Crowns
| ABOUT CROWNS |
Crowns (caps) are made from gold and/or porcelain to restore teeth when large amounts of tooth structure has been lost. Decay, fractured teeth or the replacement of old large fillings with stronger materials are frequent reasons for crown placement. Crowns can also be used to improve the way teeth look. Sometimes when a tooth is lost we can replace it with a bridge which has crowns on the teeth adjacent to the space left by the extracted tooth and suspending an artificial tooth or teeth between the crowns. The bridge forms one solid unit spanning the space left by the missing tooth. It restores function and prevents shifting of the teeth. |
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To prepare for a crown the tooth is first given anesthetic. The old filling and decay are removed, and then the tooth is prepared to precisely retain the final crown. A temporary crown is formed and placed onto the tooth with a soft temporary cement. This protects the tooth until the final crown is cemented several weeks later. An impression is taken of the tooth from which a model is made. Using the lost wax process the crown is formed and cast using special gold alloys. The casting is checked on the models for fit and polished. |
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When you return for your crown the temporary will be removed and the new crown will be checked for fit. The tooth is cleaned off, the crown is permanently cemented, and the excess cement is removed. |
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Root Canals
| ABOUT ROOT CANALS |
Teeth are made up of three layers. The outermost layer is the enamel and does not have sensation. It is very hard and protects the innermost layers of the tooth. The second layer is the dentine which has nerves from the pulp of the tooth. These nerves leave the pulp via a root canal that travels the tip of the root. Sometimes a tooth becomes very sick as a result of decay, trauma or infection. The pulp dies and the tooth becomes very painful as the pressure builds up in the jaw bone. If left untreated the tooth would become loose and eventually be lost. |
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Root canal therapy starts with anesthetic to numb the tooth and drilling a small access hole in the top of the tooth into the pulp chamber. The remains of the pulp is removed which includes the nerve. Shaping of the root canal to receive a filling is done over several appointments. Antibiotics may be given to control infection. After the canal has been cleaned, shaped and filled a reinforcing post will be made to strengthen the tooth and prepare it for a crown which will protect the weak tooth. |
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After treatment the tooth will not experience hot or cold, however, normal biting pressure is still felt. Most people do not feel a difference in the tooth. The pain associated with root canal therapy usually involves the pressure of the infection and not the dental office procedure. After the infection has been managed there is usually very little pain as the nerve in the tooth no longer is present. In the event that pain exists pain medication will have to be prescribed. |
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Dentures and Partials
| ABOUT DENTURES AND PARTIALS |
Dentures and partials are dental appliances used to replace missing teeth in situations where a fixed bridge cannot be made. Implants can sometimes increase the stability of these appliances or give one the opportunity to have a fixed bridge instead. Even though dentures and partials can be a good substitute for your natural teeth they will never chew as well as your original teeth because they rest on the gums which must endure all of the stress during chewing. Soreness of the gums under your appliance is common and reason to call Dr. Jacobs for an office visit. New dentures can take several office visits to make them comfortable. First time denture wearers often find them to feel large and it may make your feel like gagging until you become used to having it in your mouth. Because the gums and jaw bone shrink over the years the appliance may not fit well in several years and may have to be relined or remade. |
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Implants - Information concerning osseointegration and implant prostheses
This information is furnished to you so that you may understand the risks and benefits of undergoing restorative dental treatment involving osseointegrated implants.
Implant dentistry is a treatment modality which combines an implant surgeon (per periodontist or oral surgeon). prosthodontist, and dental laboratory technician. This team of professionals is dedicated to providing patients with an alternative to conventional methods of tooth replacement.
While dental implants have been studied for many years, osseointegrated implants are relatively new. The term osseointegration refers to a bond which is developed between living bone and the surface of an implant fixture. (The fixture of an implant system refers to that portion which is placed within the jaw bone). A Swedish team of researchers led by Professor Branemark has been credited with the application of principles of osseointegration to dental implants. Osseointegrated dental implants have been used in the United States since approximately 1984, although in Sweden and other countries they have been used for over twenty years. Commercially pure titanium (C.P. Titanium) fixtures have been studied for the longest period of time but other materials have more recently demonstrated the capacity to osseointegrate.
Numerous research efforts involving patients receiving C.P. Titanium implants have documented the success rate of achieving osseointergation at over 80% on the lower arch and over 90% on the upper arch. Generally, fixture integration is most predictable in the anterior of the mouth with the upper posterior yielding the lowest rate of success. Long term clinical studies of five and ten years (and more) indicate that the vast majority of implant fixtures remain functional for extended periods of time once they have achieved osseointegration. Success rates of other researchers may not represent our results but to date we have achieved similar success.
Results of studies supporting implant systems with fixtures comprised of materials other than C.P. Titanium are promising but limited. This is not to say that other systems are less predictable, only that scientific research has not yet documented clinical success rates as thoroughly. Generally it is the responsibility of the surgeon to select an implant system. Certain situations may require that a specific system be selected on the basis of criteria other than documented osseointegration success rtes (i.e. anatomic deficiencies, space constraints, financial limitations, etc.).
Osseointegrated implants may be used to support, stabilize, and/or retain removable dentures (overdentures) or fixed bridges. They may assist in replacing several teeth in an arch (partially edentulous) or all of the teeth in an arch (completely edentulous). In partially edentulous arches they may support fixed bridges together with natural teeth or independently. At times, restorations supported by implants may be electively connected to natural teeth in order to assist the natural teeth in resisting functional forces (i.e. splinting). The framework is fabricated from metal alloys while the artifical teeth may be fabricated from acrylic resin, metal or porcelain. The primary advantages associated with removable prostheses include accessibility for home care, usually reduced cost, and relative ease of prosthesis modification, should that be required. The primary advantages associated with fixed prosthesis include the absence of mucosal pressures and the fact that only the dentist can remove the prosthesis.
Not everyone is a candidate for osseointegrated implants. Patients who function well with existing conventional fixed or removable prostheses need not become involved in these procedures. At times, existing prostheses which are clinically unacceptable may be remade in a conventional fashion and satisfy a patient’s functional, comfort and esthetic needs. Emotionally, the implant procedure may be challenging for some patients. An extended period of time is required for treatment, at least two surgical procedures are required, and the patient may have to function for various time periods without a prosthesis. While integrated implants provide firm anchorage for prostheses, it is not the same as having natural teeth.
Initial diagnosis and treatment planning involves examination by a prosthodontist and a surgeon including evaluation of the oral tissues, x-rays, and mounted diagnostic models. Following evaluation, the various treatment options are presented to the patient for consideration. The final plan may include conventional or implant supported prostheses as well as necessary therapy of other areas of the mouth.
Two surgical procedures are required to place implants. At the first surgery, the implants fixtures are placed within recepticle sites in the jawbone at predetermined locations. The mucosa is sutured over the fixtures. Following a one to two week healing period, the existing denture (when applicable) may be relieved and relined to adapt to the healed ridge. A period of three (lower arch) to six (upper arch) months is required to permit the fixture to osseointegrate or bond to the bone. Care must be taken during this healing period to avoid trauma to the mucosa overlying the implant sites. At the second surgery the implant fixture is exposed and a transmucosal post (abutment) is connected. This portion protrudes through the mucosa and connects the fixture to the prosthesis. Following the second surgery the patient may again be without a prosthesis for one to two weeks. After healing, the implant supported prosthesis will be fabricated. This procedure usually requires approximately 4-6 appointments over a 2-3 month period.
At the time of the second surgery, the success of osseointegration of each fixture is usually determined. Those fixtures which do not demonstrate osseointegration are usually removed at this time. Inability of a fixture to achieve osseointegration my be associated with loss of bone height in the area. If necessary, the same site may be used for placement of additional fixtures following a nine month healing period. (This nine month healing period is also usually recommended in areas where teeth have been removed prior to fixture placement). Fixtures which demonstrate unfavorable locations or angulation may be “put to sleep” or remain in the jawbone without the connection of a transmucosal post.
The osseointegration process begins with initial bone formation around the implant in three to six months. Once the implant is placed in function, the bone formation and remodeling continues actively for another twelve to eighteen months. Some remodelling continues indefinitely and gradual loss of bone height is a normal radiographic observation around fixtures. The rate is approximately 1.5 mm the first year and .1 mm annually, which is less than the bone loss normally observed in areas of the jawbone which support conventional removable prostheses.
Implant fixtures which appear to be integrated at the second surgery may be lost in the future. Should a fixture be removed following delivery of the final prosthesis due to loss of osseointegration or mechanical failure, the prosthesis may require modification or replacement depending upon the location, size, and number of the remaining fixtures. In some instances the implant procedure fails completely and the implants must be removed and a conventional prosthesis remade. In such instances there will probably be less bone then there was initially as a result of the implant surgery. Ridge augmentation and/or skin grafting are alternative modes of treatment that may be recommended.
Optimum plaque control through meticulous home care and frequent professional recalls are essential to long term success of the implants. At regular intervals, maintenance appointments should be scheduled for examination, x-rays, prophylaxis, removal of fixed components, replacement of components, relines and remakes as recommended.
A number of risks and complications may be associated with the surgical and prosthodontic phases of implant therapy, These are reviewed thoroughly in the implant consent forms which will be provided our office and the surgeon.
Patients who contemplate receiving osseointegrated services should do so knowing that no guarantees are made and that negative consequences are possible. Where indicated and successful, the procedure offers a solution to prosthodontic restorative problems with predictable results. I am pleased to offer the osseointegrated implant prosthetic service and I hope that this information has been of value in making your decision.
Extractions
| ABOUT EXTRACTIONS |
Teeth are sometimes too sick to save due to extensive decay, gum disease, fracture, or infections. There are situations where there is not adequate room for the teeth to erupt. In these and other circumstances the patient and doctor may decide that extraction of the tooth is the best treatment. |
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The tooth is first given anesthetic. It is then removed and a pressure pack of gauze is placed over the socket. The patient keeps gentle preassure on this gauze for 45 minutes and replaces it with fresh gauze if bleeding persists. A clot forms in the socket and acts as a healing bandage. This clot must not be disturbed until healing takes place over the next week. |
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