Of all the of amazing procedures in today's dentistry, surgery that causes new bone to grow — in places where it had previously been lost — is high on the list of the most extraordinary. (When bone is lost or resorbed, it is broken down into its mineral components, which are dissolved into the bloodstream. Resorption of tooth-supporting bone often takes place after teeth are lost.) Dental techniques that cause new bone growth are important because a certain amount of bone is needed to replace lost teeth with dental implants.

Today's dental implants themselves are an amazing innovation. Implants consist of a replacement for the tooth's root, usually made of a metal called titanium. A replacement for the crown, the part of the tooth that is visible above the gums, is attached to the titanium root. Titanium has the remarkable quality of being able to fuse with the bone in which it is anchored. This process, first discovered in the 1950s, is called osseointegration.

In the case of missing upper back teeth, many people who wanted dental implants in the past were told that they did not have enough bone to anchor the implants and that they had to get removable dentures instead.

But now a new surgery called maxillary sinus augmentation can cause your body to regenerate bone where it was lost and is needed to anchor dental implants.

Bone in the upper jaw or maxilla usually supports your upper back teeth. Inside the maxilla, on either side of your upper jaw, are air spaces in the bone, which are lined with a membrane. These spaces, called the maxillary sinuses, are generally shaped like pyramids; but their shape and size is different in each person. The new surgical procedures involve lifting up the sinus membrane in the area where bone is needed and filling the space thus created with a bone grafting material. Your body then creates new bone to fill the space. This usually takes about six months. If you have almost enough bone to stabilize the implants, they can be placed simultaneously with the graft, thus saving time and avoiding a second surgical procedure.

All grafting materials used today are approved by the Food and Drug Administration (FDA) and must be prepared according to their guidelines. They are specially treated to render them completely safe for human use.

After the surgery there is usually no more than mild to moderate swelling and some discomfort, about the same as having a tooth removed.

If you are missing upper back teeth, contact us to schedule an appointment to evaluate your upper jaw. You can also learn more about this procedure by reading the Dear Doctor magazine article “Sinus Surgery.”

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

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

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

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

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

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

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

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

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

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

Root canal, or endodontic (“endo” – inside; “dont” – tooth) treatment, is often wrongly perceived as a highly unpleasant experience and one that causes tremendous pain. However, the truth is that the procedure actually relieves the pain being caused by an infected and inflamed tooth pulp (inside of the tooth). Advances in dentistry have made treatment virtually pain free and it can be completed relatively quickly, usually in a single visit. Left untreated, infection can spread into the bone immediately around the tooth's root, so prompt attention is the best course of action.

If the term “root canal” still sends shivers down your spine, don't despair. Here is some information that should help put your mind at ease.

• Root canal treatment is necessary when deep decay or trauma has caused the inside (pulp) of the tooth to become inflamed or infected. Symptoms of infection can include sharp pain when biting down, lingering pain after consuming very hot or cold foods, a dull ache and feeling of pressure near the infected tooth, and tender gum tissue surrounding the infected tooth.
• After a local anesthetic is administered to numb the infected tooth and its surrounding area, we will make a small opening on the chewing surface of the tooth. This will allow us to remove dead and dying tissue from the pulp and to then clean and disinfect the root canals. Using small instruments, we will shape the canals and seal them with biocompatible filling materials.
• You may feel slight tenderness at the treated site for a few days, but this is quite manageable and can be relieved with over-the-counter (OTC) non-steroidal, anti-inflammatory pain relievers such as aspirin or ibuprofen. You should refrain from chewing on the treated tooth until your follow-up appointment. A crown or other restoration may be needed to protect the tooth and restore it to full function.

If you think you might be a candidate for a root canal treatment, schedule an appointment as soon as possible. If you would like to learn more about the process of root canal treatment, please read the Dear Doctor magazine article “Common Concerns About Root Canal Treatment.”

If an adult has lost his or her teeth (a condition called “edentulism”), full removable dentures (false teeth) can restore the person's appearance and ability to bite, chew, and talk properly. Even with our current extensive knowledge about tooth care and restoration, over 25 percent of Americans have lost all their teeth by the time they are 65.

How much do you know about dentures? Test yourself below.

How does tooth loss affect your bones?
Bone is a living substance that is constantly changing and rebuilding itself, depending on signals it receives from surrounding tissues. The bone that surrounds your teeth is called alveolar bone (from “alveolus,” meaning sac-like). To keep healthy, alveolar bone needs stimulation or function such as chewing and your teeth touching your opposing teeth. If you lose your teeth, bone begins to melt away (resorb).

How can we minimize bone loss during tooth extraction?
We can maintain bone volume by using bone grafting techniques. While this sounds scary, it is a relatively easy procedure. The principle of bone grafting is to build a sort of scaffolding on which your body begins to build and maintain its own bone. Bone loss can be prevented by the placement of a few dental implants.

How are dentures designed and created?
The dentures that look best and work best for you are based on your original teeth. We often utilize photographs of how you looked with your natural teeth, along with your input about possible changes you would like to see. First we take detailed impressions (molds) of the residual ridges in which your teeth once rested. From these we make denture bases of a light cured plastic resin. We attach horseshoe-shaped rims made of wax to the bases, to simulate the position of the teeth as we work out their design and spacing, based on both appearance and function. The prosthetic teeth are then tried out in your mouth, adjustments are made, and the dentures are processed in a dental laboratory. The final product substitutes a pink colored plastic (methyl methacrylate) to represent the gums and white plastic material as the teeth, created to make them look as natural as possible.

What is your part in the denture fitting process?
As a patient with new dentures, you must learn to use your jaw joints, ligaments, nerves, and muscles in new ways to help stabilize your dentures and to relearn to speak, bite, chew, smile, and laugh with these new structures. It takes a little practice, but with your removable dentures you can once again enjoy a complete and normal life.

Contact us today to schedule an appointment to discuss your questions about full removable dentures. You can also learn more by reading the Dear Doctor magazine article “Removable Full Dentures.”

Being unhappy with your smile can impact your life in ways that you might not even realize. Are you awkward in social situations that require smiling? Do you shy away from becoming romantically involved? You may even miss out on a better job because you don't want to be forced to endure a live interview for fear of smiling!

If you've decided that the time is right to regain some self-confidence by having your smile redesigned, we can help. We will begin with a consultation, during which we will discuss a number of factors that will influence the process and the final result of your smile makeover including:

• What do you want from a new smile?
• How do you want your new teeth to look?
• How we can use photographs and computer simulations to show you what your new smile will look like before we even start.
• How we work with dental technicians to test shapes, sizes, and colors to personalize teeth so that they closely match your natural teeth.
• How we use “customized temporary restorations” to let you test-drive the look and feel of the final crowns and veneers so that we can guarantee success.

We can even show you “before and after” photos taken of our many patients throughout the course of their makeovers. And, of course, we will discuss the costs to you with respect to both time and money based on the extent and type of work that is necessary to give you your ideal smile.

The tools that are now at our disposal can make the entire smile redesign process an essentially painless and highly creative collaboration that includes constant interaction between you, us, and dental laboratory technicians as we all work together to create your new smile. If you think you are ready to start exploring the possibilities, please call our office to set up a consultation. To learn more about cosmetic dentistry, read the Dear Doctor magazine article “Cosmetic Dentistry: A Time For Change.”