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Ask Dr. G
Dr. Richard Gangwisch graduated from Ohio State University College of Dentistry
in 1977. After teaching dental students at Emory University's School of
Dentistry for nine years, he earned his Fellowship and Mastership from the
Academy of General Dentistry, awards for staying at the forefront of dentistry.
In 2007, he attained diplomate status in the American Board of General
Dentistry. This board certification has been achieved by relatively few
general dentists. The questions in this section are answered not only with
book knowledge, but also utilizing over 30 years of practical experience.
There is no substitute for
What are porcelain laminates?
laminates are cosmetic coverings for front teeth. In this technique, a small
amount (.5mm) of tooth structure is removed from the front of the teeth and then
an impression is taken and sent to a laboratory. In the lab, space-age
porcelain materials are formed into a very thin piece called a laminate veneer.
This porcelain can be formed and colored to appear incredibly tooth-like. The
laminates are then tried on the tooth and are glued into place with special
bonding materials. An opaquing substance can be mixed with the bonding material
to mask any dark colors of the underlying tooth. Porcelain laminates are
very conservative because only a minimal amount of tooth enamel must be removed
to make room for the porcelain. The technique can be used to cover stained
teeth, to close gaps, and to reshape deformed teeth. It can be used
to straighten crooked teeth giving the impression of "instant orthodontics".
Click on the links below to view some examples of porcelain laminates.
">Porcelain Laminates To Cover Tetracycline Stain
">Porcelain Laminates To Close Gaps
">Miscellaneous Porcelain Laminate Cases
What is bonding?
In bonding, the white composite material that is used for filling cavities
in front teeth is layered onto the front of teeth for cosmetic purposes . The
results look great initially, however, the technique is not very permanent, and
must be redone periodically. This technique has now been replaced by porcelain
laminates in adults. It is still used in children since no tooth enamel
must be removed allowing for flexibility in future cosmetic decisions.
Bonding is also used to repair fractured teeth when the dentist does not
recommend a crown (cap). Click on the links below to view some examples of
">Bonding To Cover Tetracycline Stain
">Bonding To Widen Small Teeth And To Close Gaps
">Bonding To Create A Winning Smile
">Peg Lateral Corrected With Bonding
How do you handle teeth bleaching?
Bleaching can be done in the office in one hour or at home which can take
anywhere from 2-6 weeks. Since studies have shown that the final results
are the same and patient satisfaction is only 47% with in-office bleaching
vs. 96% for at-home bleaching, we utilize the at-home bleaching technique
exclusively. The in-office method utilizes a strong light to heat a very
strong bleach solution which can cause a lot of temperature sensitivity.
There is very little sensitivity in teeth when doing the at-home system.
We make a mold of a patient's teeth, then construct an extremely thin, clear
plastic mouthpiece to hold the bleach. The patient wears this mouthpiece at
night while they sleep with the bleaching gel for up to a few weeks.
">Bleaching Example #1
">Bleaching Example #2
Tooth-colored fillings vs. silver amalgam fillings?
Silver amalgam fillings contain mercury as part of their composition. Free
mercury is very toxic, however, when it is combined with silver, it forms a very
stable compound which locks in the mercury and makes it inert. Since
amalgam has been used for well over 100 years, there has yet to be a
population study that shows any ill effects from amalgam usage. The early
tooth-colored filling materials that were available did not hold up very well.
They stained and chipped and wore down in a relatively short amount of time.
The newer "composite" tooth-colored filling materials show much better promise.
They look great, not showing the dark grey of the silver fillings. Their
longevity is still not as long as the metal ones, but they are to the point
where they are a much more esthetic alternative.
Tooth Colored Fillings in Back Teeth
What can you tell me about tooth-colored fillings?
modern tooth colored filling materials consist of a resin which hold together
finely ground quartz crystals. The resin can be tinted to get the filling
close to the color of the tooth, and the quartz crystals will reflect the
underlying natural color to obtain a very good match. Unfortunately, the
resin in the tooth colored fillings tend to absorb stains from the
mouth over time and the bond between the tooth and the filling material can
break down making it possible to get decay around the edges of the filling.
">Tooth Colored Fillings
What can you tell me about worn teeth (attrition)?
Grinding one's teeth while they sleep can not only cause jaw joint problems, but
can result in significant wear of the teeth. Once the enamel coating has
been worn away, then the softer inner layer (the dentin) will abrade at a much
faster rate, leaving cupped out areas of the chewing surfaces of the teeth.
The best way to handle this problem is prevention. Once the enamel coating
has worn away, then the only way to treat the problem is to place porcelain
crowns over the teeth to prevent any further damage. The best way to
prevent this from happening is to wear a professionally constructed mouthpiece
called a nightguard while sleeping. The "boil and bite" athletic
mouthpieces are not recommended because it restricts the jaw movement during
sleep and if the bite is not in perfect position, then it could lead to future
jaw joint problems.
What is erosion?
Erosion is a chemical process where acids in the mouth will dissolve the enamel
surface. This acid can come from the stomach, from sucking on citrus
fruits such as lemons, or from carbonated beverages. Damage from stomach
acid will tend to erode the back side (lingual) of the teeth. Lemon
sucking will dissolve the edges of the front teeth. And carbonated
beverages tend to erode at the neck of the teeth (cervical) at the level of the
gums. Although cervical erosion can be repaired with tooth colored fillings, too
much damage on the incisal edges leaves only the brittle enamel on the edges
making them very susceptible to chipping. The only solution to repair this
problem is with full coverage with porcelain crowns (caps). This will
improve the smile immensely and will protect the teeth from further erosion.
">Erosion Case #1
">Erosion Case #2
What is abrasion?
Abrasion is any type of mechanically induced loss of tooth structure. It
is mainly caused by brushing the teeth improperly. We will show you the
proper method to brush your teeth and which type of toothpaste to use to
minimize any further wear. Improper tooth brushing can cause not only loss of
tooth structure, but also gum recession. This usually leads to sensitivity
to cold liquids and foods. We can apply desensitizing agents to the root
surface to help relieve the discomfort, but the best method is prevention.
What is functional orthodontics?
Functional orthodontics utilizes various appliances in the mouth to utilize
muscle function and growth patterns to do its work. These retainer-like
appliances are usually worn full time, even while eating. As the child
grows, the forces of the appliances will redirect the growth of the jaws into a
more favorable position. Since the jaw muscles are adapting to the
different size and shape of the jaws, it results in a much more stable, long
lasting result. These appliances can be used to make larger jaws to
accommodate more teeth therefore lessening or eliminating crowding. They
can even be used to make the lower jaw longer to help eliminate bad overbites.
These appliances must be used at the proper age in order for the muscles to
adapt to the changes permanently. There are even times that the need for
braces can be totally eliminated.
">Functional Orthodontics Case #1
">Functional Orthodontics Case #2
">Functional Orthodontics Case #3
The metal brackets can now be made extremely small making them much less noticeable. We have colored elastics to tie the wires in. The kids love them - school colors, orange and brown for Halloween, red and green for holiday time. There are clear brackets made from ceramics that can be much
stronger and more color stable than the old plastic ones. The wires are now made from space age nickel-titanium which keep their form for much longer
allowing for faster tooth movement and quicker treatment times.
What can you tell me about the new invisible braces?Invisible braces
are the most exciting thing to be developed in the world of modern orthodontics.
We take a mold of a patient's crowded teeth and send them to a lab where it is
digitized into a computer. Then a technician will make a series of clear
thin plastic "aligners". Each aligner puts a gentle selected pressure on
the teeth to move them into a straighter position. It is so incredible
that people can't see that someone is undergoing orthodontics. You can
take the aligners out to eat and to brush and floss. They are extremely
comfortable to wear. These type of braces are not for all types of
orthodontic conditions. You can see us for a consult to see if you are a
candidate for this type of treatment.
">Invisible Braces Case #1
">Invisible Braces Case #2
">Invisible Braces Case #3
I lost some teeth many years ago and now they are tilting. Can they be
The back teeth have a natural tendency to touch other teeth. That goes for
teeth in the same jaw and also their chewing counterparts in the opposing jaw.
This is reminiscent of our caveman days when the diets were extremely coarse.
Teeth would wear both between the teeth and on the chewing surface during the
natural course of chewing food. Therefore, the teeth had to move to
accommodate this wear so that the teeth would continue to touch. When a
tooth is lost, this natural tendency to touch other teeth will cause the
adjacent teeth to tilt and the opposing teeth to grow down into that space
of the missing tooth. This causes a misalignment of the bite and puts
abnormal pressure on the individual teeth. This can cause TMJ (jaw joint)
pain and loosening and loss other teeth. With orthodontics, we can upright
these fallen teeth back into their original position. This allows the
teeth to mesh properly and not place any abnormal stresses on the individual
teeth or jaw joint.
">Orthodontics For Tilted Teeth
I have worn my teeth down. What can be done to correct that?When teeth are worn down abnormally do to clenching, grinding,
or various bad habits, they can cause the jaw to over close. This can put
abnormal pressure on the jaw joint. Once the enamel has been worn away,
the softer dentin is exposed and wears away even faster. To stop this
process from totally destroying the teeth, we will usually cover the teeth with
crowns (caps) to protect the teeth from further damage and to restore the
original size and shape of the teeth. Sometimes, the damage is so severe
and the jaw so over closed that we cannot place crowns on the teeth without
damaging or exposing the tooth nerve. By utilizing modern orthodontics, we
can open the bite up to make room for the crowns and take the pressure off the
">Orthodontics For Worn Teeth
My teeth look ugly because I was born without one of my front teeth. How can you help me?
It is not uncommon to be born without a full set of teeth. These
congenitally missing teeth can cause problems since the adjacent teeth will
erupt into those spaces causing misalignment. By utilizing orthodontics,
these spaces can be opened up and filled with replacement teeth, or can be
closed so there would be no need for replacement.
">Orthodontics For Missing Teeth
Pediatric Dentistry (Dentistry For Children)
What do I need to do while I am pregnant to make sure that my baby will have good teeth?
The teeth start to form in the second month of pregnancy and will calcify during
the second trimester. Adhering to a normal, healthy diet, especially with
foods that are calcium rich, is sufficient to help insure that your child will
have healthy teeth.
What extra precautions do I need to take for my teeth while I am pregnant?
Due to hormone changes during pregnancy, any plaque that is left behind will
tend to cause an exaggerated response with a condition of swollen, bleeding gums
called gingivitis. If this condition is left untreated, it can lead to
infection of the bone that holds the teeth in. Also,
pregnancy can cause a craving for sugary foods and an increase in snacking.
This can allow an increase in cavities. Contrary to popular folklore, this
is not due to the baby pulling calcium from the mother's teeth. Therefore,
meticulous oral hygiene must be performed daily while pregnant and post-partum
until the hormone balance is restored.
When do I need to start cleaning my child's teeth?
As soon as the teeth erupt, you should brush and floss their teeth. You
will need to keep this up until your child gets old enough to handle those
chores on their own.
When should my child first visit the dentist?
It is generally recommended that your child should first visit the
dentist 6 months after the first tooth erupts. In our office, we usually
recommend that we see the child during one of Mom or Dad's routine checkups.
We can look into the child's mouth and check for cavities, make certain that
proper oral hygiene is being performed, and provides a good opportunity to
answer any questions. Unless cavities are seen, the best time to start
routine cleanings, examinations, and fluoride treatments is around three years
What are baby bottle cavities?
When the teeth are exposed to sugary fluids for a prolonged period, there can be
a rapid advancement of decay. This happens mostly when putting a toddler
to bed with a baby bottle. Even liquids like milk or fruit juice have
enough sugar to fuel the decay process. This problem is characterized by
multiple cavities especially in the front teeth at a very early age. As a
rule of thumb, if you are going to put your child to bed with a bottle, only
have it filled with water.
What type of toothpaste is best for my child?
Make sure that the toothpaste that you and your child use has the American
Dental Association seal of approval. The toothpastes with this seal have
undergone stringent, independent testing to make sure that the manufacturer's
claims are accurate. It must also have fluoride in it. The fluoride
will strengthen the tooth enamel making it more acid resistant and will reduce
the bacterial population that causes plaque.
Is the fluoride in the water safe?
Water fluoridation is the best way to reduce decay for your child. The
fluoride is incorporated into the tooth enamel while the teeth are actively
forming thus making it much stronger and more decay resistant. Fluoride
has been used in municipal water systems for more than 50 years and there have
been no studies that have shown any ill health effects.
When should my child lose their first tooth?
Even though the lower front teeth are usually lost around age 6, there is no
need to panic if your child has not lost their first tooth by their 7th
birthday. There is a normal range of between age between 5 and 8 years
old. If a child has not lost a tooth by age 9, there could be an
indication of an endocrine problem and your pediatrician should be consulted.
If the baby teeth are going to fall out eventually, why is it important
that we try to save them?
Although they are less important in the front teeth, the back molars are very
important in holding space for the permanent teeth. If a baby molar is
lost too early. then the surrounding teeth will drift into that space and crowd
out the erupting permanent tooth. If a baby molar is lost too early, it is
best for the dentist to place a device called a space maintainer to hold the
space open for the permanent tooth to erupt.
My child is a thumbsucker, when should I start to be concerned?
Thumbsucking is very common in infants and young children. If the habit
continues once the permanent teeth erupt, then the tongue and other oral muscles
will be trained improperly for swallowing and can result in misalignment of the
teeth and improper growth of the mouth and jaws. I recommend starting to
break the habit around age 5. Do it by praising the child when they are
not sucking. Peer-pressure at school can also be a big help. If the
habit still continues, then consult your dentist for advise.
What are sealants?
Dental sealants are thin, plastic coatings that are applied to the chewing
surfaces of the back teeth to help prevent decay. It is impossible to get
the bristles of a toothbrush into the base of these cervices and therefore,
these areas are more prone to decay. Even though many insurance plans will not
cover the cost of sealants, the fee for a sealant is significantly less than
doing a filling and applying a sealant involves no drilling on the tooth.
Sealants do not protect against cavities that form between the teeth and along
the gumline, so daily
brushing and flossing is still a must.
How often should I bring my child in for regular checkups?
Your dentist should tell you the period of time that meets your individual
child's needs best. I usually recommend every six months as a good time
period for both children and adults. Especially in children, decay can
expand much faster, and if these areas are caught early enough, then they can be
repaired with minimal measures.
When should I start thinking about orthodontics for my child?
Your dentist can tell you during your routine checkups when the time is right
for your child to visit an orthodontist. Since we do orthodontics in our
office, we can stay on top of the situation, so if you live in the Atlanta area,
give us a call. For crowding situations, some
children can be a candidate to expand their jaws with retainers.
We usually start those cases around age 7. Cases involving bad overbites are usually started around age 11.
With spaces between the teeth, I like to wait until all of the permanent teeth
are in before deciding on a course of treatment.
">Orthodontics Without Braces
">Orthodontics Without Braces For Overbites
What is a root canal?
A root canal is a
procedure that a dentist performs to remove the contents of the "root canal" and
seal the ends of the roots with an inert filling material. The "root
canal" of a tooth is a hollow area in the center that houses a collection of
nerves and blood vessels called the dental pulp.
Why would I need a root canal?
There are a number of different reasons that a root
canal may need to be performed. Most commonly, the nerve will become
inflamed or infected so much that it will never recover its viability.
Sometimes, a fracture can split the tooth far enough that the crack invades the
nerve space allowing bacteria to slip in. There could be a teeth grinding
problem that abrades the chewing surface all of the way into the nerve space.
There also may be a need to perform a root canal procedure if a tooth is slated
for a crown (cap) if the tooth is tilted abnormally, there is not enough enamel
to get a good cosmetic result, or if the pulp chamber is too large.
Are root canals as painful as their reputation
Even though root canals have been great fodder for
late night comedians and for party stories, most root canals involve little or
no discomfort during the procedure and maybe some temporary soreness afterwards.
This soreness can usually be controlled with ibuprofen or acetaminophen or a
mild prescription pain medication. The root canals that have fed the
popular stories stem from cases where someone will wake up at 2:00 in the
morning, swollen out past their ear, and when they come in to have it treated,
it can be very difficult to get numb. That person will come away from that
telling everyone how bad their root canal experience was, when, in reality, it
was the circumstances surrounding the procedure, not the root canal itself.
Will I need further work on my tooth after I have
had a root canal?
It depends on the situation. I always
recommend that a chewing tooth be covered with a crown (cap) since they these
teeth get very brittle with the loss of the tooth nerve. Some front teeth
can be filled with a tooth-colored filling material and left as-is. These
teeth will tend to darken with time.
My front tooth had a root canal many years ago, and
now it is much greyer than my other teeth. What can be done?
A strong bleaching agent can be placed in the empty
pulp chamber to lighten the tooth back to its original shade.
What happens if I do not get my back tooth capped
after a root canal?
The dental pulp keeps the inside of a tooth moist and thus, tend to
resist fracturing. When the dental pulp is removed during a root canal, the
tooth becomes very dry and brittle. It is now very subject to fracture. Many
times, these fractures can extend all of the way down into the root and the
tooth must be removed. Then, you have paid for a root canal for a tooth that is
now in your hand. It is best to cover the tooth with a crown before that happens.
What kind of long term success can I expect out of a
The national average for five year success of a root
canal is about 95%. This is for properly restored teeth. That is
pretty good odds that you will have success. I have done many root canals
that have continued to be fully functioning teeth 25 years after I performed the
What is an apicoectomy?
On the rare occasion that a root canal is not
successful, it may be due to a difficulty in getting a good seal at the end of
the root tip. A root canal is done through the tooth. Sometimes,
canals can be very clogged with hard calcifications or very tortuous, making it
difficult to get the root canal filling material to seal well. Therefore,
an apicoectomy is performed. It is a surgical procedure where the end of
the root is exposed from under the gum and a filling is placed in the end of the
Why do wisdom teeth need to be removed?
Third molars, also known as wisdom teeth, are vestiges of our cave man days.
Having the extra molars to chew their extra-coarse diets came was very handy when
trying to survive. As time has passed, modern man has progressed to a
much softer diet. We can survive with a smaller jaw. This means that many
times there is not enough room for the wisdom teeth to erupt. Quite often,
they are lying in an odd position called an impaction. If there is enough
room for the wisdom teeth to come in and be properly cleaned, then it is best to
leave them as is. The old "spare tire" theory comes into play. It
may be needed later on in life due to loss of other molars. However, if
the wisdom teeth are impacted, they can form cysts that can enlarge and destroy
jaw bone, or they can push up against the second molar and damage some of its
root. If the wisdom tooth is partially impacted, then it can be a constant
source of gum infections.
Should all impacted wisdom teeth be removed?
The final decision of the need to remove impacted wisdom teeth must come from
your dentist. The best time to remove them is in late teens to early
twenties. At this time, the roots have not fully matured allowing for less
complications from the surgery. There are nerves that course through the
lower jaw that provide innervation to the lower lip. Once the roots have
grown to their full length, they can hook around this nerve. If they are
removed at this point in time, then there is a possibility of permanent numbness
in the lip.
If my lower wisdom teeth are bothering me, why would my upper wisdom teeth need
to be removed also?
If a lower wisdom tooth is removed and not the opposing upper one, then the
upper tooth will continue to erupt until it starts to chew against the lower
gum. Since the healing time and level of post operative discomfort is
about the same, it's not a bad idea to get the upper ones removed at the same
What should I expect from wisdom teeth surgery?
The biggest factor in determining the after effects of wisdom teeth surgery is
whether they are impacted or not. If they are impacted, then allow for 3-4
days of healing time with the probability of moderate swelling of the cheeks.
Impacted or not, there will be the need for pain medication to control post
operative discomfort. The surgery itself should not be something to get
too worried about. It is an in-office procedure that can be performed
under a local anesthetic with or without sedation. If you wish to view a
slideshow of an actual surgical removal of impacted wisdom teeth, then click on
the link below. Warning - it is vary graphic, so don't watch it if you are
squeamish about the sight of blood.
Impacted Wisdom Teeth Surgery Slide Show
What are some reasons that other teeth need to be removed?
We usually prefer to save all teeth in the mouth if possible, however, there are
situations when this is not feasible. Teeth can become so
decayed that they may not be restorable. Gum disease could be so far
advanced that the jaw bone will not hold the teeth in. There could be an
opposing tooth that is missing, making a particular tooth not worthy of
extensive restoration. We also sometimes need to remove teeth for
orthodontic purposes to make room to straighten the teeth.
What type of after-care should I do after an extraction?
Biting on gauze placed over the extraction site for an hour will help stop the
bleeding. Taking ibuprofen or acetaminophen, if your medical condition
allows, will help ease the post-operative discomfort. Otherwise, just
leave the extraction site alone. Don't drink through a straw or swish your
mouth out for the first 24 hours. This could dislodge the blood clot and
cause a dry socket.
What is a dry socket?
A dry socket occurs when the blood clot is lost prematurely. It is usually
manifested by a marked increase in pain usually 3-4 days after the extraction.
Contact your dentist for treatment if this condition occurs. Packing
medication into the socket for a few days will usually take care of the symptoms
until the area heals.
What other times should I contact my dentist after an extraction?
Although most extractions will heal uneventfully, you should contact your
dentist if you have bleeding that will not stop or unexpected swelling,
especially if accompanied by a fever. Infections in the jaw can become
very serious if left unattended.
Should I be worried about oral cancer?
Although oral cancer is very uncommon, it is still taken very seriously. Early
detection is of vital importance. Your dentist should do an oral
cancer screening exam during your routine checkups. If you have any
unusual swellings or sores that don't go away, it would be best to consult your
Gum Disease (Periodontics)
What is gum disease?
Gum disease can be gingivitis, an inflammation of the gums, or periodontitis
(pyorrhea), an inflammation of the bone that holds the teeth. Gingivitis,
although not serious alone, is a precursor to periodontitis and should be
treated before the disease progresses. Periodontitis attacks the bone
itself. If left unchecked, it can destroy enough bone so that the teeth
will loosen and could even fall out.
What can I do to help prevent gum disease?
Something as simple as brushing and flossing every day can usually be all that
is needed to keep gum disease at bay. Gum disease is caused by bacteria
that normally resides in your mouth. When you eat sugar, the bacteria uses
that as fuel to form a sticky substance in order to stick to your teeth.
This colony of bacteria is called plaque. Since they are stuck in little
nooks and crannies of your teeth, the antibodies in your saliva cannot reach
them. The plaque will excrete acids and other toxins that will not only
cause gum disease, but also tooth decay. By simply removing this layer of
plaque at least once a day (preferably more often), you can keep these toxins
from injuring your gums.
How do you treat gingivitis?
All that is needed to treat gingivitis is daily brushing and flossing, and a
routine professional cleaning to remove calculus (tartar). A
prescription-strength fluoride preparation can also help. Ask your dentist
How do you treat periodontitis?
The first line of defense for treating periodontitis is a procedure called
scaling and root planing. The dental hygienist or dentist will numb your
gums, then clean all of the root surfaces very meticulously. This will get
rid of most of the factors that were contributing to the periodontitis and allow
the gums to heal. However, if daily oral hygiene is not done, then the
disease will return. If the bone destruction has progressed too far, then
periodontal surgery may need to be performed. This surgery will move or
remove gum tissue in such a way to allow you to have enough access to perform
daily oral hygiene. As you can tell, it is best to catch the disease
before it has progressed this far.
What is a gum graft?
When the gums have receded to far away from a root surface, then a gum
graft may be needed. This recession can occur most often by brushing the
teeth with too stiff a toothbrush or too vigorously. In a gum graft, a
small piece of tissue is removed from the roof of the mouth and sewn into place
in the area of damage. With recent advancements, this technique has been
Replacement of Missing Teeth
What are the options for replacing missing teeth?
There are three options for replacing missing teeth - dental implants, fixed
bridges, and removable partial or complete dentures. Implants are great in
that no adjacent teeth need to be reduced in size and there is no loose piece
of plastic flopping around in the mouth. Fixed bridges also eliminates the
need for a loose plastic denture, but there needs to be an adequate number of
solid abutment teeth adjacent to the site. Fixed bridges may be necessary
in cases where there is not adequate bone available for implants.
Removable appliances are available as an economical alternative, but wearing
them is not as comfortable.
What are implants?
Dental implants are cylinders of titanium that are implanted into the jaw bone.
A small incision is placed in the gum and a hole is drilled into the bone.
The implant is then screwed into the bone. As terrible as this may sound,
it is actually not a very bad procedure. Since there are no nerve endings
in the bone, drilling on it does not cause any discomfort. I have had good
feedback from my patients about how easy it was to go through this procedure.
The cylinders will sit under the gums for some time undisturbed to allow the
bone to grow up to it and solidify its anchorage. Then, we place posts
into the cylinders and put crowns on. This recreates the function and
cosmetics of the original teeth. Patients love them.
">Implant Case #1
">Implant Case #2
What are bone grafts and why would I need one?
The ability to place a dental implant depends on having available bone.
Certain areas of the mouth tend to have less bone and placing an implant would
infringe on nerves or sinuses. These areas can be augmented with various
materials to stimulate natural bone growth. These materials are placed
under the gums and allowed to heal for a number of months. Then, the site
is ready to have an implant placed.
What is a fixed bridge?
A fixed bridge is used to replace missing teeth when there are good, solid teeth
on either side of the site. A crown (cap) is placed on the adjacent teeth
and are used to suspend artificial teeth across the gap. This procedure is
done when there are anatomical limitations to doing implants or when a patient
rejects implants due to cost. The teeth must be reduced about 1 mm to make
room for the porcelain and metal crowns, however, literally millions have been
placed nationwide that have given many years of good service. Most of the
bridges that I placed over 25 years ago look as good now as they did on the day
that I put them in.
">Fixed Bridge Case #1
">Fixed Bridge Case #2
What is a Maryland or bonded bridge?
A Maryland bridge serves the same purpose a fixed bridge, but it is bonded to
the adjacent teeth enamel instead of being held in place by crowns.
Therefore, minimal tooth enamel on the abutment teeth needs to be sacrificed.
They can only be placed in selected situations and are only as secure as their
bond. By the way - the term "Maryland" came from the fact that this
type of bridge was developed at the University of Maryland dental school.
What is a partial denture?
A removable partial denture is a metal and plastic plate that has teeth attached
to replace those that are missing. The metal plate is designed to rest on
the remaining teeth to make it solid while chewing and metal clasps are used to
keep the denture from dislodging while talking or chewing food. It is used
in cases when cost is a factor or when there is not adequate bone for implants
or enough solid abutment teeth for a bridge.
What do I need to know about complete dentures?
It is certainly best to keep all or some natural teeth, but some times, that is
not possible or practical. Complete dentures can still restore a
reasonable amount of functionality and cosmetics to someone without teeth.
As time goes on, the gums will shrink due to natural resorption or by an
ill-fitting denture. If the denture teeth are still in good shape, then
the plastic can be relined making the dentures fit as good as new. Even
though one does not have any teeth, there is still the need to see the dentist
to check for oral cancer.
Disclaimer: This page is provided for informational purposes only. You
must consult your dentist for advice on your individual dental needs.