Endodontic or dental implant therapy

Background. Clinicians are confronted with difficult choices regarding whether a tooth with pulpal and/or periapical disease should be saved through endodontic treatment or be extracted and replaced with an implant. Methods. The authors examined publications (research, literature reviews and systematic reviews) related to the factors affecting decision making for patients who have oral diseases or traumatic injuries.

Results. The factors to be considered included patient-related issues (systemic and oral health, as well as comfort and treatment perceptions), tooth- and periodontium-related factors (pulpal and periodontal conditions, color characteristics of the teeth, quantity and quality of bone, and soft-tissue anatomy) and treatment-related factors (the potential for procedural complications, required adjunctive procedures and treatment outcomes).

Conclusions. On the basis of survival rates, it appears that more than 95 percent of dental implants and teeth that have undergone endodontic treatment remain functional over time.

Clinical Implications. Clinicians need to consider carefully several factors before choosing whether to perform endodontic therapy or extract a tooth and place an implant. The result should be high levels of comfort, function, longevity and esthetics for patients.

Key Words: Decision-making factors; endodontic therapy; dental implants; systemic disease; oral health; treatment planning

For decades, all disciplines of dentistry have strived to prevent and treat caries and periodontal disease, as well as to restore function and esthetics to patients affected by oral diseases or traumatic injuries. Despite these efforts, many nonrestorable teeth and teeth with severe periodontal involvement have been extracted, and traditionally they have been replaced with fixed or removable prostheses. Advances in implant dentistry have provided thousands of completely and partially edentulous patients with a more functional and attractive alternative to fixed and removable prostheses. The introduction of cylindrical endosseous implants^1,2 to dentistry and their high survival rates have had a significant effect on treatment planning in prosthodontics and periodontics.³ These advances also can affect treatment planning for teeth requiring endodontic treatment.

An ideal treatment plan should address the chief complaints of the patient; provide the longest-lasting, most cost-effective treatment; and meet or exceed patients’ expectations whenever possible. However, treatment planning usually is affected by the views of the stakeholders (that is, patients, insurance companies, dentists), who have varying perspectives and expectations regarding the outcome of treatment. Treatment should be patient-centered, not be based only on dental insurance benefits and not be guided solely by the desires and clinical experience of the practitioner. It must be based on scientific evidence, and ideally it should preserve the biological environment while maintaining or restoring esthetics, comfort and function. Clinicians regularly are confronted with difficult choices. Should a tooth be saved through endodontic treatment or be extracted and replaced by a single implant?

The factors involved in the decision-making process regarding whether a tooth should receive endodontic treatment or be extracted and replaced by an implant pertain to the patient, the tooth and periodontium, and treatment-related considerations. The purpose of this article is to explore the major factors that can affect the decision regarding whether a tooth receives endodontic treatment or is extracted and replaced by an implant.

PATIENT HEALTH-RELATED FACTORS

Pulpal and periodontal conditions. Indications for endodontic treatment include teeth with irreversible pulpitis, necrotic pulps, restorable crowns, treatable periodontal conditions, salvageable resorptive defects and a favorable crown-to-root ratio.²⁵ Endodontic treatment is contraindicated when there is limited remaining tooth structure and the definitive crown will not be able to engage at least 1.5 to 2.0 millimeters of tooth structure with a cervical ferrule.^26,27 Eckerbom and colleagues,²⁸ Randow and colleagues²⁹ and Reuter and Brose³⁰ found that when a fixed partial denture had been used, abutment teeth that had undergone endodontic treatment failed more often than did teeth with vital pulps.^28–30 Aquilino and Caplan³¹ found a strong association between crown placement and the survival of endodontically treated teeth.

Implants are indicated when teeth cannot be prepared with adequate retention and resistance form. Other indications for implants include edentulous sites adjacent to teeth without restorations or the need for restorations and edentulous sites adjacent to abutment teeth with large pulpal chambers and those with a history of avulsion or luxation.³²

Biological and environmental considerations. Some patients are frustrated because of recurring problems with caries or periodontal disease. Retaining such teeth via endodontic treatment may not be the best option, because the frequently required re-treatment procedures can be challenging and frustrating for the practitioner and the patient, and they produce compromised results. It may be prudent to extract such teeth and place implants. In addition, implants may be a better option for patients who have limited ability to perform routine oral hygiene procedures.

Teeth with unique color characteristics. Color matching can be a significant challenge for certain highly visible teeth with unique dentin colorations or large areas of enamel translucency or transparency. When such a tooth requires endodontic treatment but does not need a ceramic crown, the clinician may find it to be esthetically advantageous to retain the tooth through endodontic treatment, rather than extract it and place an implant crown that does not match the surrounding environment. Because of these color-matching challenges, it sometimes is prudent to perform challenging and difficult endodontic treatment rather than to extract such teeth and replace them with implants.

When a tooth with challenging color characteristics requires both endodontic treatment and a ceramic crown, it may not be possible to achieve an appropriate color match because of thickness limitations imposed by the amount of required tooth reduction. Although a ceramic crown made for an implant may not be ideal, the dentist usually can achieve a better color result because the implant can be fabricated with a thicker amount of porcelain that enhances the color-matching potential, particularly in the challenging cervical areas.

Quantity and quality of bone. The quantity of available bone affects the feasibility of placing implants without bone grafting. Bone quality also affects implant success, with type 4 bone resulting in less success compared with types 1 through 3 bone.³³ Goodacre and colleagues³³ reported that the success rate was lower when short implants (that is, those 10 mm or less in length) were used than when longer implants were used. Although new implant surfaces and geometries have produced promising results^34–36 that may overcome the lower success rates associated with short implants, the available clinical data are limited.

After extracting a tooth, the clinician can place an implant immediately in the root socket, thereby avoiding much of the bone resorption that accompanies extraction.³⁷ However, when substantial infection is associated with an extracted tooth, the clinician may have to postpone implant placement to permit resolution of the infection.³⁸

Retaining a tooth with a poor long-term prognosis via endodontic treatment, particularly a cracked tooth, can lead to substantial bone loss by the time the tooth eventually is removed. The resulting bone defect can substantially affect the esthetic result. Consequently, early removal of the tooth and immediate placement of a dental implant may produce an environment that is more suitable for implant positioning and result in optimal esthetics.³⁹

Soft-tissue anatomy. The esthetic result around crowns can be affected negatively by an interdental papilla that does not fill the cervical embrasure space. This can occur around crowns that attach to endodontically treated teeth or dental implants. Choquet and colleagues⁴⁰ reported that soft tissue fills the cervical embrasure around dental implants when the incisocervical distance from the proximal contact to the interproximal bone crest is 5 mm or less.⁴⁰

The periodontal biotype also affects the potential for soft tissue to fill the cervical embrasure space around implants. In the presence of a thin biotype, papillae adjacent to implants seldom can be re-created when the distance between the interproximal bone crest and the desired height of the interdental papillae is more than 4 mm.⁴¹

When the biotype is thin but healthy around a natural tooth, preservation of the tooth through endodontic therapy may provide more appropriate soft-tissue esthetics than does extracting the tooth and placing a dental implant.

TREATMENT-RELATED FACTORS

Procedural complications. Endodontic treatment, like other disciplines of dentistry, occasionally is associated with procedural accidents. These mishaps can occur during access preparation, cleaning and shaping, and obturation, as well as during preparation of the post space.⁴² Some of these accidents have a negative effect on the outcomes of endodontic treatment.^43–45 In addition, the extension of root canal filling materials^10,46 and quality of obturation^47,48 affect the prognosis for endodontic treatment.

Complications also can occur in conjunction with dental implants. They include surgical complications such as hematomas, ecchymosis and neurosensory disturbance.³³ Implant loss can occur as a result of the implant’s failure to integrate with the bone or bone loss subsequent to integration. Soft-tissue complications such as inflammation and/or proliferation, soft-tissue fenestration and/or dehiscence before stage II surgery and fistulas have been reported.³³ Mechanical complications such as screw loosening, screw fracture, prosthesis fracture and implant fracture also can occur.³³ Some of these complications, such as screw loosening, are corrected easily, while others can result in clinical failure.

Adjunctive procedures. A number of adjunctive procedures affect the comparison of complicated and/or high-risk endodontic treatment with tooth extraction and placement of an implant and a crown. For instance, retaining some teeth via endodontic therapy may result in the need for treatment for periodontal disease, crown lengthening through surgery or orthodontic extrusion, a core buildup or a post and core, or a crown. Each of these procedures adds complexity, can present additional complications and risks, increases the cost of treatment and makes it more difficult for patients to comprehend and accept a treatment plan.

Implant therapy presents similar complexities. Before or in conjunction with implant placement, the clinician may need to perform grafting or distraction osteogenesis so that adequate bone is available. Sinus grafting may be needed in the posterior maxilla, and horizontal/vertical bone grafting may be required in other areas of the mouth to provide an edentulous ridge with sufficient bone in the correct location. Ridge grafting that requires bone harvesting from a remote site increases patient discomfort. These procedures also increase the cost and treatment time, and they can complicate the provisional replacement of missing teeth for esthetic and functional reasons.

Treatment outcomes. Torabinejad and colleagues⁴⁹ performed a systematic review of the literature between January 1966 and September 2004 pertaining to the success and failure of non-surgical endodontic therapy, and they assigned levels of evidence to these studies. Their search revealed that during the past 40 years, 306 articles were published with regard to the outcome of nonsurgical endodontic treatment. Fifty-one of these articles reported studies involving at least 100 teeth. The authors recorded and analyzed the success rates at one, two and five years using 95 percent confidence interval estimates.

The data show a radiographic success rate of 81.5 percent during the five-year period. Friedman and colleagues⁹ reported similar healing rates (81 percent overall) in their clinical and radiographic assessment of the four- to six-year outcome of endodontic treatment. The healed rate in their study was significantly higher for teeth without apical lesions (92 percent) compared with that for teeth with apical periodontitis (74 percent). Based on survival rates, it appears that more than 95 percent of teeth that have undergone endodontic treatment remain functional over time.^50–52 These findings do not reflect new advances and innovations in the art and science of endodontics.⁵³

On the basis of the results of studies published after 1996, the American Dental Association’s Council on Scientific Affairs reported high implant survival rates for various clinical situations.¹¹ With regard to the single-tooth implant, the Council’s evaluation of 10 studies involving more than 1,400 implants revealed survival rates ranging from 94.4 to 99 percent, with a mean survival rate of 96.7 percent. The Council also reported a mean survival rate of 87.1 percent for implant overdenture treatment and a mean survival rate of 86.8 percent for bone grafting/ implant treatments.¹¹ The Council report stated that immediate loading of implants does not lower the survival rates, with three studies reporting survival rates ranging from 93.5 to 95.6 percent.¹¹

In a systematic review of clinical studies of implants, Creugers and colleagues⁵⁴ reported a four-year survival rate of 97 percent for single-tooth implants. In another report, Lindh and colleagues⁵⁵ performed a meta-analysis of implant studies involving partially edentulous patients. They reported a success rate of 97.5 percent after six to seven years for a single-implant crown.

CONCLUSION

The decision by the clinician and patient to retain or remove teeth should be based on a thorough assessment of information related to risk factors affecting the long-term prognosis for endodontic and dental implant treatment. The clinician should consider several factors when determining whether to save a tooth through endodontic therapy or extract it and place an implant. These factors pertain to the patient’s health status, the condition of the tooth and periodontium, and treatment-related considerations.

Patient-related factors include systemic and oral health, as well as patients’ comfort and perceptions about treatment. Tooth- and periodontium-related factors include pulpal and periodontal conditions, biological environmental considerations, color characteristics of the teeth, quantity and quality of bone, and soft-tissue anatomy. Treatment-related factors include an assessment of potential procedural complications, required adjunctive procedures and treatment outcomes data.

Bradley J Engle, DMD MHS
5659 Naples Blvd
Naples, FL 34109

http://www.engleimplantdentistry.com
Tel: (239) 593-2178
Fax: (239) 593-2179
Email: info@engleimplantdentistry.com

Bradley J Engle, DMD MHS
40 S. Heathwood Drive
Suite D. Second Floor
Marco Island, FL 34145

engleimplantdentistry.com
Tel: (239) 394-4906
Fax: (239) 394-5300
Email: info@engleimplantdentistry.com

 

 

 

The ‘mini’-implant has arrived

Gordon J. Christensen, DDS, MSD, PhD

Historically, the initial users of most types of dental implants mainly were general dental practitioners, who often were severely criticized by their peers for their involvement with implants. During the evolution of and the initial successful use of implants, practitioners still did not accept implant dentistry. With the introduction and refinement of the osseointe-grated root form implant over the last 40 years, implant dentistry has been accepted slowly by both general and specialty practitioners. Root-form dental implants have allowed many types of difficult oral treatment to be accomplished that were nearly impossible before the introduction of implants.^1–4 When root-form implants were popularized, oral surgeons, periodontists, some prosthodontists and a few general dentists became involved in placing them. However, the high cost of implants for patients and the assumed difficulty in placing them has impeded implant use to the degree that they are achieving only a small part of the service potential of which they are capable.

Implants are achieving only a small part of the service potential of which they are capable. 

As a prosthodontist who has placed root-form implants for more than 20 years, I have encouraged interested, surgically oriented general dentists and prosthodontists to place root-form dental implants in healthy patients who have adequate bone. My motivation of general dentists often has been met with criticism by surgical specialists, but I stand behind my recommendations that the more dentists who take the time to become educated adequately in the surgical aspects of implant placement, the more patients will be served by this superior treatment. It is well-known that implants are used widely in many countries that lack the legal obstacles found in the United States.

As interested dentists become involved in implant dentistry, they may want to consider joining the implant organizations and attending their meetings. These groups include the American Academy of Implant Dentistry, the Academy of Osseointegration and the International Congress of Oral Implantology. The oral surgery, periodontal and orthodontic specialty organizations also provide many continuing education courses on implant dentistry.

In my opinion, the increasingly popular “mini”-implant concept will assist the movement of general dentists into implant placement, and it will serve many dental patients who would not have been able to have typical standard-sized, root-form implants.

This article includes a discussion of mini-implants and their potential uses in dentistry.

When the original root-form implants were introduced, they had a diameter of about 3.75 millimeters. Although I have heard various reasons for selection of this diameter, the logic or research supporting these reasons has been unclear. An implant of nearly 4 mm in diameter requires at least 6 mm of bone in a facial-lingual dimension for placement without grafting additional bone to augment the site. After years of placing implants in all locations of the mouth, it is my observation that seldom do I see 6 mm of bone in a facial-lingual dimension. Often, an osteotome must be used to widen the osteotomy and the minimal bone, thereby allowing placement of the 3.75-mm implant in the less-than-adequately sized bony site.

Some implant companies have recognized the challenge of minimal bone presence and made implants of a smaller diameter (ranging from 3 to 3.5 mm). Although this change is only a slight reduction in diameter, it has allowed easier placement of root-form implants in the maxillary lateral incisor area, mandibular anterior sites or in any area in which bone has shrunken. These slightly smaller-diameter implants have been used widely and have been successful, in spite of allegations that they would be too weak.

In the last few years, root-form implants ranging from 1.8 mm to slightly more than 2 mm in diameter have been promoted for long-term service. These so-called “mini”-diameter implants have been used successfully as interim implants to support provisional prostheses, while larger-diameter implants were integrating into bone. When minis were used as interim implants, the intent was to remove the mini-implants when the larger-diameter implants were put into service. As might have been anticipated, when attempting to remove these interim mini-implants, practitioners found that they could not be removed, because they had integrated into the bone during the interim service period. As a result, some of the companies producing mini-implants have applied for approval of the small-diameter implants for long-term use. The first company approved for long-term use was IMTEC (Ardmore, Okla.), makers of Sendax MDI and MDI Plus, in August 2003.

The increasingly popular ‘mini’-implant concept will assist the movement of general dentists into implant placement. 

 

The diameter of root-form implants ranges from approximately 1.8 mm to approximately 6 mm. Three general categories of implant diameters are available: the mini-implant (1.8 mm), the standard-sized implant (3.75 mm) and the wide-body implant (6.0 mm), with all sizes in between. Use of mini-diameter implants is increasing, and more research publications and clinical technique articles about them are becoming available.^5–14 Use of large-diameter implants (6 mm) also is increasing for situations in which inadequate bone is available in a crestal-apical dimension, but adequate bone is available in a facial-lingual dimension.

Bradley J Engle, DMD MHS
5659 Naples Blvd
Naples, FL 34109

http://www.engleimplantdentistry.com
Tel: (239) 593-2178
Fax: (239) 593-2179
Email: info@engleimplantdentistry.com

A Role in Geriatric Dentistry for the General Practice?

For the majority of the population, the clinical success of dental implant therapy has improved such that some clinicians consider it to be a form of standard of care.  However provocative this assessment may be, clinicians should not ignore the role of implant therapy to support the oral rehabilitation of the elderly population and of other medically compromised patients. The patient, caregiver, family and clinical team need to weigh the inherent advantages and costs of implant therapy. Tooth replacement therapy can vary from single-tooth replacement with conventional or implant-supported restorations to full-arch replacement with individual implants/tooth-to-implant–supported overdentures. Each of these options (including no tooth replacement) has advantages and costs that must be weighted in a multifactorial consideration of patients’ desires, understanding, resources and perspectives.  The predictable esthetic and functional outcomes of care depend on a comprehensive diagnostic evaluation and treatment planning.

Patients who undergo implant therapy face medical and surgical risks that are similar to those of outpatient oral surgical intraosseous procedures. The surgical team should evaluate the patient for systemic conditions that may compromise healing (for example, immunocompromised states, uncontrolled diabetes) and the systemic effects of medications. In general, the survival rates of dental implants in older patients can be affected by certain systemic conditions associated with aging, including long-term smoking, diabetes and postmenopausal estrogen therapy. In addition, the use of multiple medications influencing bone metabolism (for example, steroids, bisphosphonates) has the potential to alter the outcomes of implant therapy.  For instance, investigators recently have become concerned about surgical interventions in patients with osteoporosis who receive long-term oral bisphosphonate therapy. As part of a careful informed consent process, the dentist needs to provide the patient and his or her family with an accurate assessment of the procedures, the length of treatment time, risks and alternatives to implant treatment (including no tooth replacement and conventional fixed or removable prostheses).

Investigators often point to the ability of bone to heal in the older patient as a concern with regard to implant outcomes. Researchers have addressed this question through the clinical assessment of implants placed in the anterior mandible, a region of the oral cavity that does not experience significant age-associated osteopenia. Implants placed, restored and functioning in areas of predominantly trabecular bone (for example, atrophic maxilla) are at a higher risk of experiencing complications.Implant interfaces are maintained through dynamic modeling and remodeling processes within the bone of these regions. (“Modeling” refers to any net change in bone shape, whereas “remodeling” refers to the continuous turnover of bone without a net change in shape or size.) These processes (referred to as “the adaptive capacity” by Stanford and Brand ), in turn, allow bone to respond to the clinical procedures and occlusion over long periods.

Patient assessment. The predictable esthetic and functional outcomes of implant treatment for geriatric patients require comprehensive diagnosis and treatment planning.  The clinician should assess the patient’s medical and dental history for bruxism, periodontal disease, tobacco use, uncontrolled diabetes mellitus and metabolic diseases of bone.  Some investigators have reported elevated complications related to smoking after controlling for age and other medical conditions. Diabetes, especially type 2, is a disease of increasing concern in which control (as measured by hemoglobin A_1C levels < 7.0 percent) is considered important for successful long-term outcomes of implant therapy. Throughout the surgical and prosthetic phases of implant reconstruction, the general dentist should review the treatment with the patient and any key significant others and obtain comprehensive written and oral informed consent from the patient. It may be helpful to have a private discussion with the patient to assess his or her specific needs and desires and balance them with those of the caregiver.

To improve treatment outcomes, the dentist should design and compose the proposed prosthesis during the diagnostic phase. Planning will include issues such as the type of prosthesis (removable, fixed or a combination). Clinicians should consider the use of implants in combination with removable partial dentures in a compromised dentition to provide greater support, esthetics and potential function for the partial denture.¹⁹ On the basis of the acquired diagnostic information, the dentist can use a surgical guide or denture to indicate the desired implant position, angulation and need for hard- and/or soft-tissue augmentation before or during implant placement. The clinician should carefully evaluate the patient’s soft- and hard-tissue changes to encourage realistic patient expectations.

For geriatric patients who have a single edentulous arch or a partially edentulous arch, there is a balancing of treatment options that include fixed partial dentures (FPDs), adhesive resin restorations and single or short-span implant restorations, as well as no tooth replacement. The final decision is made after considering the patient’s desires, treatment objectives, clinical capability of the clinician, dentist’s expertise and training, treatment costs, treatment time and potential morbidity. Occasionally, given a stable occlusion, the dentist might consider a rigid tooth-to-implant fixed prosthesis (a design that does not allow any movement between the two retainers)^20,21 (Figure 1). Preoperative planning helps to achieve rational, functional and esthetic goals by ensuring that the final restorative therapy is in the patient’s best interests.²² As part of the informed consent process, the clinician should discuss with the patient treatment plan alternatives with regard to the ability to control esthetics and function with the various methods of tooth replacement.

Today’s Options for Denture Wearers

With more than 12 percent of the U.S. population at the age of 65 or older, the “baby boom generation” is tackling issues about aging. The focus is not so much about how to accept an aging body passively, but rather, how to preserve health, strength, and vitality, no matter what a person’s age.

For example, the Academy of General Dentistry has reported that 60 percent of the American adults between the ages of 35 and 44 have lost at least one permanent tooth. Your dentist want you to maintain healthy teeth throughout your life. But if tooth loss requires dentures, your dentist have several attractive options for you.

Types of dentures

Depending on your situation, dentures may be needed to replace all or some of your teeth. Different types of dentures serve different purposes.

Immediate dentures are placed immediately after removing any remaining teeth. These have the added benefit that you have the look and use of teeth while your mouth heals, making your transition to dentures more subtle. However, your jawbone and gums will gradually shrink after teeth are removed, so you will need to be fitted with conventional dentures later.

Conventional full dentures replace all or most of your upper and lower teeth. They are custom-crafted and fitted over a series of appointments to ensure an excellent fit and natural look. Your dentist will provide you with homecare instructions and have you come in for periodic adjustments or relines to ensure that your conventional dentures continue to fit properly and feel comfortable.

Overdentures look like conventional full dentures. However, overdentures fit over dental implants or a few specially prepared remaining teeth. Overdentures are more secure and feel more natural than conventional dentures. Also, the implants or remaining teeth provide stimulation that can help preserve the bone in your jaw.

Partial dentures may be a good choice when you have lost several teeth but still have some remaining. Partials help to prevent your existing teeth from shifting within your mouth. In turn, the remaining teeth support the dentures and help take the impact of biting and chewing. This reduces the pressure on other parts of your jaw.

Conventional partial dentures have clasps to attach them to your remaining teeth, while precision partial dentures have special attachments that make the clasps less visible. Another option may be a flexible partial denture; these gum-colored clasps attach around your teeth at the gumline for a very natural look.

Benefits of dentures

Dentures are important both for your oral health and the attractiveness of your smile, because they:

1) Provide the necessary support to keep your facial muscles from sagging and giving you an older appearance.
2) Allow you to eat a wider variety of foods than you could without teeth; this helps ensure that you get adequate nutrition to maintain your health.
3) Help you to speak more easily than you could without teeth.

If you have been hiding your mouth because of missing teeth, dentures may help improve how you look and feel about your smile.

Alternatives to dentures

Other options to consider besides dentures may include bridges (sometimes called fixed partial dentures) or dental implants (which are surgically placed below your gumline, providing an invisible and secure fit). Your dentist will work with you to determine the best solution for your needs.

Keep in mind, the best alternative is to not need dentures at all. With consistent and regular dental care, you may be able to preserve all your healthy teeth, so that you can keep them throughout your lifetime.

Dentistry and Special Care Needs

There is a unique branch of dentistry that is devoted to persons who have special needs. These persons may have a learning disability, a physical disease, a chronic condition, a mental illness or may not have access to good dental care (the homeless, those who abuse chemical substances or vagrants). People in these groups may have difficulty finding quality dental care for many reasons. Sometimes it is a physical barrier that keeps them from the dentist; like unable to climb outside stairs, not having dental clinics that are suitable to their needs in their neighborhoods, or dentists who are unwilling to care for them because of prejudiced attitudes.

The barrier at times can be the person himself or herself and their inability to understand the need for dental care or what is being done during procedures. Sometimes all they need is to be able to overcome anxiety associated with dental care. They may need more than patience and explanations; they may need sedation during procedures in order to be able to cope with having dental care performed. Sometimes anesthesia is required if the patient has uncontrolled bodily movements or have an inability to comprehend the proceedings and may become overly distraught or combative. General anesthesia should only be used when absolutely necessary due to the risk that anesthesia carries with it. Facilities designed to offer general anesthesia are also limited and not available in all areas.

The dentists who treat patients with special needs are going to have to address some special issues. These issues revolve around medical, consent, and equipment or product needs. Dentists who care for patients with special needs also need to have staff willing to be compassionate, and understanding of these very special patients.

Dental visits may require extra time for special needs because of equipment or for the time involved in explaining, soothing or assessing the ability of the patient to give legal permission to complete dental work. If the patient is unable to understand what the dental proceedings are about, a relative or legal guardian may need to be present that can act on the patients behalf.

Those in need of special care dentistry can find them in general dental practices, dental care given by health boards or dental clinics and dental hospitals. Not only do patients with special needs require at times special facilities or equipment; they also need dentists with compassion and the ability to understand the unique needs of their dental patients with special needs. Unfortunately parents or caregivers of young children with special needs may experience greater difficulty in finding appropriate dental care due to the nature of the specialty and special needs of children in general.

Adults and children with special needs still require the same kind of quality dental health care as those of us without special physical or mental needs.

Those who are searching for special care dentistry can ask for referrals from local dentists, their primary care physician or look in the phone book under special care dentistry. You may be able to locate special care dentistry registries online by searching using Google or other search engines. Websites such as “Hands On Health” South Carolina is just one such Special Care Dentistry Directory, where dentists can register as being providers for special needs patients.

Bradley J Engle, DMD MHS
5659 Naples Blvd
Naples, FL 34109

http://www.engleimplantdentistry.com
Tel: (239) 593-2178
Fax: (239) 593-2179
Email: info@engleimplantdentistry.com

Careers in Dentistry

Dentistry is the branch of medical science that deals with the prevention, diagnosis and treatment of the teeth, gums, jaws and other related structures of the mouth. It includes the repair as well as replacement of defective teeth in order to cure and infuse confidence in the person.

Dental practice generally includes filling cavities, treating gums related problem, removal of the decayed teeth and the nerves of the teeth as well as replacing lost teeth with dental plates. Gold, silver, amalgam or cements with fused Porcelain Inlays are often used in order to fill the visible gaps in teeth. They may even treat teeth with fluorides in order to prevent and control tooth decay. Preventive dentistry is very significant, as it deals with the frequent examination of a patient’s teeth at regular intervals. It has the benefit of detecting and treating a disease before it starts troubling the patient seriously.

There are a number of career options in dentistry. This includes private practice that could be done in the form of solo practice, associateship and solo group practice. There is also retail dentistry, consultation dentistry, oral pathology, oral and maxillofacial radiology, endodonctis, orthodonctis and pediatric dentistry.

Private Practice

a) Solo Practice: Solo practice calls for an acute sense of responsibility for managing and planning every detail related to dental office and practice. There are certain factors that need to be kept in mind before establishing a solo practice, such as location, prevalent economic condition of the community, size of the community, relative number of patients and the availability of specialists in that particular area.

b) Solo- group Practice: Solo group practice is the variation of solo practice. In this kind of practice where two or more dentists share day-to-day operations among them. Dentists share specific operational and equipment charges, but possess complete discretion power over their specific practices.

c) Associateship: An associateship is an agreement that deals with the hiring of dentists by an established practice owner or owners. It creates a relationship between employer/employee with financial reimbursements in the form of salary and/or bonus. The employee- dentist agrees to work for a specified period, using the already established facilities, equipment, supplies and staffs.

Retail Dentistry: Retail dentistry refers to the dental services that are delivered in a commercial retail form. They can either be dental operations located inside large retail departmental stores or practices that make use of retail type management and marketing techniques.

Consultation Dentistry: Consultation dentistry deals with dentists who are employed by insurance companies as consultants. These posts are mainly part- time and salaries are based on per case handled, which is negotiable with the employing bureau.

Oral Pathology: Oral pathology involves the microscopic examination of tissues that are suspected to be abnormal and/or pathologic. Through the use of developed diagnostic methods and abnormal condition of oral and perioral tissues are identified, diagnosed and treated in order to improve the health of the patient.

Pediatric Dentistry: Pediatric dentistry refers to the practice and imparting of knowledge about the comprehensive, preventive and therapeutic oral health care designed especially for children ranging from infants to adolescence.

There are immense possibilities of growing fast in the field of dentistry. At the same time, it requires patience and sincerity on part of students to achieve success. One can develop both personally and professionally in the field of dentistry.

Bradley J Engle, DMD MHS
5659 Naples Blvd
Naples, FL 34109

http://www.engleimplantdentistry.com
Tel: (239) 593-2178
Fax: (239) 593-2179
Email: info@engleimplantdentistry.com

Restorative Dentistry treats any kind of dental defect

If you are suffering from any kind of dental defect then you must approach a dentist at the earliest. Ignoring dental defects can increase your problem and one will certainly have to undergo traumatic experience for this. Certainly no one would like to undergo such problem. Restorative dentistry is a medical procedure that is undertaken by a dentist to cure any kind of dental defects. Many people avoid visiting a restorative dentist because of dental phobia. So, all those should just calm down as there are many new methods and advancement in technology that has made the whole process painless and less time consuming as well. The time taken for treatment is less in comparison to the traditional procedure. Some of common problems of dental defects are tooth decay, captivities, worn and chipped teeth that can happen to anyone.

It is better to avoid any kind of dental ailment so that you can have a healthy gums and teeth. You need to take some extra care of your teeth so that you can stay away from any kind of dental defects. Healthy teeth will keep you away from all kinds of dental problem, you can smile and laugh openly and can join social gatherings, boosts your confidence level and you can experience success in your life. The process that is undertaken to cure the teeth loss is dental implants. The procedure involves the placing of titanium roots in the jaw bone that instigates the growth of new teeth. Restorative dentistry is meant to carry out surgical procedure on your teeth that helps you to cure any kind of dental ailments. One of restorative dentistry procedure is operative dentistry which is done to fill the gaps in the teeth. Another process is period ontology that involves treatment of gums.

Endodontics is also a dental process that is associated with root canal treatment while the prosthodontics is associated with the replacement of teeth. Restorative dentistry helps to restore single tooth to full mouth reconstruction and rehabilitation. Restorative dentistry can also undertake simple tooth recontouring or small direct restorations by the use of various indirect restoration methods like inlays, onlays, crowns, fixed bridges, implant crowns, implant bridges and porcelain veneers. Porcelain veneers is the most sought after treatment. Any of the above restorative procedure is meant to give you healthy teeth and ultimately your teeth can stay away from various dental defects.

Before considering a dentist for dental treatments, make sure to check whether the dentist is approved by American Dental Association. This will make you assure of getting a better treatment and he will use latest methods to help you out from the defects or ailments. Also do check for the charge that the dentist is going to take for the treatment because an experienced dentist will surely charge high compared to others. 

Bradley J Engle, DMD MHS
5659 Naples Blvd
Naples, FL 34109

http://www.engleimplantdentistry.com
Tel: (239) 593-2178
Fax: (239) 593-2179
Email: info@engleimplantdentistry.com

Dental Implant is the best treatment for missing teeth

Well, scientific technology has advanced so much that nothing seems to be impossible for specialists in any field. The effect of enhanced technology can be seen everywhere, even in the field of dentistry too. Though there are numerous dental defects that may occur to anyone in a given period of time, scientific developments in this field have created options for curing all the dental defects. Some of the dental defects that may crop up are missing tooth, misaligned teeth, broken or chipped teeth and stained yellow teeth. Dental implant is a treatment that can be used for curing the dental defect of missing teeth. This is a problem that can occur to anyone in this world and dental implant is the right way to go about it.

It is said that when it is the matter of your health, then you should always consult a specialist rather than going to a general practitioner. Well, your health is something that you cannot compromise with. Dental implant would definitely help you in curing your dental defect to perfection. As far as the treatment process of dental implant is concerned, titanium roots are placed in the jawbone of the patient and that too in place of the missing tooth. After carrying out this procedure, certain time period is being provided for letting the place heal. Then, the metal anchors are being placed on them for the growth of teeth. One thing that needs to be taken care is that you ought to have strong jawbones and a good oral health.

The entire procedure of dental implant is a surgical process and metal anchors are placed with the help of machines. Usually, the time period given for the bonding of titanium roots with jawbone is around 4 to 6 months. And the entire process takes around 1 year and you will get to see a new development in your smile. After all, smile is the biggest asset and you would take every effort or pain to make it healthier. It is one of the most attractive things that fetch compliments and you would definitely adopt different methods to make it even more attractive.

Missing teeth is one such dental defect that usually occurs when you face any accident or happen to be in your old age. It is the right time that you tend to call for a specialist orthodontist and opt for dental implant. Dental implants have inculcated a fresh life to the smile of the patients with missing tooth. Such people have started living a healthier life, after undertaking this treatment. In fact, the result of the dental implants seems to look so real that you will not be able to distinguish between the real and the forged teeth. What more can you ask for, when dental implant gives you a healthier lifestyle?

Dental implants are one of the most suitable treatments for missing teeth. After all, your health is the most important thing in your life. Moreover, more and more people have been moving towards being healthy. The reason behind this is increasing consciousness for the same. One of the best advantages of dental implant is that you can restore your smile. All you need is the help of a dentist who is registered with American Dental Association, so it becomes sure that the dentist is really experienced. 

Bradley J Engle, DMD MHS
5659 Naples Blvd
Naples, FL 34109

http://www.engleimplantdentistry.com
Tel: (239) 593-2178
Fax: (239) 593-2179
Email: info@engleimplantdentistry.com