My Blog

Posts for tag: dental implants

By John A. Pagliei, Jr., DMD
April 04, 2019
Category: Dental Procedures
Tags: dental implants   dentures  
DentureswithImplantsCouldHelpYouAvoidBoneLoss

Even with modern prevention and treatment advances, losing teeth in later life is still a sad but common part of human experience. Just as generations have before, many today rely on dentures to regain their lost dental function and smile.

But although effective, dentures have their weaknesses. The most serious: they can't prevent jawbone deterioration, a common problem associated with tooth loss.

Bone health depends on chewing forces applied to the teeth to stimulate replacement growth for older bone cells. When teeth are gone, so is this stimulation. Dentures can't replicate the stimulus and may even accelerate bone loss because they can irritate the bone under the gums as they rest upon them for support.

But there's a recent advance in denture technology that may help slow or even stop potential bone loss. The advance incorporates implants with dentures to create two hybrid alternatives that may be more secure and healthier for the supporting bone.

The first is known as an overdenture, a removable appliance similar to a traditional denture. But instead of deriving its support from the gums alone, the overdenture attaches to three to four implants (or only two, if on the lower jaw) that have been permanently set into the jawbone. This not only increases stability, but the implants made of bone-friendly titanium attract and foster increased bone growth around them. This can help slow or even stop the cycle of bone loss with missing teeth.

The second type is a fixed denture. In this version, four to six implants are implanted around the jaw arch. The denture is then secured in place to these implants with screws. It's a little more secure than the overdenture, but it's also more expensive and requires good quality bone at the implant sites.

If you've already experienced significant bone loss you may first need bone grafting to build up the implant sites for these options, or choose traditional dentures instead. But if you're a good candidate for an implant-supported denture, you may find it provides better support and less risk of continuing bone loss than traditional dentures.

If you would like more information on implant-supported dental 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 “Overdentures & Fixed Dentures.”

By John A. Pagliei, Jr., DMD
May 09, 2018
Category: Oral Health
IncreaseYourImplantsSuccessChancesbyKeepingYourGumsHealthy

If you’ve just received a dental implant restoration, congratulations! This proven smile-changer is not only life-like, it’s also durable: more than 95% of implants survive at least 10 years. But beware: periodontal (gum) disease could derail that longevity.

Gum disease is triggered by dental plaque, a thin film of bacteria and food particles that builds up on teeth. Left untreated the infection weakens gum attachment to teeth and causes supporting bone loss, eventually leading to possible tooth loss. Something similar holds true for an implant: although the implant itself can’t be affected by disease, the gums and bone that support it can. And just as a tooth can be lost, so can an implant.

Gum disease affecting an implant is called peri-implantitis (“peri”–around; implant “itis”–inflammation). Usually beginning with the surface tissues, the infection can advance (quite rapidly) below the gum line to eventually weaken the bone in which the implant has become integrated (a process known as osseointegration). As the bone deteriorates, the implant loses the secure hold created through osseointegration and may eventually give way.

As in other cases of gum disease, the sooner we detect peri-implantitis the better our chances of preserving the implant. That’s why at the first signs of a gum infection—swollen, reddened or bleeding gums—you should contact us at once for an appointment.

If you indeed have peri-implantitis, we’ll manually identify and remove all plaque and calculus (tartar) fueling the infection, which might also require surgical access to deeper plaque deposits. We may also need to decontaminate microscopic ridges found on the implant surface. These are typically added by the implant manufacturer to boost osseointegration, but in the face of a gum infection they can become havens for disease-causing bacteria to grow and hide.

Of course, the best way to treat peri-implantitis is to attempt to prevent it through daily brushing and flossing, and at least twice a year (or more, if we recommend it) dental visits for thorough cleanings and checkups. Keeping its supporting tissues disease-free will boost your implant’s chances for a long and useful life.

If you would like more information on caring for your 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 “Gum Disease can Cause Dental Implant Failure.”

By John A. Pagliei, Jr., DMD
August 03, 2017
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 John A. Pagliei, Jr., DMD
August 21, 2016
Category: Dental Procedures
AntibioticsCouldHelpEnsureyourImplantSurgeryisSuccessful

If you're considering dental implants to replace one or more missing teeth, you'll need to undergo a minor to moderate surgical procedure (depending on the number of implants) to install them. Depending on your current health status and medical history, you may need antibiotics before or after the procedure to help ensure a successful outcome.

Although implants have a high success rate (over 95%), they can still fail — and bacterial infection is a major culprit. Installing implants requires surgically accessing the bone through the gum tissues; you may also need other invasive procedures like tooth extraction or bone or gum tissue grafting. These disruptions to the soft tissues can introduce bacteria into the bloodstream.

In certain individuals, this can increase infection risk not only around the implant but also in other parts of the body. You may be at higher risk, for example, if you have serious health problems like cardiovascular disease or diabetes, a weakened immune system, you use tobacco or you're over or under normal weight. The American Dental and American Heart Associations both recommend antibiotics before dental implant surgery as a preventive measure against infection if you have a prosthetic heart valve, a history of infective endocarditis, a heart transplant or some congenital heart conditions.

For other patients with low to moderate risk for infection, there's vigorous debate on administering antibiotics before implant surgery. There are some side effects to antibiotic use, ranging from diarrhea to allergic reactions, and an increased concern in general to the developing resistance of many infectious agents due to the prevalent use of antibiotics. Many dentists and physicians are becoming more discriminate in the patients for which they prescribe antibiotics before surgical procedures.

It really comes down, then, to your particular case: not only the specific procedures you need but also your general health. After weighing these factors against the possible benefits for protecting your health and improving your odds of a successful outcome, we'll recommend whether antibiotic treatment for implants is right for you.

If you would like more information on the role of antibiotics in dental procedures, please contact us or schedule an appointment for a consultation.

FixedorRemovableDecidingWhichImplant-SupportedBridgeisBestforYou

Although dental implants are best known as single tooth replacements, they can actually play a role in multiple or complete tooth loss (edentulism) restorations. While replacing multiple teeth with individual implants is quite expensive, there’s another way to incorporate them in a restoration at much less cost — as supports for bridges.

In this case, only a few strategically placed implants are needed to support restorations of multiple crowns fused together into a single unit. Implant-based bridges consist of two main types: the first type is a fixed bridge, which is permanently attached to the implants and can’t be removed by the patient. It’s often the preferred treatment for patients who’ve lost most or all of their teeth but have not yet experienced significant bone loss in the jaw.

This choice, however, may not be the best option for patients with significant bone loss. In these cases, there’s a second type of fixed bridge: an implant-supported fixed denture. This type of fixed denture provides support for the lost bone support of the lips and cheeks. If a fixed bridge is not possible due to finances or inadequate bone support to place 4 to 6 implants, a removable denture (also known as an overdenture) that’s supported and held in place by implants is the next best alternative. Unlike a fixed bridge, an overdenture can be removed by the patient for cleaning purposes, and will require less investment than a fixed bridge.

For people with bone loss, the overdenture does more than restore chewing and speech function. Because bone loss can diminish support of the facial structures — actually shorten the distance between the chin and the tip of the nose — an overdenture provides additional bulk to support these structures to improve appearance. Depending on what the patient needs for facial support, overdentures for the upper jaw can be designed as “full palates,” meaning the denture plastic completely covers the upper jaw palate, or open in which the plastic doesn’t completely cover the palate.

Besides the condition of your teeth, gums and bone, your own personal preferences and financial ability will also play a role in which option is best for you. After considering all these factors, we can recommend which of these types of implant-based restorations will fit your needs. With either bridge, fixed or removable, you’ll certainly benefit from the improvement to both your mouth function and your smile.

If you would like more information on implant-supported bridges, 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 “Fixed vs. Removable.”