For more complex situations, we offer advanced restorative options not typically available from general dentists. Our dentists have undergone extensive training to be able to provide treatment plans for everything from a single tooth replacement with an implant to more difficult situations such as restoring an unstable bite, full-arch implant supported teeth to replace dentures, and tissue grafting.
The most common use of implants is when a single tooth has been extracted and needs to be replaced. The advantage of an implant over a bridge is primarily an advantage of long-term prognosis. Bridges most often fail due to the development of cavities on one or more of the teeth supporting the bridge. Implants are made of titanium that is embedded in the bone. The implant supports an artificial crown of metal or porcelain that replaces the missing tooth. Neither the implant nor the crown it supports are susceptible to cavities. Also, to create a bridge, we must re-shape the teeth adjacent to the space created by the missing tooth. In re-shaping, we reduce the teeth in height and width. This is usually not desirable because in reducing the teeth we weaken them, especially if the teeth on either side of the space do not have crowns or large fillings on them.
Although single tooth replacement is the most common use for dental implants, we routinely use implants as a way to replace dentures that are not functioning properly, or to avoid using tissue supported complete dentures altogether. This can be done a number of ways such as using several implants to stabilize a complete denture, replacing the missing teeth with porcelain crowns, or using a metal framework to support acrylic teeth and gums. Each situation has a number of different options, but implants give us better functional and aesthetic options than we have ever had before.
TMD, which is short for temporomandibular joint disease (or disorder), encompasses a number of different clinical conditions related to dysfunction of the temporomandibular joint or TMJ. The most common complaints are pain and restricted movement. In many cases the jaw can lock open or lock closed. Unfortunately, the design of the temporomandibular joint does lend itself to problems. The most endearing thing about the TMJ is that if it is that if used successfully in Scrabble in its entirety, it is worth 34 points.
The TMJ joint can be particularly resistant to treatment. Initial therapies are aimed at reducing pain and inflammation within the joint. This can be accomplished by medication, massage therapy, and often using an acrylic splint on the teeth which is designed to place the jaw in a position that will reduce pressure on the joint. Also, in many cases the bite will need to be altered to improve the positioning of the joint.
Extreme tooth wear can be very debilitating. Once the enamel layer is worn through, the teeth often become sensitive to changes in temperature. The loss of tooth height can also cause problems for the jaw joint by creating a bite that is over-closed, forcing the joint into uncomfortable positions while chewing. An over-closed bite can also cause shortening of the incisors, creating an unaesthetic appearance.
Once we have established the cause of the worn dentition and taken steps to prevent further wear, we decide whether or not it is necessary to try and re-establish the lost height by replacing the missing tooth structure. If there is an absence of symptoms in either the jaw joint or the teeth, and the aesthetics of the teeth are not of a concern, it is usually not necessary to replace the lost tooth structure. However, in many cases, it is desirable to establish an improved bite and aesthetics by restoring the worn tooth structure with porcelain or filling material. This is done in a systematic way to allow for healthy functioning of the jaw joint and teeth.
There are many situations where a person's bite is not ideal. Symptoms could include, but are not limited to, difficulty chewing food efficiently, constantly chipping teeth, pain in the TMJ, or the feeling of having more that one position where the teeth fit together. In these situations, there is often benefit to creating a more harmonious bite. We do this by designing a position where the chewing surfaces of the teeth work harmoniously with the ideal position for the TMJ. Creating a new, balanced bite can be accomplished by moving the teeth, changing the chewing surfaces of the back teeth with porcelain or composite, or a combination of movement and restorations.
Gingival grafting, also known gum-grafting, is used in some circumstances to treat recession of the gums. Gingival grafting can be used to cover exposed roots where recession has occurred and also to help prevent recession around natural teeth and implants.