Modern dental implants not only help you maintain your normal chewing ability and speech patterns after you have lost a tooth or teeth — they also keep you looking younger. How do they do this? Read on.

Do lost teeth cause tooth-supporting bone to “melt” away? Yes. Of course, the bone does not actually melt. Bone is a living tissue, and under normal conditions it constantly dissolves and rebuilds. Stimulation by the small stresses from the contact of upper and lower teeth — something that normally happens hundreds of times each day — keeps these two forces in balance. When a tooth is missing, the bone that normally surrounds and supports the tooth (called alveolar bone) no longer receives the stimulation that causes it to rebuild, and it begins to diminish over time.

What happens if you don't replace missing teeth? The first year after a tooth is lost, the width of the bone that once surrounded the tooth decreases by 25 percent. Over the years, gradually increasing bone loss results in sunken cheeks and lips, making you look older. Gum tissue also decreases, affecting your ability to chew and speak.

What happens if you lose all your teeth? For people who have lost all their teeth, called edentulous, the effects are severe. After the alveolar bone is lost, the bone beneath it, called basal bone, also begins to be resorbed, eventually causing the lower part of the face to partially collapse.

Do partial or full dentures prevent bone loss? Unfortunately, just the contrary is true. A removable denture pressing on a person's gum increases bone loss because the pressures from biting are not transferred into the internal structure of the bone but instead are compressive, which damages the bone over time. This is why dentures begin to fit poorly after they have been worn for a while. This problem can be reduced by anchoring dentures with strategically placed dental implants.

What is a dental implant? A dental implant is a tooth-root replacement that is made of titanium. This metal is able to osseointegrate, or fuse with the bone. For a single tooth replacement, a crown that looks and functions like natural tooth is attached to the titanium implant. As mentioned above, implants can also be used to anchor dentures.

Does an implant prevent bone loss? Yes. When dental implants fuse to the jaw bone, they stabilize the bone. They also provide tooth-to-tooth stimulation that was formerly supplied by the natural tooth.

How long do dental implants last? Dental implants have been shown to last at least 10 years. For most people, implants will last the rest of their lives.

Contact us today to schedule an appointment to discuss your questions about tooth loss and dental implants. You can also learn more by reading the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”

Until recently anyone who needed to repair cavities in his or her teeth ended up with a mouth full of “silver” fillings. Dental amalgam, which has a silver appearance, was the tooth restoration material of choice. Amalgam, a combination of metals including silver, mercury, and other metals, is still used — but today there are other options that mimic the original teeth they are restoring.

You may have read about some people's concerns about the mercury used in dental amalgam. According to the American Dental Association (ADA), scientific studies have found no ill effects arising from using dental amalgam in fillings for adults or children: “While questions have arisen about the safety of dental amalgam relating to its mercury content, the major US and international scientific and health bodies, including the National Institutes of Health, the US Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.” Dental amalgam is still used for molars (back teeth) that must withstand heavy pressure from chewing.

For teeth that are more visible, materials that look and perform more like the original teeth — and are thus more pleasing in appearance — are now available. Dentistry is now taking a “biomimetic approach” (from words meaning “life mimicking”). The new materials — composite resins and porcelains — look like teeth because in many ways their structure imitates the biologic structure of teeth.

Composite resins are made of a plastic material (methacrylate) combined with fillers made of silica, a form of glass. They are able to bond to natural tooth structure and resemble the dentin, the inner layer of the tooth, which has a porous structure similar to bone.

Dental porcelains are a form of ceramic. They are non-metallic materials formed by the action of heat, like the ceramics used in porcelain cups and bowls. They come in a powder form that is mixed with water, shaped, and then placed in an oven until they reach the proper hardness. The end product is translucent and very hard, resembling the densely packed crystals of calcium that make up a tooth's normal outer layer, the enamel.

The old amalgam fillings required removal of tooth material to prepare a site in which they could be placed. Composite resins and porcelains can be used to treat teeth that have small or large amounts of damage to their natural substance because the materials bond directly to the remaining dentin and enamel. Thus they end up stabilizing and strengthening the restored tooth, as well as providing a natural-looking appearance.

Contact us today to schedule an appointment to discuss your questions about tooth colored fillings. You can also learn more by reading the Dear Doctor magazine article “The Natural Beauty of Tooth Colored Fillings.”

If you are dissatisfied with the way your smile looks, and your dentist is unhappy with the way your teeth fit together — but you don't like the idea of wearing braces — clear aligners may be your best solution. How much do you know about this teeth-straightening alternative? Below are some FAQs on the subject.

What do we mean by clear aligners? Clear aligners are a system for straightening teeth that uses clear plastic removable “trays” that fit over your teeth. As the teeth move to fit the trays, new trays are substituted that are designed to continue to move your teeth into the desired position. This system is an alternative to the traditional system of brackets and wires known as braces.

How can teeth be moved to new positions? The connection that holds a tooth in place in your jaws — the periodontal ligament — is not immobile. It constantly changes its position based on the normal forces of your bite. As the ligament is pushed on one side and pulled on the other, the living cells of your mouth respond by depositing bone and cementum (the protective covering of the tooth's root) on one side and dissolving it on the other. Normally this happens in a balance, maintaining your teeth in their position. We can manage these slight changes by applying constant light forces to move teeth in a predictable way.

How long does it take to move teeth to their optimum position using clear aligners? As with braces, the process is gradual. Total treatment time can range from six months to two years.

Do the trays have to be worn all the time? As you move through the sequence of trays, each is worn for 20 hours per day for two weeks. They may occasionally be removed for important social occasions.

How does an orthodontist design the sequential trays that are used? The trays are designed using a computer, based on an assessment and images of your mouth, teeth and jaws.

What kinds of problems can clear aligners correct? This method works well to correct mild to moderate crowding or spacing. If your back teeth already fit together as they should, the system may be ideal. If you have an extreme overbite or underbite, braces might work better.

Are clear aligners an alternative for everyone? Clear aligners are recommended for adults and recently, teenagers. They are not usually recommended for young children.

Why is it important to have your teeth straightened? Besides the obvious benefit of feeling better about yourself and your appearance, straight and well-aligned teeth work better. You will experience a better-functioning bite and can improve your oral health.

Contact us today to schedule an appointment to discuss your questions about orthodontics and clear aligners. You can also learn more by reading the Dear Doctor magazine articles “Clear Orthodontic Aligners” and “Moving Teeth With Orthodontics.”

The best method for permanently replacing a missing tooth is with a dental implant. But did you know that there are two main techniques for placing implants? Implants can be placed either using a one stage or a two stage surgical technique, and as their names suggests, one is performed in one step while the other requires a second surgery.

With a one-stage procedure, a healing abutment is placed at the time of surgery. An abutment is a connector that attaches the implant from the bone into the mouth and which protrudes through the gum tissues. Following a 3 to 6 month healing period in which the implant fuses to the bone, a crown is then placed on the implant restoring the immediate appearance of a healthy, normal tooth. One-stage implant systems are generally used when the bone quality is good, guaranteeing good initial implant stability. They are also used when cosmetics is not a concern, such as the back areas of the mouth.

Under special conditions an implant can be placed and a crown placed on top of it at the same time. However, this is a very special circumstance requiring ideal conditions and surgical experience as well as crown fabrication know-how. It is generally safer and wiser not to subject an implant to biting forces until it is fully healed and integrated with the supporting bone.

A two-stage procedure is typically used for replacing teeth where there is no immediate need for a cosmetic solution and when more of a margin of safety is required. With this approach, the implant(s) are placed into the jawbone and the gum tissues cover them. They are not exposed to the mouth, but stay buried and left to heal. Once healed, a second surgery is performed to attach an abutment for securing the crown in place. This approach is used when there is poorer bone quality or quantity. This may make it necessary to regenerate bone around the implant at the time of its placement. There may also be other health considerations dictating that a two-stage approach may be indicated.

Depending on your individual situation and medical status, our implant team will determine which approach is best for you. To learn more about these two procedures, read the Dear Doctor article, “Staging Surgery In Implant Dentistry.” You are also welcome to contact us to discuss your questions or to schedule an appointment.

FAQs About This New and Miraculous Procedure

How can sinus surgery contribute to the replacement of missing back teeth with dental implants?
Dental implants must be anchored the in bone to be successful. Maxillary sinus surgery can help regenerate bone that has been lost and is critically needed to anchor dental implants.

What are the maxillary air sinuses?
Inside the upper jaw, or “maxilla,” are structures known as the maxillary air sinuses, one on either side of the upper jaw. Each sinus is an air-filled space lined by a membrane. Upper back teeth are normally encased in the bone of the maxilla, below the sinuses.

Why is it important to replace missing back teeth?
Replacing back teeth restores the ability to eat, chew, and talk properly. The back teeth also provide facial and cheek support.

Why use dental implants?
Dental implants are the state-of-the-art method for replacing missing teeth.

Why does bone loss occur?
Unless special precautions are taken to prevent it, when teeth are lost, the bone supporting them is also lost.

If there is insufficient bone to anchor dental implants, what are the alternatives?
If all the back teeth are lost and dental implants cannot be placed, removable upper dentures may be the only alternative.

How do you determine whether a sinus surgical procedure is necessary?
The size, shape, and remaining bone of the maxillary sinuses influence whether you can have dental implants with or without a sinus surgical procedure.

How does surgery grow bone?
A small window is created in the sinus wall above where implants need to be placed. The sinus membrane is lifted and the space thus created filled with bone grafting and biologically active bone generating materials. The window is then closed and simply heals.

How is the surgery done?
The surgical procedures are performed from inside the mouth in the area just above the missing back teeth. They are generally carried out under local anesthesia (small shots, just like for a filling), sometimes with the addition of sedation or anti-anxiety medication.

How do bone grafts work?
Bone grafts act as scaffolds that the body replaces with its own bone. The most well researched bone substitute grafting material is currently bovine (cow) bone. All grafting materials are approved by the Food and Drug Administration. They are specially treated to render them completely sterile, non-contagious, and free of rejection factors.

What can I expect after surgery?
Moderate swelling and discomfort after surgery generally lasts for a few days to a week, about the same as having an upper impacted wisdom tooth removed. Supportive treatment usually includes a course of antibiotics to prevent infection and prescription strength medication of the aspirin or ibuprofen type. A decongestant may also be prescribed, if necessary. Healing is generally uneventful.

Who performs this surgery?
Maxillary sinus augmentations are usually carried out by oral surgeons, periodontists, or appropriately trained general dentists. Proper assessment of your situation and diagnosis are critical pre-requisites to the right procedure.

If you are missing upper back teeth, contact us today to schedule an appointment and discuss maxillary sinus augmentation. You can also learn more about this procedure by reading the Dear Doctor magazine article “Sinus Surgery: Creating Bone for Dental Implants out of Thin Air.”