Posts for category: Dental Procedures

By Shapiro & Rollman DDS
July 10, 2020
Category: Dental Procedures
LadyGagaWasntBornThisWay

Sometimes, looking at old pictures can really bring memories back to life. Just ask Stefani Germanotta—the pop diva better known as Lady Gaga. In one scene from the recent documentary Five Foot Two, as family members sort through headshots from her teen years, her father proclaims: "Here, this proves she had braces!"

"If I had kept that gap, then I would have even more problems with Madonna," Lady Gaga replies, referencing an ongoing feud between the two musical celebrities.

The photos of Gaga's teenage smile reveal that the singer of hits like "Born This Way" once had a noticeable gap (which dentists call a diastema) between her front teeth. This condition is common in children, but often becomes less conspicuous with age. It isn't necessarily a problem: Lots of well-known people have extra space in their smiles, including ex-football player and TV host Michael Strahan, actress Anna Paquin…and fellow pop superstar Madonna. It hasn't hurt any of their careers.

Yet others would prefer a smile without the gap. Fortunately, diastema in children is generally not difficult to fix. One of the easiest ways to do so is with traditional braces or clear aligners. These orthodontic appliances, usually worn for a period of months, can actually move the teeth into positions that look more pleasing in the smile and function better in the bite. For many people, orthodontic treatment is a part of their emergence from adolescence into adulthood.

Braces and aligners, along with other specialized orthodontic appliances, can also remedy many bite problems besides diastema. They can correct misaligned teeth and spacing irregularities, fix overbites and underbites, and take care of numerous other types of malocclusions (bite problems).

The American Association of Orthodontists recommends that kids get screened for orthodontic problems at age 7. Even if an issue is found, most won't get treatment at this age—but in some instances, it's possible that early intervention can save a great deal of time, money and effort later. For example, while the jaw is still developing, its growth can be guided with special appliances that can make future orthodontic treatment go quicker and easier.

Yet orthodontics isn't just for children—adults can wear braces too! As long as teeth and gums are healthy, there's no upper age limit on orthodontic treatment. Instead of traditional silver braces, many adults choose tooth-colored braces or clear aligners to complement their more professional appearance.

So if your child is at the age where screening is recommended—or if you're unhappy with your own smile—ask us whether orthodontics could help. But if you get into a rivalry with Madonna…you're on your own.

If you have questions about orthodontic treatment, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Magic of Orthodontics” and “Orthodontics For The Older Adult.”

By Shapiro & Rollman DDS
June 30, 2020
Category: Dental Procedures
Tags: fillings  
EvenwithMercuryDentalAmalgamisaSafeChoiceforToothFilling

One of the top concerns in public health today is exposure to the metallic element mercury within the environment. At abnormal levels, mercury can have a toxic effect on our nervous systems and cause other health problems.

These concerns over mercury have also increased attention on one material in dentistry that has included the metal in its makeup for over a century — dental amalgam for filling teeth. Amalgam is a metal alloy that can include, in addition to mercury, silver, tin, and copper. When first mixed dental amalgam is a moldable material used for fillings in prepared teeth. It then hardens into a durable restoration that can withstand biting forces.

While the use of amalgam has declined with the introduction of life-like colored fillings, it's still used for teeth like molars subject to high biting forces. With what we now know about the ill effects of mercury (which can make up to half of an amalgam mixture) is it safe to continue its use?

The American Dental Association has performed extensive research into amalgam safety. They've found that mercury is stabilized by the other metals in the amalgam. This prevents "free" molecules of mercury, the real source of harm to health, from escaping into the blood stream in the form of vapor. Although trace amounts of mercury vapor from the amalgam are released as a person chews, those levels are well below the threshold that could cause harm.

From a patient standpoint, the biggest drawback to dental amalgam isn't safety — it's the appearance of teeth it's used on. Silver fillings aren't considered attractive. And now there are viable filling alternatives that not only look like natural teeth but can withstand biting forces almost as well as amalgam. These materials include composite resins, mixtures of glass or quartz within resin, or glass and resin ionomers. Each of these has advantages and disadvantages depending on how and where they're applied.

After a thorough dental examination, we'll be able to advise you on what filling material will work best to produce the best result. And if we do suggest dental amalgam you can rest assured it will be a safe choice.

If you would like more information on the safety of dental amalgam, 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 “Silver Fillings — Safe or Unsafe?

By Shapiro & Rollman DDS
June 20, 2020
Category: Dental Procedures
Tags: dental implants  
ImplantSurgeryASafeandRoutineProcedure

Unlike other tooth replacement options, dental implants require a surgical procedure. But don't let your imagination run wild — the procedure is relatively minor and easy for most people to undergo.

Implants are unique among restorations because they replace a tooth's root. A metal titanium post, substituting for the root, must be surgically placed into the jawbone. While the procedure itself is simple and no more involved than a tooth extraction, it does require careful attention to detail before, during and afterward.

Our first step is to examine the target site with x-rays (often CT scanning) to pinpoint the best location for placement. This is critical because where we place the implant will have a huge bearing on how attractive and natural the implant finally appears. From this evaluation we frequently create a surgical guide.

Surgery begins with a local anesthesia to completely numb the site. You will feel no pain during the procedure and only minimal discomfort for a few days afterward. We then make small incisions in the gums to access the bone and create a small channel or hole.

Using the surgical guide, we then initiate a drilling sequence that gradually increases the size of the channel until it's the size and shape of the implant post. One thing we must do at this point is take our time: we use gentle pressure and water-cooling to avoid overheating and damaging the bone.

Once we're finished with drilling we remove the implant from its sterile packaging and imbed it directly into the prepared channel. It's then a matter of verifying the location with x-rays and then closing the gum tissue with self-absorbing sutures if necessary.

Most patients only need mild pain medication like aspirin or ibuprofen to manage discomfort afterwards. You won't even notice it in a week or less. After several weeks in which the bone grows and adheres to the implant (a process called osseointegration), you'll be ready for the final step, attaching the life-like porcelain crown to the implant.

Although the process can take several weeks to months, your discomfort should be minimal at any stage. In the end, your patience will be rewarded with a new, more attractive smile.

If you would like more information on the process of obtaining 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 “Dental Implant Surgery.”

By Shapiro & Rollman DDS
June 10, 2020
Category: Dental Procedures
Tags: dental implant  
YourGumsandBoneNeedtoBeHealthyBeforeGettingImplants

If you've been dealing with a tooth that needs to be removed—or it's already missing—you may be looking to replace it with a dental implant. And it's a great choice: No other restoration can provide the appearance and function of a real tooth like an implant.

You and your smile are ready for it. The question is, though, are your gums and underlying bone ready? These dental structures play a critical role in an implant's stability and eventual appearance. A problem with them may make placing an implant difficult if not impossible.

An implant requires around 2.0 millimeters of bone thickness surrounding the implant surface for adequate support and to minimize the chances of gum recession. But tooth loss often leads to bone loss that can drop its thickness below this threshold. This can make placing an implant problematic.

Fortunately, though, we may be able to address the lack of sufficient bone through bone grafting. By placing grafting material within the empty socket, we create a scaffold for new bone cells to grow upon. Over time this subsequent growth may be enough to maintain an adequate thickness of bone for an implant to be placed.

The gums may also pose a problem if they've shrunk back or receded from their normal positions, as often happens because of gum disease (which may also have precipitated the tooth loss). Again, grafting procedures can help ensure there's adequate gum coverage for the implant. And healthier gums may also help protect the underlying bone from loss.

There are several techniques for placing gum tissue grafts, depending on how much recession has taken place. One procedure in particular is often used in conjunction with implant placement. A small layer of synthetic collagen material or gum tissue referred to as pa dermal apron is included with the implant when its placed. Settling into the bone socket, this apron helps thicken the gum tissues, as well as preserve the underlying bone.

During your preliminary exams, we'll assess your bone and gum health to determine if we should take any steps like these to improve them. It may add some time to the implant process, but the end result will be well worth it.

If you would like more information on 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 “Immediate Dental Implants.”

By Shapiro & Rollman DDS
March 22, 2020
Category: Dental Procedures
Tags: dentures  
DenturesRequirePlanningandAttentiontoDetailtoLookNatural

Twenty-six percent of American adults between 65 and 74 have lost all their teeth to dental disease. This isn’t an appearance problem only—lack of teeth can also harm nutrition and physical well-being.

Fortunately, we have advanced restorative options that can effectively replace missing teeth. Of these, there’s a tried and true one that’s both affordable and effective: removable dentures.

Dentures are simple in design: a plastic or resin base, colored with a pinkish-red hue to resemble gums to which we attach prosthetic (false) teeth. But while the design concept isn’t complicated, the process for creating and fitting them can be quite involved: they must conform to an individual patient’s jaws and facial structure if they’re going to appear natural.

If you’re considering dentures, here’s some of what it will take to achieve a successful outcome.

Positioning the teeth. The position of the prosthetic teeth on the base greatly determines how natural they’ll appear and how well they’ll function. So, we’ll need to plan tooth placement beforehand based on your facial and jaw structures, as well as photos taken of you before tooth loss. We’ll also consider how large the teeth should be, how far to place them forward or back from the lips, and whether to include “imperfections” from your old look that you see as part of your appearance.

Simulating the gums. While the teeth are your smile’s stars, the gums are the supporting cast. It’s important that we create a denture base that attractively frames the teeth by determining how much of the gums show when you smile, or adding color and even textures to better resemble gum tissue. We can also add ridges behind the upper teeth to support speech.

Balancing the bite. Upper and lower dentures don’t operate in and of themselves—they must work cooperatively and efficiently with each other during eating or speaking. So while appearance matters, the bite’s bite adjustment or balance might matter more. That’s why we place a lot of attention into balancing and adjusting the bite after you receive your dentures to make sure you’re comfortable.

This is a detailed process that we may need to revisit from time to time to make sure your dentures’ fit remains tight and comfortable. Even so, modern advances in this traditional restoration continue to make them a solid choice for total tooth loss.

If you would like more information on denture restorations, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Removable Dentures.”