Dental Implants

More and more people are getting dental implants to replace missing teeth. They're a long-term solution that is imbedded in your jawbone, just like your natural teeth. They even go your natural teeth one better, since they can't develop cavities. Plus, unlike fixed bridges or removable dentures, dental implants will not affect neighboring healthy teeth or lead to bone loss in the jaw. If properly cared for, dental implants can last a lifetime.

Dental implant surgery is, of course, surgery, and is best done by a trained surgeon. Your oral and maxillofacial surgeon (OMS) has the specialized education and training in the complexities of the bone, skin, muscles and nerves involved, to ensure you get the best possible results. A 2014 study suggests greater implant success rates when performed by a dental specialist.

Implants are made of titanium metal that "fuses" with the jawbone through a process called "osseointegration." There's no short cut to get around that process, and it usually takes several months once the implant is put into your jawbone. Osseointegration, however, is why implants never slip or make embarrassing noises like dentures, and why bone loss is usually not a problem.

After more than 20 years of service, the vast majority of dental implants first placed by oral and facial surgeons in the United States continue to function at peak performance. More importantly, the recipients of those early dental implants are still satisfied they made the right choice.

This procedure is a team effort between you, your dentist and your periodontist. Your periodontist and dentist will consult with you to determine where and how your implant should be placed. Depending on your specific condition and the type of implant chosen, your periodontist will create a treatment plan tailored to meet your needs.

Replacing a Single Tooth:   If you are missing a single tooth, one implant and a crown can replace it.

Replacing Several Teeth: If you are missing several teeth, implant-supported bridges can replace them.

Replacing All of Your Teeth:   If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them.

Sinus Augmentation:   A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants.

Ridge Modification: Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come.

 

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Dental Sealants

Dental sealants act as a barrier to prevent cavities. They are a plastic material usually applied to the chewing surfaces of the back teeth (premolars and molars) where decay occurs most often.

Thorough brushing and flossing help remove food particles and plaque from smooth surfaces of teeth. But toothbrush bristles cannot reach all the way into the depressions and grooves to extract food and plaque. Sealants protect these vulnerable areas by "sealing out" plaque and food.

Sealants are easy for your dentist to apply. The sealant is painted onto the tooth enamel, where it bonds directly to the tooth and hardens. This plastic resin bonds into the depressions and grooves (pits and fissures) of the chewing surfaces of back teeth. The sealant acts as a barrier, protecting enamel from plaque and acids. As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing and may last several years before a reapplication is needed. During your regular dental visits, your dentist will check the condition of the sealants and reapply them when necessary.

The likelihood of developing pit and fissure decay begins early in life, so children and teenagers are obvious candidates. But adults can benefit from sealants as well. 

Applying sealant is a simple and painless process. It takes only a few minutes for your dentist or hygienist to apply the sealant to seal each tooth.

The application steps are as follows:

  • First the teeth that are to be sealed are thoroughly cleaned.
  • Each tooth is then dried, and cotton or another absorbent material is put around the tooth to keep it dry.
  • An acid solution is put on the chewing surfaces of the teeth to roughen them up, which helps the sealant bond to the teeth.
  • The teeth are then rinsed and dried.
  • Sealant is then painted onto the tooth enamel, where it bonds directly to the tooth and hardens. Sometimes a special curing light is used to help the sealant harden.

How Long Do Sealants Last?

Sealants can protect teeth from decay for up to 10 years, but they need to be checked for chipping or wearing at regular dental check-ups. Your dentist can replace sealants as necessary.

Does Insurance Cover the Cost of Sealants?

Many insurance companies cover the cost of sealants. Check with your dental insurance carrier to determine if sealants are covered under your plan.

 

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Extractions

Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired. Other reasons include:

A crowded mouth: Sometimes dentists pull teeth to prepare the mouth for orthodontia. The goal of orthodontia is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend pulling it.

Infection: If tooth decay or damage extends to the pulp -- the center of the tooth containing nerves and blood vessels -- bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canal therapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.

Risk of infection: If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant), even the risk of infection in a particular tooth may be reason enough to pull the tooth.

Periodontal (Gum) Disease: If periodontal disease -- an infection of the tissues and bones that surround and support the teeth -- have caused loosening of the teeth, it may be necessary to the pull the tooth or teeth.

Dentists and oral surgeons (dentists with special training to perform surgery) perform tooth extractions. Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed. If you are having more than one tooth pulled or if a tooth is impacted, your dentist may use a strong general anesthetic. This will prevent pain throughout your body and make you sleep through the procedure.

If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a hard-to-pull tooth must be removed in pieces.

Once the tooth has been pulled, a blood clot usually forms in the socket. The dentist will pack a gauze pad into the socket and have you bite down on it to help stop the bleeding. Sometimes the dentist will place a few stitches -- usually self-dissolving -- to close the gum edges over the extraction site.

Sometimes, the blood clot in the socket breaks loose, exposing the bone in the socket. This is a painful condition called dry socket. If this happens, your dentist will likely place a sedative dressing over the socket for a few days to protect it as a new clot forms.

Although having a tooth pulled is usually very safe, the procedure can allow harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. If you have a condition that puts you at high risk for developing a severe infection, you may need to take antibiotics before and after the extraction. Before having a tooth pulled, let your dentist know your complete medical history, the medications and supplements you take.

Following an extraction, your dentist will send you home to recover. Recovery typically takes a few days. The following can help minimize discomfort, reduce the risk of infection, and speed recovery.

Take painkillers as prescribed. Bite firmly but gently on the gauze pad placed by your dentist to reduce bleeding and allow a clot to form in the tooth socket. Change gauze pads before they become soaked with blood. Otherwise, leave the pad in place for three to four hours after the extraction. Apply an ice bag to the affected area immediately after the procedure to keep down swelling. Apply ice for 10 minutes at a time. Relax for at least 24 hours after the extraction. Limit activity for the next day or two. Avoid rinsing or spitting forcefully for 24 hours after the extraction to avoid dislodging the clot that forms in the socket. After 24 hours, rinse with your mouth with a solution made of 1/2 teaspoon salt and 8 ounces of warm water. Do not drink from a straw for the first 24 hours. Do not smoke, which can inhibit healing. Eat soft foods, such as soup, pudding, yogurt, or applesauce the day after the extraction. Gradually add solid foods to your diet as the extraction site heals. When lying down, prop your head with pillows. Lying flat may prolong bleeding. Continue to brush and floss your teeth, and brush your tongue, but be sure to avoid the extraction site. Doing so will help prevent infection.

 

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Fixed Full Dentures

Dentures, also known as false teeth, are prosthetic devices constructed to replace missing teeth; they are supported by the surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable (removable partial denture or complete denture). However, there are many different denture designs, some which rely on bonding or clasping onto teeth or dental implants (fixed prosthodontics). There are two main categories of dentures, the distinction being whether they are used to replace missing teeth on the mandibular arch or on the maxillary arch.

A fixed denture consists of a dental implant bridge (sometimes called permanent dentures) that is supported by four or more dental implants. Because the dental implants function like the natural roots, the permanent dentures will feel very much like your natural teeth did.

 

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GUM SURGERY

Periodontal disease begins with bacteria present in the mouth attaching to the teeth. The bacteria collect and multiply, forming a biofilm called dental plaque. If this plaque is left on the teeth, the adjacent gingival tissues can become inflamed, resulting in the development of gingivitis, an early form of gum disease.  Daily flossing and twice-daily brushing with a toothpaste that fights bacteria can help prevent gingivitis. Plaque and food debris are removed by oral hygiene practices and thus clean the surface of the teeth and eliminate bacterial plaque at the gum line of the teeth.

[It needs to be clear from this section that gingivitis is an early form of gum disease that can lead to periodontitis, a serious form gum disease, if left untreated] 

However, if plaque and food debris are not removed and oral hygiene practices are not maintained, then gingivitis will get worse and the gum tissue can become more inflamed, bleeding can occur, the area between the tooth and gum tissue can become deepened to form a periodontal pocket and periodontal disease can develop.

A periodontal pocket develops as the plaque bacteria from the biofilm continues to accumulate and moves below the gum line. At this point, home care is not very effective in removing the dental plaque. If it is left untreated by the dentist or dental hygienist, the biofilm will continue to spread below the gum line and infect the inside of the pocket. The bacteria in the plaque produce by-products that cause the adjacent soft and hard tissue to degrade, forming a deeper pocket in the process. This type of advanced periodontal disease can affect the roots of the teeth and they can become infected, too. The teeth may become loose or uncomfortable and the patient will require gum surgery. The patient would be required to have initial therapy to treat diseased periodontal pockets through scaling and root planning. The dental hygienist would utilize an ultrasonic scaling device to remove plaque, tartar and food debris below the gum line and would hand scale the tooth and root surface to make it smooth and disease free. Scaling and root planing can be completed in two to four sessions depending on how much oral disease the patient may have. Thorough oral hygiene procedures would be reviewed with the patient to improve oral care cleaning techniques at home.

Types of Gum Surgery

  1. Gingival Flap Surgery– If pockets are greater than 5 millimeters in depth, the periodontist would conduct this procedure to reduce the periodontal pockets that were noted in a patients chart. Most patients who have been diagnosed with moderate to severe periodontitis would go through this procedure. The periodontist would cut the gum tissue to separate the gum tissue from the teeth, conduct a thorough deep cleaning with an ultrasonic scaling device as well as hand instruments to remove tartar, plaque and biofilm below the pockets.
  1. Gingivectomy– This procedure is conducted to remove excess gum tissue that may be overgrown on the teeth to provide a better area to clean the teeth. The periodontist would numb the patients gum tissue and cut and eliminate the extra gum tissue in the mouth.
  1. Gingivoplasty– This type of gum surgery is used to reshape healthy gum tissue around the teeth to make them look better. If a person has tooth recession where the gum is pushed away from the tooth, a gingivoplasty can be done. A gum graft can be done where the tissue is taken from the roof of the mouth (this is called a graft) and then stitched into place on either side of the tooth that is recessed.

After gum surgery, it is important that the periodontist or dental hygienist inform you how to clean the teeth and gum tissue with a toothbrush and an antimicrobial fluoride toothpaste, floss and antibacterial mouth rinse. Please consult your periodontal specialist or dentist for more information of how to care for your gum tissue and teeth after gum surgery.

 

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Invisalign®

Invisalign takes a modern approach to straightening teeth, using a custom-made series of aligners created for you and only you. These aligner trays are made of smooth, comfortable and virtually invisible plastic that you wear over your teeth. Wearing the aligners will gradually and gently shift your teeth into place, based on the exact movements your dentist or orthodontist plans out for you. There are no metal brackets to attach and no wires to tighten. You just pop in a new set of aligners approximately every two weeks, until your treatment is complete. You’ll achieve a great smile with little interference in your daily life. The best part
about the whole process is that most people won't even know you're straightening your teeth.

Your doctor will take x-rays, pictures and impressions of your teeth, which Invisalign will use to create a digital 3-D image of them. From these images your doctor will map out a precise treatment plan, including the exact movements of your teeth, and tell you the approximate length of treatment. Using the same technology your doctor will be able to show you a virtual representation of how your teeth will move with each stage of treatment. While every case is unique to each patient, treatment typically takes approximately a year for adults. For teens the length of treatments is comparable to that of braces.

Based on your individual treatment plan, a series of custom-made, clear aligners is then created specifically for you. These aligners are made of a smooth, comfortable, BPA-free plastic that won't irritate your cheeks and gums like traditional metal braces often do. Simply wear them throughout the day, and remove them when you eat or to brush and floss your teeth. As you wear each set of aligners, your teeth gently and gradually begin to shift into place. And because they're virtually invisible, most people won't even notice you're wearing them.

Approximately every two weeks, you will begin wearing a new set of aligners, advancing you to the next stage of your treatment. To monitor your progress, you will also have occasional checkups with your doctor, usually only every six weeks or so. For best results and a timely outcome, you should wear your aligners for 20 to 22 hours per day, throughout your entire treatment. At every stage, you will be able to see how much closer you are to having the smile that reflects the real you.

 

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Flouride Treatments

Fluoride is a mineral that occurs naturally in many foods and water. Every day, minerals are added to and lost from a tooth's enamel layer through two processes, demineralization and remineralization. Minerals are lost (demineralization) from a tooth's enamel layer when acids -- formed from plaque bacteria and sugars in the mouth -- attack the enamel. Minerals such as fluoride, calcium, and phosphate are redeposited (remineralization) to the enamel layer from the foods and waters consumed. Too much demineralization without enough remineralization to repair the enamel layer leads to tooth decay.

Fluoride helps prevent tooth decay by making the tooth more resistant to acid attacks from plaque bacteria and sugars in the mouth. It also reverses early decay. In children under 6 years of age, fluoride becomes incorporated into the development of permanent teeth, making it difficult for acids to demineralize the teeth. Fluoride also helps speed remineralization as well as disrupts acid production in already erupted teeth of both children and adults.

A dentist in his or her office can also apply fluoride to the teeth as a gel, foam, or varnish. These treatments contain a much higher level of fluoride than the amount found in toothpastes and mouth rinses. Varnishes are painted on the teeth; foams are put into a mouth guard, which is applied to the teeth for one to four minutes; gels can be painted on or applied via a mouth guard.

Fluoride supplements are also available as liquids and tablets and must be prescribed by your dentist, pediatrician, or family doctor.

When Is Fluoride Intake Most Critical?

It is certainly important for infants and children between the ages of 6 months and 16 years to be exposed to fluoride. This is the timeframe during which the primary and permanent teeth come in. However, adults benefit from fluoride, too. New research indicates that topical fluoride -- from toothpastes, mouth rinses, and fluoride treatments -- are as important in fighting tooth decay as in strengthening developing teeth.

In addition, people with certain conditions may be at increased risk of tooth decay and would therefore benefit from additional fluoride treatment. They include people with:

  • Dry mouth conditions: Also called xerostomia, dry mouth caused by diseases such as Sjögren's syndrome, certain medications (such as allergymedications, antihistamines, anti anxietydrugs, and high blood pressure drugs), and head and neck radiation treatment makes someone more prone to tooth decay. The lack of saliva makes it harder for food particles to be washed away and acids to be neutralized.
  • Gum disease: Gum disease, also called periodontitis, can expose more of your tooth and tooth roots to bacteria increasing the chance of tooth decay. Gingivitis is an early stage of periodontitis.
  • History of frequent cavities: If you have one cavity every year or every other year, you might benefit from additional fluoride.
  • Presence of crowns and/or bridges or braces: These treatments can put teeth at risk for decay at the point where the crown meets the underlying tooth structure or around the brackets of orthodontic appliances.

Fluoride is safe and effective when used as directed but can be hazardous at high doses (the "toxic" dosage level varies based on an individual's weight). For this reason, it's important for parents to carefully supervise their children's use of fluoride-containing products and to keep fluoride products out of reach of children, especially children under the age of 6.

In addition, excess fluoride can cause defects in the tooth's enamel that range from barely noticeable white specks or streaks to cosmetically objectionable brown discoloration. These defects are known as fluorosis and occur when the teeth are forming -- usually in children younger than 6 years. Fluorosis, when it occurs, is usually associated with naturally occurring fluoride, such as that found in well water. If you use well water and are uncertain about the mineral (especially fluoride) content, a water sample should be tested. Although tooth staining from fluorosis cannot be removed with normal hygiene, your dentist may be able to lighten or remove these stains with professional-strength abrasives or bleaches.

Keep in mind, however, that it's very difficult to reach hazardous levels given the low levels of fluoride in home-based fluoride-containing products. Nonetheless, if you do have concerns or questions about the amount of fluoride you or your child may be receiving, talk to your child's dentist, pediatrician, or family doctor.

A few useful reminders about fluoride include:

  • Store fluoridesupplements away from young children.
  • Avoid flavored toothpastes because these tend to encourage toothpaste to be swallowed.
  • Use only a pea-sized amount of fluoridated toothpaste on a child'stoothbrush.
  • Be cautious about using fluoridated toothpaste in children younger than age 6. Children younger than 6 years of age are more likely to swallow toothpaste instead of spitting it out.

Even though there are no scientific studies to suggest that people who drink bottled water are at increased risk of tooth decay, the American Dental Association (ADA) says that such people could be missing out on the decay-preventing effects of optimally fluoridated water available from their community water source. The ADA adds that most bottled waters do not contain optimal levels of fluoride, which is 0.7 to 1.2 parts per million (this is the amount that is in public water supplies, in the communities that have fluoridated water). To find out if your brand of bottled water contains any fluoride, check the label on the bottle or contact the bottle water manufacturer.

The amount of fluoride you receive in your drinking water depends on the type of home water treatment system used. Steam distillation systems remove 100% of fluoride content. Reverse osmosis systems remove between 65% and 95% of the fluoride. On the other hand, water softeners and charcoal/carbon filters generally do not remove fluoride. One exception: some activated carbon filters contain activated alumina that may remove over 80% of the fluoride.

If you use a home water treatment system, have your water tested at least annually to establish the fluoride level your family is receiving in the treated water. Testing is available through local and state public health departments as well as private laboratories. Also, check with the manufacturer of the product you purchased or read the information that came with the water treatment system to determine the product's effects on fluoride in your home water.

To find out how much fluoride is in your tap water, ask your local dentist, contact your local or state health department, or contact your local water supplier. Information for contacting your local water supplier should be on your water bill or see the "local government" section of your phone book.

Approximately 62% of the U.S. population served by public water supplies has access to adequate levels of fluoride in their water, and 43 of the 50 largest U.S. cities have water fluoridation systems.

 

 

 

 

 

 

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Orthodontics

Orthodontics is the branch of dentistry that corrects teeth and jaws that are positioned improperly. Crooked teeth and teeth that do not fit together correctly are harder to keep clean, are at risk of being lost early due to tooth decay and periodontal disease, and cause extra stress on the chewing muscles that can lead to headaches, TMJ syndrome and neck, shoulder and back pain. Teeth that are crooked or not in the right place can also detract from one's appearance.

The benefits of orthodontic treatment include a healthier mouth, a more pleasing appearance, and teeth that are more likely to last a lifetime.

A specialist in this field is called an orthodontist. Orthodontists receive two or more years of education beyond their four years in dental school in an ADA-approved orthodontic training program.

Only your dentist or orthodontist can determine whether you can benefit from orthodontics. Based on diagnostic tools that include a full medical and dental health history, a clinical exam, plaster models of your teeth, and special X-rays and photographs, an orthodontist or dentist can decide whether orthodontics are recommended, and develop a treatment plan that's right for you.

If you have any of the following, you may be a candidate for orthodontic treatment:

Overbite, sometimes called "buck teeth" — where the upper front teeth lie too far forward (stick out) over the lower teeth

Underbite — a "bulldog" appearance where the lower teeth are too far forward or the upper teeth too far back

Cross bite — when the upper teeth do not come down slightly in front of the lower teeth when biting together normally

Open bite — space between the biting surfaces of the front and/or side teeth when the back teeth bite together

Misplaced midline— when the center of your upper front teeth does not line up with the center of your lower front teeth

Spacing — gaps, or spaces, between the teeth as a result of missing teeth or teeth that do not "fill up" the mouth

Crowding — when there are too many teeth for the dental ridge to accommodate

How Does Orthodontic Treatment Work?

Many different types of appliances, both fixed and removable, are used to help move teeth, retrain muscles and affect the growth of the jaws. These appliances work by placing gentle pressure on the teeth and jaws. The severity of your problem will determine which orthodontic approach is likely to be the most effective.

Fixed appliances include:

Braces — the most common fixed appliances, braces consist of bands, wires and/or brackets. Bands are fixed around the teeth or tooth and used as anchors for the appliance, while brackets are most often bonded to the front of the tooth. Arch wires are passed through the brackets and attached to the bands. Tightening the arch wire puts tension on the teeth, gradually moving them to their proper position. Braces are usually adjusted monthly to bring about the desired results, which may be achieved within a few months to a few years. Today's braces are smaller, lighter and show far less metal than in the past. They come in bright colors for kids as well as clear styles preferred by many adults.

Special fixed appliances — used to control thumb sucking or tongue thrusting, these appliances are attached to the teeth by bands. Because they are very uncomfortable during meals, they should be used only as a last resort.

Fixed space maintainers — if a baby tooth is lost prematurely, a space maintainer is used to keep the space open until the permanent tooth erupts. A band is attached to the tooth next to the empty space, and a wire is extended to the tooth on the other side of the space.

Removable appliances include:

Aligners — an alternative to traditional braces for adults, serial aligners are being used by an increasing number of orthodontists to move teeth in the same way that fixed appliances work, only without metal wires and brackets. Aligners are virtually invisible and are removed for eating, brushing and flossing.

Removable space maintainers — these devices serve the same function as fixed space maintainers. They're made with an acrylic base that fits over the jaw, and have plastic or wire branches between specific teeth to keep the space between them open.

Jaw repositioning appliances — also called splints, these devices are worn on either the top or lower jaw, and help train the jaw to close in a more favorable position. They may be used for temporomandibular joint disorders (TMJ).

Lip and cheek bumpers — these are designed to keep the lips or cheeks away from the teeth. Lip and cheek muscles can exert pressure on the teeth, and these bumpers help relieve that pressure.

Palatal expander — a device used to widen the arch of the upper jaw. It is a plastic plate that fits over the roof of the mouth. Outward pressure applied to the plate by screws force the joints in the bones of the palate to open lengthwise, widening the palatal area.

Removable retainers — worn on the roof of the mouth, these devices prevent shifting of the teeth to their previous position. They can also be modified and used to prevent thumb sucking.

Headgear — with this device, a strap is placed around the back of the head and attached to a metal wire in front, or face bow. Headgear slows the growth of the upper jaw, and holds the back teeth where they are while the front teeth are pulled back.

 

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Perio Scaling and Root Planing

You visit the dentist every six months for your dental check-up and professional cleaning, then one visit the dentist tells you that you have gum disease. Gum disease is an inflammation of the gum tissue that could affect the teeth and supporting bone in your mouth. Plaque bacteria, acids and certain foods all contribute to the development of gum disease. Fortunately, two common methods exist to reverse the disease — dental scaling and root planing.

Dental scaling occurs with manual hand instruments, ultrasonic instruments or both. The dentist will start the procedure with a thorough examination of your mouth. Next, an ultrasonic scaling device will be used to eliminate the plaque bacteria with sonic vibrations. The ultrasonic scaling device removes tartar (calculus), plaque and biofilm from the tooth surface and underneath the gum line. A manual instrument may be used next to remove the remainder.

Root planing involves detailed scaling of the root surface to decrease inflammation of the gum tissue. The dentist scales the root surface to smooth out rough target areas, eliminating plaque and biofilm development.

How Will It Feel?

If your gum tissue is sensitive and diseased, local anesthesia can be administered to numb the tissue. If your teeth are sensitive before or after the professional cleaning, it may be recommended that you use a desensitizing paste to provide you with sensitivity relief. Dental scaling and root planing may take two to four visits based upon the level of oral disease in the mouth. If you have periodontal disease, dental scaling and root planing will be completed first and then periodontal surgery will be conducted thereafter.

Better Oral Health

The dental hygienist will educate you how to care for your teeth and gum tissue. Proper flossing and brushing will be reviewed to help you eliminate the development of future bacteria and tartar formation.

 

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Sinus Lift Procedure

A sinus lift is surgery that adds bone to your upper jaw in the area of your molars and premolars. It's sometimes called a sinus augmentation. The bone is added between your jaw and the maxillary sinuses, which are on either side of your nose. To make room for the bone, the sinus membrane has to be moved upward, or "lifted." A sinus lift usually is done by a specialist. This could be either an oral and maxillofacial surgeon or a periodontist.

What It's Used For

A sinus lift is done when there is not enough bone height in the upper jaw, or the sinuses are too close to the jaw, for dental implants to be placed. There are several reasons for this:

  • Many people who have lost teeth in their upper jaw — particularly the back teeth, or molars — do not have enough bone for implants to be placed. Because of the anatomy of the skull, the back of the upper jaw has less bone than the lower jaw.
  • Bone may have been lost because of periodontal (gum) disease.
  • Tooth loss may have led to a loss of bone as well. Once teeth are gone, bone begins to be resorbed (absorbed back into the body). If teeth have been missing for a long time, there often is not enough bone left to place implants.
  • Tooth loss may have led to a loss of bone as well. Once teeth are gone, bone begins to be resorbed (absorbed back into the body). If teeth have been missing for a long time, there often is not enough bone left to place implants.
  • The maxillary sinus may be too close to the upper jaw for implants to be placed. The shape and the size of this sinus varies from person to person. The sinus also can get larger as you age.

Sinus lifts have become common during the last 15 years as more people get dental implants to replace missing teeth.

Preparation

The bone used in a sinus lift may come from your own body (autogenous bone), from a cadaver (allogeneic bone) or from cow bone (xenograft).

If your own bone will be used in the sinus lift, it will be taken from other areas of your mouth or body. In some cases, the surgeon removes bone from your hip or tibia (the bone beneath the knee).

You will need X-rays taken before your sinus lift so the dentist can study the anatomy of your jaw and sinus. You also may need a special type of computed tomography (CT) scan. This scan will allow the dentist to accurately measure the height and width of your existing bone and to evaluate the health of your sinus.

If you have seasonal allergies, you should schedule the procedure when they are not active.

How It's Done

Your surgeon will cut the gum tissue where your back teeth used to be. The tissue is raised, exposing the bone. A small, oval window is opened in the bone. The membrane lining the sinus on the other side of the window separates your sinus from your jaw. This membrane is gently pushed up and away from your jaw.

Granules of bone-graft material are then packed into the space where the sinus was. The amount of bone used will vary, but usually several millimeters of bone is added above the jaw.

Once the bone is in place, the tissue is closed with stitches. Your implants will be placed four to nine months later. This allows time for the grafted material to mesh with your bone. The amount of time depends on the amount of bone needed.

Follow-Up

After the procedure, you may have some swelling of the area. You may bleed from your mouth or nose. Do not blow your nose or sneeze forcefully. Either one could cause the bone-graft material to move, and loosen the stitches.

Your dentist may give you saline sprays to keep the inner lining of your nose wet and prescribe medicine to prevent congestion and inflammation. You also will be given pain medicine, an antibiotic and an antimicrobial mouthwash to help prevent infection. Most patients have only a little discomfort after a sinus-lift procedure.

You will see the specialist after 7 to 10 days. He or she will evaluate the surgical site and remove stitches if they will not dissolve on their own. You might be asked to return a few more times to make sure the area is healing properly.

After a sinus lift, you need to wait several months for the bony material to harden and integrate with your jaw. Depending on the grafting material used, implants may be placed in four to nine months.

Some specialists have started using proteins called growth factors to help the new bone harden faster. Platelet-rich plasma, which contains the growth factors, is taken from your blood before surgery and mixed with the graft that is placed into your sinus. Human-recombinant bone morphogenetic protein is an engineered protein that is now available. It stimulates bone formation without grafting. The U.S. Food and Drug Administration has approved its use during a sinus lift procedure.

Risks

The main risk of a sinus lift is that the sinus membrane could be punctured or torn. If the membrane is torn during the procedure, the surgeon will either stitch the sinus tear or place a patch over it. If the repair is not successful, your surgeon may stop the procedure and give the hole time to heal.

Your dentist can redo the sinus lift once the membrane has healed. This usually takes a few months. A healed membrane tends to be thicker and stronger, which means a second attempt at a sinus lift is likely to be successful. However, other factors also affect success.

Infection is a risk of any surgical procedure. However, this rarely occurs after sinus lifts.

On rare occasions, the existing bone does not integrate with the bony graft material, and the grafted area does not develop a blood supply. If this happens, any implants placed in this area will fail because there is no live bone for them to attach to. If this happens, you can have the sinus lift procedure repeated.

When To Call a Professional

After a sinus lift, contact your surgeon if:

  • Any swelling or pain gets worse over time. (It should decrease after the first two days or so.)
  • The bleeding does not stop after one to two days.
  • Bleeding is bright red and continuous. (Normal bleeding after this procedure oozes slowly and is dark red with possible clots.)
  • You think the bony material may have been dislodged after sneezing or blowing your nose.
  • Pain does not decrease over time.
  • You develop a fever.

 

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