Bone Graft and Dental Implants Why Need

DENTAL IMPLANTS AND BONE GRAFTS

Dental implants have become a increasingly popular option to replace missing teeth.  But before your general dentist, periodontist, or oral surgeon places a dental implant to replace one or more missing teeth, a bone graft may be required prior to the placement of the implant.  It may sound a little intimidating at first, but bone grafts are in general a very predictable, painless, and routine part of dental care.

WHAT IS A BONE GRAFT?

As we age and get older, our oral soft and hard tissue structures change.  Specifically gingival and bone structures supporting where teeth were once present and now missing, atrophies and becomes smaller.  A predominant reason why our jaws have the current density and amount of bone they do is due to the presence of existing teeth.  With teeth in support and in constant function, it stimulates the bone and allows continuous bone regeneration and prevents bone from degeneration.  Without teeth to support the adjacent bone, the jaw bone atrophies and degenerates to a basal bone level.

Most jaw bone will atrophy within the first year and a half after the tooth is initially missing, and will then continue to undergo bone loss at a indefinite slow rate.  For patients with total complete loss of teeth, this usually results in a very thin ridge of bone in the lower jaw (mandible); for the upper jaw (maxilla) the results are less pronounced.

BONE GRAFT HISTORY

In the past, bone grafts were frequently done in a hospital setting.  It was not uncommon for surgeons to use a patient's ribs or hip bone to increase lower jaw size.  Sometimes skin grafts were also taken from a patient's thigh and placed inside the mouth to prevent the tissues from moving the denture while patient is talking and chewing.  Fortunately with modern research and technology, a more preventive and contemporary approach has made the dental implant procedure less invasive and more minimalistic. 

WHAT CAN CAUSE BONE LOSS  THAT MAKES BONE GRAFT NECESSARY?

Potential bone loss causes within the oral cavity may include the following below: 

• Tooth Extraction - In cases where it is a dental and medical necessity to remove a permanent adult tooth, bone loss within the jaw can happen if the tooth is not replaced with an implant.
• Sinus Deficiency - Whereas in cases where a molar is removed from the upper jaw (maxilla), air pressure within the sinus cavity can "push down" on the sinus floor and cause bone resorption.  The result is an enlarged sinus (hyperneumatized sinus).  A sinus lift may be necessary to "push" up the sinus floor. 
• Periodontal Disease - With periodontitis, bacteria not only affects and causes gingival inflammation, but bacteria has begun to erode the bone structure and cause bone loss.  If periodontal disease is not treated with the appropriate dental cleaning, it may lead to tooth loss and subsequent bone loss.
• Tumors - Abnormal growth can be either benign or cancerous.  If either tumors are not controlled or removed it can cause bone destruction and loss.
• Developmental Defect - Some cases of birth defects can cause portions of the jaw bone to be missing or irregular in density and amount. 
  
• Accidental Trauma - Unfortunate accidental circumstance in a dental emergency, these trauma cases may result in tooth loss.  Accidents may include inadvertent heavy sports contact, playground mishaps, automobile accidents, and accidental slips and falls.  With loss of tooth eventually follows loss of bone.
• Orthodontic Malposition and Misalignment - If a tooth does not have an opposing dentition, said tooth can super erupt (over erupt), causing bone loss.
• Dentures -  A denture is a removeable prosthesis that replaces one or more missing teeth.  The denture, complete or partial, can be anchored by a dental implant to help with retention.  The denture area that is not anchored by a dental implant can result in alveolar bone loss as the tissue beneath said area is not stimulated.
• Dental Bridge - A dental bridge is a permanent prosthesis designed to replace a missing space by attaching a "floating" tooth between two or more adjacent front and back crowns. The portion of the bridge filling in the gap of the missing tooth that does not stimulate the jaw's alveolar bone can result in bone loss.  Good oral hygiene via proper brushing and flossing is also needed to prevent bone loss around the attached crowns. 
• Osteomyelitis - Rare case where bacteria has caused an infection of the jawbone and bone marrow.  Result is bone inflammation and reduced blood flow, causing bone necrosis and loss.

SO WHY IS BONE GRAFT NECESSARY?

The jaw bone's, also called alevolar bone, main purpose is to support and hold a tooth firmly in place.  In order for a tooth to be stable and not be mobile, the area needs to have sufficient bone.  Without adequate bone, the tooth can have periodontal issues and eventually lead to tooth loss.

With a dental implant, the bone serves the same structural support purpose.  The jaw needs to have sufficient bone structure to support the implant firmly.  In the case of a tooth extraction, it may be possible to place a dental implant same day immediately after the tooth is removed.  Sometimes it may not be feasible to place an "immediate implant" due to a dental infection.  In such situations a socket preservation graft may be necessary, as this graft fills up the void from the extracted tooth.  The graft retains the bone volume while the adjacent alveolar ridge proliferates and fills the missing space with live bone.  Typically the preservation graft may take between three to six months healing times before an implant can be placed.

If you have any questions on dental implants and bone grafts, be sure to consult your family dentist.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

What causes tooth sensitivity to cold, heat, and pressure?

SENSITIVE TOOTH!

 
"I was eating a cold ice cream fruit bar and suddenly my tooth started to ache.  I must have bit down wrong!"

Patients occasionally come to me complaining their teeth are sensitive.  The pain may come suddenly, other times it may be a gradual onset.  Even simple oral hygiene techniques like flossing, brushing, eating, and drinking can cause a temporary pain and discomfort in the teeth.  Discomfort can range from mild to excruciating, and can be lingering or nonlingering.  Sometimes it is obvious as to the cause of the discomfort, sometimes it may not. 

WHAT ARE SYMPTOMS OF TEETH SENSITIVITY?

Tooth discomfort can be subjective; some common symptoms include:

• Throbbing pounding acute pain that occurs by itself
• Pain that is temperature dependent to cold and/or heat, such as drinking cold water or hot coffee
• Pain that comes about from eating and biting pressure
• Bleeding and sore gums
• Pain caused from breathing in cold air

CAUSES OF SENSITIVE TEETH

While the causes may vary, it is likely that the tooth's nerve has been affected.  Within the inner most layer of the tooth is a pulp chamber consisting of live nerve tissues.  If the nerve has been affected, the result may be sensitivity and/or pain.  The dentist will need to do an evaluation via an examination to determine the cause of the sensitivity; an x-ray may also be necessary to determine if there is decay, fracture, or infection.

• Tooth decay (also known as caries) that has invaded the pulp
• Tooth decay that has not invaded the nerve
• Broken teeth that has pulpal involvement
• Fractured cusp that has caused the tooth to weaken
• A chipped tooth that has caused worn enamel
• Root exposure
• A root fracture that violated the tooth's root
• Tooth has localized abscess and infection
• A tooth that has exposed dentinal tubules
• Periodontal involvement with bleeding gums/gingiva

TREATMENT OF SENSITIVE TEETH 

To bring adequate relief of the sensitive or painful tooth, it may be necessary via a process of elimination to rule out certain causes first.  A conservative approach is usually taken so as to appropriately treat the condition.

• A tooth colored filling if the sensitivity is from decay that has not intruded onto the nerve
• A porcelain crown if it's due to cusp fracture or weakened cusp
• A root canal and crown if the nerve has been affected to either a fracture or abscess
• Tooth extraction if the tooth is not restorable due to extensive coronal and/or root fracture
• Fluoride varnish for exposed dentinal tubules
• Dental cleaning to remove plaque, bacteria, calculus, and tartar buildup along the gumline
• Antibiotics and analgesics as necessary adjunctive treatment
• Anti-sensitivity toothpaste (ie. Sensodyne) for exposed dentinal tubules, exposed enamel and root surfaces

Generally speaking, if you develop any of the above mentioned sensitivity and discomfort with your teeth, be sure to schedule an evaluation with your dentist.  It may also warrant emergency dentistry treatment if you have tremendous lingering tooth ache pain, discomfort, and/or swelling.  If you have any questions on the causes and treatment of sensitive teeth, be sure to consult your family dentist.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Dental Implants with Dentures, the Overdenture

DENTAL IMPLANTS

Dental implants have become an increasingly popular method to replace one or more missing teeth.  With an average time span of three to six months after the implant has solidified and osseointegrated into the jawbone, the implant abutment and dental crown are then placed to complete the implant restoration, helping the patient achieve optimal esthetics, chewing, and speech.

IMPLANT SUPPORTED OVER-DENTURE

Complete full dentures often rely on the existing bone ridge and gingiva for retention (ie. to ensure the denture does not fall out and stays in properly).  Denture adhesives can help to ensure the denture stays in, but must be used periodically throughout the day.  Dental implants can also be used in certain denture case to help make sure the denture stays in place.  Also known as implant over-dentures, multiple single implants are placed on top of the ridge.  The dentures then "snap" in place on top of the implants, firmly holding the denture in place.  The result is increased fit and retention, without the need for denture adhesives.

How can Dental Implants Help Hold the Denture in Place?

• There is sufficiently thin bone ridge, denture adhesive does not help and the denture still "wobbles" and moves around.
• The patient does want the constant need to apply adhesive to the denture and wants a more permanent solution.
• Due to extreme muscle and bone atrophy, there is near nonexistent bone structure and ridge to support a denture in place.
• One does not have the physical ability or dexterity to apply denture adhesive, and would like a easier and more convenient method to hold the denture in place

Benefits of A More Secured Denture

• Increased ability to chew
• Eliminates need for denture adhesive
• Increased self confidence
• No need to worry the denture falling out

If you have any questions on how dental implants can help support and retain a complete denture, please contact you family dentist.

From you gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Dental Implants of Multiple Teeth

Multiple Dental Implants

DENTAL IMPLANTS

A dental implant, which is also known as an endosseous implant or dental fixture, is a type of dental treatment to replace a single missing tooth.  There are however, times when it may be necessary to replace more than one missing teeth, and multiple dental implants may be a viable treatment solution.

WHEN ARE MULTIPLE DENTAL IMPLANTS INDICATED

There are times when more than one dental implant may be considered:

1. There is an existing dental bridge that has failed due to extensive tooth decay or root fracture, and the teeth supporting the bridge needs tooth extraction.  Multiple dental implants may be used to replace the teeth supporting the bridge.
2. There are multiple missing front teeth, and a long span fixed dental bridge is not desirable as part of conservative dentistry and to prevent over treatment, or when a  partial denture or flipper is not a desired option.
3. There are more than one missing consecutive posterior / back teeth in a row, and one wants to gain back chewing function of their back teeth.
4. One is missing all of their teeth, and as part of a comprehensive dental reconstructive program, multiple dental implants may be used to restore the patients smile, form, and give back proper chewing and occlusion.  Such cases may be done by the prosthodontists, dentists who specializes in full mouth rehabilitation scenarios.
5. One has a denture that is loose, and is not able to be supported well by adhesive or denture relines.  By placing several dental implants, the implant will help anchor the denture in place.
6. There is severe periodontal disease (gum and bone disease) and more than one teeth have to be extracted due to advanced bone loss and/or gum infection.

AM I A CANDIDATE FOR MULTIPLE DENTAL IMPLANTS?

You, your dentist, and dental surgeon will discuss together if more than one dental implants are suitable for you.  Factors that need to be considered include medical history, bone width, age, existing conditions and habits that may delay healing (ie. smoking presence, diabetes), conditions that may prolong bleeding (ie. blood disorder), and finances.

If you have any questions or concerns regarding multiple dental implants, the steps and costs involved, please consult with your family dentist.
 
From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Teeth Whitening At the Dentist

Teeth Whitening

Teeth whitening has become a popular part of cosmetic dentistry, and is easy to do!  Thinking about getting your teeth whitened?  What is it like getting your tooth bleached?  Ever wonder what exactly it is?  How and why does it work? 

A tooth has essentially three layers: enamel, dentin, and pulp.  Enamel is the hard outer layer, dentin is the softer inner layer of the tooth, and the pulp is where the nerve and live tissues are.  Children's teeth (baby teeth) are naturally white when they first erupt.  Over time, as people age and permanent teeth erupt, teeth become less porous and the teeth appear darker and stained.

FOODS THAT CAUSE DARK AND GREY STAINS

Foods and drinks such as tea, wine, soy sauce, coffee, blueberries, and betel nuts can cause dark and yellow stains within the enamel of the teeth.  Over time, the stains can penetrate the enamel layer and the dentinal tubules, causing teeth to appear grey, dark, and yellow.  Other products than can also cause teeth staining include coke, certain antibiotics like tetracycline, and excessive fluoride.

HOW TEETH WHITENING WORKS

Bleaching products use hydrogen peroxide that interacts with water to form carbamide peroxide.  The peroxide travels within the enamel tubules to the dentin, breaking down the stains in the enamel and dentin.  Teeth thus appear to be whiter and brighter as the stains are dissolved and the enamel and dentin are more porous in the process.

TEETH WHITENING WITH STORE PRODUCTS

In the store, one can purchase whitening toothpastes, paint-on gels, and whitening mouthwashes.  These products may contain a mild abrasive that remove very mild extrinsic surface stains.  Some companies such as Crest sell whitening strips, which can help remove mild to moderate dark stains.  Most of these products contain very little hydrogen peroxide and have not been tested, so such whitening effects may not be as effective.

IN-OFFCE TEETH BLEACHING

• The dentist can fabricate custom whitening trays for one to do tooth whitening at home.  Once molds of teeth are taken and trays are made, one places a hydrogen peroxide gel within the custom trays.  The trays are worn over a period of two to three weeks.
• Some dentists also offer same day bleaching.  A high concentration of carbamide peroxide gel up to 40% is placed on the teeth for a duration of 25-30 minutes and repeated two to three times.  This method is effective against moderate to heavily stained teeth due to the gel concentration, and usually takes a single 90 minute session.

TEETH WHITENING SIDE EFFECTS

Dental bleaching is relatively safe but as with any dental procedure there are side effects.  Tooth whitening side effects include minor cold/hot tooth sensitivity, gums irritation from the hydrogen peroxide gel, and lingering tooth sensitivity to cold.

Interested in teeth whitening?  Be sure to consult with your family dentist.  Tooth bleaching can be a regular part of your regular dental care; you and your dentist can discuss which whitening method may be appropriate.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Dental Implants Single Tooth

Dentistry today is vastly different due to increases in oral health research and technology, and dental implants is one of the leading services dentists are able to provide today for their patients.  Implants are many times a viable option as to afford a long term replacement and viable solution to missing teeth.

Today, let's go over the single tooth dental implant, which is also known as an endosseous implant or dental fixture.

WHAT IS A DENTAL IMPLANT?

A dental implant is a component that is surgically placed within the jaw bone, which in turn supports a prosthesis (ie. dental porcelain crown, bridge, or denture).  Via a biological process called ooseointegration, the implant fixture (typically made from titanium), forms an intimate bond to the bone.  At this point the dental surgeon would also determine if a bone graft is required.  If there is insufficient bone structure to hold the implant firmly in place, additional bone may need to be be added to the implant site via a bone graft.  If the implant area is in an area of esthetic importance (ie. front tooth with an exposed smile line) the dentist may elected to add additional gingival tissue to improve the appearance of the implant fixture via a soft tissue graft.

After the implant is placed, the implant fixture is given time to heal and integrate with the bone, usually for 3-6 months.  Once the implant osseointegrates with the bone, an abutment is attached to the implant which contains and hold the dental prosthetic (ie. crown, bridge, or denture).  The dental prosthetic may then be attached to the abutment and implant via cement or screw..

WHEN IS A SINGLE TOOTH IMPLANT INDICATED?

There are situations when a single implant may be desirable:

1. Accidental trauma to a single tooth, while the teeth adjacent to the affected area are normal and healthy.  An example would the loss of a front tooth due to an accident.
2. A tooth has cracked from heavy occlusal trauma (bruxism and nighttime grinding) and is not saveable with a root canal and/or dental crown.
3. A tooth that has such severe decay it is no longer restorable with a root canal and crown.
4. A tooth with an existing filling or crown that has such deep and severe decay it is not longer saveable with a new restoration.
5. A tooth that has luxated (tooth fell out of its socket) from a sports or playground accident, or physical altercation. 
6. A tooth has cracked and sustained a fracture after a root canal from normal chewing, and the tooth is no longer saveable and requires tooth extraction.
7. A tooth that has severe localized periodontal disease with aggressive bone loss.  With such periodontal involvement and bone loss, the tooth may be mobile and have poor bone support and susceptible to infection.
8. One particular area of the jaw has an inherent missing tooth.  For example, some people are genetically born with a single missing adult tooth, and this may cause difficulty chewing, self awareness in their smile, or food-induced gum trauma and irritation.

AM I CANDIDATE FOR A SINGLE TOOTH IMPLANT? 

The dentist and surgeon would determine if you are a viable candidate for a single tooth dental implant.  A successful implant would require healthy jaw bone and gingiva.  Oral hygiene, diabetes, smoking, a compromised immune system, and heavy uncontrolled bruxism/grinding are important factors to take into consideration of the implant's success.  Age may be a factor; one may want to wait until the age of 20 as that is when the jaw bone has completed its full maturation growth cycle. 

COST OF DENTAL IMPLANTS

What does a dental implant cost?  The costs of the implant from start to finish will vary widely and dependent on many factors. These factors include: type of material used, state where the service is performed, the type of insurance coverage, if a bone graft is required, the type of abutment used, and the type of crown that is placed.  The dentist's front office would be able to give you an estimate of the costs associated with the dental implant. 

If you have any questions or concerns regarding dental implants, the steps involved, and the costs involved, please consult with your family dentist.
 
From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Medication Effects on Teeth, A Dental View

 MEDICATIONS EFFECTS ON TEETH, A DENTAL VIEW

There are unfortunate (sometimes emergency) cases where one can sustain a traumatic and inadvertent injury to the dentition and oral cavity.   Such dental trauma may also stem from a medical or pharmacological condition, such as a drug's side effect or due to a body's physical condition.
A cursory understanding of medical conditions, diseases, and side effects from drugs will help one see how said conditions relates from a dental point of view, and also allows one to see how the body and the oral cavity, teeth, and gums inter-relate with one another.

Let's examine some possible dental and teeth damage due to various medical conditions:
1) Xerostomia 2) Sjogren's syndrome 3) Bulimia and Gastroesophageal reflux disease 4) Methadone side effect 5) Recreational drug use side effect 6) Medication side effects 7) Chemotherapy and radiation

XEROSTOMIA

Xerostomia, or dry mouth, can be due to aging, immunosuppressive medications, prescription medications, and chemical and radiation therapy.  With dry mouth saliva production is lowered, placing the teeth at higher risk of dental decay, necessitating the need for tooth colored fillings (resins).
Medications are many but can include antihypertensives, antidepressnats, diuretics, steorids, anticonvulsants, antianxiety agents, antipsychotics, and acne treatments.

SJOGREN'S SYNDROME

Sjogren's Syndrome is an autoimmune disorder that is characterized by excessive antibody production that are directed against certain tissues in the body.  Gland inflammation is a distinct characterization of Sjogren's, and affects the lacrimal glands in the eyes and also causes inflammation of the salivary glands.  The affected glands result in decreased tear production in the eyes and decreased saliva production in the mouth, hence dry eyes and dry mouth and lips are key indicators of this Sjogren's Syndrome.  With dry mouth dental decay may be more prevalent and may require tooth colored fillings to restore the dentition. 

BULIMIA / GASTROESOPHAGEAL REFLUX DISEASE

Bulimia is a psychologically induced condition where vomiting is forced and self-induced. Patients have tremendous fear of weight gain and have a severe negative overweight image of their bodies, thus forcing themselves to vomit in order to lose weight .  Hence the teeth are constantly exposed to acids in the stomach, if untreated can lead to enamel erosion and deterioration, which can then affect the dentin.  Tooth colored fillings or porcelain crowns may be required.

METHADONE SIDE EFFECTS

Methadone, a prescription medication by one's physician, is used as an anti-addictive medication for opioid addiction (ie. oxycodone, hydrocodone), and may also be used as an analgesic and antitussive. 
Methdaone's damage on the teeth can be extremely extensive, from enamel and dentin erosion to teeth fracture.  Such cases often require extensive dental treatment including porcelain crowns, surgical tooth extractions, and dental implants.

RECREATIONAL DRUG USE SIDE EFFECTS

Methamphetamine is a recreational drug when taken due to dependence, can cause severe teeth erosion and rampant dental decay / cavities.  Dental fillings, root canals, and porcelain crowns may be required in such cases to restore the dentition. 

MEDICATION SIDE EFFECTS

Tetracycline is an antibiotic, when taken during tooth formation, can cause malformations of the teeth.  Malformations may range from relatively minor enamel striations to complete enamel discoloration and dentin weakness, causing eventual tooth failure and fracture.  If the effects are minor, treatment may not be required.  If the effects are major, dental treatments may include porcelain veneers, dental crowns, and/or root canal therapy.

CHEMOTHERAPY / RADIATION

Chemotherapy and radiation, commonly used for cancer treatment, can negatively affect salivary production and thus cause dry mouth, which increases one's risk of tooth decay and gum disease.  Common dental affects may include rampant and extensive cavities and swollen & bleeding gums.  Patients undergoing chemotherapy and radiation may thus be at increased need of fillings.

CONCLUSION

It is this author's hope that after reading this blog, one will have a little more appreciation of the negative side effects of various drugs and medical treatments on the oral dentition.  While in most cases dental treatment can be rendered to address aforementioned negative effects on the dentition, a close relationship between the patient's dentist and physician is necessary to control and maintain the drug side effects, and to prevent the drug from overpowering teeth and periodontal health.

From your family Bellevue dentist,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com