two possible approaches. A removable denture can be fitted with a metal frame that firmly connects with implants embedded in the jaw. Alternatively, a denture can be permanently attached to implants with screws. Each way has its pros and cons, but both have two decided advantages over traditional dentures.
First, because implants rather than the gums provide their main support, implant-denture hybrids are often more secure and comfortable than traditional dentures. As a result, patients may enjoy greater confidence while eating or speaking wearing an implant-based denture.
They may also improve bone health rather than diminish it like standard dentures. This is because the forces generated when chewing and eating travel from the teeth to the jawbone and stimulate new bone cell growth to replace older cells. We lose this stimulation when we lose teeth, leading to slower bone cell replacement and eventually less overall bone volume.
Traditional dentures not only don't restore this stimulation, they can also accelerate bone loss as they rub against the bony ridges of the gums. Implants, on the other hand, can help slow or stop bone loss. The titanium in the imbedded post attracts bone cells, which then grow and adhere to the implant surface. Over time, this can increase the amount of bone attachment and help stymie any further loss.
An implant-supported denture is more expensive than a standard denture, but far less than replacing each individual tooth with an implant. If you want the affordability of dentures with the added benefits of implants, this option may be worth your consideration.
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.”
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