Posts for category: Dental Procedures

By Shapiro & Rollman DDS
April 26, 2021
Category: Dental Procedures
Tags: dental implant  
OvercomingBoneLossPreventingYouFromGettinganImplant

Introduced to the United States in the 1980s, dental implants have quickly become the go-to restoration for tooth replacement. And for good reason: they're not only incredibly life-like, they're highly durable with a 95% success rate.

But as desirable as they are, you may face a major obstacle getting one because of the condition of the bone at your implant site. To position the implant for best appearance and long-term durability, we must have at least 4-5 mm of bone available along the horizontal dimension. Unfortunately, that's not always the case with tooth loss.

This is because bone, like other living tissue, has a growth cycle: Older cells die and dissolve (resorb) and newer cells develop in their place. The forces transmitted to the jaw from the action of chewing help stimulate this resorption and replacement cycle and keep it on track. When a tooth is lost, however, so is this stimulus.

This may result in a slowdown in cell replacement, causing the eventual loss of bone. And it doesn't take long for it to occur after tooth loss—you could lose a quarter of bone width in just the first year, leaving you without enough bone to support an implant. In some cases, it may be necessary to choose another kind of restoration other than implants.

But inadequate bone isn't an automatic disqualifier for implants. It's often possible to regenerate lost bone through a procedure known as bone augmentation, in which we insert a bone graft at the missing tooth site. The graft serves as a scaffold for new bone cells to grow upon, which over time may regenerate enough bone to support an implant.

Even if you've had a missing tooth for some time, implementing bone augmentation could reverse any loss you may have experienced. In fact, it's a common practice among dentists to place a bone graft immediately after a tooth extraction to minimize bone loss, especially if there will be a time lag between extraction and implant surgery.

Bone augmentation could add extra time to the implant process. But if successful, it will make it possible for you to enjoy this popular dental restoration.

If you would like more information on dental implant 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 “Dental Implants After Previous Tooth Loss.”

WhatChrissyTeigensInaugurationNightCapMishapCouldMeanForYou

Inauguration night is usually a lavish, Washington, D.C., affair with hundreds attending inaugural balls throughout the city. And when you're an A-List celebrity whose husband is a headliner at one of the events, it's sure to be a memorable night. As it was for super model Chrissy Teigen—but for a slightly different reason. During the festivities in January, Teigen lost a tooth.

Actually, it was a crown, but once she told a Twitter follower that she loved it “like he was a real tooth.” The incident happened while she was snacking on a Fruit Roll-Up (those sticky devils!), and for a while there, husband and performer John Legend had to yield center stage to the forlorn cap.

But here's something to consider: If not for the roll-up (and Teigen's tweets on the accident) all of us except Teigen, her dentist and her inner circle, would never have known she had a capped tooth. That's because today's porcelain crowns are altogether life-like. You don't have to sacrifice appearance to protect a tooth, especially one that's visible when you smile (in the “Smile Zone”).

It wasn't always like that. Although there have been tooth-colored materials for decades, they weren't as durable as the crown of choice for most of the 20th Century, one made of metal. But while gold or silver crowns held up well against the daily grind of biting forces, their metallic appearance was anything but tooth-like.

Later, dentists developed a hybrid of sorts—a metal crown fused within a tooth-colored porcelain shell. These PFM (porcelain-fused-to-metal) crowns offered both strength and a life-like appearance. They were so effective on both counts that PFMs were the most widely used crowns by dentists until the early 2000s.

But PFMs today make up only 40% of currently placed crowns, down from a high of 83% in 2005. What dethroned them? The all-ceramic porcelain crown—but composed of different materials from years past. Today's all-ceramic crowns are made of more durable materials like lithium disilicate or zirconium oxide (the strongest known porcelain) that make them nearly as strong as metal or PFM crowns.

What's more, coupled with advanced techniques to produce them, all-ceramic crowns are incredibly life-like. You may still need a traditional crown on a back tooth where biting forces are much higher and visibility isn't an issue. But for a tooth in the “Smile Zone”, an all-ceramic crown is more than suitable.

If you need a new crown (hopefully not by way of a sticky snack) or you want to upgrade your existing dental work, see us for a complete exam. A modern all-ceramic crown can protect your tooth and enhance your smile.

If you would like more information about crowns or other kinds of dental work, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Crowns & Veneers.”

By Shapiro & Rollman DDS
March 27, 2021
Category: Dental Procedures
Tags: crowns  
HeresWhatYouNeedToKnowAboutDentalInsuranceandChoosingaCrown

Millions of Americans rely on dental insurance to help them better afford dental care. Depending on the benefit package, an insurance policy can be useful in restoring dental health compromised by disease or injury.

But how life-like that restoration may appear is often a secondary concern with many insurance plans. For example, dental insurance will pay for a crown restoration that restores function to a tooth, but not necessarily of the highest aesthetic quality for achieving a truly life-like appearance.

To be sure, not all dental crowns are the same. Some are all metal, usually gold or silver. Some are “hybrids,” made of an interior metal shell with an outer fused porcelain shell (porcelain-fused-to-metal or PFM). In recent years all -ceramic crowns made of stronger life-like ceramics have become the most popular.

The type of crown used will depend a great deal on the type and location of the tooth. Teeth on the back of the jaw that encounter greater biting forces and are not as noticeable in the smile may do better with a metal or PFM crown. Visible side and front teeth are more likely candidates for all-ceramic. Your dentist will give you your best options as it pertains to your dental needs and appearance.

There's also a difference in crown workmanship. Dental laboratories now use milling machinery that sculpts a crown from a single block of material. Although some final handwork by skilled technicians is still necessary, milling has streamlined the process—and the cost—for producing a crown of high functioning quality.

But crowns that achieve the most natural smile appearance require more in the way of artistic craftsmanship. This in turn can increase the crown's price—beyond what many dental policies agree to cover. You may then be faced with a decision: an insurance-covered functional crown with an acceptable level of life-likeness or a more life-like crown for which you may have to pay more out-of-pocket.

Your dentist can advise you on your best options for a crown restoration, also factoring in what your insurance will cover. Ultimately, though, you'll have to weigh the kind of smile you desire with your dental situation and finances.

If you would like more information on dental crown 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 “Porcelain Dental Crowns.”

DentalImplantsAreEvenMoreAdvancedThanksToTheseOtherTechnologies

When dental implants hit the scene in the 1980s, they revolutionized the field of dental restorations. But as groundbreaking as they were then, they're even more advanced now.

Some of the advancements have to do with improvements in implant design and manufacturing. Implant sizes and shapes were once quite limited, but today they come in a variety of forms to better match the types of teeth they replace.

But there has also been important progress in complementary technologies that help us realize better outcomes. Many of these other advances have had a positive impact on the planning and surgical stages of implant installation.

CT/CBCT scanning. For the best outcome, it's critical to install an implant at the most appropriate location on the jaw. This can be difficult to determine, however, because of the location of oral and facial structures like nerves or sinuses that might interfere with implant placement. But using a type of computer tomography (CT) scanning called cone beam CT, we can produce a 3-D computer graphic image that helps us navigate possible obstructions as we pinpoint the ideal location for an implant.

Digital smile displays. We're now able to produce digital models of the mouth, which can assist with more than implant placement—we can also use them to visualize what a new smile with implants will look like before we install them. This is especially helpful in situations where only a few teeth need to be replaced: We want to ensure that the new implant crowns blend seamlessly with the remaining teeth for the most natural appearance.

Custom-made surgical guides. We've been using surgical guides to mark the exact drilling locations during implant surgery for many years. But 3-D printing technology can now help us produce surgical guides that are even more useful and precise. Using a 3-D printer, we can produce oral devices based on the patient's individual dental dimensions captured through digital scanning. That produces a better fit for the guide on the teeth and more accurate implant placement.

Together, these and other technological advances are helping us achieve even more successful results. Not only can they help us produce implant outcomes that can last for years or even decades, but also the most beautiful smiles possible.

If you would like more information on dental implant 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 “How Technology Aids Dental Implant Therapy.”

By Shapiro & Rollman DDS
February 15, 2021
Category: Dental Procedures
Tags: dental implants  
HowLongIstheImplantProcessItDependsonYourBoneHealth

If you're thinking about getting dental implants, you may be curious about how long it might take. The answer depends on the health of your supporting bone.

Bone is an integral part of implant functionality as bone cells gradually grow and adhere to the newly placed implant to give it its characteristic strength. The implant also requires an adequate amount of bone to accurately position it for the best appearance outcome.

If the bone is sufficient and healthy, we can proceed with the surgical placement of the implant. The most common practice following surgery is to allow a few weeks for the bone integration described previously to take place before finally attaching the crown. With an alternative known as a “tooth in one day” procedure, we install a crown right after surgery, which gives you a full smile when you leave.

There's one caveat to this latter method, though—because the implant still requires bone integration, this immediate crown is temporary. It's designed to receive no pressure from biting or chewing, which could damage the still integrating implant. We'll install the permanent crown after the implant and bone have had time to fully mesh.

So, if your supporting bone is sound, the complete implant process may only take a few weeks. But what if it's not—what if you've lost bone and don't have enough to support an implant? In that case, the length of process time depends on the severity of the bone loss and if we're able to overcome it. In some cases, we can't, which means we'll need to consider a different restoration.

But it's often possible to regenerate lost bone by grafting bone material at the implant site. If the bone loss is moderate, it may take 2 to 4 months of regrowth after grafting before we can perform implant surgery. If it's more significant or there's disease damage to the socket, it may take longer, usually 4 to 6 months. It largely depends on the rate of bone regeneration.

In a nutshell, then, the health of your jaw's supporting bone has a lot to do with whether the implant process will take a few weeks or a few months. Regardless of the time, though, you'll gain the same result—new, functional teeth and a more attractive smile.

If you would like more information on dental implant 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 “Implant Timelines for Replacing Missing Teeth.”