In other situations, the implants are allowed to heal under the gumline for the traditional 3-6 months. A fixed or removable prosthesis may be indicated during this healing time. The need to have this delayed approach is determined by your “team” to minimize any risks and overall time spent obtaining your objectives.
Dental implants eliminate the need to remove enamel from the neighboring teeth for a bridge, and have advantages of stimulating bone to remain, avoid decay or periodontal disease, and have a “track record” that far outlasts bridges. The disadvantages with implants are they do have one or two surgical procedures. The costs for implant restorations tend to be double the fees of bridges over teeth, however these costs improve over time when considering there is little need to replace them (unlike bridges).
The advantages of bridges are the non-surgical approach (unless a tooth needs removal), the time of treatment is shorter, typically around a month, and bridges may be most conservative if crowns already exist on the adjacent teeth and only need to be removed and replaced with a bridge. Disadvantages with bridges include the unnecessary and permanent removal of enamel of the adjacent supporting teeth, the loss of bone from the missing tooth under the bridge, and the longevity of the restoration depends on the health of either of the supporting teeth (avoiding decay and periodontal disease).
In summary, the implant approach “solves a one tooth problem with a one tooth solution”.
The first “modern era” crowns were fabricated from gold alloys. The accuracy of the fit was determined by the accuracy of impression materials to make the “mold”. With accuracy improvements with models, full gold crowns became the standard in which all materials would be compared. To make the gold appear like tooth structure, plastic was molded to the gold. This unfortunately resulted in wear and displacement of the plastic, which inspired English investigators to invent methods of fusing porcelain to metal. The “porcelain fused to metal” crowns were, and still are, being used. Their main disadvantages include their abrasiveness to the teeth around them, the brittle nature of porcelain often results in chipping from the metal, they irritate gum tissue when not done properly, and they frequently do not appear natural.
To address the lack of cosmetic predictability of the previous efforts, all ceramic crowns were developed. The task of investigators was to improve the durability of these materials, while maintaining the translucency of the resulting crown. Over several decades, the all-ceramic crown has evolved from hand-stacked porcelain jackets, to laboratory based CAD/CAM (computer-aided design and machining) crowns, to chair side CAD/CAM methods where the patient waits for the final crown in one appointment. CAD/CAM crowns, and their associated ceramic materials, are becoming the new norm. The differences now are whether they are made DURING the appointment or from a laboratory taking two or more appointments.
No impression materials are typically used–impressions and stone models are replaced with a 3D camera to make a “digital model”.
Sophisticated software is used to create the digital crown (CAD) on the computer as you watch.
The restoration is milled (CAM) in as little as 10 minutes using shaded ceramic materials specific for their intended purpose.
Further color and shade modifications are made to match the adjacent teeth in your mouth.
The final restoration is then seated in less than two hours!
With this technology there is no need to wear temporary crowns, since you leave with the final rendition. Therefore, there is no need for additional appointments to replace lost temporaries, or have a second shot for anesthesia. The accuracy of the digital camera is at the micron level and the gum tissues tolerate these restorations beautifully. The overall appearance of a well-designed ceramic restoration is spectacular!
I’ve heard that some dental offices send their lab work out of the country to be fabricated. Does your office do that?
The American Dental Association recommends “bite wing” radiographs every two years and a full-mouth series or panoramic radiograph every five years for responsible dental supervision. We always explain the rationale for radiographs in your situation.
I’ve heard that the dental unit water lines need special treatment to make the water safe for patients. Do you treat the water?
Dental emergencies occur at any time—usually Friday night after hours! Patient of record will get priority appointments if the problem is to be managed the next day. Dr. Stewart and staff live locally to the office, so that most times we are available for the various problems we have seen over the years:
Toothache—the management of a toothache often needs direct supervision. Many times this problem could be TEMPORARILY managed with medications until the next day. An x-ray would be taken along with clinical evaluation to determine the proper course of action.
Swelling—the sign of advanced inflammation or possibly infection must be addressed with direct supervision the next morning. Night management for patients of record would be through medications, to allow proper rest for the patient.
Filling out—typically the loss of a filling will not produce acute pain. The filling should be either replaced or another restoration recommended depending on the extent of the injury. Most patients experience the aggravation of food packing between the teeth after a meal. This will hurt the gum tissue, and is remedied temporarily by flossing, until an appointment can be scheduled.
Broken tooth—depending on the symptoms and whether we have the social embarrassment of a front tooth involved, priority treatment will be given. Broken back teeth will be addressed as needed. Often smoothing the sharp areas of the fractured tooth area the next morning will suffice until a restorative appointment can be scheduled. Sometimes a root canal is needed and this will be supervised by an endodontist if the patient does not have a general dentist that performs this type of treatment.
Broken denture or partial—this again will be managed on a priority basis. Please call and leave a message to obtain the first available emergency appointment. Weekend occurrences will be handled on an individual basis—starting with a phone call to Dr. Stewart. We aim to avoid any social setbacks!