Of all the of amazing procedures in today's dentistry, surgery that causes new bone to grow — in places where it had previously been lost — is high on the list of the most extraordinary. (When bone is lost or resorbed, it is broken down into its mineral components, which are dissolved into the bloodstream. Resorption of tooth-supporting bone often takes place after teeth are lost.) Dental techniques that cause new bone growth are important because a certain amount of bone is needed to replace lost teeth with dental implants.

Today's dental implants themselves are an amazing innovation. Implants consist of a replacement for the tooth's root, usually made of a metal called titanium. A replacement for the crown, the part of the tooth that is visible above the gums, is attached to the titanium root. Titanium has the remarkable quality of being able to fuse with the bone in which it is anchored. This process, first discovered in the 1950s, is called osseointegration.

In the case of missing upper back teeth, many people who wanted dental implants in the past were told that they did not have enough bone to anchor the implants and that they had to get removable dentures instead.

But now a new surgery called maxillary sinus augmentation can cause your body to regenerate bone where it was lost and is needed to anchor dental implants.

Bone in the upper jaw or maxilla usually supports your upper back teeth. Inside the maxilla, on either side of your upper jaw, are air spaces in the bone, which are lined with a membrane. These spaces, called the maxillary sinuses, are generally shaped like pyramids; but their shape and size is different in each person. The new surgical procedures involve lifting up the sinus membrane in the area where bone is needed and filling the space thus created with a bone grafting material. Your body then creates new bone to fill the space. This usually takes about six months. If you have almost enough bone to stabilize the implants, they can be placed simultaneously with the graft, thus saving time and avoiding a second surgical procedure.

All grafting materials used today are approved by the Food and Drug Administration (FDA) and must be prepared according to their guidelines. They are specially treated to render them completely safe for human use.

After the surgery there is usually no more than mild to moderate swelling and some discomfort, about the same as having a tooth removed.

If you are missing upper back teeth, contact us to schedule an appointment to evaluate your upper jaw. You can also learn more about this procedure by reading the Dear Doctor magazine article “Sinus Surgery.”

When you have your teeth bleached in a dental office, the results almost seem like magic. Let's push aside the magician's cape and see what is really happening in professionally-applied, in-office tooth whitening.

How do teeth become discolored?
A tooth's enamel covering is mostly composed of mineral crystals. At a microscopic level, you can see a framework or matrix of organic (living) matter interspersed between the crystals of enamel creating a very irregular surface capable of retaining stains. Chromagenic (color generating) organic compounds can become part of this organic matrix resulting in tooth staining. They can be bleached without affecting the mineral structure of the tooth's enamel.

As people get older and their teeth wear, the enamel loses its youthful translucency and the underlying layer, called dentin, thickens and becomes more yellow. Such changes to the actual tooth structure are called intrinsic staining. Other causes of intrinsic discoloration are exposure to high levels of fluoride or tetracycline antibiotic administration during childhood, tooth decay, or root canal problems, among others. Discoloration can also be caused by external staining from certain foods, drinks, or tobacco products. Such surface stains are called extrinsic staining.

Behind the Magic
Materials used for tooth bleaching are hydrogen peroxide and carbamide peroxide. Peroxides are commonly used as bleach, and you may have seen them used as hair bleaches, for example. Hydrogen peroxide is a strong oxidizing agent that attacks the organic molecules responsible for tooth discoloration, bleaching them until they lose their color. Carbamide peroxide also contains urea, which is a compound that permits the peroxide to remain in contact with the teeth for longer amounts of time without harming them.

Often called power bleaching, the in-office technique uses a high concentration of peroxide solution (35-45% hydrogen peroxide), placed directly on the teeth in the form of a gel. A heat or light source may enhance the peroxide release. The gel is applied with trays custom fitted to your mouth, and specific barriers are applied to protect sensitive gum tissue from the solution. Results show teeth becoming up to ten shades lighter in about an hour.

In-office bleaching under the supervision of my staff and me is recommended if you have severely stained teeth, and particularly if you are about to have veneers or crowns made. It's a way to rediscover the pearly translucency of your youthful smile.

Contact us today to schedule an appointment to discuss your questions about tooth bleaching. You can also learn more by reading the Dear Doctor magazine article “Teeth Whitening.”

If you have a tooth that just doesn't look good because of decay or injury, a porcelain laminate veneer is probably a good way to make it look as good as it ever did — and maybe even better! Dental veneers are composed of thin layers of dental ceramic material. They essentially replace the original tooth enamel and require preparation of the tooth by removing a small amount of enamel to allow room for the placement of the veneer.

Recently, more and more dentists have been using minimal prep or prepless techniques that do not require this preparation. In such cases, the porcelain is bonded directly to the outer layer of the tooth's enamel. Highly skilled dental technicians can design a custom-fit veneer that feathers into the tooth just short of the gum line.

Prepless techniques cannot be used in all situations, but when they are used appropriately the results are beautiful and very stable. Should you get prepless veneers? The following is a list of advantages and disadvantages of prepless veneers.

Advantages of prepless veneers include:

• Tooth preparation or reduction is not needed, leaving the original tooth whole.
• They are not placed under the gum tissue, eliminating the possibility that the restorations negatively impact the gum tissue.
• They can be used to change the appearance of teeth that are too small or misshapen making the teeth look larger and eliminate unwanted spacing.
• They can be used to “lengthen” teeth that have been worn down by grinding.
• Since the underlying tooth has not been reduced, prepless veneers are reversible and practically risk-free.

Disadvantages include:

• There are many cosmetic situations in which they cannot be used, and traditional veneers (requiring preparation) must be used instead.
• Prepless veneers cannot be used in cases in which orthodontic treatment is recommended to move the teeth, such as improper tooth position, poor bite, or a poor facial profile.
• Since they are added on to existing tooth structure, they do not work for teeth that are relatively large or in a forward position in a smile.
• They do not usually work for lower teeth because of space restrictions.
• They cannot replace lost or damaged enamel.

Working with prepless veneers requires special skills and training. Please discuss our credentials and experience with us when you inquire about this technique. We can assess your specific situation and let you know whether restoration without the drill is appropriate for you.

Contact us today to schedule an appointment to discuss your questions about prepless veneers. You can also learn more by reading the Dear Doctor magazine article “Porcelain Veneers Without the Drill.”

The term “root canal” strikes fear into many dental patients. But rest assured that this procedure is the best solution to many severe dental problems. It can be pain-free and will actually relieve pain and suffering from infections and dental injuries.

Why would you need root canal treatment? This procedure becomes necessary when the pulp, the nerve tissue on the inside of a tooth's root, becomes inflamed or infected because of deep decay, or when it has suffered a severe injury as a result of an accident or blow to the mouth. The pulp is composed of living tissues including nerves and blood vessels.

Root canal treatment may be necessary if you have a wide variety of signs or symptoms. The pain can feel sharp or intense when biting down, or linger after eating hot or cold foods. Sometimes it can be a dull ache or there may be tenderness and swelling in your gums near the site of the infection.

After trauma, the pulp of a tooth can be exposed or damaged because a tooth has fractured or cracked, necessitating root canal treatment. And the procedure is often needed for permanent teeth that have been dislodged or knocked out.

What exactly is root canal treatment? Root canal treatment is also called endodontic treatment, from the Greek roots “endo” meaning “inside” and “odont” meaning “tooth.” During the procedure, the area is numbed to relieve pain. A small opening is created in the chewing surface of the tooth and very small instruments are used to remove dead and dying tissue from the inside. The pulp is needed during a tooth's growth and development, but a mature tooth can survive without it. The canal is disinfected and then sealed with filling materials. Sometimes root canal specialists use microscopes to work at an intricate level of detail on these tiny areas of the tooth's root.

By having root canal treatment, you prevent inflammation and infection from spreading from the root of a particular tooth to other nearby tissues. Infection can result in resorption, an eating away of the root and its anchoring bone, and you could lose your tooth or teeth. So please don't hesitate when we recommend this treatment. It's not as bad as you think, and you will feel significantly better afterwards.

Contact us today to schedule an appointment to discuss your questions about root canal treatment. You can also learn more by reading the Dear Doctor magazine articles “Common Concerns About Root Canal Treatment” and “Trauma & Nerve Damage to Teeth.”

Even with all the medical know-how we possess at the dawn of the 21st century, complete tooth loss is still a big problem. In this country, more than a quarter of all adults between ages 65 and 74 have lost all of their teeth. For these individuals, removable full dentures are often still used as an affordable and effective way to replace missing teeth.

Success with dentures originates from a collaboration among dentist, laboratory technician, and, of course, the denture-wearer. Creating false teeth that look natural is as much an art as it is a science. We take a number of steps to make sure you will get the best results. These include:

• Positioning the teeth. Using facial landmarks and photographs of how you used to look before your teeth were lost helps us determine where to place each tooth and how the upper and lower teeth should line up in relation to each other. For example, we will consider what size the teeth should be; how close to the lip they should be; and how much space should exist between the upper and lower teeth when they are at rest.
• Simulating natural gums. If you are someone with a “high lip dynamic” (a lot of gum shows when you smile), it is particularly important to simulate real gum tissue in a set of full dentures. Fortunately, there are many colors and textures available to create a realistic effect. Again, photographs can be helpful in achieving this.
• Balancing the bite. We must make sure that your upper and lower dentures come together in a way that facilitates normal biting, chewing, and speech.

As a denture wearer, you will need to visit our office regularly to make sure the gum tissue and bone upon which your dentures rest stay healthy. It's common to see a gradual loss of bone in people who wear dentures at a rate that varies from person to person. This bone loss can affect the fit of your dentures and lead to other health problems, which we can address if we are monitoring you on an ongoing basis.

If you have any questions about dentures, please contact us or schedule an appointment for a consultation. You can learn more about this topic by reading the Dear Doctor magazine article “Removable Full Dentures.”