Dental implants are made of titanium, and they are used to replace the roots of missing teeth. Titanium is a material very well tolerated by the body and is used for other prosthetic devices such as artificial hips. Dental implants can be used to replace a single tooth, several teeth, as anchors for a fixed bridge, or to help retain a denture.

Implant placement is done in the office with local anesthetic and is surprisingly atraumatic. Most patients experience little postoperative pain or swelling. Once the implant (or implants) are placed, they must remain undisturbed for 3-6 months to allow the bone to heal and "fuse" with the implant. After the fusion, or integration has occurred, the implant is then restored with a crown, a bridge, or an implant retained denture.

Dental implants have a very high success rate, greater than 95%. Once an implant has integrated, there is no reason it should fail as long as it is well maintained with patient home care and professional monitoring at regular intervals. The success of dental implants is diminished in patients who smoke, and those who have certain underlying medical conditions, such as diabetes. A close working relationship between the periodontist and restorative dentist helps insure a successful result.

What is a periodontist?

Periodontics is an accredited specialty in dentistry responsible for the structures that support the teeth and dental implants. A periodontist cares for the foundation in your mouth: the bone, the gums, the attachment of the gum to tooth and bone, and implants. After completion of college and dental school, a periodontist must train for an additional three years to be awarded specialty certification. A periodontist will most often limit his or her practice to the specialty and will focus solely on healthy foundations and implants.

What is the relationship between the periodontist and restorative dentist?

A close working relationship between the periodontist and restorative dentist will help insure the best possible patient care. The periodontist is responsible for the healthy foundation on which the restorative dentist can build crowns and bridges. A relationship between the patient, periodontist and restorative dentist that embodies good communication and is founded on mutual respect will not only help to create the best clinical result, it will offer the patient comfort and reassurance during the process.

What is home care instruction?

Bacteria collect on teeth daily, and if not removed, they work their way under gums causing infection and loss of bone. These bacteria must be removed each day, using home care techniques which we customize for each patient. Even though daily flossing is an appropriate and admirable goal, we recognize that not every patient has the motivation or dexterity to be effective. We tailor our home care instruction and training to each individual's needs and ability. Our goal is to make you as effective as possible, not frustrate you with unrealistic expectations.

What is periodontal disease?

Periodontal disease is a chronic infection. Bacteria work there way underneath the gum tissues, and dissolve the bone which holds the teeth in place. This creates a space, or "pocket" between the gum and the tooth, much like a moat around a castle. As the bacteria dissolve more and more bone, the space deepens creating an environment where patients can no longer remove the bacteria with a toothbrush or dental floss. As an increasing amount of supporting bone is lost, teeth begin to loosen and shift. When a sufficient amount of bone is lost, the affected teeth must be removed. The loss of bone and weakening of support can occur slowly over a period of time, or in quicker spurts, and may occur without any noticeable signs or symptoms. Smoking, underlying medical problems (for example, Diabetes), certain medications (for example, nifedipine), and stress can markedly accelerate the progression of the disease. Periodontal disease may also contribute to heart problems, stroke and low birth weight babies.

A thorough periodontal evaluation is necessary to delineate the degree of infection, the amount of bone loss, and the prognosis for individual teeth. The goals of periodontal therapy include the eliminate of bacterial deposits and periodontal pockets they have caused, and the creation of an environment the patient can maintain in health.

Periodontal treatment includes a detailed and individually structured review of home care and the physical removal of bacteria and hard deposits with a process called scaling and root planing. If residual pockets or defects remain after a suitable healing period, they can be eliminated with a minor surgical procedure done in the office under local anesthetic. Defects in the bone can often be resolved by rebuilding the bone using a procedure called guided tissue regeneration. Ultimately, with good home care and compliance, the vast majority of patients retain their teeth in health and comfort.

Are chemical agents used in treating periodontal disease?

A variety of chemotherapeutic agents are available to help control the infection in the gums around the teeth. These currently include Peridex, Periostat, Atridox, PerioChip and the use of systemic antibiotics. The nature of your problem and how you respond to treatment will help determine when it is appropriate to include these tools.

What is recession?

Gum recession occurs when the gum tissue moves away from the neck of the tooth exposing the root surface of the tooth. The exposed root surface can be unsightly, have increased sensitivity and be more susceptible to decay. If the gum continues to recede, the tooth becomes more difficult to clean and the susceptibility to sensitivity and decay increases.

Recession most often occurs as the result of an underlying anatomical problem, and is generally not the result of disease. There are two kinds of gum tissue over a tooth a firm pink tissue at the margin of the gum (gingiva) and a looser redder tissue which extends into the cheek and lip. A sufficient amount of pink tissue is necessary the normal traumatic forces of tooth brushing or eating. When there is insufficient firm pink tissue, and this is superimposed on a tooth which is prominent, too large for the jaw bone, or protruding towards the cheek or lip, the gum tissue recedes. In most cases, this is easily correctable with a soft tissue graft, where healthy firm pink tissue is transferred from the palate (adjacent to the teeth) to the affected site. This procedure is done in the office with local anesthetic and has a high predictability of success.

What is crown lengthening?

Crown lengthening is a surgical procedure to expose more tooth structure, either for esthetics, because the smile is too "gummy," or because a tooth has broken or decayed and more tooth needs to be exposed in order "grab" the tooth with a restoration.

In the case of esthetics, we have all seen people with short teeth, or a "gummy" smile. By repositioning the gum at a different level on the tooth, we can create a more normal relationship between the gum and the tooth as it relates to a given patient's facial contour, lip position and smile. Sometimes this is all that is necessary to achieve a favorable result, and sometimes it serves as the preparation of the foundation so esthetically pleasing veneers or crowns can be fabricated by the patient's restorative dentist.

When a tooth breaks, or there is deep decay on the side of a tooth, the amount of remaining tooth structure compromises the ability adequately retain a restoration. A crown lengthening procedure exposes additional tooth structure so the subsequent restoration will have sufficient retention and not fall off. The procedures also creates enough room for the gum to attach to the tooth so that it can be maintained in health when the patient cleans.

What happens to the jaw bone when teeth are removed?

When a tooth is extracted (because it has lost a lot of bone, due to decay or a failed root canal, or because it can't be restored), the remaining bone dissolves away and this results in a sunken or depressed appearance in the jaw bone. This can be treated in several ways:

Ridge preservation: If a loss of contour is anticipated prior to the extraction, hard tissue grafting procedures to enhance the bone, or soft tissue grafting procedures enhance the gum can be done at the time of the extraction. This will prevent a loss of contour from occurring.

Ridge augmentation: If a loss of contour has already occurred, a hard tissue ridge augmentation can be done to rebuild the jaw bone, or a soft tissue ridge augmentation can be done to rebuild the contour and appearance of the gum. A hard tissue augmentation creates the bone necessary to support a dental implants, and both hard and soft tissue procedures create a natural looking soft tissue contour where teeth are missing. Ovate pontic: When you look at a tooth, it has a very natural appearance as it emerges from the gum tissue. When a tooth is lost, and is replaced with a false tooth (pontic) as part of a fixed bridge, it, too, can have a natural look appearance if the gum is prepared properly before the bridge is placed. This done be creating a small concave depression in the gum and then build the contour of the false tooth into this depression in a very natural way.