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Posts for category: Dental Procedures

By Bernard J Daly, DMD
January 29, 2020
Category: Dental Procedures
DoYouHaveAdequateBonetoSupportanImplant

Besides their life-likeness, implants are also prized for their high success rate. More than ninety-five percent of implants continue to function effectively after ten years.

Implants’ advanced technology explains some of their reliability and longevity—they’re as close to natural teeth as we’re now able to achieve. But their impressive success rate also owes to the detailed protocols that dentists follow to install them. One critical part of these protocols is ensuring a patient has enough bone in their jaw to support and precisely situate the implant for the best functional and aesthetic outcome.

Unfortunately, there are situations where a patient doesn’t have enough bone to achieve a satisfactory result. This often happens if there’s been months or years between losing the tooth and considering an implant. The reason why relates to the nature of bone as living tissue.

Like other cellular tissues in the body, bone has a life cycle: Older, worn-out cells die and are absorbed by the body, and new cells form to replace them. The growth cycle in the jaw receives stimulation from the forces generated when we chew, which travel up through the teeth to the bone.

However, this stimulation stops after tooth loss for the related area of bone, which can slow new bone growth. Over time, the volume and density of the bone around a missing tooth gradually decreases, enough eventually to make an implant impractical.

Insufficient bone volume, though, doesn’t necessarily mean an implant is out of the question. We may be able to address the problem by attempting to regenerate the bone through grafting. This is a procedure in which we insert graft material into the affected area of the jawbone. The graft then becomes a scaffold upon which bone cells can grow. ¬†After several months, we may have enough regenerated bone to support an implant.

If there’s been too much bone loss, we may still need to consider another form of restoration. But if we can successfully build up the bone around your missing tooth, this premier restoration for replacing lost teeth could become a reality for you.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation.

By Bernard J Daly, DMD
December 10, 2019
Category: Dental Procedures
DontBreakItLikeBeckham

During his former career as a professional footballer (that's a soccer star to U.S. sports fans) David Beckham was known for his skill at “bending” a soccer ball. His ability to make the ball curve in mid-flight — to avoid a defender or score a goal — led scores of kids to try to “bend it like Beckham.” But just recently, while enjoying a vacation in Canada with his family, “Becks” tried snowboarding for the first time — and in the process, broke one of his front teeth.

Some fans worried that the missing tooth could be a “red card” for Beckham's current modeling career… but fortunately, he headed straight to the dental office as soon as he arrived back in England. Exactly what kind of treatment is needed for a broken tooth? It all depends where the break is and how badly the tooth is damaged.

For a minor crack or chip, cosmetic bonding may offer a quick and effective solution. In this procedure, a composite resin, in a color custom-made to match the tooth, is applied in liquid form and cured (hardened) with a special light. Several layers of bonding material can be applied to re-construct a larger area of missing tooth, and chips that have been saved can sometimes be reattached as well.

When more tooth structure is missing, dental veneers may be the preferred restorative option. Veneers are wafer-thin shells that are bonded to the front surface of the teeth. They can not only correct small chips or cracks, but can also improve the color, spacing, and shape of your teeth.

But if the damage exposes the soft inner pulp of the tooth, root canal treatment will be needed to save the tooth. In this procedure, the inflamed or infected pulp tissue is removed and the tooth sealed against re-infection; if a root canal is not done when needed, the tooth will have an increased risk for extraction in the future. Following a root canal, a tooth is often restored with a crown (cap), which can look good and function well for many years.

Sometimes, a tooth may be knocked completely out of its socket; or, a severely damaged tooth may need to be extracted (removed). In either situation, the best option for restoration is a dental implant. Here, a tiny screw-like device made of titanium metal is inserted into the jaw bone in a minor surgical procedure. Over time, it fuses with the living bone to form a solid anchorage. A lifelike crown is attached, which provides aesthetic appeal and full function for the replacement tooth.

So how's Beckham holding up? According to sources, “David is a trooper and didn't make a fuss. He took it all in his stride." Maybe next time he hits the slopes, he'll heed the advice of dental experts and wear a custom-made mouthguard…

If you have questions about restoring damaged teeth, please contact our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Trauma and Nerve Damage to Teeth” and “Children's Dental Concerns and Injuries.”

JawSurgerymaybeNecessarytoCorrectSomeTypesofPoorBites

In a normal bite, the upper and lower teeth line up and fit together when you close your jaws. When they don’t, you have a poor bite or “malocclusion.” The most common cause is teeth out of position, which can be corrected by moving them with braces.

Sometimes, though, the size and position of the jaws is the primary cause for the malocclusion and not the teeth. If the discrepancy is minor, tooth movement alone might be sufficient; but if there’s a wide discrepancy in the symmetry of the face or the size of one jaw over the other then a surgical solution may be necessary. One common procedure is orthognathic surgery, which literally means to “straighten the jaw.”

A wide range of irregularities — both minor and major — can be corrected by adjusting and realigning the bone in the jaw. While orthognathic surgery can certainly improve your facial profile and smile, its main purpose is to restore function that’s been lost due to poor jaw alignment. Candidates for the surgery have difficulty chewing, biting or swallowing food, chronic pain or headaches related to the jaw joints, chronic mouth breathing and dry mouth, or sleep apnea.

In many cases, treatment involving orthognathic surgery requires a team approach between orthodontist, oral surgeon and general dentist. While the surgeon surgically alters and repairs the jaw or facial structure, the services of an orthodontist may still be needed to move teeth misaligned due to the underlying problem with the jaw structure. The general dentist ensures teeth and gums remain healthy during all the other treatment phases.

Orthognathic surgery can benefit both oral and general health, as well as improve the appearance of the entire face. The process, however, can be complicated: you or your family member will need to undergo a thorough examination to determine if you or they are a good candidate for the surgery. If so, the end result can be life-changing.

If you would like more information on the treatment of jaw development disorders, 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 “Jaw Surgery & Orthodontics.”

By Bernard J Daly, DMD
October 21, 2019
Category: Dental Procedures
Tags: dental implant  
HeresWhattoExpectBeforeDuringandAfterImplantSurgery

When you hear the word “surgery,” your first thought might be of a high-charged operating room with a surgeon operating intently as a nurse mops sweat from their brow. While there are high-stakes surgeries, most aren’t quite that dramatic.

Dental implant surgery falls into the latter category. It does qualify as a surgical procedure because we make incisions and tissue alterations for the implant. But it’s no more rigorous than a surgical tooth extraction.

Still, if you’re new to implant surgery, it’s natural to feel some apprehension about it. To calm any nervousness, here’s a rundown of what to expect before, during and after the procedure.

Pre-Planning. Implant surgery is usually a routine affair because of meticulous planning beforehand. Often, we map out the implant site using CT scanners or other high-level imaging, identifying obstacles like nerves, blood vessels and sinus cavities, verifying there’s enough bone present to support an implant. With this information we can create a surgical plan or guide for placement in the mouth to accurately situate the implant.

Site Prep. On the day of the surgery we’ll first administer local anesthesia to numb the entire work area to pain. We’ll start with a few small gum incisions to expose the bone. Then using the surgical plan or guide, we’ll create a small channel for the implant with a drilling sequence that successively enlarges it until we achieve the best fit for the implant.

Implant Placement. Once we’ve completed drilling the channel, we’ll remove the implant from its sterile packaging and install it in the channel. After we’ve made any necessary adjustments and verified proper placement with x-rays, we’ll suture the gum tissue back into place.

After the Surgery. You might experience mild to moderate discomfort afterward that’s usually manageable with over-the-counter pain relievers like ibuprofen or acetaminophen. We can, if necessary, prescribe medication if you require something stronger. We may also prescribe an anti-bacterial mouth rinse for a short time to reduce the risk of infection.

After the implant has integrated with the bone which usually takes about 8-12 weeks, we’ll install your life-like crown or restoration. Your new smile and improved dental function will be well worth the process.

If you would like more information on the process for obtaining 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 “Dental Implant Surgery.”

By Bernard J Daly, DMD
October 01, 2019
Category: Dental Procedures
YouMayNeedanEndodontistforaToothWithInteriorDecay

You depend on your family dentist for most of your oral care. There are some situations, though, that are best handled by a specialist. If you or a family member has a deeply decayed tooth, for example, it might be in your long-term interest to see an endodontist.

From the Greek words, endo ("within") and odont ("tooth"), endodontics focuses on dental care involving a tooth's interior layers, including the pulp, root canals and roots. While general dentists can treat many endodontic problems, an endodontist has the advanced equipment and techniques to handle more complex cases.

The majority of an endodontist's work involves teeth inwardly affected by tooth decay. The infection has moved beyond the initial cavity created in the enamel and dentin layers and advanced into the pulp and root canals. The roots and underlying bone are in danger of infection, which can endanger the tooth's survival.

The most common treatment is root canal therapy, in which all of the infected tissue is removed from the pulp and root canals. Afterward, the empty spaces are filled and the tooth is sealed and crowned to prevent future infection. General dentists can perform this treatment, primarily with teeth having a single root and less intricate root canal networks. But teeth with multiple roots are a more challenging root canal procedure.

Teeth with multiple roots may have several root canals needing treatment, many of which can be quite small. An endodontist uses a surgical microscope and other specialized equipment, as well as advanced techniques, to ensure all of these inner passageways are disinfected and filled. Additionally, an endodontist is often preferred for previously root-canaled teeth that have been re-infected or conditions that can't be addressed by a traditional root canal procedure.

While your dentist may refer you to an endodontist for a problem tooth, you don't have to wait. You can make an appointment if you think your condition warrants it. Check out the American Association of Endodontists webpage www.aae.org/find for a list of endodontists in your area.

Advanced tooth decay can put your dental health at risk. But an endodontist might be the best choice to overcome that threat and save your tooth.

If you would like more information on endodontic dentistry, 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 “Why See an Endodontist?