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Posts for category: Dental Procedures

By Dr. Mark C. Pothitakis
January 02, 2022
Category: Dental Procedures
Tags: dental implants  
AnImplantCouldFailifSupportingStructuresBecomeDiseased

From an appearance standpoint, it might be difficult to tell a new dental implant and crown from a natural tooth. There is, however, one big difference between an implant and crown from a real tooth, one which could impact an implant's longevity: how each attach to the jaw.

A natural tooth is held in place by a tough, but elastic gum tissue called the periodontal ligament. The ligament lies between the tooth and the bone, extending out tiny fibers that attach to both. This holds the teeth firmly in place, while also allowing the tooth to gradually move in response to mouth changes. It also facilitates the delivery of infection-fighting agents to protect the teeth and gums against disease.

By contrast, an implant is imbedded in a prepared channel shaped into the jaw bone. Over time, bone cells grow and adhere to the titanium surface, which serves to fully secure the implant to the jaw. The periodontal ligament doesn't attach to the implant, so it relies solely for stability on its attachment to the bone.

Thus, although highly durable, implants don't share the properties real teeth have because of their connection with the periodontal ligament. They don't move dynamically like real teeth; and more importantly, they lack some of the disease-fighting resources available to natural teeth.

So, what difference would the latter make? Implants aren't composed of organic material, and are therefore unaffected by bacterial infection. The problem, though, is that the gums and bone supporting the implant are susceptible to disease. And, because an implant lacks the defenses of a real tooth that the periodontal ligament provides, an infection within these tissues could quickly undermine their support and cause the implant to fail.

To avoid this and protect the longevity of your implant, it's important that you practice daily oral hygiene. You should brush and floss your implant to clear away disease-causing plaque from the surrounding tissues just as you do natural teeth.

Your dental provider will also include cleaning around your implants during your regular visits, albeit with different tools that are more protective of the implant and crown surfaces. During these visits they'll also closely inspect the tissues around the implant for any signs of infection and initiate prompt treatment if necessary.

If you would like more information on taking care of your 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 Maintenance.”

By Dr. Mark C. Pothitakis
December 08, 2021
Category: Dental Procedures
Tags: veneers  
VeneersMayNotBeaGoodOptionforaTeenager

People love dental veneers—those thin, porcelain shells bonded to teeth to mask stains and blemishes. For a relatively modest price, they can vastly improve a smile.

But what if it's your teenager who needs a smile upgrade? Teens also experience dental flaws like adults—which, at their age especially, disrupt their self-image and social confidence.

So, can veneers work for teens? Technically, yes, but there's a possible snag, depending on the maturity level of their teeth.

The potential problem relates to the tooth preparation that precedes the bonding of the veneers. One option is no-prep veneers and they are a nice solution depending on the size and shape of the existing teeth. If the teeth are slight in size, no preparation is necessary. If the teeth are large, even though veneers are thin, they can still look unnaturally bulky when bonded to unprepared teeth. A dentist may need to remove some of the tooth's surface enamel before applying the veneers.

Although this alteration has little effect on an adult tooth (other than requiring a veneer or restoration from that time on), it could damage a less mature tooth and stunt its development. A younger tooth can have a larger pulp—the central tooth chamber containing blood vessels and nerves—that's closer to the enamel surface than an adult tooth.

Because of the pulp's proximity to the surface of an immature tooth, there's a risk of damaging it during the tooth preparation phase for veneers. If that happens, the tooth may need additional treatment to save it.

We don't depend on a teen's calendar age to determine whether or not it's safe to install veneers. Instead, we examine the teeth and measure how close the pulp may be to the surface, as well as the thickness of the middle layer of dentin. Veneers could be acceptable if it appears the teeth have reached a healthy level of maturity.

If not, though, we may need to consider less invasive ways to improve a teen's smile. For stains or other outer discolorations, whitening with a bleaching solution significantly brightens teeth. We can repair chips by bonding and sculpting color-matching dental material to the teeth. And, these or similar cosmetic measures won't endanger an immature tooth like a veneer application.

Once a young patient's teeth have matured, we can revisit the subject of veneers. That may take time, but the more attractive smile that results will be worth the wait.

If you would like more information on dental care for adolescents, 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 “Veneers for Teenagers.”

By Dr. Mark C. Pothitakis
December 03, 2021
Category: Dental Procedures
ImplantsStreamlineDentalWorkUpgradesforGradualToothLoss

One day, you lose one… followed by another…and then another. And then, after years of dental disease, you finally lose all your remaining teeth.

But between the first tooth lost and the last, years or even decades could pass. Individuals in the past caught in this downward spiral often decided the cost of continually upgrading their restorations with each lost tooth was simply too much. Instead, they opted at some point to have their remaining teeth extracted, even relatively healthy ones, to make way for full dentures.

That's still an option you might one day want to consider. Today, though, you have another alternative: With the help of dental implants, you can easily update your restorations with gradual tooth loss and keep more of your natural teeth longer. And keeping them longer is often the best scenario for maintaining optimum oral health.

Most people are familiar with dental implants as single replacements for individual teeth. It's a straightforward application. A dentist imbeds a titanium metal post into the jawbone at the missing tooth site, to which they later attach a life-like crown.  Over time, the titanium post attracts new bone growth, resulting in enhanced durability for the implant, while also helping to reduce the bone loss that typically occurs after losing teeth.

But implants can also be used to support more traditional restorations like bridges or partial dentures. When used in that manner you only need a small number to support a restoration for multiple teeth, a much more affordable method than an individual implant for each tooth. And with planning and forethought, earlier installed implants could be incorporated into the next phase of restoration.

This helps make the process of updating restorations more manageable and affordable, while also prolonging the life of your remaining teeth. And should the time come when you lose all your teeth, implants can support a full fixed bridge or a removable denture. Including dental implants in your ongoing treatment strategy can pay dividends toward maintaining your best oral health.

If you would like more information on the many applications for 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 “Replacing All Teeth But Not All at Once.”

By Dr. Mark C. Pothitakis
November 28, 2021
Category: Dental Procedures
RemovingaToothCouldHelpCorrectThisParticularBiteProblem

Dentists extract millions of teeth each year, mostly because of disease. But sometimes a healthy tooth is removed to gain a more favorable, long-term dental health outcome.

An example of this is extracting teeth for the sake of orthodontic treatment. This is often beneficial when treating bite problems caused by crowding, a condition in which not enough space on the jaw exists to accommodate all of the teeth coming in. When this happens, the limited space can force teeth out of their proper alignment.

Crowding also complicates correcting the bite problem with braces: As with the eruption phase, there's no available room for orthodontic movement. One solution that may arise after a detailed examination is to open up space on the jaw by removing some of the teeth.

Planning this kind of tooth extrication requires careful forethought with the end in mind—ultimately, the dental providers involved want the resulting appearance after braces to look as natural as possible. For that reason, dentists usually choose teeth for extraction that are outside of the "smile zone" (the teeth visible while smiling) like premolars and molars.

Additionally, dentists are concerned about bone loss after extracting the teeth. Bone often diminishes around empty tooth sockets, especially if those sockets were damaged during extraction. This loss in bone can weaken the jaw structure and cause significant problems while moving teeth with braces.

To avoid this, dentists take great care during tooth removal not to damage the socket. Additionally, they may place a bone graft within the socket immediately after removing the tooth, especially if the space will remain vacant for a significant period of time. A bone graft serves as a scaffold upon which new bone cells can form and accumulate.

After the extractions, the orthodontist may then proceed with correcting the bite. Patients may also need some form of prosthetic teeth to fill in the spaces while wearing braces. Often prosthetic teeth can be incorporated with the braces for a more natural look. After braces, any remaining gaps may require further restoration, either with dentures, bridges or, later in adulthood, dental implants.

Complex bite problems like crowding pose unique challenges in correcting them. But using techniques like tooth extraction can help achieve a successful and satisfactory outcome.

If you would like more information on treatments for bite problems, 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 “Tooth Removal for Orthodontic Reasons.”

By Dr. Mark C. Pothitakis
November 13, 2021
Category: Dental Procedures
Tags: root canal  
YourDecayedToothMightNeedaDifferentKindofRootCanalTreatment

Advanced decay doesn't necessarily mean it's curtains for an infected tooth. Millions of teeth in that condition have been saved by a tried and true procedure called root canal therapy.

Although they may vary according to the complexity of a case, all root canal procedures share some similarities. After numbing the tooth and gum areas with local anesthesia, the procedure begins with a small hole drilled into the tooth to access the infected pulp and root canals, tiny passageways inside the root.

The dentist then uses special instruments to clear out infected tissue from the pulp and canals, followed by thoroughly sanitizing the resulting empty spaces. This is followed with filling the pulp chamber and root canals with a rubber-like substance (gutta percha) to seal the interior of the tooth from further infection. Later, the dentist typically crowns the tooth for further protection and support.

Root canals have become the standard treatment for teeth with advanced decay. There are, however, some circumstances where performing a root canal isn't a good idea. For example, a previously root-canaled tooth with a crown and supporting post. A dentist would need to fully disassemble the restoration to gain access into the tooth, which could significantly weaken it.

But there may be another option if a standard root canal is out of the picture: a surgical procedure performed by an endodontist (a specialist in interior tooth treatment) called an apicoectomy. Instead of drilling through the tooth crown, the endodontist accesses the tooth root through the adjacent gum tissue.

Like a traditional root canal, the procedure begins by anesthetizing the tooth and surrounding gums. The endodontist then makes a small incision through the gums to expose the diseased tissues at the tooth's root. After removing the infected tissue and a few millimeters of the root tip, they place a small filling to seal the end of the root canal against infection and suture the gum incision.

This is a specialized procedure that requires the state-of-the-art equipment and advanced techniques of an endodontist. But it does provide another possible option for saving a diseased tooth that might otherwise be lost.

If you would like more information on treatments for tooth decay, 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 “Apicoectomy: A surgical Option When Root Canal Treatment Fails.”