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Posts for category: Dental Procedures

By Donald K. Ruddell, DDS
November 27, 2018
Category: Dental Procedures
Tags: bridge   partial denture  
ATeensMissingToothMayRequireaTemporaryReplacement

Besides reduced biting and chewing function, a missing tooth can cause an embarrassing inhibition to healthy social interaction. This can be especially so for teens who greatly value peer relationships and acceptance.

Be that as it may, we typically discourage a permanent replacement for teens with a missing tooth, particularly dental implants. While we value a patient’s psychological needs, the long-term effect on dental health may be too great to advise otherwise.

The effect we’re concerned with involves jaw growth and development. Although a person’s permanent teeth have usually all erupted by early adolescence, the jaws continue to grow until the late teens or early twenties. Natural teeth can adapt to this growth because the periodontal ligament that holds them in place allows for incremental tooth movement. The teeth move in response to jaw growth and are thus able to maintain their proper relationship and alignment in the jaw as growth occurs.

Dental implants, on the other hand, are imbedded into the jaw bone: they, therefore, can’t move like natural teeth and thus can’t adjust their position with jaw growth, particularly the upper jaw as it grows forward and down. This can result in the implants appearing as though they are left behind or retreat into the jaw. It can also affect the position of the gums and inhibit their growth around the implants.

It’s best then to hold off implants and other permanent restorations until the jaw has finished developing. That, however, isn’t always easy to determine: specialized x-ray diagnostics may help, but it’s not an exact science. Your input as a parent will also be helpful, such as whether you’ve noticed the end of growth spurts (not changing clothes or shoe sizes as often) or your child’s recent similarity in appearance to other adult members of your family. It thus becomes a judgment call, based on examination and experience, as to whether it’s safe to proceed with implants — and may require erring on the side of caution.

In the meantime, there are temporary restorations that can improve appearance while you wait for the appropriate time to undertake a permanent restoration. Two of the most useful are removable partial dentures (RPDs) or a bonded bridge, a less invasive form of the traditional bridge. With a proper assessment we can advise you on which option is your best choice.

If you would like more information on tooth restorations for teenagers, 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 “Teenagers & Dental Implants.”

PayingAttentiontoCertainFactorsHelpsEnsureSuccessfulImplantOutcomes

Implants are highly regarded by both dentists and patients for their versatility and durability. But it’s their life-like appearance that “seals the deal” as the restoration of choice — not only mimicking an individual tooth, but emerging from the gum line and blending indistinguishably with other teeth in color and symmetry.

To achieve this result, we must consider a few factors beforehand, particularly the amount of bone available at the intended implant site. An implant requires a certain amount of bone to properly position it for the most natural crown appearance. The bone present around adjacent teeth can also affect your appearance: in the absence of adequate bone the papillae, triangular shaped gum tissue between teeth, may not regenerate properly between the implant and the natural teeth. This can leave a noticeable void, what dentists call “black hole disease.”

Bone loss is a significant problem particularly after tooth loss. It’s quite possible for you to lose a quarter of the bone’s width in the first year after tooth loss. To avoid this, we often use bone grafting techniques immediately after extraction to lessen bone loss; if it’s already occurred we may be able to use similar reconstructive techniques to rebuild and encourage renewed bone growth. In the end, though, if there remains a significant level of bone loss it may be necessary to consider another option for tooth replacement other than implants.

The thickness of your gum tissue, a genetic trait, can also have an impact on the implant’s ultimate appearance. Thicker gum tissues are generally more resilient and easier to work with surgically. Thinner gum tissues are more susceptible to recession and tend to be more translucent, which could cause the underlying metal implant to be visible. Thus, working with thinner gum tissues requires a more delicate approach when trying to achieve a visually appealing result.

All these factors must be balanced, from implantation to final crown placement. But with careful planning and attention to detail throughout the process, many of these issues can be overcome to produce a satisfying result — a new and appealing smile.

If you would like more information on the aesthetics of 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 “Matching Teeth & Implants.”

By Donald K. Ruddell, DDS
October 18, 2018
Category: Dental Procedures
Tags: dental implants  
WhatyoucanExpectifYoureUndergoingImplantSurgery

If you’re considering different options for tooth replacement, dental implants are likely high on your list. Implants have a proven reputation for both durability and life-like appearance that can restore mouth function and revitalize your smile.

There is one aspect concerning implants, however, which gives people pause — the surgical procedure required to place the implants in the jawbone. If you’re leery about undergoing this procedure we can put your mind at ease — for most patients implant surgery is a minor, pain-free process with little discomfort afterward.

While there are variations in style, implants generally have two major components: a titanium post that’s implanted into the jawbone and a permanent life-like crown that’s affixed 6 to 12 weeks after implant surgery. Titanium is the metal of choice because of its affinity with bone cells; over time bone will grow to and attach itself around the implant, a process known as osseo-integration. The metal post is normally spiral in shape, allowing it more surface area for bone to adhere to.

In the beginning of the procedure we administer local anesthesia to fully numb the area before proceeding. After accessing the bone through tiny incisions in the gum tissue, we create a small channel in the exposed bone. A surgical guide may be used to prepare the precise location for the implant with a series of drilling sequences that increases the channel until it matches the implant size. While this takes place, you should only feel a mild vibration and a little pressure from the drill.

The implants are then removed from their sterile packaging and placed immediately into the prepared site. The gum tissues are then sutured into place with self-absorbing sutures. Most people have only mild discomfort after the surgery that can be managed with a prescription-strength non-steroidal anti-inflammatory drug like ibuprofen. We may also prescribe antibiotics and other care instructions to ensure successful gum tissue healing.

With proper planning and precise implant placement by skilled hands, implant surgery is an easy and uneventful procedure. And, with your new crowns in place, your new, beautiful smile will make the experience a distant memory.

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 Donald K. Ruddell, DDS
September 28, 2018
Category: Dental Procedures
NewFrontTeethforaTeenagedDavidDuchovny

In real life he was a hard-charging basketball player through high school and college. In TV and the movies, he has gone head-to-head with serial killers, assorted bad guys… even mysterious paranormal forces. So would you believe that David Duchovny, who played Agent Fox Mulder in The X-Files and starred in countless other large and small-screen productions, lost his front teeth… in an elevator accident?

“I was running for the elevator at my high school when the door shut on my arm,” he explained. “The next thing I knew, I was waking up in the hospital. I had fainted, fallen on my face, and knocked out my two front teeth.” Looking at Duchovny now, you’d never know his front teeth weren’t natural. But that’s not “movie magic” — it’s the art and science of modern dentistry.

How do dentists go about replacing lost teeth with natural-looking prosthetics? Today, there are two widely used tooth replacement procedures: dental implants and bridgework. When a natural tooth can’t be saved — due to advanced decay, periodontal disease, or an accident like Duchovny’s — these methods offer good looking, fully functional replacements. So what’s the difference between the two? Essentially, it’s a matter of how the replacement teeth are supported.

With state-of-the-art dental implants, support for the replacement tooth (or teeth) comes from small titanium inserts, which are implanted directly into the bone of the jaw. In time these become fused with the bone itself, providing a solid anchorage. What’s more, they actually help prevent the bone loss that naturally occurs after tooth loss. The crowns — lifelike replacements for the visible part of the tooth — are securely attached to the implants via special connectors called abutments.

In traditional bridgework, the existing natural teeth on either side of a gap are used to support the replacement crowns that “bridge” the gap. Here’s how it works: A one-piece unit is custom-fabricated, consisting of prosthetic crowns to replace missing teeth, plus caps to cover the adjacent (abutment) teeth on each side. Those abutment teeth must be shaped so the caps can fit over them; this is done by carefully removing some of the outer tooth material. Then the whole bridge unit is securely cemented in place.

While both systems have been used successfully for decades, bridgework is now being gradually supplanted by implants. That’s because dental implants don’t have any negative impact on nearby healthy teeth, while bridgework requires that abutment teeth be shaped for crowns, and puts additional stresses on them. Dental implants also generally last far longer than bridges — the rest of your life, if given proper care. However, they are initially more expensive (though they may prove more economical in the long run), and not everyone is a candidate for the minor surgery they require.

Which method is best for you? Don’t try using paranormal powers to find out: Come in and talk to us. If you would like more information about tooth replacement, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Crowns & Bridgework,” and “Dental Implants.”

By Donald K. Ruddell, DDS
August 29, 2018
Category: Dental Procedures
Tags: teeth whitening  
StainingWithinaToothRequiresaClinicalWhiteningApproach

Home whitening kits are a popular way to turn a dull smile into a dazzling one. But these self-applied products only work for teeth with outer enamel stains — if the discoloration originates inside a tooth, you’ll need professional treatment.

Known as “intrinsic staining,” this type of discoloration most often occurs within a tooth’s pulp or dentin layers. There are a number of causes like tooth trauma or tetracycline use at an early age. A root canal treatment used to remove infection from deep within a tooth can also cause discoloration: sometimes blood pigments left after tissue removal or the filling materials themselves can stain a tooth’s interior.

Intrinsic staining can often be treated by placing a bleaching agent, usually sodium perborate, into the tooth’s pulp chamber. But before undertaking this procedure on a tooth that’s undergone a root canal treatment, we want to first ensure the filling is intact and still adequately sealing the tooth from infection. We also want to make sure the supporting bone is also healthy.

If all’s well, we access the pulp in the same way as the root canal treatment, and preferably through the same access hole. We then clean out the pulp chamber of any stained matter and then ensure the root canals remain filled and sealed off from the pulp chamber.

We can then place the bleaching agent into the pulp, a process that will need to be repeated every three or four days to achieve the desired level of brightness. After each session we place a cotton pellet over the opening and held in place with a temporary adhesive; we can easily remove and re-apply this covering during subsequent sessions. Once we’ve achieved the desired color change, we seal the tooth with a permanent filling and restore the access cavity with a tooth-colored composite resin material bonded to the enamel and dentin.

There are other options for an intrinsically stained tooth like veneers or crowns that outwardly cover the discoloration. Internal bleaching, however, is a more conservative approach that causes less alteration of the tooth. If successful, it can restore a stained tooth to a brighter, more attractive shade.

If you would like more information on internal bleaching, 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 “Whitening Traumatized Teeth.”