January 2014 - Prosthodontist in Johannesburg
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January 2014

Dr Kaplan answers some commonly asked questions about teeth implants and explains how advances in technology have made this procedure efficient and effective for many patients. If you have any questions that are not covered below, please contact Dr Kaplan.

Q. I’ve heard about teeth implants, what are they?
A. They are an excellent means of replacing missing teeth. The titanium implant osseointegrates (biologically binds) to the bone, and a full crown goes on top. The result is a natural looking, secure means of replacing teeth.

Q. My dentist told me I’ve lost bone in my jaw. . . can it be re-grown?
A. Often the lost bone can be restored –– bony ridges can be augmented and even places where there is no bone can be improved considerably. These procedures are called “guided bone regeneration,” or “bone grafts”. Ask your dentist if you are a candidate.

Q. How do I know if I am a good candidate for teeth implants?
A. An evaluation with diagnostic records and a CT–Scan which is a 3–dimensional type x–ray that accurately measures the amount of bone remaining to anchor the implants.

Q. How long do teeth implants last?
A. Statistics indicate that they may last in excess of 35 years. Once successfully integrated with the surrounding bone, implants have the same long–term potential as natural teeth, if properly taken care of.

Q. How long have teeth implants been around?
A. The current cylinder type of titanium has been used in excess of 30 years. Implants were invented in 1957 in Stockholm, Sweden. They were then tested in the 1960’s and introduced in Europe and the U.S. in the 1970’s and early 1980’s. Implants are safe and provide for an excellent option for people with missing teeth.

Q. What is the success rate of implants?

A. Highly successful. Implants boast low infection potential, no rejection by the body, ninety-five to ninety–eight percent success rate for the lower jaw, and eighty–six to ninety–two percent success rate for the upper jaw. However, implants must be maintained by the patient with proper oral hygiene and frequent dental exams and cleanings.

Those of us who are not completely happy with the smile we have been given, can rest assured that the advances in cosmetic dentistry have made many procedures more effective and more affordable.  Here Dr Kaplan takes a look at some common cosmetic dentistry procedures and explains which are best to address common dental problems, to restore a natural-looking smile, and help you feel confident again.

Q: How Do I Find And Choose A Cosmetic Dentist?
A: Working with a highly trained cosmetic dentist is the best way to avoid future problems. In addition to checking the dentist’s credentials and commitment to continuing education, patients are recommended to ensure that the dentist has sufficient experience performing the required procedures.

Q: What Is Bonding Used For in Cosmetic Dentistry?
A: Composite tooth coloured composite resin is used to reshape, repair or change the colour of a tooth. The composite resin is sculpted, hardened and then polished to give it a natural look. Bonding is usually well suited for teeth that are chipped or slightly decayed. It can also be used to restore small tooth cavities, to smooth out chipped, cracked or broken surfaces or to close the gaps between teeth that are spaced apart. It can also be used to cover the whole external surface of a tooth to give it new colour and shape.

Q: How Can Jagged Teeth Be Corrected With Cosmetic Dentistry?
A: Thanks to advances in cosmetic dentistry, it is possible for the front teeth to be reshaped without using anaesthesia. With the appropriate treatments, and of course with the dentist’s experience, remarkable changes can be made very easily. When major cosmetic improvements are to be made, crowns provide full coverage restorations ( crowns) or veneers may be needed.

Q: What Causes Discolouration And Dulling Of The Teeth?
A number of factors can contribute to discolouration: aging, staining and chemical damage are some examples. Teeth whitening or bleaching is an effective procedure that can restore the whiteness of the teeth. However, it is important to remember that daily intake of tea and coffee can exacerbate staining.

Q: What Cosmetic Dentistry Options Are There For Missing Teeth?
A: Missing teeth can be replaced with bridges. Bridges fill up the spaces left by missing teeth, however, your prosthodontist may also recommend implants.

Q: I Have Been Told That I Have A Weak Biting Surface- What Can Be Done About This?
A: When cosmetic improvements are t be made, crowns provide invaluable assistance. Crowns are positioned over the tooth, covering a lot f its enamel. A crown encapsulated the tooth, making it stronger and giving you a stronger and more durable biting surface.

Q: What Are Porcelain Inlays?
A: Porcelain inlays are  indicated as a replacement for large defective silver fillings which have come to the end of the usefulness. It may be more conservative in preserving natural tooth material to use porcelain inlays rather than for crowns. Two visits required for the procedure.

Porcelain inlays have become popular today as an alternative to gold inlays that were done so successfully in the past.

Teeth that are damaged, loose, cracked or missing require restorative dentistry to repair, restore or make them look more natural. Dr Kaplan is a prosthodontist, or an advanced dentist, who has over 40 years of experience in restorative dentistry. He provides some expert tips on cosmetic and restorative dentistry.

Q. My Crown In The Front Doesn’t Match My Teeth –– It Looks Fake. What Can Be Done?
A. This is the hardest thing to do in restorative dentistry – match a single front tooth. Look for an excellent cosmetic dentist who works with a “master ceramist” in his or her office. Sometimes it is necessary to do more than one tooth. In that case, bonding or porcelain laminates might be the answer. Remember, it takes a great deal of artistry involved on the part of the dentist and ceramist.

Q. What’s A Cap? What’s A Crown?
A. A cap and a crown are the same thing. The entire tooth surface is reduced and usually replaced with artificial material such as porcelain or porcelain bonded to metal.

The soft tissue around the upper front teeth is inflamed because of ill-fitting crowns. These crowns were removed. Provisional crowns were fitted and gum treatment was done. The final crowns preserve the health of the soft tissue and give the patient a confident smile.

Q. I’ve Lost A Tooth. What Can Be Done?
A. Today’s restorative dentistry offers many options:

  • Tooth bonded back in place
  • A removable appliance
  • A fixed bridge
  • An implant and crown
Q. What’s The Difference Between Bonding and Porcelain Laminate Veneers?
A. Bonding is a tooth–coloured plastic (composite) resin material and is done in one visit (little tooth reduction, no anesthesia required). Porcelain laminate veneers can mask dark stains better with less long–term chipping than bonding. They are made by a ceramist and do not stain, offering greater choice in colour, shape, and vitality. They do require only two office visits.

Q. What’s The Difference In Cost Between Bonding and Veneers?
A. Generally bonding is 1/2 to 1/3 of the cost of veneers or crowns. Your best bet is to review the fee range and advantages/disadvantages for all restorative dentistry procedures described in a book called Change Your Smile (Quintessence Publishing Company).

Q. How Long Does A Bonding/Veneer last?
A. On the average, bonding lasts three to eight years. Porcelain laminate veneers lasts four to twelve years or more.

Q. Why Should I Spend A Lot Of Money On A Root Canal? Why Not Just Pull The Tooth?
A. Losing a tooth can be the beginning of many more lost teeth. Saving the tooth maintains space, keeps other teeth from shifting, and eliminates the need and cost of a bridge or implant and crown. Although seemingly expensive, it is actually quite cost effective.

Q. I Have So Many Dental Problems, Sometimes I Think I Should Just Pull Out All My Teeth
A. To be able to wear a denture comfortably requires sufficient retention. Bone is invariably lost when teeth are pulled and then continues to reabsorb and shrink back, resulting in poor–fitting loose dentures. These consistently require remaking and never function as natural teeth. Taste, speech and overall functions are severely compromised. Most times, if even the root can be saved, a good dentist can give a patient good functioning and esthetically pleasing, long–lasting teeth. Today, dental implants used to anchor a denture add stability and are an ideal choice for most denture patients.

Q. I Have A Space Between My Two Front Teeth. How Can It Be Closed?
A. There are several ways in which this can be corrected:

Orthodontics is the best way (multiple visits)
Bonding (one visit)
Porcelain laminate veneers (two visits)
Crowns (two visits)

Q. My Teeth Are Too Small, Can I Have Bigger Teeth?
A. Yes. it’s possible either with composite resin bonding, porcelain laminate veneers or full crowns if they break or are already broken. Have a consultation, which will include a diagnostic wax–up to see how you can look with long or perhaps wide teeth.

Q. My Eye Teeth Are Too Pointed. Help! I Look Like A Vampire!
A. Cosmetic contouring or reshaping your natural teeth would be the best possible procedure for this. It only takes one quick, painless appointment to improve your look.

Q. My Teeth Are Uneven, What Can I Do?
A. Cosmetic contouring, porcelain laminate veneers, orthodontics, bonding, or crowns can be used to correct this.

Q. I Was Hit In The Mouth And My Teeth Are Broken, Chipped, And Cracked. What Can I Do?
A. Translumination or an intraoral camera can be used to determine the extent of the cracks. Your possible choices to correct the problem would be:

  • Bonding
  • Porcelain laminate veneers
  • Porcelain crowns
Q. I Have Big Dark Silver Fillings . . . Can They Be Made Tooth-Coloured?
A. Yes. Possible tooth coloured replacement choices include:

  • Composite (plastic) resin
  • Porcelain inlay/onlay
  • Porcelain crowns
  • Amalgam fillings replaced with porcelain inlays.
Q. My teeth stick out in the front. Are braces my only option?
A. No. Many times a compromise can be suggested after a restorative dentistry consultation.

Possible options include:

  • Cosmetic contouring
  • Bonding
  • Porcelain laminate veneers
  • Crowns

Keep in mind that orthodontics is usually the best choice for these situations.

Q. My Teeth Don’t Show When I Smile.
A. Orthodontics is your best bet –– the teeth can usually be brought down enough to show. However, at times orthognathic surgery may be suggested as well.

Bonding or porcelain laminate veneers or full crowns are a possible compromise.

The soft tissue around the upper front teeth is inflamed because of ill-fitting crowns. These crowns were removed. Provisional crowns were fitted and gum treatment was done. The final crowns preserve the health of the soft tissue and give the patient a confident smile.