ScreworCementWhichisBestforAttachingYourImplantCrown

If you’re in the initial planning stages for a dental implant, you may already be encountering a number of options to consider. One that may come up is how the visible crown will attach to the metal implant imbedded in the bone.

Generally speaking, implants are composed of two parts: a metal post most often made of titanium placed into the bone that serves as the “root” for the new tooth; and a visible, life-like crown made of dental porcelain that attaches to an abutment on the titanium post. The crown can be attached in one of two ways: either with a small screw through the biting surface of the crown into a receiving hole in the abutment or cemented to it.

The major advantage of a screwed crown is that it allows for easy removal of the crown if needed. While the titanium post can often last a lifetime, porcelain crowns more often need repair or replacement since they receive the brunt of the biting forces in the mouth. A screw-attached crown is much easier to remove than a cemented one.

On the other hand, screwed crowns have a small access hole that must be restored with a tooth-colored filling to help the crown appear natural. This isn’t too great an issue with back teeth but does make achieving a natural appearance in the front more difficult. Cemented crowns look more like a natural tooth and are thus more flexible in achieving the desired appearance.

Besides the possibility the cement may cause gum inflammation or bone loss, the chief detraction from cemented crowns is the difficulty in removing them. Crowns are often damaged in this process so it’s highly likely it will have to be replaced rather than repaired. It’s possible to use weaker cement, but this raises the risk of the crown coming loose at some point from the abutment.

As we plan for your implant, we’ll discuss which type of attachment will work best for you, depending on the tooth to be replaced and other conditions with your oral health. The end result, though, should be the same — a new, natural-looking tooth that serves you well for many years to come.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “How Crowns Attach to Implants.”

By Embree Dentistry
June 14, 2017
Category: Dental Procedures
IfatAllPossiblePrimaryTeethareWorthSaving

Primary (baby) teeth might not last long, but their impact can last a lifetime. Their first set of teeth not only allows young children to eat solid foods, but also guide permanent teeth to form and erupt in the proper position.

Unfortunately, primary teeth aren't immune to tooth decay. If the decay is extensive, the tooth may not last as long as it should. Its absence will increase the chances the permanent teeth won't come in correctly, which could create a poor bite (malocclusion) that's costly to correct.

If a primary tooth is already missing, we can try to prevent a malocclusion by installing a “space appliance.” This keeps nearby teeth from drifting into the empty space intended for the permanent tooth. The best approach, though, is to try to save a primary tooth from premature loss.

We can often do this in much the same way as we would with a permanent tooth — by removing decayed material and filling the prepared space. We can also perform preventive applications like topical fluoride or sealants that strengthen or protect the tooth.

It becomes more complicated, though, if the pulp, the interior of the tooth, becomes decayed. The preferred treatment for this in a permanent adult tooth is a root canal treatment. But with a primary tooth we must also consider the permanent tooth forming below it in the jaw and its proximity to the primary tooth. We need to adapt our treatment for the least likely damage to the permanent tooth.

For example, it may be best to remove as much decayed structure as possible without entering the pulp and then apply an antibacterial agent to the area, a procedure known as an indirect pulp treatment. We might also remove only parts of the pulp, if we determine the rest of the pulp tissue appears healthy. We would then dress the wound and seal the tooth from further infection.

Whatever procedure we use will depend on the extent of decay. As we said before, our number one concern is the permanent tooth beneath the primary. By focusing on the health of both we can help make sure the permanent one comes in the right way.

If you would like more information on caring for children's primary teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Canal Treatment for Children's Teeth.”

EvenwithMercuryDentalAmalgamisaSafeChoiceforToothFilling

One of the top concerns in public health today is exposure to the metallic element mercury within the environment. At abnormal levels, mercury can have a toxic effect on our nervous systems and cause other health problems.

These concerns over mercury have also increased attention on one material in dentistry that has included the metal in its makeup for over a century — dental amalgam for filling teeth. Amalgam is a metal alloy that can include, in addition to mercury, silver, tin, and copper. When first mixed dental amalgam is a moldable material used for fillings in prepared teeth. It then hardens into a durable restoration that can withstand biting forces.

While the use of amalgam has declined with the introduction of life-like colored fillings, it's still used for teeth like molars subject to high biting forces. With what we now know about the ill effects of mercury (which can make up to half of an amalgam mixture) is it safe to continue its use?

The American Dental Association has performed extensive research into amalgam safety. They've found that mercury is stabilized by the other metals in the amalgam. This prevents "free" molecules of mercury, the real source of harm to health, from escaping into the blood stream in the form of vapor. Although trace amounts of mercury vapor from the amalgam are released as a person chews, those levels are well below the threshold that could cause harm.

From a patient standpoint, the biggest drawback to dental amalgam isn't safety — it's the appearance of teeth it's used on. Silver fillings aren't considered attractive. And now there are viable filling alternatives that not only look like natural teeth but can withstand biting forces almost as well as amalgam. These materials include composite resins, mixtures of glass or quartz within resin, or glass and resin ionomers. Each of these has advantages and disadvantages depending on how and where they're applied.

After a thorough dental examination, we'll be able to advise you on what filling material will work best to produce the best result. And if we do suggest dental amalgam you can rest assured it will be a safe choice.

If you would like more information on the safety of dental amalgam, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Silver Fillings — Safe or Unsafe?

ConsiderBoneHealthWhenDecidingBetweenImplantsandDentures

Losing permanent teeth is never good — unlike primary teeth, no natural replacements wait in the wings. But the good news is you have a number of options for replacing them with life-like prosthetic (false) teeth.

Today's premier choice is dental implants, preferred by dentists and patients alike for their durability and life-likeness. But because of their cost when replacing multiple teeth, many people opt for traditional dentures. And now dentures are easier to wear and maintain thanks to new, advanced materials and designs.

Still, there's one major area where implants have the definite edge over dentures — long-term bone health. Older bone cells die and dissolve (resorb), replaced then by newly formed cells. Teeth help perpetuate this cycle through the forces generated when we chew that travel through the roots to stimulate the formation of new bone.

But because this stimulation through a tooth ends when it's lost, new bone beneath the empty socket may not keep up with the resorption rate of older bone. As a result, you could lose as much as a quarter of normal bone width in just the first year after losing a tooth.

This bone loss will continue to accumulate even if you wear dentures, which can't replicate the bone growth stimulation of natural teeth. What's more, the constant pressure on the bony ridge of the gums can accelerate bone loss. Eventually, the firm, comfortable fit you first had with your dentures will become looser and less comfortable with the shrinking bone volume.

Implants, on the other hand, can stop bone loss and may even reverse it. This is because the titanium metal of an implant has a special affinity with bone cells that readily grow and adhere to it. This creates the anchorage responsible for the implant's durability, but it's also healthy for the bone.

Of course, this doesn't have to be a binary choice between the two restorations thanks to a new hybrid advancement that combines implants with dentures. We can install as few as two implants to support a removable denture. You'll enjoy greater stability, fit and durability with your dentures, while also improving bone health through the implants.

So before you decide on a dental restoration, be sure to discuss with us your implant options. Your oral health and appearance could benefit immensely.

If you would like more information on dental restoration, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”

OvercomingGumRecessionwillRestoreDentalHealthandyourSmile

Your gums not only help hold your teeth securely in place, they also help protect them. They're also part of your smile — when healthy and proportionally sized, they provide a beautiful frame for your teeth.

But if they become weakened by periodontal (gum) disease, they can detach and begin to shrink back or recede from the teeth. Not only will your smile be less attractive, but you could eventually lose teeth and some of the underlying bone.

Treating gum recession begins with treating the gum disease that caused it. The primary goal is to remove the source of the disease, a thin film of food particles and bacteria called dental plaque, from all tooth and gum surfaces. This may take several sessions, but eventually the infected gums should begin showing signs of health.

If the recession has been severe, however, we may have to assist their healing by grafting donor tissue to the recession site. Not only does this provide cover for exposed tooth surfaces, it also provides a “scaffold” for new tissue growth to build upon.

There are two basic surgical approaches to gum tissue grafting. One is called free gingival grafting in which we first completely remove a thin layer of surface skin from the mouth palate or a similar site with tissue similar to the gums. We then attach the removed skin to the recession site where it and the donor site will usually heal in a predictable manner.

The other approach is called connective tissue grafting and is often necessary when there's extensive root exposure. The tissue is usually taken from below the surface of the patient's own palate and then attached to the recession site where it's covered by the surrounding adjacent tissue. Called a pedicle or flap, this covering of tissue provides a blood supply that will continue to nourish the graft.

Both of these techniques, but especially the latter, require extensive training and micro-surgical experience. The end result is nothing less than stunning — the tissues further rejuvenate and re-attach to the teeth. The teeth regain their protection and health — and you'll regain your beautiful smile.

If you would like more information on treating gum recession, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Periodontal Plastic Surgery.”





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Ann Arbor, MI Dentist
Embree Dentistry
2340 E Stadium Blvd Suite 7
Ann Arbor, MI 48104

(734) 973-0000

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