Invisalign

by Dr. O. Karnakova

Invisalign is a clear orthodontic aligner tray made to replace traditional braces. Unlike braces, they do not contain any metal, are constructed out of a smooth comfortable plastic, and are removable. They are used to correct moderate under bites, open bites, crowding, cross bites, and gaps between teeth (diastema).

Invisalign should be worn a minimum of twenty-two hours per day and should only be taken off when eating or brushing. A new set of custom aligners are to be worn approximately every two weeks.

Invisalign offers many advantages over traditional braces. They are virtually invisible and are more esthetically pleasing. The aligners are much more comfortable to wear as compared to the metal brackets and wires. Braces also make it more difficult to maintain optimum oral hygiene. The brackets can trap food debris and plaque, resulting in gum infection.

Invisalign trays can be removed to perform oral hygiene and do not have any food restrictions. Studies have shown that Invisalign can align teeth faster than braces when used correctly.

A disadvantage of Invisalign is that they are not designed to correct severe malocclusions. Teeth that are overly rotated, severely misaligned, or have large gaps over 6mm are not candidates. Invisalign treatment also has the potential for higher costs than traditional braces. Another potential disadvantage with Invisalign treatment is noncompliance. Patients who do not wear their trays for at least twenty-two hours per day may slow the progress of treatment. Not wearing the aligners for long extended periods of time may relapse the progress and require additional costs with mid-course correction.

HISTORY AND BENEFITS OF DENTAL IMPLANTS

History and Benefits of Dental Implants

by Dr. Howard Kopel

The first evidence of dental implants is attributed to the Mayan population roughly around 600 AD where they excelled in utilizing pieces of shells as implants as a replacement for mandibular teeth. The first post-type endosseous implant is attributed to Formiggini (“Father of Modern Implantology”) in the 1940’s. In the ensuing decades many different materials and techniques were employed to find a predictable implant system for replacing missing teeth. In 1978, Dr. P. Brånemark presented a two-stage threaded titanium root-form implant that modern implants are based on. Finally, today our implants have special coatings that promote osseointegration with the bone they are placed in and have become a very predictable modality.

Today it is no longer necessary to have removable partial dentures and full dentures as our parents and grandparents needed after having extractions. Gone are the days that embarrassing and uncomfortable loose dentures must be endured. Drilling down perfectly good teeth to place fixed bridgework is an outdated procedure now that implants are readily available.

Here are many reasons dental implants are often the first choice and a standard of care compared to other options to restore missing or damaged teeth.

  • Next best thing to healthy, natural teeth.  Strong and stable, a dental implant restores a lost tooth so that it looks, feels, fits and functions like a natural tooth. Other options can lead to bone deterioration, and may interfere with eating, smiling, speaking and other activities of everyday life.
  • Built to last. Dental implants are a long-term solution. Traditional, tooth-supported dental bridges only last five to seven years, and with proper care often more than 10 years, but at some point they may need to be replaced. While dental implants may need periodic adjustments, they can last a lifetime when properly placed and cared for over time.
  • Enjoy life without worrying about your teeth!  No need to stay home or feel uncomfortable in public, embarrassed because your smile looks different, or worrying that missing teeth will limit your ability to join in the fun or that removable dentures or tooth-supported replacement teeth will loosen or fall out when you talk, eat or laugh. Teeth restored with dental implants are teeth that let you, not your teeth, lead your life.
  • Retain your natural face shape, and smile.  A face without teeth can sag and appear sunken and sad. Dental implants allow you to maintain the natural shape of your face and smile.
  • Protect healthy bone. Leaving empty spaces in your mouth after losing one or more teeth can lead to additional health issues, such as the loss and deterioration of some of your jawbone. When it is not being used to support a natural tooth, the jawbone deteriorates, losing its strength and firmness. Dental implants are the only dental restoration option that preserves and stimulates natural bone, actually helping to stimulate bone growth and prevent bone loss.
  • Keep your teeth in your mouth – not in a cup. Dental implants allow you to keep your teeth where they belong – in your mouth. And no more worrying that your dentures might slip or fall out. Brush, floss and care for teeth that have been replaced using dental implants exactly the way you would natural teeth – in your mouth.
  • Speak easy.  Adjusting to removable dentures can mean struggling to pronounce everyday words. Not so with dental implants, which function like natural teeth.
  • Eat your favorite foods! Taste and enjoy the foods you love without hesitation. You can bite naturally, eat virtually anything you want and, unlike removable dentures that can feel uncomfortable, you can experience the full taste of the food you eat with dental implants, too.
  • Look Mom, no cavities! Cavities cannot occur in an implant-restored crown, or replacement tooth; however, you will need to visit your dentist as scheduled and clean and care for it and your gums and mouth every day, the same as you would if it were a natural tooth.
  • Keep teeth in place – silently. Dentures may slip when you eat, talk, smile, laugh, kiss, yawn or cough, so that you have to “reposition” them back into place in the mouth. Dental implants are fixed in place and fuse naturally with your jawbone, meaning your replacement teeth won’t move, click or shift.
  • Protect your healthy teeth. Placing a tooth-supported bridge requires grinding away the teeth on one or both sides of the missing tooth or teeth – thereby damaging healthy teeth to restore those that are missing. The modified healthy teeth are attached to, and support, the bridge. Dental implants go in the jawbone, in the spot where your missing tooth root was, without impacting healthy teeth. They also help prevent healthy, adjacent teeth from shifting as they would if an empty space were left for an extended period of time.
  • More predictable than other repair and restoration methods. Dental implant treatment has a track record of reliable, long-term successful outcomes and is often considered “more predictable” than other treatments to repair or replace missing teeth, including bridgework, removable appliances and retreatment of failing root canal (endodontic) therapy.

Posterior Dentition

Dr. Karnakova with Dr. Zak Dental Care discusses the problem of Posterior Dentition. The lack of posterior teeth may have many negative consequences on the oral health. Posterior teeth support the vertical height of the face, and may lead to a posterior bite collapse if missing.

 

Loss of Vertical Dimension

Vertical dimension is the space between the upper and lower jaws. In a normal occlusion with a full dentition the space is ideal with the teeth and jaw working in harmony. Over time, especially in older patients this space can diminish if the natural teeth are worn down  from bruxism or lost due to decay or periodontal disease.

This loss of vertical dimension or bite collapse can result in damage to the jaw joints, severe pain or dysfunction in the jaw joints, frequent muscle tension headaches, tooth fractures and tooth loss, and aggravation of periodontal disease if present. Other resulting issues are shortening of the lower face height, an inverted smile (corners of the mouth sag), a toothless smile, frequent cracking or chapping at the corners of the mouth (angular cheilitis), and problems chewing.

Restoring the proper vertical dimension and associated cosmetic and functional problems can be obtained by proper treatment planning. In the case of a full dentition with worn teeth, the teeth can be crowned and returned to their natural size. For partial or fully edentulous patients implants can be utilized along with removable or hybrid appliances. Below are some before and after pictures depicting loss of vertical dimension and its correction.

by Dr. H. Kopel, DDS

 

 

Lack of Posterior Dentition

It is not uncommon for people to have concerns about the health of their anterior teeth due to concerns of esthetics and a beautiful smile. Equally as important are posterior teeth, which play an important role in chewing, grinding, and crushing food. Anterior teeth are designed for biting and tearing, and are unable to handle the stress of chewing.

The lack of posterior teeth may have many negative consequences on the oral health of an individual. Posterior teeth support the vertical height of the face, and may lead to a posterior bite collapse if missing. The missing of posterior teeth can also lead to the drifting, flaring, or extrusion of remaining dentition. Speech impairment and temporal mandibular disorders can also be a consequence. In addition, unnecessary stress is placed on the remaining dentition, and can lead to fractures or breakage.

Ideally, the best treatment for replacing missing posterior teeth is an implant, which have the greatest long-term prognosis. Bridges or partial dentures may also be used to restore missing teeth. Each method of replacing missing dentition is based on a patient-by-patient case. Please consult with your dentist for available treatment options best suited for your needs.

by Dr. O. Karnakova, DDS

Dental Prosthesis Care

by Dr. O. Karnakova

Among many of the different care approaches for fixed tooth retained bridges and fixed implant bridges, brushing and flossing still remains the most effective and preferred method by dentists. Inadequate oral hygiene will eventually lead to gum disease and the formation of cavities. Ideally, brushing should be performed after every meal, or a minimum of two times daily for at least two minutes.

It is important to brush around the gumline, where plaque is most prone to accumulate. The toothbrush should be held at a forty-five degree angle, using a combination of gentle horizontal strokes and a vertical sweeping stroke towards the occlusal surface of the tooth. Flossing should be performed a minimum of two times daily and is essential at removing plaque where the toothbrush cannot. To floss around the tooth or implant, the floss should be wrapped in a "C" shape to hug the abutment. Gently slide the floss up and down in a vertical motion for a minimum of three to five times. On the downward motion, the floss should slide about two to three millimeters below the gumline. It is also important to floss underneath the bridge by use of a floss threader. Floss threaders feature a stiff plastic end and are effective at inserting the floss under the bridge. Simply use the stiff end to thread the floss under the bridge, and gently slide the floss back and forth parallel to the occlusal plane.

Partial dentures and full dentures can accumulate bacteria and plaque much like natural teeth. Patients should rinse their denture with water after every meal to remove any food particles. Brushing is recommended at least once per day and also prevents staining. It is best to use a brush specifically designed for cleaning dentures or a soft bristled toothbrush. Avoid using hard bristles that can potentially damage the appliance. Special denture cleaning solutions, gels, or pastes are recommended for cleaning the denture because they do not contain abrasive materials. Toothpaste should not be used because they contain abrasive particles that can damage the denture. Polident is a recommended tablet solution by dentist for cleaning or soaking your dentures at night. Please follow the labeled instructions for the length of time the denture should be soaked.

Patients with a removable or fixed prosthesis should visit their dentist for gum treatment every three to four months. The accumulation of plaque over time hardens into a substance called calculus or tartar that can cause many health concerns. Calculus can only be removed by a dental professional. Visiting the dentist regularly ensures that the gums and dental prosthesis are in good health and increases its life span. If a denture breaks or does not fit properly, please take it to your dentist. Do not attempt to adjust or repair the denture yourself as it can cause irreversible damage.