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Posts for category: Dental Procedures

By C. Roger Macias Jr., DDS
April 05, 2019
Category: Dental Procedures
Tags: dental implants  
KnowtheRisksandBenefitsforSame-DayToothReplacement

While there’s usually a period of months between implant placement and the permanent crown, a new technique known as same-day tooth replacement installs both the implant and a temporary crown during the same visit. But be advised — it does have its risks and isn’t for everyone.

Successful same-day replacements require special attention during the three phases for implants: the removal (extraction) of the existing tooth; placement of the implant in the bone; and attachment of the crown, the visible tooth, to the implant. The tooth extraction lays the foundation for the entire process; the extraction procedure must be performed carefully to avoid undue damage to the socket. In addition, if infection or disease has compromised the site, an implant may not be possible immediately.

The implant must then be placed in the bone so that it’s stable and immovable. All implants stabilize with time as the bone grows and adheres to them, but we need greater stability for a same-day tooth replacement when an extraction is performed.

Our last consideration is positioning the implant so that the attached crown blends in naturally with the surrounding gum tissue and adjacent teeth. We must place it at the proper depth below the gum tissues so that the crown appears to emerge from them in the proper tooth length.

Taking extra care during all these phases, including the angle of crown attachment, will increase our chances of success. We still run a risk of implant damage or failure, however, from biting forces before the implant fully integrates with the bone. This means avoiding chewy foods and other situations that might increase the force on the implant. We may also use a temporary crown that’s slightly shorter than adjacent teeth so it won’t make full contact with the opposing tooth.

If you’d like to know if you’re a good candidate for a same-day tooth replacement, see us for a detailed examination. After reviewing your needs, we’ll be able to discuss with you the risks and benefits for a new look in one day.

If you would like more information on same-day tooth 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 “Same-Day Tooth Replacement with Dental Implants.”

By C. Roger Macias Jr., DDS
March 16, 2019
Category: Dental Procedures
LadyGagaWasntBornThisWay

Sometimes, looking at old pictures can really bring memories back to life. Just ask Stefani Germanotta—the pop diva better known as Lady Gaga. In one scene from the recent documentary Five Foot Two, as family members sort through headshots from her teen years, her father proclaims: "Here, this proves she had braces!"

"If I had kept that gap, then I would have even more problems with Madonna," Lady Gaga replies, referencing an ongoing feud between the two musical celebrities.

The photos of Gaga's teenage smile reveal that the singer of hits like "Born This Way" once had a noticeable gap (which dentists call a diastema) between her front teeth. This condition is common in children, but often becomes less conspicuous with age. It isn't necessarily a problem: Lots of well-known people have extra space in their smiles, including ex-football player and TV host Michael Strahan, actress Anna Paquin…and fellow pop superstar Madonna. It hasn't hurt any of their careers.

Yet others would prefer a smile without the gap. Fortunately, diastema in children is generally not difficult to fix. One of the easiest ways to do so is with traditional braces or clear aligners. These orthodontic appliances, usually worn for a period of months, can actually move the teeth into positions that look more pleasing in the smile and function better in the bite. For many people, orthodontic treatment is a part of their emergence from adolescence into adulthood.

Braces and aligners, along with other specialized orthodontic appliances, can also remedy many bite problems besides diastema. They can correct misaligned teeth and spacing irregularities, fix overbites and underbites, and take care of numerous other types of malocclusions (bite problems).

The American Association of Orthodontists recommends that kids get screened for orthodontic problems at age 7. Even if an issue is found, most won't get treatment at this age—but in some instances, it's possible that early intervention can save a great deal of time, money and effort later. For example, while the jaw is still developing, its growth can be guided with special appliances that can make future orthodontic treatment go quicker and easier.

Yet orthodontics isn't just for children—adults can wear braces too! As long as teeth and gums are healthy, there's no upper age limit on orthodontic treatment. Instead of traditional silver braces, many adults choose tooth-colored braces or clear aligners to complement their more professional appearance.

So if your child is at the age where screening is recommended—or if you're unhappy with your own smile—ask us whether orthodontics could help. But if you get into a rivalry with Madonna…you're on your own.

If you have questions about orthodontic treatment, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Magic of Orthodontics” and “Orthodontics For The Older Adult.”

By C. Roger Macias Jr., DDS
February 24, 2019
Category: Dental Procedures
Tags: dental implants  
WhattoExpectBeforeDuringandAfterImplantSurgery

People are choosing dental implants at an increasing rate to replace missing teeth, either as an individual tooth or as a support for other restorations. But unlike other replacement options, we must surgically install the titanium post at the heart of the system directly into the jawbone.

While the term “surgery” might make you nervous, there's nothing at all to worry about. Here's what you need to know about before, during and after this relatively minor procedure.

Before. While the actual procedure is no more complicated than a tooth extraction, it ultimately depends on careful planning beforehand. Using x-ray diagnostics, we prepare a precise surgical guide to help us locate the best position to place them for a successful outcome. We'll also need to check bone volume to make sure there's an adequate amount to securely anchor the implant. If the bone is insufficient you may need bone grafting to build up the site or another replacement option.

During. The actual procedure begins, of course, with local anesthesia to numb the site — you should feel no pain and very minimal discomfort. We access the bone through the gums; often using a surgical guide for alignment, we create a small channel or hole with a sequence of drills that gradually increase the size until it can accommodate the implant. We remove the implants from their sterile packaging and install them immediately into the channel. After confirming their proper positioning with x-rays, we can close the gum tissues over it for protection during healing or attach a healing abutment that extends through the gum tissue thereby avoiding a second surgical procedure.

After. Because we disrupt relatively little of the soft tissue and bone, there's only minimal discomfort afterward easily managed with aspirin, ibuprofen or similar anti-inflammatory medication. We may also prescribe antibiotics to guard against infection while the gums heal. During the next several weeks, the titanium post, which has an affinity to bone, will become more secure as bone cells grow and adhere to it. It's also during this time that a dental lab creates your permanent crown or other restoration that matches the color and tooth shape so it will blend with your other teeth.

This process is complete when we install the final restoration onto the implant. You'll have a new smile and better function.

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 “Dental Implant Surgery.”

By C. Roger Macias Jr., DDS
February 04, 2019
Category: Dental Procedures
CrazyLittleThingCalledHyperdontia

The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.

The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.

Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.

Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.

After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.

Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.

If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”

By C. Roger Macias Jr., DDS
December 16, 2018
Category: Dental Procedures
Tags: partial denture  
CantAffordDentalImplantsConsiderPartialDentures

We’ve come a long way in our ability to restore missing teeth. Today’s top choice is dental implants, prized not only for their close resemblance to real teeth but also their durability.

The rise of implants, though, hasn’t put older restorative methods out to pasture—many continue to offer patients a viable and affordable choice for tooth replacement. One example is the removable partial denture (RPD).

Once quite common, RPDs’ popularity has only slightly diminished with the advent of implants. They’re a fair option in terms of dental function and appearance, and much less expensive than implants or fixed bridges.

Similar to a full denture—a removable appliance that replaces all the teeth on a dental arch—a RPD can replace multiple missing teeth in a variety of configurations. A traditional RPD is usually constructed of vitallium, a lightweight but strong metal alloy, which allows for a very thin and comfortable frame. It’s covered in a gum-colored resin or plastic with prosthetic (false) teeth precisely set at the missing teeth’s locations. The appliance stays in place through a series of clasps that attach to the remaining teeth.

 Each RPD is custom-made to fit a patient’s mouth contours and the locations and patterns of the missing teeth. The top design goal for each individual RPD is to minimize any rocking movement during chewing; achieving that goal will depend not only on how many teeth are missing and where, but also what type of teeth are being replaced. For example, teeth missing from the back would require a different support design than teeth missing from the side or front.

RPDs’ biggest benefits are comfortable fit, effective dental function and good appearance. However, their means of attachment can create difficulties keeping remaining teeth clean of disease-causing bacterial plaque. Furthermore, an ill-fitting or unstable RPD could damage or even loosen natural teeth. It’s therefore essential for wearers to diligently practice daily hygiene (including cleaning the RPD) and undergo regular fit monitoring with their dentist.

Even with these constraints, a RPD can do an acceptable job providing dental function. What’s more, it can definitely improve your smile.

If you would like more information on options for dental restoration, 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 “Removable Partial Dentures: Still a Viable Tooth-Replacement Alternative.”



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