Engle Implant Dentistry's Blog

Endodontic or dental implant therapy

engle2009 — Sat, 13 Mar 2010 19:22:33 +0000

Background. Clinicians are confronted with difficult choicesregarding whether a tooth with pulpal and/or periapical diseaseshould be saved through endodontic treatment or be extractedand replaced with an implant.Methods. The authors examined publications (research, literaturereviews and systematic reviews) related to the factors affectingdecision making for patients who have oral diseases or traumaticinjuries.

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

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

Clinical Implications. Clinicians need to consider carefullyseveral factors before choosing whether to perform endodontictherapy or extract a tooth and place an implant. The resultshould be high levels of comfort, function, longevity and estheticsfor 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 preventand treat caries and periodontal disease, as well as to restorefunction and esthetics to patients affected by oral diseasesor traumatic injuries. Despite these efforts, many nonrestorableteeth and teeth with severe periodontal involvement have beenextracted, and traditionally they have been replaced with fixedor removable prostheses.Advances in implant dentistry have provided thousands of completelyand partially edentulous patients with a more functional andattractive alternative to fixed and removable prostheses. Theintroduction of cylindrical endosseous implants¹^,² to dentistryand their high survival rates have had a significant effecton treatment planning in prosthodontics and periodontics.³ Theseadvances also can affect treatment planning for teeth requiringendodontic treatment.

An ideal treatment plan should address the chief complaintsof the patient; provide the longest-lasting, most cost-effectivetreatment; and meet or exceed patients’ expectations wheneverpossible. However, treatment planning usually is affected bythe views of the stakeholders (that is, patients, insurancecompanies, dentists), who have varying perspectives and expectationsregarding the outcome of treatment. Treatment should be patient-centered,not be based only on dental insurance benefits and not be guidedsolely by the desires and clinical experience of the practitioner.It must be based on scientific evidence, and ideally it shouldpreserve the biological environment while maintaining or restoringesthetics, comfort and function. Clinicians regularly are confrontedwith difficult choices. Should a tooth be saved through endodontictreatment or be extracted and replaced by a single implant?

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

PATIENT HEALTH-RELATED FACTORS

Pulpal and periodontal conditions. Indications for endodontic treatment include teeth with irreversiblepulpitis, necrotic pulps, restorable crowns, treatable periodontalconditions, salvageable resorptive defects and a favorable crown-to-rootratio.²⁵ Endodontic treatment is contraindicated when thereis limited remaining tooth structure and the definitive crownwill not be able to engage at least 1.5 to 2.0 millimeters oftooth structure with a cervical ferrule.²⁶^,²⁷ Eckerbom and colleagues,²⁸Randow and colleagues²⁹ and Reuter and Brose³⁰ found that whena fixed partial denture had been used, abutment teeth that hadundergone endodontic treatment failed more often than did teethwith vital pulps.²⁸^–³⁰ Aquilino and Caplan³¹ found a strongassociation between crown placement and the survival of endodonticallytreated teeth.

Implants are indicated when teeth cannot be prepared with adequateretention and resistance form. Other indications for implantsinclude edentulous sites adjacent to teeth without restorationsor the need for restorations and edentulous sites adjacent toabutment teeth with large pulpal chambers and those with a historyof avulsion or luxation.³²

Biological and environmental considerations. Some patients are frustrated because of recurring problems withcaries or periodontal disease. Retaining such teeth via endodontictreatment may not be the best option, because the frequentlyrequired re-treatment procedures can be challenging and frustratingfor the practitioner and the patient, and they produce compromisedresults. It may be prudent to extract such teeth and place implants.In addition, implants may be a better option for patients whohave limited ability to perform routine oral hygiene procedures.

Teeth with unique color characteristics. Color matching can be a significant challenge for certain highlyvisible teeth with unique dentin colorations or large areasof enamel translucency or transparency. When such a tooth requiresendodontic treatment but does not need a ceramic crown, theclinician may find it to be esthetically advantageous to retainthe tooth through endodontic treatment, rather than extractit and place an implant crown that does not match the surroundingenvironment. Because of these color-matching challenges, itsometimes is prudent to perform challenging and difficult endodontictreatment rather than to extract such teeth and replace themwith implants.

When a tooth with challenging color characteristics requiresboth endodontic treatment and a ceramic crown, it may not bepossible to achieve an appropriate color match because of thicknesslimitations 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 becausethe implant can be fabricated with a thicker amount of porcelainthat enhances the color-matching potential, particularly inthe challenging cervical areas.

Quantity and quality of bone. The quantity of available bone affects the feasibility of placingimplants without bone grafting. Bone quality also affects implantsuccess, with type 4 bone resulting in less success comparedwith types 1 through 3 bone.³³ Goodacre and colleagues³³ reportedthat the success rate was lower when short implants (that is,those 10 mm or less in length) were used than when longer implantswere used. Although new implant surfaces and geometries haveproduced promising results³⁴^–³⁶ that may overcome thelower success rates associated with short implants, the availableclinical data are limited.

After extracting a tooth, the clinician can place an implantimmediately in the root socket, thereby avoiding much of thebone resorption that accompanies extraction.³⁷ However, whensubstantial infection is associated with an extracted tooth,the clinician may have to postpone implant placement to permitresolution of the infection.³⁸

Retaining a tooth with a poor long-term prognosis via endodontictreatment, particularly a cracked tooth, can lead to substantialbone loss by the time the tooth eventually is removed. The resultingbone defect can substantially affect the esthetic result. Consequently,early removal of the tooth and immediate placement of a dentalimplant may produce an environment that is more suitable forimplant positioning and result in optimal esthetics.³⁹

Soft-tissue anatomy. The esthetic result around crowns can be affected negativelyby an interdental papilla that does not fill the cervical embrasurespace. This can occur around crowns that attach to endodonticallytreated teeth or dental implants. Choquet and colleagues⁴⁰ reportedthat soft tissue fills the cervical embrasure around dentalimplants when the incisocervical distance from the proximalcontact to the interproximal bone crest is 5 mm or less.⁴⁰

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

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

TREATMENT-RELATED FACTORS

Procedural complications. Endodontic treatment, like other disciplines of dentistry, occasionallyis associated with procedural accidents. These mishaps can occurduring access preparation, cleaning and shaping, and obturation,as well as during preparation of the post space.⁴² Some of theseaccidents have a negative effect on the outcomes of endodontictreatment.⁴³^–⁴⁵ In addition, the extension of root canalfilling materials¹⁰^,⁴⁶ and quality of obturation⁴⁷^,⁴⁸ affectthe prognosis for endodontic treatment.

Complications also can occur in conjunction with dental implants.They include surgical complications such as hematomas, ecchymosisand neurosensory disturbance.³³ Implant loss can occur as aresult of the implant’s failure to integrate with thebone or bone loss subsequent to integration. Soft-tissue complicationssuch as inflammation and/or proliferation, soft-tissue fenestrationand/or dehiscence before stage II surgery and fistulas havebeen reported.³³ Mechanical complications such as screw loosening,screw fracture, prosthesis fracture and implant fracture alsocan 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 complicatedand/or high-risk endodontic treatment with tooth extractionand placement of an implant and a crown. For instance, retainingsome teeth via endodontic therapy may result in the need fortreatment for periodontal disease, crown lengthening throughsurgery or orthodontic extrusion, a core buildup or a post andcore, or a crown. Each of these procedures adds complexity,can present additional complications and risks, increases thecost of treatment and makes it more difficult for patients tocomprehend and accept a treatment plan.

Implant therapy presents similar complexities. Before or inconjunction with implant placement, the clinician may need toperform grafting or distraction osteogenesis so that adequatebone is available. Sinus grafting may be needed in the posteriormaxilla, and horizontal/vertical bone grafting may be requiredin other areas of the mouth to provide an edentulous ridge withsufficient bone in the correct location. Ridge grafting thatrequires bone harvesting from a remote site increases patientdiscomfort. These procedures also increase the cost and treatmenttime, and they can complicate the provisional replacement ofmissing teeth for esthetic and functional reasons.

Treatment outcomes. Torabinejad and colleagues⁴⁹ performed a systematic review ofthe literature between January 1966 and September 2004 pertainingto the success and failure of non-surgical endodontic therapy,and they assigned levels of evidence to these studies. Theirsearch revealed that during the past 40 years, 306 articleswere published with regard to the outcome of nonsurgical endodontictreatment. Fifty-one of these articles reported studies involvingat least 100 teeth. The authors recorded and analyzed the successrates at one, two and five years using 95 percent confidenceinterval estimates.

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

On the basis of the results of studies published after 1996,the American Dental Association’s Council on ScientificAffairs reported high implant survival rates for various clinicalsituations.¹¹ With regard to the single-tooth implant, the Council’sevaluation of 10 studies involving more than 1,400 implantsrevealed survival rates ranging from 94.4 to 99 percent, witha mean survival rate of 96.7 percent. The Council also reporteda mean survival rate of 87.1 percent for implant overdenturetreatment and a mean survival rate of 86.8 percent for bonegrafting/ implant treatments.¹¹ The Council report stated thatimmediate loading of implants does not lower the survival rates,with three studies reporting survival rates ranging from 93.5to 95.6 percent.¹¹

In a systematic review of clinical studies of implants, Creugersand colleagues⁵⁴ reported a four-year survival rate of 97 percentfor single-tooth implants. In another report, Lindh and colleagues⁵⁵performed a meta-analysis of implant studies involving partiallyedentulous patients. They reported a success rate of 97.5 percentafter six to seven years for a single-implant crown.

CONCLUSION

The decision by the clinician and patient to retain or removeteeth should be based on a thorough assessment of informationrelated to risk factors affecting the long-term prognosis forendodontic and dental implant treatment. The clinician shouldconsider several factors when determining whether to save atooth through endodontic therapy or extract it and place animplant. These factors pertain to the patient’s healthstatus, the condition of the tooth and periodontium, and treatment-relatedconsiderations.

Patient-related factors include systemic and oral health, aswell as patients’ comfort and perceptions about treatment.Tooth- and periodontium-related factors include pulpal and periodontalconditions, biological environmental considerations, color characteristicsof the teeth, quantity and quality of bone, and soft-tissueanatomy. Treatment-related factors include an assessment ofpotential procedural complications, required adjunctive proceduresand 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

engle2009 — Sat, 13 Mar 2010 19:17:02 +0000

Gordon J. Christensen, DDS, MSD, PhD

Historically, the initial users of most types of dental implantsmainly were general dental practitioners, who often were severelycriticized 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 theintroduction and refinement of the osseointe-grated root formimplant over the last 40 years, implant dentistry has been acceptedslowly by both general and specialty practitioners. Root-formdental implants have allowed many types of difficult oral treatmentto be accomplished that were nearly impossible before the introductionof implants.¹^–⁴ When root-form implants were popularized,oral surgeons, periodontists, some prosthodontists and a fewgeneral dentists became involved in placing them. However, thehigh cost of implants for patients and the assumed difficultyin placing them has impeded implant use to the degree that theyare achieving only a small part of the service potential ofwhich they are capable.

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

As a prosthodontist who has placed root-form implants for morethan 20 years, I have encouraged interested, surgically orientedgeneral dentists and prosthodontists to place root-form dentalimplants in healthy patients who have adequate bone. My motivationof general dentists often has been met with criticism by surgicalspecialists, but I stand behind my recommendations that themore dentists who take the time to become educated adequatelyin the surgical aspects of implant placement, the more patientswill be served by this superior treatment. It is well-knownthat implants are used widely in many countries that lack thelegal obstacles found in the United States.

As interested dentists become involved in implant dentistry,they may want to consider joining the implant organizationsand attending their meetings. These groups include the AmericanAcademy of Implant Dentistry, the Academy of Osseointegrationand the International Congress of Oral Implantology. The oralsurgery, periodontal and orthodontic specialty organizationsalso provide many continuing education courses on implant dentistry.

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

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

When the original root-form implants were introduced, they hada diameter of about 3.75 millimeters. Although I have heardvarious reasons for selection of this diameter, the logic orresearch supporting these reasons has been unclear. An implantof nearly 4 mm in diameter requires at least 6 mm of bone ina facial-lingual dimension for placement without grafting additionalbone to augment the site. After years of placing implants inall locations of the mouth, it is my observation that seldomdo I see 6 mm of bone in a facial-lingual dimension. Often,an osteotome must be used to widen the osteotomy and the minimalbone, thereby allowing placement of the 3.75-mm implant in theless-than-adequately sized bony site.

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

In the last few years, root-form implants ranging from 1.8 mmto slightly more than 2 mm in diameter have been promoted forlong-term service. These so-called “mini”-diameter implantshave been used successfully as interim implants to support provisionalprostheses, while larger-diameter implants were integratinginto bone. When minis were used as interim implants, the intentwas to remove the mini-implants when the larger-diameter implantswere put into service. As might have been anticipated, whenattempting to remove these interim mini-implants, practitionersfound that they could not be removed, because they had integratedinto the bone during the interim service period. As a result,some of the companies producing mini-implants have applied forapproval of the small-diameter implants for long-term use. Thefirst 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 conceptwill assist the movement of general dentists into implant placement.

The diameter of root-form implants ranges from approximately1.8 mm to approximately 6 mm. Three general categories of implantdiameters are available: the mini-implant (1.8 mm), the standard-sizedimplant (3.75 mm) and the wide-body implant (6.0 mm), with allsizes in between. Use of mini-diameter implants is increasing,and more research publications and clinical technique articlesabout them are becoming available.⁵^–¹⁴ Use of large-diameterimplants (6 mm) also is increasing for situations in which inadequatebone is available in a crestal-apical dimension, but adequatebone 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?

engle2009 — Sat, 13 Mar 2010 19:12:18 +0000

For the majority of the population, the clinical success ofdental implant therapy has improved such that some cliniciansconsider it to be a form of standard of care. However provocativethis assessment may be, clinicians should not ignore the roleof implant therapy to support the oral rehabilitation of theelderly population and of other medically compromised patients.The patient, caregiver, family and clinical team need to weighthe inherent advantages and costs of implant therapy. Toothreplacement therapy can vary from single-tooth replacement withconventional or implant-supported restorations to full-archreplacement with individual implants/tooth-to-implant–supportedoverdentures. Each of these options (including no tooth replacement)has advantages and costs that must be weighted in a multifactorialconsideration of patients’ desires, understanding, resourcesand perspectives. The predictable esthetic and functionaloutcomes of care depend on a comprehensive diagnostic evaluationand treatment planning.

Patients who undergo implant therapy face medical and surgicalrisks that are similar to those of outpatient oral surgicalintraosseous procedures. The surgical team should evaluate thepatient for systemic conditions that may compromise healing(for example, immunocompromised states, uncontrolled diabetes)and the systemic effects of medications. In general, the survivalrates of dental implants in older patients can be affected bycertain systemic conditions associated with aging, includinglong-term smoking, diabetes and postmenopausal estrogen therapy. In addition, the use of multiple medications influencing bonemetabolism (for example, steroids, bisphosphonates) has thepotential to alter the outcomes of implant therapy. For instance,investigators recently have become concerned about surgicalinterventions in patients with osteoporosis who receive long-termoral bisphosphonate therapy. As part of a carefulinformed consent process, the dentist needs to provide the patientand his or her family with an accurate assessment of the procedures,the length of treatment time, risks and alternatives to implanttreatment (including no tooth replacement and conventional fixedor removable prostheses).

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

Patient assessment. The predictable esthetic and functional outcomes of implanttreatment for geriatric patients require comprehensive diagnosisand treatment planning. The clinician should assess the patient’smedical and dental history for bruxism, periodontal disease,tobacco use, uncontrolled diabetes mellitus and metabolic diseasesof bone. Some investigators have reported elevated complicationsrelated to smoking after controlling for age and other medicalconditions. Diabetes, especially type 2, is a disease ofincreasing concern in which control (as measured by hemoglobinA_1C levels < 7.0 percent) is considered important for successfullong-term outcomes of implant therapy. Throughout the surgicaland prosthetic phases of implant reconstruction, the generaldentist should review the treatment with the patient and anykey significant others and obtain comprehensive written andoral informed consent from the patient. It may be helpfulto have a private discussion with the patient to assess hisor her specific needs and desires and balance them with thoseof the caregiver.

To improve treatment outcomes, the dentist should design andcompose the proposed prosthesis during the diagnostic phase.Planning will include issues such as the type of prosthesis(removable, fixed or a combination). Clinicians should considerthe use of implants in combination with removable partial denturesin a compromised dentition to provide greater support, estheticsand potential function for the partial denture.¹⁹ On the basisof the acquired diagnostic information, the dentist can usea surgical guide or denture to indicate the desired implantposition, angulation and need for hard- and/or soft-tissue augmentationbefore or during implant placement. The clinician should carefullyevaluate the patient’s soft- and hard-tissue changes toencourage realistic patient expectations.

For geriatric patients who have a single edentulous arch ora partially edentulous arch, there is a balancing of treatmentoptions that include fixed partial dentures (FPDs), adhesiveresin restorations and single or short-span implant restorations,as well as no tooth replacement. The final decision is madeafter considering the patient’s desires, treatment objectives,clinical capability of the clinician, dentist’s expertiseand training, treatment costs, treatment time and potentialmorbidity. Occasionally, given a stable occlusion, the dentistmight consider a rigid tooth-to-implant fixed prosthesis (adesign 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 restorativetherapy is in the patient’s best interests.²² As partof the informed consent process, the clinician should discusswith the patient treatment plan alternatives with regard tothe ability to control esthetics and function with the variousmethods of tooth replacement.

Today’s Options for Denture Wearers

engle2009 — Sat, 13 Mar 2010 19:00:28 +0000

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

engle2009 — Sat, 13 Mar 2010 18:57:28 +0000

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

engle2009 — Sat, 13 Mar 2010 18:55:35 +0000

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

engle2009 — Sat, 13 Mar 2010 18:53:33 +0000

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

engle2009 — Sat, 13 Mar 2010 18:52:22 +0000

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

Types of Dental Implants

engle2009 — Wed, 10 Feb 2010 01:08:38 +0000

There are a variety of types of dental implants available as there are many different circumstances under which patients could require them. As well, no two patients’ mouths are exactly the same. The majority of dental implants on the market today are constructed from an inert metal called titanium. Titanium has been found to work exceptionally well at connecting with live bone tissue in the mouth. The process where titanium fuses with existing bone is referred to as “osseointegration.” Either a periodontist or an oral surgeon who works from the hospital or a private clinic usually undertakes dental implants.

Root form implants are “cylindrical or screw type implants” that greatly resemble the form of a root of a tooth with a surface area that makes for good adhesion to the existing bone. Root form implants are the most commonly used of all dental implants and there are positioned in a patient’s mouth where the depth and width of the jawbone is the greatest. If the patient’s jawbone is deemed either too short or too narrow for root form dental implants then sometimes bone grafting will need to be done before implants can be even considered an option for the patient.

Some patients have jawbones that for one reason or another (such as a very narrow jawbone) make bone grafting impossible therefore an other option must be taken into consideration. This option is called plate form implants. This narrow implant can be positioned directly into the existing bone. In other more extreme cases when there is a great deal of bone loss, another type of implant, known as the subperiosteal implant may be used. This type of dental implant is placed on top of the bone while still being under the patient’s gums.

Another type of implant is an artificial bone substitute which is made of synthetic material land is positioned on top of the existing bone to do two important functions- first to help encourage the rebuilding and regrowth of the ridge that is shrinking and secondly to provide as much support as possible for the fitting of dentures. The material used in this kind of implant is very much like a person’s natural bone therefore it easily affixes itself to the jawbone and begins to grow. An other form of dental implants, known as endosteal implants are placed directly into the patient’s jawbone and take over the function of the root of the tooth.

Root form implants are used in the case of deep, wide bone and their purpose is to provide a foundation for the replacement of one to a number of missing teeth. The shape of the plate form implant is both long and flat as it is designed to fit into the mouths of patients who have narrow jawbones. Subperiosteal implants have two methods for placement in the mouth- the “dual surgery method involves an impression being taken of the bone and later the jawbone is exposed and the implant is put in place; the second is the “single surgery” method whereby a CAT scan is taken of a patient’s jawbone and from that, a model of the jawbone is designed.

There are four types of bone grafts. The first, autografts are taken from the patient’s own body. The second grafts, allografts come from recently deceased human donors. The third type, xenografts are taken from animals, most often cow (called bovine). The fourth type, alloplastic grafts are inert and are constructed from synthetic man made materials.

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

Is Dental Implant Surgery A Wise Choice For You?

engle2009 — Wed, 10 Feb 2010 01:06:57 +0000

Dental implant surgery is not quite as simple and straight forward as it might seem. In fact, it usually involves a multi step process, only the last of which is actually inserting a false tooth. But before an oral surgeon can do any of that, he or she must do a considerable amount of analytical work and then lay the groundwork for this false tooth implant.

What does the groundwork consist of? Quite simply, laying groundwork for a false tooth involves simulating a root. This can be done in a number of different ways, but it usually involves making an incision on part of the gums, opening it up, and then drilling down into the bone. For those of you who are gagging or cringing at this point, don’t worry; if you opt for dental implant surgery, your oral surgeon will find ways to make it bearable, even if the very thought of it is hideous.

Once your oral surgeon has drilled down into the bone, he or she will implant a false root, which is almost always made out of metal. He or she will then close and stitch up the incision. Now, all you have do to is wait for that metal to grow into a nice false tooth just kidding! Now that the first part of the dental implant surgery is complete, you will usually have to wait several months for the incision to heal and for the implant to ossify, or have bone grow around it and seal it into place.

The next step in dental implant surgery involves paying careful attention to that false root. You will want to eat soft foods whenever possible and you will want to avoid chewing with that side of your mouth. In the first few days, that might be quite easy, as it will be painful if you attempt to eat with that side of your mouth, anyway. But in order to insure a successful dental implant surgery, you will have to continue avoiding that implant, so that it can heal faster and more completely.

Once your gum has healed and the implant is locked into place by bone, you will then return to complete the dental implant surgery. The last part, of course, is putting in the actual false tooth. This usually involves attaching your tooth to the false root and then netting it into place with titanium.

The end result of any successful dental implant surgery is a new set of teeth that are firmly in place and attached to a strong artificial, yet ossified, bone implant.

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