How to Succeed in Periodontal Therapy Part 3

The Power of Story There are successful dental practices alongside unsuccessful dental practices. Each one of them provides similar services and has similar patients, yet some succeed and others do not. So what’s the difference? It’s really very simple. It’s explained in a story. Would you like to hear it? It’s every dentist’s story and it goes like this. A few years back every dentist was a dental student. And before this they were taking pre-dental classes, which were predominantly math and science courses. In fact most pre-dental students majored then, and still do even today, in biology or chemistry, not because they like these subjects, but because they want to be dentists and believe their chances are better if they obtain a degree in one of these fields. The science classes in colleges and universities that are prerequisites for dentistry, medicine and veterinary sciences are popular, not because most of the students taking them love these subjects.  It is because they are required courses in order to become doctors. So the class sizes are large and often are taught by graduate students. This is because professors prefer working with those who happen to enjoy their particular field. They do not enjoy dealing with people who are only there for the grade. So why isn’t there more of a stink about this? It is because the unwritten objective of these courses is not to teach toward comprehension anyway. These courses are for the most part filters designed to weed out professional school applicants.  So if lectures are complicated, possibly given by someone whose native language isn’t English, and the...

One Stop Dental Implants

I just received this written question from a patient who is trying to figure out what he should do. “I don’t understand why some places claim they can do all the work in one visit, Dr. Young says I have to wait to heal after that 1st step.” This individual lost a lower first molar a while back and would like to replace it with a dental implant. The area is now healthy, having been grafted with bone months ago. In the spirit of good due-diligence he is reading things on the Internet and talking with friends. Evidently some are saying that he should be able to have the tooth placed on the implant the same day the implant is placed. I don’t advertise this option for a reason, it is not predictable enough. There are situations where this can work, but there are just as many, if not more, where it will not. The reason has to do with how bone heals to the surface of a dental implant. When dental implants are placed they must be in intimate contact with the surrounding bone. Bone cells do not travel long distances. They replicate and grow into open spaces not inhabited by other cells of the body. When dental implants are placed immediately following the extraction of teeth, sometimes the socket left behind by the tooth is larger or a different shape compared with the diameter of the implant. This results in a gap between the implant and the bone. It still may be possible to place the dental implant in this situation as long as there remains enough...

Placing Dental Implants is Easy Until it Isn’t

I read recently an interview with a well known dentist about dental implants. His contention was that the surgical elements are easy compared with the restorative elements. Reading further in the article he admits to offering weekend training courses on how to place dental implants. I agree with this gentleman that placing dental implants is a piece of cake for the most part, until you fail to position the implant correctly to assure an optimum esthetic and/or functional outcome. In addition I also sense from the article that he is being somewhat selective. This is good and correct. I only hope that his followers understand this what he is doing. There is an advantage to having a three year residency when it comes to knowing how to manage complicated dental implant surgical procedures. And even beyond this decades of clinical experience doesn’t hurt...

Dental Implants or Fixed Bridge?

Which is the better way to replace a missing tooth, dental implant or fixed bridge? The Fixed Bridge Fixed bridges (also called Fixed Partial Dentures) have been around for decades. They involve the removal of enamel along with an outer layer of dentin from the teeth on either side of the missing tooth. Crowns are then made to fit over the prepared teeth that are fused together usually using a metal substructure. In this way a false tooth can fill the missing-tooth space. Benefits of the Fixed Bridge Treatment time from start to finish is usually shorter compared with the dental implant. No surgery is usually involved. Cost for this restoration is usually slightly less compared with the dental implant/crown. (If root canals are indicated, however, this may not be the case). A temporary fixed bridge can be worn while the final bridge is being made in the dental laboratory. This means that the individual will not have to wear a removable device with a false tooth in it. Weaknesses of the Fixed Bridge  Bridges are more difficult to clean. Flossing around a bridge is more difficult. The longevity of the bridge is not as good as the implant/crown for a couple of reasons. Teeth under the bridge are still at risk of re-decaying (implants can’t decay) and bridges are more dependent on the dentist’s eye-hand skills. The dental implant is machine-made at high tolerances, so the fit is better. The cost to replace a failed bridge is much greater because three teeth are now involved – the two teeth that were prepared along with the space. The cost...

How is a Dental Implant a Wise Economic Decision?

I made the statement in an earlier post that a dental implant can be a smart choice even financially. My assumption, if you are reading this, is you are looking at different treatment options and the dental implant certainly isn’t on the cheap side. So allow me to show you how a dental implant can be a wise economic decision. If the choice is between a single implant restored as a single crown versus a 3-unit bridge (see diagrams nearby)  — and the dentist says that both are reasonable options (meaning that each one has a high probability of success) then go with the dental implant, even if it’s a little more expensive. Here is why. When you replace a missing tooth with a 3-unit bridge, you have to cut down the teeth on either side of the space in order to place essentially three crowns fused together. You have turned a one-tooth problem into a three-tooth problem. On top of this, now flossing is more difficult. Later on, if one of the two teeth decays, it is very likely the bridge will have to be replaced. It is not uncommon for the decay to have weakened the tooth to the extent that it now is lost. In this way more teeth are lost over time. On the other hand, should a tooth on either side of a dental implant have a problem, it is still a one-tooth problem, not affecting its neighbors. And if there is a problem with the crown on the dental implant, it can be replaced without having to remove the dental implant. You see,...

Dental Implants and Toothaches – How do they Compare?

As most everyone knows, a toothache can be excruciating. The classic throbbing pain comes from the nerves within the tooth. Dental implants don’t have nerves within them, yet one of the most common fears people have is that implants can cause severe pain. Certainly nerves around a dental implant can be stimulated if there is a problem in the same way they respond to other injuries to the body. Because implants have over a 95% success rate, this a rare event. Dental implants in and of themselves do not cause nerves or other living cells within the body to react, which happens to be one of the unique properties of titanium and why most other bone implants, like artificial joints, are made out of this very interesting...