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Posts for: December, 2014

SinusSurgerymdashCreatingBoneforDentalImplantsldquoOutofThinAirrdquo

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.”


By John G. Fisher, DMD
December 22, 2014
Category: Dental Procedures
50CentHasHisOwnStyle-EveninHisSmile

On his way to the top of the urban contemporary charts, the musician, actor and entrepreneur known as 50 Cent (born Curtis James Jackson III) earned his street credibility the hard way; his rise from youthful poverty to present-day stardom is chronicled in many of his rhymes. So when it came time for the rapper to have cosmetic work performed on his teeth, he insisted on doing it in his own way.

“I told [the dentist] to leave [my front teeth] a little bigger than the other ones, because I need to still see me when I look in the mirror,” he told his co-host on the New York radio station Power 105.1. “Don't give me no whole ’noter guy — I like me!”

We understand how 50 Cent feels — in fact, we think it's a perfectly reasonable request.

Cosmetic dentistry has come a long way in recent years, as we strive to meet the increasing expectations of our patients. We realize that different people have different perceptions of what makes a smile attractive — and that in dental aesthetics, beauty really is in the eye of the beholder. That's why, before we begin cosmetic work, we want to hear what you like and don't like about your smile as it is now. In addition, we can also perform what is called a “smile analysis.”

This procedure doesn't cause any discomfort — but it's a crucial part of cosmetic enhancement. In doing the analysis, we look at the various parts of an individual's smile: the spacing, size and alignment of the teeth; the health and position of the gum line; the relationship of the upper and lower jaws; and the relative shape and size of the face. All of these features combine to make a person's smile unique. By looking at them closely, we can help determine the best way for you to improve your smile.

But how can you tell if the cosmetic changes you're contemplating will end up being just right for you? Fortunately, with today's technology, it's easier than ever. Computer imaging offers a chance to visualize the final outcome before we start working on your teeth; it's even possible to offer previews of different treatment options. If you want to go a bit further, we may be able to show you a full-scale model of your new smile.

In some situations, we can even perform a provisional restoration — that is, a trial version of the new smile, made with less permanent materials. If the “temporary” smile looks, feels, and functions just right, then the permanent one will too. If not, it's still possible to make changes that will make it work even better.

Whether you're thinking about having teeth whitening, cosmetic bonding, porcelain veneers, or dental implants to improve your smile, you probably have a picture in your mind of how the end result should look. Will your teeth be perfectly even and “Hollywood white” — or more “natural,” with slight variations in size, spacing and color allowed? Either way, we can help you get the smile you've always wanted.

If you would like more information about smile makeovers and options in cosmetic dentistry, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “Cosmetic Dentistry.”


By John G. Fisher, DMD
December 19, 2014
Category: Oral Health
Tags: oral health   oral hygiene  
CananAppHelpYouBrushYourTeeth

If you’re the kind of person who can’t do without a smart phone, you’ve probably heard the expression “There’s an app for that!” These nifty little programs let you get directions, check the weather, watch stock prices… even optimize your sleep patterns and make high-pitched dog whistles. And shortly, you’ll be able to check how well you’ve been brushing your teeth.

News reports have mentioned a soon-to-be-available toothbrush that will interface with an app on your smart phone. The brush has sensors that record how much time you spend brushing, whether you reach all parts of your mouth, and whether you brush correctly (with up and down motions, not just side to side). It charts your oral hygiene habits, scores your brushing technique — and, if you allow it, shares information about how well (or poorly) you’re doing with your family, friends… even your dentist.

So do you need to run out and buy one of these gizmos as soon as they’re available? Of course not! However, anything that encourages you to take better care of your oral hygiene can’t hurt. A wise dentist once said: The important thing is not the brush, but the hand that holds it.

If you’re a “gadget person,” you may be intrigued by the device’s high-tech design, and the fact that it interfaces with your phone. Plus, maybe the idea of compiling (and sharing) your brushing record has a certain appeal. On the other hand, you might prefer a sleek, light electric brush that doesn’t keep track of your movements. Or maybe the simplest brush of all — a manual one, with soft bristles and a comfortable handle — works best for you.

The most important thing is that you regularly practice good oral hygiene: Brush twice a day, for two minutes each time, and floss once a day. Use whichever brush is best for you, and be sure to change it every three months, or when the bristles get stiff. Stay away from sugary snacks between meals (they contribute to decay by keeping your teeth bathed in acidic byproducts). Don’t use tobacco in any form, or chew on things that don’t belong in your mouth. And remember to come in for regular exams and professional cleanings. If an app helps you do these things — we're all for it.

If you would like to learn more about maintaining good oral hygiene, please contact us or schedule an appointment for a consultation. For more information, see the Dear Doctor magazine article “Top 10 Oral Health Tips For Children.”


MoreThananewSmile-DentalImplantsHelpStopBoneLossasWell

Since their introduction over three decades ago, dental implants have evolved into dentistry’s premier tooth replacement choice. While their primary purpose is to replace missing teeth and rejuvenate a patient’s smile, they’re also regarded for another important benefit: they can slow or stop bone loss accelerated by the loss of teeth.

Like all living tissue, bone has a life cycle. Older bone dissolves and is absorbed by the body, a process called resorption. New bone forms and grows to replace the resorbed bone in response to stimuli occurring within the body. In the jaw, this stimulation comes from the forces the teeth receive when we bite or chew.

When a tooth is lost, however, it no longer transmits these force stimuli to the adjacent bone. This results over time in less new growth to replace resorbed bone, and the overall bone mass shrinks. In fact, about a quarter of the normal bone width will diminish in the first year alone after tooth loss. Other serious problems follow, like gum recession or chewing and speaking difficulties. A person’s appearance may also suffer, because as resorption continues unchecked, the underlying foundational bone will continue to shrink. As more teeth are lost, a decrease in the distance between the nose and chin may result causing the lower third of the face to become smaller in size.

Dental implants can interrupt this process by encouraging bone growth around the implant. Implants are made of “osseophilic” titanium, meaning the metal has a natural affinity with bone. After implantation, bone cells will begin to grow and attach to the titanium post. The enhanced growth stabilizes bone loss by providing stimulation to the bone as teeth once did, thereby maintaining bone levels and minimizing potential effects on the patient’s appearance.

Ironically, too much bone loss could make the installation of implants more difficult, since they require a minimum level of bone mass for anchorage. Receiving an implant as soon as is practical once a tooth is lost will minimize the chances of that occurring — and a better chance of improving bone health overall.

If you would like more information on how dental implants improve bone health, 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 “The Hidden Consequences of Losing Teeth.”


By John G. Fisher, DMD
December 01, 2014
Category: Dental Procedures
Tags: crown  
CustomizedTemporaryCrownsletyouRehearseYourFutureSmile

Modern restorations for severely damaged or missing teeth are truly remarkable. Although the type of restoration may differ — dental implant, bridge, or veneer — the end result is a life-like facsimile that matches the shape and color of your natural teeth.

To achieve this result, though, the new crown or veneer requires fabrication in a dental laboratory, a meticulous process that may take a few weeks. In the interim, we often install temporary crowns. These help in a number of ways: because we’ve prepared the teeth for final restoration by removing some of the tooth structure, the temporary crown protects and stabilizes the teeth, reduces sensitivity and helps maintain gum health. Temporary crowns also enable the patient to present a more natural smile while waiting for the permanent restoration.

Temporary crowns are typically manufactured to fit a wide range of patients, similar to an “off-the-rack” suit from a clothing store. In recent years, though, customized “tailored” temporary crowns designed specifically for an individual patient have grown in popularity among dental professionals as well as patients.

In creating a customized temporary crown, we first perform a smile analysis similar to one used for a permanent restoration. After a careful assessment of your mouth, we would then make recommendations about the elements to include in the temporary crown, including shape and color. We would also factor in your desires and concerns into the final design. Working together with the dental laboratory, we would then have the temporary crowns produced and ready to apply as soon as we complete the preparatory work.

Customized temporary crowns also serve another important purpose as a kind of “dress rehearsal” for the permanent restoration. This gives you an opportunity to “try out” the smile you’ll have with the permanent restoration in your daily life. We can then use your experience to make adjustments to the permanent crowns before final production.

While customized temporary crowns involve more effort and expense than the traditional, the benefits are worth the added cost, especially if you’re involved with an extensive “smile makeover” procedure. Not only will you look better while your permanent restoration is under construction, your temporary look will give you added confidence that your future smile is right for you.

If you would like more information on temporary and permanent 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 “Concepts of Temporary Restorations.”