What is a Prosthodontist?

            A prosthodontist specialist is a Dentist that has 3 or more years training beyond that of a regular General Dentist. It is one of the 7 recognized specialties by the American Dental Association. Prosthodontists are involved with fabricating Dentures, Crowns, Bridges, and other aspects of restorative dentistry.

Not only does a prosthodontist deal with simple cases, but are specially trained for the more complex cases.  Some examples are patients who need full mouth reconstruction, with real teeth or in combination with dental implants, cancer patients who have lost their jaws, nose, ears, etc. and is not limited to the mouth.

Teeth in a day

            There has been much talk of “teeth in a day” “teeth in an hour” “teeth in 10 minutes” etc. but what most people don’t realize is that these are temporaries that are used until the implant “heals”, and this cannot be done with everyone. It depends upon that particular person, and that particular situation, and there may be compromises involved. A more conventional approach may be temporary “bonded bridges”, temporary “retainers”, temporary dentures or partial dentures, etc. and when the implant “heals” then the final “permanent” restoration can be completed. Incomplete. I will send you the completed article later.

Dental implants have been a revolution in dentistry. They have many advantages as compared to previous technologies. They look, feel and function more like your natural teeth. Your speech, taste, looks, and chewing ability are more natural. The success rate for dental implants are very high. They are conservative; no need to grind down your adjacent teeth for a bridge. They don’t get recurrent decay; this is the leading cause of failing conventional dental work. Until dental implants were invented, we did not have the technology to maintain the jawbone levels once teeth were extracted.

With all these advantages (and many more, see our webpage: TriValleyImplants.com), you would think that more people would prefer this treatment option. However, the fear of PAIN is a major concern of many people. What sane person would like to have their jawbone drilled? Actually, there are very few pain nerves in the jawbone. Most are in the gum soft tissue area. With older surgical techniques, the gum needed to be cut and pealed. This meant longer procedure times, more pain and delayed healing.

We use the latest minimally invasive surgical placement techniques to not only significantly reduce the discomfort of dental implant placement, but reduce healing time as well. Many patients may not need any pain medication at all. In many situations the procedure may even be 10 minutes or less! Of course, this will vary between patients, but our philosophy is to reduce trauma as much as possible without compromising the outcome. Our technology is good, but not as good as nature. Implants are the closest technology we have to nature.

Implant consultations are free. We have reasonable fees and 100% financing. Let’s see what we can do for you. The University of Illinois at Chicago, NY Brookdale Hospital, and The University of the Pacific graduate

.

Gregory K. Louie DDS, DICIO, AFAAID, Prosthodontics Specialist
520 La Gonda Way, Suite 101
Danville, CA  94526
925-785-9089 Member: ADA,CDA,ACP,AAID,AACD,ICOI,AGD

Imaging technology:

There are two types of x-ray imagery commonly used in dentistry.  Conventional 2 dimension (2D) and Computerized tomography (3D).  Each has their advantages and disadvantages, but with the availability of 3D, and being able to see in 3 dimensions, not only it is much easier to work around dangerous anatomical areas, but surgical guides can be fabricated with high accuracy from this data. The type of 3D machines used in dental offices is of the Cone Beam type (CBCT). These machines have about 30 times less radiation as conventional helical scan 3D (CAT) machines found in hospitals, and are thus much safer. Dimensional distortion is very small as compared to 2D images. 20% or more uneven distortion can occur with 2D, and the distortion varies with film and patient position, as well as the manufacturer brand of machine involved. 3D imagery does not have this limitation. We provide complimentary implant consultations with free CBCT scans.

Bioactive technology:

There have been many advances in improving wound healing (implant integration). Natural products from the body include extracting growth factors (healing proteins) from the blood or tissues. In implant dentistry, 3 types of growth factor techniques are used to extract growth factors: Platet Rich Plasma (PRP), Platelet Rich Growth Factors (PRGF), and Platelet Rich Fibrin (PRF). Each of these too, has their advantages and disadvantages. For those who do not like the idea of having blood drawn, there are 2 synthetic growth factor products available in the US that can also improve wound healing, Gem-21 and Infuse. We use all of these techniques, and more.

The latest technology we use involves using a special type of Laser to biostimulate healing.

Surgical techniques:

Especially with the availability of 3D imagery, minimal surgical techniques are becoming more popular. Only a small hole is needed in the tissues for implant placement. Healing is more rapid, and there is very little or no pain afterwards. Although it is not possible to use these techniques with every patient, but this is our preference.

Small diameter implants, commonly known as mini dental implants, were first used as a temporary implant to support a temporary crown or bridge until the regular implants healed, however, because of the success of these implants, in 1997 the FDA approved these smaller diameter implants (less than 3mm in diameter) for use as a definitive implant for use in final restorations.

Because of the significantly smaller size of these implants, a minimal surgical procedure is needed, hence, very little pain and fast healing is usually the case. Because of their smaller size, these types of implants can be placed into areas of thinner bone, without the necessity of additional bone grafting that may be needed than if regular sized implants were to be placed. Also, medically compromised patients, who may not cope well with conventional implant placement, may do better with this minimal surgical placement technique.

However, because of their significantly smaller size, these implants have less surface area, and thus cannot support loads as well as conventional implants, therefore, their use is limited in cases where there is limited load placed upon these implants. But with proper design and use, these types of implants have a very high success rate, similar to conventional implants in excess of 95%. Some common applications include support for crowns, bridges, and overdentures. Similar to conventional implants, it is possible to immediately place the temporary or final restorations on the same day the implants are placed in many situations.

This is a complex question with several factors to keep in consideration. If done properly, with the correct implant, in the correct circumstances, in the correct conditions, and with the proper maintenance, the implant should last a very long time. Here are some of the factors that can affect implant (and crown) life expectancy.

  1. The health of the patient

    It may be obvious that the patient should be in relatively good health.  As long as the patient is able to heal in a relatively normal way, dental implants can be very successful. This includes patients that are controlled diabetics, patients taking medications commonly used for osteoporosis, and other conditions that result in slower healing, can still have successful results.
  2. Any parafunctional habits

    Grinding and clenching can be very destructive to dental work and implants. There are many ways to compensate for this, such as splinting of the implants, modifying the bite, fabricating dental implant guards, and other techniques.
  3. The implant

    All implants are not created equal. There are significant differences between them. This is a science all to its own that few people (including dentists) really understand.  Some factors to consider are: The seal between the implant and crown (abutment), the screw thread design, the surface coating design, the taper or straight design, and the implant material itself. It is best to select an implant system tailored specifically unique to the patient, and not try to use one implant system for everybody; every persons situation and body is different.
  4. Quality and quantity of bone

    Research has shown that not only should there be at least 2.5mm of bone surrounding the implant for long term success, the density should also be adequate to support the biting force for eating. Patients are often told that they cannot have implants because there is not enough bone.  This is not true any longer. We can now grow the necessary bone with new technology.
  5. Quality and quantity of the surrounding soft tissue

    One of the problems that sometimes lead to implant loss, is inflammation around the neck of the implant (implantitis) leading to loss of bone, and the possible loss of the implant. One way to reduce this possible problem, and make the implant more resistant to this is to make sure that the gums around the implant is of the thicker tough type of gums (keratinized gingiva).  If there is not enough of this tissue, there are many ways to also grow this tissue.
  6. Maintenance

    Maintenance is probably the most important factor. If the area is not kept clean, the bacteria, plaque, tarter, and the resulting inflammation will destroy the tissues around the implant. Regular teeth/implant cleanings are mandatory. This may be the most difficult factor of all. Frequently, the dentistry is the easy part. Changing the habits of people is the more difficult part. It is important to realize that these are generalizations. It is best to think to long-term results. You only want to do this once, do it the correct way, and do not take shortcuts.

Teeth bleaching, better known as teeth whitening has become very popular, but frequently, there are questions regarding the safety of these products on the teeth and gums.

The way these products work, is by oxidizing the stains that have been collecting on the surface of teeth, and within the enamel crystals of teeth. The active ingredient is peroxide based. Hydrogen peroxide, urea peroxide, or carbamide peroxide are the most popular, and are available in strengths between 3% to 35%.  Because, these products cause teeth sensitivity, and will soften the tooth enamel, manufacturers will often add ingredients to reduce the sensitivity, and tooth softening.  Sodium Fluoride, Calcium Gluconate, Strontium Chloride, and Silver Nitrate are some of the more common additives.

Two application techniques are commonly used: In-office bleaching, and take home bleaching. Each work equally well. In-office bleaching involves shining a powerful light on the bleach-coated teeth.  Because peroxide reacts to light, and a higher strength bleach is used,  quicker results will occur. However, this technique is usually less comfortable and more costly. The second technique is to have bleaching trays made, and the patient applies the bleach into the tray themselves. This is a more convenient technique. Any unused bleach can be stored in the refrigerator for touch-ups later.  Over the counter bleaches can also be used in the tray for significantly lower cost, however, it will take longer to reach the desired result when compared to the in-office bleaching technique.

Used as directed, Tooth enamel hardness and any tooth sensitivity should return to normal within a week. The use of desensitizing toothpastes and fluoride mouthwashes will speed the recovery of any sensitive teeth. There should be no lasting damage to the teeth or dental work.  If color matching is desired for upcoming dental work, It is recommended to whiten the teeth weeks before the dental procedure so that the color will be stable.