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PATIENT EDUCATION

Doctor Patricia Yepes Javeriana (Javeriana University), who specializes in child and youth dentistry, at Sonrisas Factory gives the following recommendations to promote good oral health for children:

  • Let your child know about the importance of eating breakfast every day.
  • Encourage consumption of water instead of juice or soda.
  • Recognize that certain foods in social events (birthday’s parties) such as gums, candies and chocolates should be consumed sparingly.
  • The foods are less harmful to the oral health are those that are broken down very quickly in the mouth, such as ice cream. Sticky foods can stay for hours stuck to the teeth (gum, candy, chocolates).
  • Replace the baby bottle with a cup by the first birthday. Do not give any sugary drinks to an infant because the lack of saliva and tongue movement during sleep can bring about tooth decay.
  • Do not cut small pieces or blend foods when the child gets the molars because they need to stimulate the chewing skills. This will reduce the crowding of teeth.
  • A high-protein diet prevents cavities.

 

Advantages of Dental Implants

1.  Who is a good candidate for dental implants?

 The ideal candidates for dental implants must have healthy gums and enough bone to support the implant. This is the reason why we ask you to send us your dental records and panoramic radiographs.

 2.  If your answer to some of these questions is yes, you can be considered an ideal candidate for placement of implants:

  •  Have you lost one, some or all of their teeth?
  • Do you have trouble with your removable prosthesis? (loosening, pain, etc.)
  • Do you feel uneasy when you smile, speak or eat?
  • Has a dentist told you your teeth are in poor condition?
  • Are you missing a tooth somewhere in your mouth?

 3.  What are the options to replace missing teeth?

  •  The first option is to place a titanium artificial root (dental implant) to hold the porcelain crown.
  •  The next option is a bridge, which is to wear down the tooth of the pair to put the crown on it and another crown on the tooth lost.
  •  The third option is a removable bridge, which is held by hooks and stabilized by a plastic or metal structure covering the soft palate and tongue area. The patient can take it off.

 4.  What is a dental implant?

Dental implants are small titanium cylinders that function as artificial roots once they are placed into the jaw. This allows the artificial teeth to be attached to these roots and one can recover a beautiful smile and be able to speak and chew comfortably.

Dental implants allow us to comfortably chew, smile and talk just as securely as we would with our natural teeth. By electing dental implants there is no need to touch, wear or damage adjacent teeth to replace missing teeth.

5.  How is a dental implant different from a dental bridge?

A dental implant literally replaces a missing tooth. A dental implant simulates the root of a tooth to which the cosmetic dentist attaches a cosmetic tooth. A dental bridge, on the other hand, is non-surgical and uses the adjacent teeth to support a new cosmetic tooth. A dental implant is not invasive to surrounding teeth (especially desirable if they are healthy and in good condition).

By simulating the root, it engages the bone and keeps it healthy. Because a dental implant is an individual tooth it is also easier to floss. A dental bridge can be a good choice if the adjacent teeth are in need of restoration. However, there are other subtle factors such as age, timing and bone health that you should discuss with your dentist when deciding which options may be best for you.

Many materials have been used throughout the history of dentistry and medicine. Currently the only material that is considered valid for dental implants is titanium.

6.  What is the surgical procedure?

Surgical treatment consists of placing the artificial root or implant within the jaw. Placing the implants under local anesthesia is painless. Sedation and general anesthesia are options for nervous patients. The procedure lasts one to two hours.

7.  How is the post-operative?

It is not painful. The day after surgery, the patient will have a slightly swollen face. The doctor will prescribe painkillers, antibiotics and anti inflammatory medicine for a short period.

8.  When the new tooth will be placed on the implant?

The time between surgical procedure and placing crowns varies by case. It takes seven to ten days to allow time for the implant to be attached securely to the bone. You can wait longer if the patient so wishes (ie, due to travel).

9.  Is the treatment painful?

No, it is not. You need surgery for dental implant treatment, but the pain and all the other implications can be perfectly controlled.

10.  Which is the success rate of dental implants?

Today the success rate of implants is 90%, this percentage is endorsed by numerous scientific studies. 

11.  What are the benefits of implants?

 Dental implants are an alternative for:

  • The patient who cannot function comfortably with conventional dentures.
  • The patient who has lost teeth and wants to avoid removable partial dentures.
  • The patient who needs a crown or fixed bridge but doesn't want to damage his or her adjacent healthy teeth.
  • The person who wants to have the dental solution that is the closest to what Mother Nature created.

12.  How long does an implant last?

Implants have remained in patients' mouths for up to 30 years or longer. We recommend a preventive maintenance program to help insure the long-term success of your implants and teeth.

13.  How much does an implant cost compared to other forms of dentistry?

The cost of implant dentistry is comparable to that of fixed bridgework or other advanced dental procedures in most cases.

14.  How long will I be off work?

Generally we recommend the day of the implant placement and the day after. Most of our patients are back to work the next day after implant placement. It's an individual decision.

 

Implants vs. Bridgework

Considerations to help you decide what is right for you when you have had a tooth removed 

Teeth basically have two main parts; the crown is the part you see in the mouth and the root is the part that is encased in bone and keeps the tooth in place. A dental implant is a tooth replacement, and unlike the root of a tooth, it is fused to the bone of the jaw. A crown is attached to the implant and in effect it becomes a stand-alone tooth functioning and appearing just like that natural tooth you have lost. The basic prerequisites for a succesful implant include: 1) a sufficient quantity and quality of bone to anchor or support the implant, 2) the adjacent teeth and gums are healthy and 3) the quality of the adjacent teeth will allow for a natural-looking cosmetic result.

By contrast, a fixed bridge is a restoration or prosthesis, that is fixed in place by attaching to the natural adjacent teeth. The tooth to be replaced is called a "pontic" after the French "pont" for bridge. The adjacent teeth, called abutments, just like a bridge spaning a river or canyon, provide support to either side. The way that the bridge attaches is that the abutment teeth are "prepared" by removing the enamel layer and are replaced by crowns to which the false tooth is attached. Thus a three-unit bridge is three crowns joined together with the middle crown being a false tooth, with the side crowns cemented or bonded to the adjacent natural teeth.

The following illustrations show the general advantages and disadvantages of a three-unit fixed bridge versus an implant restoration. This is a general guideline only, a consultation with your dentist is necessary to review all the risks, benefits and alternatives to determine which option is best for you.

imagen1

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Sensitive Teeth

Tooth sensitivity is largely caused by exposure of tooth's dentin. The enamel covering of the tooth is inert; that is it has no nerve supply and therefore protects the teeth from temperature and pressure changes. When dentin is "exposed" (most often caused by gum recession), the dentin, which contains nerve fibers, will let you know that it is responding to heat, cold or touch the only way that it knows how - by saying "ouch". That "ouch" can range from a twinge to downright excruciating.

Brushing: Sometimes Too Much of a Good Thing

The causes of recession can vary, but a common one is an excessive and improper brushing technique, especially for individuals with genetically thin gum tissues. Once exposed, the dentin of the root surfaces can become vulnerable to erosion by acids and irritation from sweets, primarily in the form of sugars. Ice cream is a "double whammy" - it causes sensitivity from the combination of both cold and sweet. Worn and hard bristle toothbrusshes, citrus fruits, sodas, candies and many other things can irritate dentin once exposed.

The mechanism of tooth sensitivity is still being investigated. The dentin consists of tiny little tubules which contain living cells encased in a hard bone-like substance of the dentin. It's thought that pain is felt by "transduction" by differences in pressure set up from the outside of the tooth to the inside - the pulp.

Decay, of course, can algo cause the tooth sensitivity. As the destructive process of decay works into the structure of a tooth, it finally invades the pulp chamber containing the nerves, increasingly irritating them and escalating the level of pain. If the nerve becomes infected and dies, the acute pain can be very severe, secondly only to having a baby or passing a kidney stone, or so we've been told. 

The removal of decay prior to placing a filling can lead to sensitivity. For this situation, a dentist may typically place a lining or desensitizing material to protect the tooth from sensitivity; however, it may take a while, from a few days to a week, for the tooth to calm down. As teeth age they tend to become naturally less sensitive as more dentin is laid down inside the tooth, which is called "secondary dentin". This causes the pulp to constrict and get smaller. As a result of this precess, the dentin thickens and becomes less permeable reducing sensitivity. Ice cream may once again be enjoyable.

Taking Steps to Minimize Sensitivity

So what can you do about it? First, don't brush the affected teeth too hard or too often - or even try stopping for a few days and see if it helps. The goal of brushing is quite simple: to remove plaque. This only requires a very gentle action with a soft brush.

Second, use a toothpaste containing fluoride. Fluoride increases the strength of the tooth surfaces and makes them more resistant to attack by acides, sweets and excessive brushing. You should actually use the fluoride toothpaste like an ointmet so that it's in contact with the affected site in a more concentrated way and for a longer time period when brushing. There are toothpastes on the market containing potassium products for sensitivity, but studies show their effectiveness is quite variable.

Another treatment for dentin sensitivity is really aimed at applying a barrier to cover the sensitive areas. These barriers range from concentrated, professionally-applied fluoride varnishes to filling materials that are chemically bonded to cover and replace lost tooth structure.

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Immediate Dentures

A transition which can be traumatic both emotionally and physically

Typically when people lose their last remaining teeth and "convert" to a full upper denture, it can be quite traumatic, both physically and psychologically. These types of appliances are actually called "immediate dentures", because they are placed immediately following the extractions so that patients are never without teeth. This way, the patient's physical appearence is mantained and the ability to chew and speak is not compromised. The psychological part, at least for some, is that it's difficult to lose their last natural teeth and learn to feel comfortable with false teeth. 

However, these immediate dentures are rather temporary in nature. As healing progresses after the teeth are initially removed, the gums shrink, sometimes quite a lot, leaving space underneath the dentures which can then move around. The dentures become difficult to tolerate making eating and speaking difficult. The best thing to do at this stage is simply to have the dentures "relined", which can be carried out by your dentist in no more than a day or two. This relatively quick and inexpensive procedure usually makes them fit better and is a good interim remedy.

Once your healing phase is complete, your dentist will make your final denture. A new and accurate impression of your jaw will be necessary. This impression will be very accurate because all of your extraction sites have healed. The new denture will provide you with the greatest stability that a denture can attain for you personally, given the amount of bone support remaining. At this point, you will decide whether or not a denture satisfies your need physically and emotionally. Those options include adding implants to improve your denture retention and stability or it may be possible to have enough implants placed to create a fixed bridge that will be just like your natural teeth.

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Dental Implants

Your Third Set of Teeth

There is no questions that over the last two decades dental implants have revolutionized tooth replacement and the practice of dentistry. The concept of dental implants is not new, the earliest recorded attempts of their use were discovered in the Mayan civilization dating back to 600 A.D. Today's highly successful dental implants consist of root replacement for a natural tooth, to which a crown is attached, just like the teeth in your mouth  when you smile, there is no visible difference. In addition they do not decay and are relatively free from developing gum disease. As with most treatment modalities in dentistry today, this not only involves scientific discovery, research and understanding but application in clinical practice. The practice of implant dentistry requires expertise in planning, surgical placement and crown fabrication; it is as much about art and experience as it is about science. It also requires teamwork between you, the patient, your dentist, an implant surgeon and dental technician.

What is a Dental Implant?

Teeth essentially can be thought of as having two main parts, the crown, the part above the gum tissues, and the root, the part that is suspended in the bone by the periodontal ligament which keeps the tooth in place. A dental or endosseous implant is actually a root replacement, but unlike the root of a tooth it becomes anchored teeth. The amazing thing about currently used dental implants is that they actually fuse with, or "integrate" into the bone, a process known as "osseo-integration". They are for the most part made of commercially pure titanium, a metallic substance used for many years in medicine and dentistry. The actual process of osseo-integration is essentially a biochemical fusion of living bone cells and bone substance to an oxide layer that forms on the surface of the titanium.

Chance Findings in Science

As with many scientific advances the discovery of osseo-integration was happily, quite by chance! In 19522, Dr. P. I. Branemark, a Swedish orthopedic surgeon was studying healing in the bones of a rabbit limb. He inserted a small optical chamber through which healing changes in the minute blood vessels of the bone could be observed. When the study was completed it was noted that the optical chamber, made of titanium had fused to the bone and could not be removed. Nearly all currently used dental implant systems in their multiple shapes and sizes utilize this magical bone loving property of titanium.

Early applications of implants in dentistry

One of the many successful applications of osseo-integration has been in dentistry with the development of dental implants; root form replacements for missing teeth. Significantly, the application of implants in dentistry was researched for approximately 25 years before becoming available for clinical use in dental practice. Dental implants were first introduced for people who had lost all their teeth and who had great difficulty stabilizing or tolerating dentures, largely because they had lost so much jaw bone upon which dentures rest. Because dental implants fuse to the bone they stabilize it and prevent further bone loss. Resorption, is a normal and inevitable process in which bone is lost when it is no longer supporting or connected to teeth. Only dental implants can stop this process and preserve the bone.

Today most implants are placed for either single or multiple tooth loss. The implants first used in the pioneering "Branemark" system were basically a one size fits all design. The original implants were all the same width, circumference, with only the length being variable. The original surfaces of the implants were machined smooth and polished. It was well known that integration is best in the densest bone, generally in the front part of the lower jaw.

Innovations from Clinical Practice

Clinical use and research have led to modifications of implant design and improvements such as the following:

  • Improved surface characteristics - from the initial smooth and polished surfaces to the current, acid etched sandblasted, nanotech surfaces. This technical advance significantly increases the microscopic surface area of implants and thereby markedly improves the degree of attachment to bone. This also increases the success rates of osseo-integration , even where bone quality is less dense.
  • Improved shapes and sizes for different tooth size replacements - Implants are made in different widths which together with improved surface characteristics provide for maximum bone to implant contact. They can therefore more easily carry the same forces as are applied to natural teeth. For example, back molar teeth have one or more roots to withstand higher biting forces necessary for chewing. Implants have likewise been developed to mirror there functions. Teeth in different areas of the mouth are designed differently to accomodate different functions.
  • Improvements in design for aesthetics - connections from implants to crowns have improved to make the teeth look perfectly natural as they emerge from the gum tissues to mimic natural teeth exactly. Materials used are essentially the same as for regular crowns to imitate natural aesthetics, function and durability. Crowns are either directly connected to the implants themselves by tiny invisible screws in the back non-visible parts of the teeth, or are cemented over little tooth like receptors just like regular crowns.

Implant Treatment - A Collaborative Approach to Treatment

Normally implants are placed by periodontists and oral surgeons, dental specialists who have undertaken training in implantology and surgery as part of their training. Implant placement requires planning and will involve collaborative efforts between the implant surgeon, dentist and laboratory technician who are responsible for building a crown on a succesfully integrated implant.

Diagnostic Steps

Your dentist and/or surgeon will follow routine procedures to asses your medical status and general health; carefully examine your mouth and the site where the potential implant or implants are to be placed; make study models of your mouth to asses your bite; take photographs if there is an aesthetic concern; take special radiographs of the site to assess bone quantity and quality; make surgical guides or templates to ensure accurate surgical implant placement. A discussion of all  the risks, benefits and alternatives of placing implants in your particular case should take place with you and you dental "team".

Implant positioning

Sometimes describes as "top down treatment planning", providing that your bite is pretty functional and other teeth are aligned correctly, the teeth to be replaced are recreated in a wax model form. The idea is then to establish the position of the underlying bone and to make sure implant(s) can be positioned directly under the wax tooth form to the implant, beneath. The implant positions can the ben predetermined using a combination of specialized radiographs and imaging technology to assure success and in the process avoid major structures like nerves and air sinuses. From this information surgical guides are fabricated to assist the surgeon in precise implant placement which in turn assures the restorative dentist that a crown will fit in the right position. If the bite will not accommodate implant placement orthodontic (braces) treatment may be necessary to reposition teeth, or bone may need to be regenerated surgically.

 

Surgical Placement

Dental Implant surgery is a relatively comfortable procedure usually carried out under local anesthesia, sometimes with the assitance of oral medication or intravenous conscious sedation for anxious patients. Some minor vibration is generally experienced during the implant site preparation, but it is quite tolerable. Since there are no open wounds following the surgery and it is minimally invasive, there is little post-operative discomfort, perhaps a day or two. The implant(s) need to be left for a period of 2-6 months to fuse or integrate with the bone in most circumstances. The healing time depends upon the bone density of the site, the more dense the bone, the quicker the integration. When the implant has integrated with the bone a crown can be made and the implant "loaded" that is, subjected to biting forces. Following succesful integration your dentist will make a crown which fits on the implant and will be exactly like a normal tooth both in form and function.

One and Two Stage Systems

In some implant systems the implants are placed, covered with the gum tissue and left to integrate or fuse to the bone. In these two stage systems, the implant is uncovered and a small connector, called a "healing abutment" is attached to the implant which connects it to the mouth above the gum. The gum tissue heals around it. After a 4-6 week period crowns can be fabricated for tooth replacement. In the one stage system the implant is left exposed at surgery, slightly protruding through the gum tissue. The two stage systems are initially more protective, however each system has its place, merits and indications. 

Types of Implants and Restorations

There are now more than 40 different types of what can now be termed traditional or standard implants available today. There are also two others, mini and micro-mini implants. Mini implants are like traditional implants but usually smaller in diameter where as micro-mini implants are a variation of the now more traditional implant design, but smaller, narrower and more screw like in appearence, they are more temporary in nature and designed to be easily removed.

Types of Implants Restorations:

  • Single tooth replacements: use one implant and as the name suggests support a single crown.
  • Multiple tooth replacements: multiple missing teeth can be replaced with multiple implants supporting fixed bridgework as small as a 3-unit bridge supported by two implants, or with multiple implants supporting a greater number of teeth. Usually a minimum number of 4-8 implants are needed to replace a full arch of teeth, 10 or more crowns by fixed bridgework.
  • Combinations of fixed and removable bridgework: generally where implants are used to support a section of fixed bridgework, to which is attached a removable section.
  • Over-dentures: where two or more implants, either standard or mini-implants, are placed to provide stabilization of the denture and preserve the underlying bone. Whereas most traditional full dentures press directly on the gum and bone causing bone loss by resorption, implant supported over-dentures protect the bone. Over-dentures are now considered the standard of care by the American Dental Associaction for the patients who have lost all of their teeth in one or both jaws. 
  • Anchorage for tooth movement (orthodontics): Implants, either standard, mini, or micro-mini implants, are now being used to provide very stable and non-movable anchor units to allow quicker and easier tooth movement.
  • Temporary bridgework: utilize micro-mini implants which are later removed when the permanent implants are healed and teeth permanently replaced. They ensure that at no time will a person be without teeth and can therefore be socially comfortable and functional.

Innovations

Immediate implant placement: More recently and in the right circumstances it has become possible to remove teeth and immediately place dental implants into the sockets. The preconditions include that there is sufficient healthy bone left into which to place an implant following tooth removal, and that the socket can accomodate an implant of approximately the same size as the tooth root removed.

Immediate implant loading: Immediate "loading" refers to the ability to not only place an implant into a socket but also to place a crown on the implant simultaneously. This procedure engenders more risk and skill and can only be carried out if the situation is appropiate. One of the keys to success of this technique is to make sure that the crown of the tooth is completely free of movement. If it is not the implant will not integrate or fuse successfully to the bone. This is more difficult to achieve for a single tooth replacement than it is for multiple teeth; they can be splinted or joined together, much like pickets in a fence, thereby guaranteeing rigidity.

Techincal Challenges

Implants are more challenging for dental clinicians to achieve acceptable aesthetic results in highly visible areas like the front of the mouth, particularly in  people who show not only teeth but the gum tissues as well. In such cases the whole tooth/gum tissue complex must be recreated including the "papillae". It is here that knowledge and experience really come to the forefront with correct prior assesment and diagnosis of the situation being paramount together with knowledge of what can be achieved. Other challenges include creating or generating bone and/or gum tissues where insufficiency exists. Both of these can be accomplished in today's world quite predictably with a variety of grafting, regenerative and plastic surgical techniques. 

Implant Success when and when not tu use Implants

A collaborative team approach is necessary to correctly asses your situation and plan the right personalized treatment options for you. While implants are highly successful in the right place, they may not be for everyone or every situation. In the right situation implant success rates in the high nineties have been consistently shown by vigorous research. Even in areas of poor bone quality and amount, success albeit slightly more limited, is quite common. 

There are many other types of highly successful dental tooth replacement systems, like fixed or removable bridgework. Sometimes implants can be used in combination with, or to support fixed or removable bridgework.

Implant success is critically dependant upon:

  • Careful assessment, diagnosis, and understanding of the site where implant replacement is sought and how the site relates to the function of the rest of the teeth.
  • The judgement, clinical experience and collaborative efforts of the implant team - dentist, surgeon and technician.

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