How long do dental implants last?

Watch Dental Video about Dental Implants

There exists a series of clinical and radiological criteria for the identification of an implantation success.

Of course, the patient counts freedom from pain as a success, but pain is a very unreliable partner in medicine. For example, as a rule, malignant tumors are only painful shortly before the end. A general rule in medicine is that slow changes are rarely painful, while only acute changes are noticed as pain.

So what constitutes a successful implant? The doctor does not just evaluate pain, he has a series of negative criteria whose absence is a condition for success and at whose occurrence a failure must be admitted. A successful implant must be clinically fixed in the jaw, be free of any inflammation and pain, and not show any loss of bone.

In most implant systems, a loss of bone around the implant can be observed in the first two years. This is probably due to the implant superstructures, the so-called abutments.

However, since most implant systems do not have a conus, but a plug connection, the initial bone resorption is defined as “normal”. In this process, the decrease of the height of the bone around the implant should not be more than 0.2 mm after the second year following the implantation. The majority of the loss is registered in the first year, both in toothless jaws as well as in partially edentulous jaws, with a decrease of around 0.4 – 0.5 mm / year, while only 0.1 – 0.2 mm / year are measured in the second year and the years following that. Implants performed in combination with bone augmentations show a significantly higher resorption rate in the first year (1.1 mm), but approaching that of the area bone in the subsequent progress.

Conical connection between implant and abutment

Physicians use standardized analytical processes in order to assess the success rate of an implant system. A common procedure is the analysis of the retention period: Contrary to the frequently used ratio calculated between all failed implants and all placed implants (“Input-Output Statistics”), the analysis of the retention period results in a realistic representation of the failures. In this case, the probability of the loss of an implant is calculated based on its retention time. Since the effect relating to the retention period is missing in the simple “input-output statistics”, their failure rates are significantly lower. However, in the calculation of corrected failure rates, there is also a degree of uncertainty due to the fact that the individual implant, the patient, or the implant-supported construction can be subject of the success assessment as a “calculation unit”.

So when you read an implant statistic, it is important that the correct analysis method was used. At the present time, hundreds of thousands of implants of varying kinds are placed worldwide every year. Unfortunately, the evaluation of the life span and thus the success rate of implants in the various areas of application are conducted in very different ways! The multitude of possible approaches mentioned above, the definition of the inclusion and exclusion criteria of different studies, as well as the variable definition of what constitutes an implant success complicate the assessment of the results and the comparability of the surveys among them.

Nevertheless, scientifically substantiated long-term results have been documented for the most common implant systems that are anchored in the bone by now, while such data has not yet been presented for other systems such as, for example, implants underneath the periosteum or ceramic implants.

Depending on the implant system used, the success probability for implants in toothless lower jaws for bar-supported provisions in implant-related statistics after 8-10 years is given with 88-97% and in patient-related statistics after 5 or 8 years with 95 and 97%. For fixed, conditionally removable replacements, the success rate in implant-related statistics after 8 years is between 92 and 98% and in patient-related analyses 86%.

Thanks to such analyses, news findings are still being arrived at. Thus, for example, a perforation of the osseous sinus cavity floor during the placement of the implant in the upper jaw apparently does not influence the prognosis for the placed implants. Nevertheless, one should be careful not to injure the sinus cavity during the implantation. It is postulated that implants, which are projecting into the sinus cavity, can be more easily infected in a sinus cavity infection within the course of a simple infection. However, there are still very few studies regarding this point.

A lack of a stable anchoring after the healing phase of the implants or a loss due to functional stress express themselves clinically through a mobility of the implant and would necessitate a removal. Reasons for such a failure during the healing phase could be an improper action during bone preparation with a thermal injury to the bone, an infection of the implant bedding during the healing phase, premature mechanical stress, or structurally weak bone bedding.

mplant?

Anybody who acquires the ability to see beauty never grows old!

Every person is unique, and so is their smile. A smile serves as an invitation to our fellow human beings to get to know us. Stars show us how it’s done: Julia Roberts, George Clooney, etc., have particularly attractive smiles.

Not everyone is naturally blessed with beautiful, even, white teeth. Do you only smile and laugh with your hand covering your mouth or with your lips closed? This can be a thing of the past now. Smile and laugh spontaneously, joyously, confidently, and in a relaxed way! With the aid of orthodontic treatments, veneers (ceramic covers) and/or ceramic crowns, unattractive gaps, misalignments, or dark teeth that can no longer be brightened (due to older root canal treatments) can be removed, and an appealing and favorable look can be created – it’s easier than you think!

Bleaching the teeth prior to reconstructive and beautifying procedures can further improve results.

Beautiful people with flawlessly white teeth beam at us from magazines, billboards, TV, and other media. Is it even possible to have teeth that are that white? Yes, an uncomplicated method makes it possible for everyone: It’s called bleaching.

Red / White Aesthetics

Teeth become darker or spotty due to consumption of tea, coffee, red wine, tobacco, and coca cola, or simply as a result of the natural ageing process. Through bleaching, your own teeth can be brightened without any complications.

Usually, the results last for two to three years or longer, depending on your personal oral hygiene and eating habits. If necessary, you can have another professional dental bleaching done after two years.

“Freshly squeezed orange juice affects the dental enamel more than modern bleaching.”

Professional brightening is done with active oxygen, which decolorizes the unattractive color pigments present in the teeth. Through this process, no dental enamel is removed, cut, or etched away. The extent of the brightening is individual and depends on the base tone of your teeth. Depending on the degree of discoloration, a brightening of about 1 – 14 shades is possible.

Prior to bleaching, the dentist should check the teeth and fillings and, if necessary, professional cleaning (oral hygiene) should be performed. Furthermore, it should be noted that only one’s own teeth can be brightened (no crowns, bridges, or veneers can be brightened). This is another reason why bleaching is the optimal starting point before inserting a ceramic-technical provision.

So is it possible to measure, categorize, and standardize smiles?

Aesthetics of the Gums

Yes, we can show you a way.

The gums should be pale pink, lie flat on the tooth and, when observed closely, show a stippling pattern (similar to that of an orange). The first upper tooth is the lightest, the second one is a bit darker, and the third one is the darkest.

A smile is considered young and dynamic when we see more upper jaw teeth than lower jaw teeth. Of particular importance for a harmonic appearance is the symmetry of the upper teeth; a slight asymmetry of the teeth in the lower jaw, on the other hand, promotes a natural appearance. Furthermore, the proper interaction of saturation, surface, and spatial contrasts, as well as translucency and opalescence, is important in order to obtain a natural appearance.

Other parameters for a charming smile are dental geometry and red-white aesthetics. With the aid of modern dentistry, it’s possible to face life with a flawless white smile nowadays. The range of possibilities for “polishing up” your personal dental image is broad. Body care, hygiene, and “taking time out for oneself” are all becoming a bigger and bigger priority in today’s society.

“Wellness” is the name for the new magic formula for feeling well and for satisfaction in your private as well as in your professional life. Dental aesthetics doesn’t just consist of beautiful white teeth; above all, it consists of healthy teeth in a healthy body. According to a Thai proverb, “a smiling person shows teeth.”

Osteoporosis – Bisphosphonate Therapy

Osteopathy

How is the dental care of patients done during and after administering bisphosphonates?

Bisphosphonates (BP) have been used successfully in certain tumor diseases (multiple myeloma) and in the bone metastasis of other tumors, but also in case of osteoporosis and other bone metabolism disorders for more than 20 years. Even quickly progressing diseases can be treated successfully.
Chemically, BP’s are similar to pyrophosphate, which, among other things, plays a significant role as an autologous regulator in bone mineralization.

The big difference between these two substances is the chemic bond between them; pyrophosphate has a phosphorus-oxygen-phosphorus bond (P-O-P bond), while all BP’s have a phosphorus-carbon-phosphorus bond (P-C-P bond). This bond is more resistant to the enzymatic cleavage of osteolytic cells since BP’s are bound to the hydroxylapatite of the bone; this slows down the resorption of bone by osteoclasts (bone-destroying cells).

Depending on the drug, the half-life period may be between a few months and years. BP’s are administered through the vein or the mouth. The side effect profile has been appraised as favorable for years, while it has only been in recent years that osteonecrosis of the jaw, i.e. non-healing wounds of the jawbone, has been brought to the fore.

At first, it was believed that these are normal wound infections, but a pathogenic contamination of the bone (dentogenic infections) or a jaw-related soft tissue bone wound (tooth extractions, jaw surgeries) could not be found in all patients. Since then, case histories have been accumulating, giving the impression of a progressing disease rate. Based on the scientific case collections, there is a generally strengthening view that a relevant risk for a BP-induced osteonecrosis of the jaw exists in patients who are given high doses of an intravenous BP medication over a longer period of time due to a malignant primary disease.

It is interesting to know that similar osteonecroses of the jaw were already found in the 19th and 20th centuries in factory workers who had been breathing in vapors of yellow and white phosphorus over extended periods in the manufacture of match heads. These osteonecroses of the jaw led to suppurations in the bone – including the formation of fistulas. The smell and the inability to eat normally caused the affected persons to be socially isolated, and, in 20-50% of the sufferers, the osteonecrosis of the jaw led to their death, in part, due to suicide. The ban of yellow phosphorus in the production of matches in 1912, led to the extinction of the disease given the nickname, “phossy jaw” and thus, to the extermination of an occupational disease.

The exact reason for the osteonecroses of the jaw caused by bisphosphonate is still unclear. However, there are clues for a multifactorial etiology – in other words, is it assumed that multiple causes are responsible for the occurrence of this disease. Bad oral care, periodontitis, bad toot canal treatment and the foci/fistulas frequently associated with them, certain metabolic diseases such as, for example, diabetes mellitus, might promote the development of the osteonecroses of the jaw! Radiation therapy of jaw metastases while being medicated with BP’s constitutes a particularly high risk.

Besides the factors already mentioned, the individual risk profile is substantially influenced by the type of application of the bisphosphonates (intravenously versus orally), the dosage, the duration of the therapy, and the BP type.

So what does an osteonecrosis of the jaw look like? Osteonecroses of the jaw, which are associated with BP’s, show a clinical and radiological resemblance to normal osteoradionecrosis (ORN), which is caused by excessive radiotherapy. In such cases, too, the leading symptom of the exposed bone is the lack of any tendency to heal. A striking feature in BP-associated osteonecroses of the jaw is the often strong mouth odor (halitosis), which may point to an infection.

There may be a total lack of pathological changes in the X-ray. One conspicuous detail is the radiological and intraoperative findings of “persistent alveoles;” normally, new bone develops within 8-12 weeks of a tooth extraction – but this is not the case in osteonecroses of the jaw. Since BP’s reduce the activity of the osteoclasts and osteoblasts, the overall result is decreased bone remodeling, so that the suspension of reparative and resorptive processes in the alveole becomes quite plausible.

Apart from that, there is often a widening of periodontal gaps. If necessary, further diagnostic measures such as a CT, an MRI, or a scintigraphic examination are indicated. The care concept involves prophylaxis prior to and the early detection during/after a BP therapy, as well as the treatment of manifest BP-associated osteonecroses of the jaw.

Pressure Points

Prophylaxis before the administration of bisphosphonates: As long as the pathogenesis of the BP-associated osteonecroses of the jaw has not been further clarified, all patients should be clinically and radiologically examined prior to a BP therapy, and chronically inflammatory processes in the area of the mucosa and the jaw should be rehabilitated. To do so, the doctor prescribing BP’s transfers the patient to a dentist and/or a cranio-maxillofacial surgeon. He will evaluate the individual risk profile (taking into account the abovementioned criteria), conduct a radiological examination, and define a rehabilitation plan – which must consider the following issues:

• Consultation and education about the risk of an osteonecrosis of the jaw before and after a bisphosphonate therapy.
• Rehabilitation of potentially inflammatory processes in the area of the jaw and the oral cavity.
• Smoothing of sharp bone edges.
• Restorative measures on teeth worthy of conservation.
• Intensification of the oral hygiene.
• Check of the patient’s dental prosthesis for the risk of pressure points.
• Integration into a continuous recall.

In this process, invasive prophylactic measures, in particular prophylactic tooth extractions, should be limited to patients with a high risk profile. Therefore, a decision for the removal of teeth is subject to different criteria than in a pre-radiotherapeutic tooth restoration. The decisive aspect regarding the prognosis are not carious lesions on predilection areas (tooth neck, cutting edges), but the periodontal condition. While the bacterial flora in the periodontium has largely returned to normal 1-2 years after a radiological therapy, patients with BP-associated osteonecroses of the jaw mention frequent spontaneous losses or removals of loose teeth.

Therefore, teeth with periodontal damages that cannot be restored in the foreseeable future should be removed prior to beginning the administration of BP’s with a relevant risk profile. In high-risk patients, the tooth restoration should be completed prior to the start of the treatment with BP’s. An interval of 14 days between the restoration and the start of the BP treatment would be desirable here; however, there is very few resilient data in medical literature.

Prevention and early detection during an ongoing bisphosphonate therapy

Patients taking BP medication should regularly report to their dentists every 6 months. In case of discomfort, in particular regarding pressure points due to a dental prosthesis or due to progressively loosening teeth, the dentist must be consulted early. With regard to prevention, preference should be given to the conservative therapy, compared to the operative therapy (in particular in case of periodontal diseases). However, necessary surgical interventions should not be delayed and, in high-risk patients, should be conducted under the same conditions as after a radiological treatment of tumors in the cranio-maxillofacial area.

Regarding this issue, the following recommendations may be given:

• Long-term continuation of the recall (at least every 3 months, in particular prior to a renewed BP infusion or in case of need);
• A detailed instruction and sensitization of the patients so that any corresponding symptoms can be subjected early to a targeted diagnosis and therapy;
• Conservative restoration of changes that may potentially be threatened by an infection;
• Conservative therapy including an individually adjusted intensive oral care and cautious tooth cleaning;
• Early exact endodontic therapy of devitalized teeth;

If surgeries are required: As a rule, interventions are to be conducted by a cranio-maxillofacial surgeon, oral surgeon, or a dentist familiar with the disease pattern, subject to the following provisions:

• If possible, an atraumatic surgical technique is to be used;
• Systemic anti-infective prophylaxis;
• No secondary healing, as is otherwise common in dento-alveolar interventions (tooth extractions!!), but a plastic covering of the wound areas;
• Possibly, epiperiostally prepared cloth for a plastic covering in order to prevent a further reduction in the periosteal provision of the jawbone.

Therapy of the osteonecroses of the jaw associated with BP

An osteonecrosis of the jaw caused by bisphosphonates is difficult to treat; the course of the therapy is uncertain. In case of small findings, a therapy may be attempted with a local revision and/or a long-term open after-care. If this is not successful or if there are extensive findings, a bone resection is required. Currently, the following recommendations apply in such cases:

• Therapy through a surgical facility with the possibility of a treatment under general anesthesia, inpatient care, and parenteral, anti-infective therapy, in which the respective therapy indication is determined by the practitioner;
• Gentle, but complete removal of the necrotic bone – insofar as intraoperatively recognizable – and (obligatory!) histological reconditioning (also to exclude metastases and relapse);
• Safe plastic covering under a tension-free mobilization of sufficient soft tissue or – if required – plastic cloth;
• Mechanical rest of the surgery area (liquid to passed food, possibly nasogastric tube or PEG (percutanous endoscopic gastrostomy));
• Since bisphosphonates may remain tied to the hydroxylapatite of the bone for years, there is, according to current knowledge, no evidence for an interruption of the therapy with bisphosphonates.

Dental implant care of patients with a bisphosphonate therapy

To date, there is only isolated data in the medical literature pointing toward an increased risk profile for the development of a BP-related osteonecrosis of the jaw due to dental implants. A patient, with implants that were already inserted prior to the BP therapy, will surely require intensified follow-up care. It is unknown up to what point in time it is possible to implant safely prior to a planned BP therapy. An implantation at the time on an ongoing BP therapy must be determined individually depending on the existing risk profile (primary disease, type, duration of the administration and dosage of the medication, cofactors, etc.).

As long as there are alternatives, sufficient possibilities for a dental provision, high-risk patients receiving an intravenous administration of BP’s due to a malignant primary disease, should currently abstain from getting implants.

“Bruxism” is the medical term for teeth grinding

Grinding of the teeth can lead to dental issues

The grinding of teeth is also know by the Latin name bruxism and usually happens when the patient is sleeping.

People deal with stress differently, when the jaws and teeth are used this is known as bruxism.

When we talk of stress in this case we mean so-called distress. Eustress rarely causes tension which requires release. The difference between eustress and distress can be illustrated in the following story: The fox is hunting a rabbit, the fox has eustress as he thinks to himself that if he catches the rabbit he has a fine meal, the rabbit on the other hand suffers from distress as it is a matter of life and death.

Many people use their jaws and teeth to relive stress when sleeping. They usually don t realize that they are grinding their teeth and may only wake up with some muscular pain in the jaw. Bruxism in young people can lead to jaw joint problems when then grow up. Therefore, it is important to identify young people who suffer from this problem and help them with psychotherapy. Children generally grind their teeth and usually do not require therapy.

Using the jaw and teeth to relive stress is not all bad; problems arise when the grinding of the teeth talks place over many years and damages the teeth. In the picture you can see how grinding of the teeth has affected the teeth and how the teeth have shortened. Other problems are jaw joint problems, ear pain, parodontal damage and facial pain.

The dental therapy for bruxism is usually only a symptomatic therapy i.e. a mouth guard which slows down the rate at which the teeth are ground down. Behavior such as no food before going to bed, no alcohol, no nicotine or caffeine can help the patient sleep better but do not offer a cure for bruxism. A psychotherapy can help shortened the bruxism phases and many patients learn to live and deal with bruxism very successfully. When there are problems in the patient’s private life or work environment then the patient can start to use the mouth guard before going to sleep to help cope with the stress.

Teeth which have been sanded down as a result of bruxism can only be built-up in combination with a mouth guard as without the guard the teeth will be ground down again.

Batey Relief Alliance reaches new milestone at 14th-year anniversary.
posted in news | no comments » | october 10th, 2011
NEW YORK. – The Batey Relief Alliance (BRA) celebrates on October 23rd, 2011 14th-year anniversary addressing the socio-economic and health needs for children and their families severely affected by extreme poverty, disease and hunger in Haiti and the Dominican Republic, through health, education, community development and disaster relief programs.

“We will also celebrate, proudly, BRA’s establishment of its first Food Security system that will help produce long-term food independence and economic self-sufficiency for more than 35,000 rural batey residents and farmers through USAID and USDA-funded food distribution and agricultural/cooperative development projects,” said Ulrick Gaillard, BRA’s founder and CEO. According to Gaillard, the organization’s newest food security milestone is credited to the continuing support and collaboration of the Dominican government.

With the financial and technical assistance of the USAID, through a Food for Peace/IFRP program, within a period of four years from 2007-2011, BRA distributed 656.48 metric tons (equivalence of 33million servings) of food rations at a value of $2.3 million to 986,800 impoverished and vulnerable people living with HIV/AIDS and Tuberculosis, vulnerable/orphaned children, Cholera patients, earthquake-affected Internally Displaced People, pregnant women, the elderly who are without a pension or health coverage living in more than 17 provinces and 168 vulnerable and impoverished Dominican Republic Batey communities, rural and urban slums and Haiti’s border regions.

Meanwhile the organization partnered with USDA in 2009, through a two-year Food for Progress-funded program of $1.2 million, to create the first major Batey-run cooperative Food Security System, by producing crops and animal and developing community infrastructures for 35,000 beneficiaries within seven Batey communities in the province of Monte Plata, involving 7,700 cooperative members/farmers and community health promoters in skills training and technical assistance, veterinarian and health services, sharing of equipment and provision of credit.

BRA will present its 2011 “TRUE PARTNERS AWARDS” to USAID, USDA and Charlie Mariotti, Senator for the Monte Plata province, at the 14-year anniversary celebration festivities to be held on Friday, October 21st at 2:30pm at the organization’s Medical Center complex located inside Batey Cinco Casas in the province of Monte Plata.

More than 1,000 people are expected to attend the event, including government, diplomatic and media officials, foreign and local partners and local residents. Dominican President, Dr. Leonel Fernandez Reyna, US Ambassador to the DR, Raúl Yzaguirre and USAID Interim Director to the DR, James Watson have been invited to be our Guests of Honor.

BRA is member of the Clinton Global Initiative (CGI)—collaboration between the private sector, non-governmental organizations and other global leaders committed to effectively confront the world’s most pressing issues and identifying groundbreaking solutions that reduce poverty, improve the environment, and increase access to health care and education.

The McGill Consensus Statement on Overdentures

For purposes of this discussion, teeth basically have two main parts; the crown is the part you see in the mouth, and the root is the part that is encased in bone and keeps the tooth in place. A dental implant is actually a root replacement, and unlike the root of a tooth, it is actually fused to the bone of the jaw. A crown is attached to the implant and in effect it becomes a stand-alone tooth, functioning and appearing just like the natural tooth you have lost. The basic prerequisites for a successful implant include:

• a sufficient quantity and quality of bone to anchor or support the implant,
• the adjacent teeth and gums are healthy,
• and the quality of the adjacent teeth will allow for a natural-looking cosmetic result.

By contrast, a fixed bridge is a restoration or prosthesis (replacement part), that is fixed in place by attaching to the natural adjacent teeth. The tooth to be replaced is called a “pontic” after the French “pont” for bridge. The adjacent teeth, called abutments, just like a bridge spanning a river or canyon, provide support on either side. The way that the bridge attaches is that the abutment teeth are “prepared” by removing the enamel layer and are replaced by crowns (caps) to which the false tooth (pontic) is attached. Thus a three-unit bridge is three crowns joined together with the middle crown being a false tooth, with the side crowns cemented or bonded to the adjacent natural teeth.

The following illustration shows the general advantages and disadvantages of a three-unit fixed bridge versus an implant restoration. Please note these are general guidelines only. A discussion with your dentist is necessary to discuss your specific situation. Please see your dentist to review all the risks, benefits and alternatives to determine which option is best for you.
Advantages of Dental Implants

• Esthetic, functional, predictable, reliable
• Does not affect adjacent teeth
• Does not decay
• Less likely to develop gum disease

Disadvantages of Dental Implants

• More expensive
• More planning time
• Requires minor surgery
• Requires healing time before permanent tooth replacement

Advantages of Bridges

• Esthetic, functional, predictable, reliable
• Less costly
• Requires less time for final result

Disadvantages of Bridges

• Requires enamel removal of adjacent teeth
• If adjacent teeth have crowns, they must be redone
• Tooth decay is potential problem
• Root canal treatment may be required if nerves are affected
• Greater tendency for gum disease
• Less longevity than implants

Because missing front teeth are considered aesthetically and socially unacceptable, most people consider their replacement a higher priority than back (posterior) teeth normally hidden from sight. From a dental point of view, however, you should definitely consider their replacement, if not for cosmetic reasons, then for the loss of function created by their absence.

Besides their obvious role in chewing, the posterior teeth affect the overall bite and help ease some of the excessive pressure on the front teeth created by chewing. Dentists generally agree the loss of posterior teeth can lead to a wide array of consequences, especially involving the remaining teeth, gums, jaw muscles, ligaments and joints:

• Decrease in chewing efficiency
• Tipping, migration and rotation of remaining adjacent teeth
• Eruption or extrusion of unopposed teeth
• Excessive wear or erosion of remaining teeth
• Loss of alveolar jaw bone and reduction of the residual boney ridges
• Painful dysfunction of the temporomandibular joints (TMD) that unite the lower jaw with the skull

And, just because the site of the missing teeth is hidden from view doesn’t mean there won’t be changes to your appearance. For instance, the loss of the posterior teeth can cause a reduction in facial height that becomes increasingly noticeable over time.

Unfortunately, that’s only the beginning of problems you may encounter from missing posterior teeth. Some of the above factors, particularly shifting or migration of teeth, can set off a chain reaction that weakens the overall dental system.

When you lose a tooth, the remaining teeth tend to shift at an accelerated rate.

For instance, teeth normally move to maintain contact with adjacent and opposing teeth as natural wear slowly occurs over time (you won’t notice this movement because of the equilibrium created by the teeth touching each other). When you lose a tooth, however, the remaining teeth tend to shift at an accelerated rate. This creates a force greater than normal along the tooth, causing abnormal displacement of the tooth in the jaw bone. If these teeth shift too much they may become worthless in the future.

Along the same lines, if the teeth erupt too much there may not be enough room to replace the missing teeth below them. Also, as a tooth moves, it changes the relationship of how the jaw bone is attached to the tooth. This change may leave the tooth more vulnerable to periodontal disease.

Obviously, then, replacement would help deter some of these consequences — but which method is best? Dentists now recognize implants as the best option for replacing missing teeth. They have some obvious benefits: as a free-standing restoration, adjacent teeth aren’t usually affected by the preparation process and the replacements are easier to clean and can contribute to the support of the bite.

The most critical factor for implantation is that adequate bone height and volume exists where an implant will be placed. If not, a non-removable fixed bridge is the second best option, although there are a number of considerations to take into account.

First, teeth must be present on both sides of the missing teeth to create a fixed bridge — and you are actually asking two teeth to do the work of three. The adjacent teeth have to be drilled down for bridge placement, so there is a greater risk to the nerves — a future root canal treatment may be necessary. There is also a greater risk of trapped food under a bridge than around an implant restoration.

A third and least favorable option is a removable partial denture. Removable restorations can be difficult to wear and trap more food. Because they are moveable, they may put additional stress on the teeth that hold them in place, which could lead to loosening and loss of those teeth.

In summary, I think you can now see the importance of replacing missing teeth, seen or unseen. Excellent options in dental implants or bridgework are worth looking into and discussing with your dentist.

Bleaching by definition actually changes natural tooth color. Nearly all bleaching products contain carbamide peroxide or its breakdown product hydrogen peroxide, which helps remove both deep (intrinsic) and surface (extrinsic) stains. Deep staining is seen commonly as a result of changes to the tooth due to natural aging, old root canal treatments, large fillings, tetracycline antibiotic or excess fluoride intake during development. Surface stains are caused by substances such as coffee, tea, red wine and tobacco.

Over-the-counter, (OTC) products for home use have a lower concentration of the active ingredient which helps remove both types of stains. The American Dental Association reports that the accumulated data on neutral pH 10% carbamide peroxide supports both the safety and effectiveness of these home use products.

The same carbamide or hydrogen peroxide bleaching agents are applied by your dentist. They are stronger, however, varying in concentrations from about 15% – 35%, and sometimes used together with a specialized light or laser. This reportedly accelerates the process, down to a visit or two instead of two or three weeks for the home use OTC products. In all instances, look for the ADA Seal of Acceptance on the products used and consult with your dentist for advice before proceeding.

Studies indicate that bleaching can successfully achieve noticeable increases in whitening of stained teeth.

Bleaching attempts to whiten your natural teeth as opposed to improving whiteness with restorative materials like veneers and crowns which require removal of some of the tooth structure. Bleaching has proven to be a very effective method that involves less time and expense than restorative dental treatment.

While bleaching can dramatically improve your smile, there are some potential side effects such as tooth sensitivity and irritation of the gums or other oral tissues. These conditions are generally temporary with very rare reports of irreversible damage. Tooth sensitivity tends to appear earlier in treatment. When using the stronger professionally applied agents the dentist will sometimes isolate the gums and soft tissues with a “rubber dam” and/or protective gel.

When considering this technique, be aware of the following:

• Bleaching is not a permanent solution: the effects will diminish over time. Optimally, this period lasts six months to a year — referred to by dentists as the “fade rate.”
• Although fading is inevitable, it is possible to slow down the process by avoiding foods and habits that cause staining. Some patients may need a tooth-whitening “touch-up” with the home bleaching technique for 1-2 days, once or twice a year.
• Acceptable color matching can be difficult to achieve due to the mix of natural teeth with pre-existing crowns, bridgework or fillings. Dentists can sometimes improve the color match by adjusting the concentration of the bleaching gel, as well as the actual contact time on the teeth.

While many over-the-counter whitening products produce successful results, patients should still seek a professional consultation before bleaching. Your dentist can discuss your cosmetic needs and review with you all the risks, benefits and alternatives to bleaching.

Factors which can influence implant success

Dear Doctor,
I thought dental implants had a high success rate. A friend of mine had an implant that failed, can you tell me why?

Dear Brian,
Dental implants traditionally have a very high success rate. The majority of studies that have been done indicate long-term success rates well over 95%. However, there are many factors that can compromise the success rates of implants. These can be divided into three categories: general health concerns, local factors and maintenance issues. It is important to consult with your dentist or dental professional prior to having dental implants placed to determine whether you are a good candidate. Most implant failures can be eliminated through proper case selection.

1. General health concerns that may impact an implant’s success include such factors as smoking, certain drugs, osteoporosis, history of radiation treatment, or a compromised immune system.
2. Local factors that could impact implants include bone quality, bone quantity, and initial stability of the implant at the time of placement. Bite-related concerns depend upon the amount of stress that the patient will be placing on the implants. When evaluating an implant patient, your dentist has to evaluate whether you clench or grind your teeth. This will impact both the potential short and long-term success of implants.
3. Finally there are maintenance issues, while implants are wonderful high-technology replacements for teeth, they need routine maintenance. This includes daily cleaning and continued professional management. Without ongoing professional care, implants just like any other technically sophisticated device are susceptible to breakdown.

I believe that one should have confidence that implants are an excellent choice to replace missing teeth, but feel free to consult with your dental professional about your unique case requirements — how many dental implants you need, your medications, your medical history, and local findings such as bone quality and quantity. If you are properly evaluated by a qualified dental professional and determined to be a good candidate, there is no reason why you cannot have extremely high success rates as do most patients.