Dental Implants and Cosmetic Dentists Blog

provisional hybrid bridge

The all on 4 dental implant solution has recently become well known in the dental implant world. Dr Paulo Malo of Malo Clinic in Lisbon claims to have been the pioneer of this dental implant treatment although some evidence exists that similar treatments to the all on 4 were being used prior to this. The all on 4 basically refers to the placement of 4 implants strategically placed in order to avoid complex bone grafting procedures in the upper and lower jaws. The treatment is not always possible as there are complex cases which are not suitable for the all on 4 treatment.

all on 6 bridge showing 6 small access holes whereby hybrid bridge is secured to the 6 implants

The all on 4 protocol involves placing implants at a 45 degree angle in order to avoid the maxillary sinuses on the upper jaw and the inferior dental nerve in the lower jaw. The two anterior implants are placed according to the anatomy of the jaw bone. Together the 4 implants provide a foundation to support a fixed hybrid bridge. The hybrid bridge is made of acrylic and usually consists of 10-12 teeth.

So what is an all-on-6 ?

plaster model showing position of dental implants

basically in some cases where patients have very good amounts of bone, it is not necessary to place angled implants in order to avoid the anatomical structures mentioned above. This means that the implants can be placed in a conventional means…basically vertically as there is sufficient space and bone for the implants. In such cases one can place 6 implants in order to provide greater support and stability to the hybrid bridge.

implants in the mouth prior to fitting bridge

the all on 6 protocol basically allows patients to have implants placed and fixed teeth completed in just one day. The fixed bridge which is fitted after surgery is a provisional hybrid bridge. This provisional bridge is usually used for upto 6 months while the implants heal and fuse with the jaw bone. Once it has been confirmed that the implants have all osseointegrated then the final hybrid bridge can be completed.

the hybrid bridge is fitted in the mouth on the 6 implants the small holes are covered with tooth coloured dental filling material

Sometimes one needs to be make changes to the final bridge. The patient may want to change the colour of the final bridge, the appearance of the teeth or alter the amount of lip support.  Together with the dental technician one can create the perfect smile you have always wanted.

Tetracycline stain on adult teeth

Did you know that Tetracycline antibiotic can cause long term permanent tooth discolouration? Tetracycline has been used in the past for curing a variety of illnesses however it discolours teeth permanently if it is given to children while the adult teeth are forming. If this occurs the teeth are discoloured usually with a brownish colour.

Unfortunately this type of staining is not always treatable with conventional tooth whitening techniques. Tooth whitening can be unpredictable and can not provide the necessary result for the patient and for this reason the treatment of choice is usually porcelain laminate veneers.

Porcelain veneers are thin layers of porcelain which can be bonded carefully to teeth in order to correct the shade, shape and appearance. The treatment requires that a thin layer of the natural tooth be removed in order for the veneer to be bonded to.

For further information please www.brightonimplantclinic.com

Oral B Dental floss, using dental floss will reduce the incidence of gum disease

Good oral hygiene has a very important role to play, not only to keep your teeth and gums healthy, but there is also some evidence to suggest that unhealthy gums could be a contributing factor in some systematic diseases, such as cardio vascular disease and strokes.

Brushing twice a day is very important so as to remove plaque, however brushing alone can not remove all the plaque, thus using dental floss and/or inter-dental brushes are a very important part of one’s dental hygiene routine.

Plaque accumulates inter-dentally (between the teeth) and can cause inflammation of the gum, this could lead to gum disease. Another reason is the fluoride from toothpaste can not penetrate the sticky layer of plaque, thus increasing the risk of dental caries (dental decay).

advanced gum disease, note the amount of gum recession, these teeth have a very poor prognosis

Gum disease is a condition that can occur in some individuals, it is a reaction to some of the harmful bacteria that can be found in dental plaque. it is very important to look after your teeth and gums in order to have teeth which will last many years. You may have early signs of gum problems and it is not always apparent. It is therefore important that you visit your dentist at least 1-2 times per year to ensure that your gums are healthy

There are other factors that can affect an individuals response to this bacteria such as:

• Smoking
• Medication
• Systemic disease
• Genetic factor
• Crowded teeth

pink healthy gum tissue

Signs and symptoms of gum disease:

• Bleeding gums
• Bad breath
• Teeth shifting
• Swollen gums

If you experience any of the above signs or symptoms it would be wise to see a dentist and they can refer you to a hygienist.

For further information visit www.brightonimplantclinic.co.uk

Have you ever seen dark or black lines around dental crowns ? Unfortunately for many people this is something that occurs around their crowns soon after having the crowns fitted or after some time in the mouth.

The dark line is usually seen at the margin of the crown and if the crown is at the front of the mouth in a very visible area it may be noticeable.

The dark line is caused more commonly by a specific type of crown called porcelain fused to metal crown. In the past this type of crown was the most common when wanting to have a tooth crowned with tooth colored porcelain.

Porcelain on its own is not very strong and for that reason it was bonded onto metal in order for the porcelain to be strengthened. This worked well functionally as the crowns are generally very strong, however the metal is usually not tooth coloured !

Several metals can be used for making the framework onto which the porcelain was bonded. Metals can vary in colour but generally most used in porcelain bonded to metal crowns are grayish in colour.

The metal structure that supports the porcelain is known as a metal coping. This coping fits accurately over the tooth prepared to receive the porcelain bonded to metal crown. The porcelain is applied carefully over the metal coping in order to create a tooth coloured porcelain crown.

The margins of the crown are where the problems usually occur. The junction where the metal finishes and meets the porcelain can pose a problem aesthetically to the dentist and to the patient. Sometimes this margin is visible in the mouth and if this should be the case a dark line may become apparent.

Sometime the junction may be tucked slightly under the gum tissue in order to hide this margin, however this may darken the gum tissue in future.

Unfortunately this means that if a dark line is present around a crown, its most probably a porcelain fused to metal crown.

What can be done?

The only remedy for this problem is to replace the porcelain fused to metal crown with a metal free crown. It’s really a simple solution. Thankfully today we have porcelains that are stronger and more resistant to chewing forces hence they are sufficiently strong without the need for a metal coping.

The advantage of using metal free crowns means that one no longer needs to accept dark crown lines.

an example of a metal free crown, note that the inside is white or tooth coloured

Empress or Emax are types of porcelains used today which function very well in eliminating the dark lines around crowns.

What are the advantages of metal free crowns

1                excellent aesthetics

2                biocompatible

3                as they are metal free, some patients prefer to have no metals in their mouth as this has been known to cause general health problems

4                accurate fit,

5                if there is some gum recession then no dark lines will be seen

metal free crowns, no metal margins ! lovely white teeth !

what are the disadvantages of metal free crowns

1               Not all metal free crowns are as strong as each other. Emax is stronger than most other metal free crowns

2               Metal free crowns are not recommended for all teeth. Back teeth which have higher than normal stresses and forces may fracture some of the weaker metal free crowns

3               If the tooth underneath is discoloured due to root canal treatment or presence of metal posts etc, the metal free crowns may transmit the darker shade through the crown. This may result in a grey or bluish shaded crown. In these cases Zirconia crowns may be an alternative solution. See previous blog regarding discoloured metal free crowns.

For further information please feel free to contact our clinic

www.brightonimplantclinic.co.uk

have you ever wondered why some teeth may appear darker than normal ?

Natural teeth have a blood supply , this means that each and every natural tooth in our mouths have a separate artery and vein which are connected inside each tooth. This is quite amazing given that these vessels are tiny and bring nutrients to each tooth continuously. The vessels enter and exit each tooth mainly through the tip of the root called the apex. Sometimes these delicate vessels may become damaged as a result of trauma or extensive tooth decay. If this happens the vessels inside the tooth may become damaged and become completely detached from the larger artery or vein connected to each tooth. During this process the damaged vessels inside the tooth may bleed inside the tooth causing blood to pool inside the tooth.

A little information about blood. It contains small amounts Iron and this has the effect of staining the tooth over time. Unfortunately over time this staining impregnates the tooth surface from the inside out. The tooth will appear bluish or blackish if this has happened. Usually the treatment of choice is to remove the damaged vessels by means of a root canal treatment. See our post on root canal treatments if you need information about root canal treatments. The discolouration of the tooth can be improved by removing the stained material by means of internal tooth whitening.

Internal tooth whitening differs from normal tooth whitening , with internal tooth whitening we place whitening gel inside the tooth and the effect of the gel works from the inside out.

Once the tooth has been whitened it can be sealed with a composite resin or it may require crowning or veneer. It is important to note that if the tooth is not whitened or if the colour of the tooth is not improved then this may affect the final colour and shade of the crown or veneer.

Anterior teeth crowns are more commonly made of metal free materials such as Emax or Empress. These crowns usually give excellent  aesthetics  as they allow natural light to shine through in the same way as natural teeth. The disadvantage of this is that if the tooth underneath is discoloured then this will make the final crown or veneer also discoloured.

if you have any further questions please feel free to email or contact our practice

If you are considering dental implant treatment to replace all of the upper or lower teeth you have the option of choosing fixed teeth on implants or a denture on implants ( known as an overdenture on implants)

Lets start by discussed the advantages and disadvantages of each option

Fixed teeth.

This option is usually the more popular among patients. Having fixed teeth means that one is able to function, ie eat and speak with ease as the teeth are fixed and don’t move. Usually for fixed teeth a bridge is attached to the dental implants and 8-12 teeth are fixed usually by means of small screws to the implants that were placed into the jaw. Usually this treatment is carried out in just one day. The treatment of all on 4 or same day teeth means that one is able to remove problem teeth, place a minimum of 4 implants and fixed teeth attached to the implants on the same day. As the fixed bridge is secured to the implants by small screws its possible to remove the bridge without too much trouble. Naturally only your implant dentist will be able to do this as this will not be something you will be able to do yourself. Fixed teeth therefore are more easy to accommodate, better with biting and functioning and generally are more stable than a denture on implants. Patients also generally feel more comfortable with fixed teeth and psychologically patients prefer having something which is not removable frequently each day ( for example its recommended that an overdenture be removed and cleaned after meals.)

However the disadvantages of a fixed bridge are that the cleaning of the bridge is more complex and requires more time to maintain properly. Small brushes and floss need to be used each day in order to prevent the build up of plaque and food debris around the implants which hold the fixed bridge in place.

A fixed bridge treatment is usually more expensive than an overdenture.

One of the most important disadvantages of the fixed bridge is that there may be a lack of lip support with the final result. What does this mean. After losing teeth our jaw bone usually shrinks, and when this happens the lips which are supported by the jaw bone changes form. In the upper and lower jaws it may cause patients to look older with the onset of loss of teeth. If a patient has been wearing full dentures for a long period time and the bone loss has been extensive or severe then a fixed bridge may not provide the same amount of support as there was before with the full removable denture. This is unfortunate as the patient may be presented with a dilemma of fixed teeth but poor aesthetic result at the end of treatment. The lip support is very important when choosing which option to consider as a lack of lip support can drastically age the appearance of the individual.

Denture on locators

In this option a denture is made which fits very accurately onto implants. The denture either upper or lower usually clicks into position and is maintained stable by the implants and some small unique attachments usually called ‘locators’.

The overdenture provides good function as the teeth are secured and stable with the help of the implants. A very small amount of movement will exist between the denture and the implants as the teeth are removable and not fixed. I am referring to a movement of less then 1 mm in all directions. In order to remove the overdenture the patient will need to exert some force in order to remove the denture. Usually a small click is heard when the overdenture is seated correctly and when it is removed.

As discussed above the overdenture will provide good function and allow patients to eat comfortably and speak without the overdenture moving. It is recommended that the overdenture is removed after meals for cleaning and overnight. This is one of the advantages of the overdenture over a fixed bridge as some patients may have difficulty in keeping a fixed bridge properly clean. This can be due to arthiritis or lack of manual dexterity in order to keep the fixed bridge clean. In these cases an overdenture may be better in order to allow patients to clean their teeth and be able to visually see that the overdenture has been thoroughly cleaned. Cleaning the implants in the mouth is considered easier than a fixed bridge as this will only require a normal brush. Its very important that when cleaning implants which support and overdenture that the patient is able to see that the implants are properly cleaned. The implants and their locator attachments are easy to clean and don’t usually attract plaque as they are highly polished surfaces and plaque does not usually adhere to them however if plaque is left for long enough then this will eventually accumulate around the implant and the locator attachment. Studies have shown that this plaque around implants can cause gum disease around implants known as peri implantitis.

An overdenture on implants will also provide very good final aesthetic results. Because bone shrinks when natural teeth are removed the jaw will change shape. By using an overdenture one would be able to replace this missing bone and tissue. In doing so the natural proportion of the mouth will be better and hence the final result can be aesthetically better than if a fixed bridge were used.

An overdenture on implants is usually cheaper than fixed teeth.

An overdenture on the upper jaw can sometimes be easier to speak with. Because the roof of the mouth is covered with the overdenture air does not leak through small air spaces which can sometimes be found with fixed teeth.

Lastly a denture on locators will require more frequent maintenance as the small clips which the denture uses to attach to the implants do wear out with time. This means that more visits will be required to change these small attachments every 4-6 months or so. The attachments are generally inexpensive and wear out due to the in and out movements several times per day.

Is there any age limit for having dental implant treatment ? Due to medical advancements the average population is living longer and meaning that more people may experience the need for long term permanent fixed teeth. In the past removable dentures have been a choice for tooth replacement however these are usually associated with discomfort and generally an inability to function properly. What’s more removable dentures do not accommodate changes in the jawbone, which occur when natural teeth are lost. When we lose our natural teeth, bone resorbs or in other words shrinks. This happens most soon after the tooth or teeth are removed. After about 1 year the bone changes continue to occur are less but still continue gradually over time. The gum tissues which cover bone and are usually the base on which dentures sit are therefore only accurate soon after a removable denture is made. As bone changes with time so do the gum tissues which cover the jaw bone. This means that removable dentures are not very accurate even after a few months after they are originally made

The good news is that dental implants can actually stimulate bone growth. The reason for this is that dental implants are placed into the jaw bone and hence provide some stimulus (during chewing and function) to the jaw bone. So the good news is that your jaw bone will not resorb as much  if you have dental implants as opposed to full or partial dentures.

In our clinic we have placed dental implants in patients over 90 years of age and there has been little difference in healing times or recuperation.  What’s more is the improvement in patients quality of life has been positively significant. Patients are able to eat healthier foods like raw vegetables, nuts and generally more nutritious foods when there is better chewing ability.

When dental implants are placed the procedure usually requires a number of visits. The implant is usually placed during a small operation, which may be carried out under local anesthetic or intravenous sedation. The implant treatment plan may be carried out in several ways. In certain cases implant placement with immediate function is preferred as this allows the implants to be placed and provisional teeth placed onto the implants in usually a one-stage procedure. The procedure is not possible in all cases as it depends on several factors including general bone volume and density. Having dental implants with immediate function can actually improve bone healing as recent research has shown.

It is important to always undergo a thorough examination prior to dental implant treatment. Your implant dentist will ensure that you are both medically and dentally fit before you are able to have dental implant treatment.

Many patients ask me how long do dental implants last. Well it can vary from person to person depending on several factors. Firstly its important that the implant is placed correctly. The implant placement should ideally be placed into good areas of bone with sufficient bone volume and density. Once the implant is placed and restored with a crown or bridge, it is paramount to maintain the implant as best as possible. Caring for a dental implant is similar to that of a natural tooth. Daily brushing and flossing is necessary to prevent plaque and food debris accumulation. The gum tissue around the implant is sensitive to similar diseases that affect gum tissue around natural teeth. Regular visits to your dentist and or hygienist will ensure that the surrounding gum tissues are well looked after and maintained healthy. The gum tissues around teeth are known as the periodontium and the gum disease around natural teeth is known as periodontal disease or periodontitis. Lastly the name used for gum disease affecting the tissues around dental implants is known as peri-implantitis.

ok so with general terminology discussed we can highlight what may affect the long term lifespan of dental implants. Oral hygiene is very important to maintain the adjacent tissues around dental implants and by brushing , flossing and using regular mouth rinsing one is able keep the areas around dental implants disease free. Factors which may affect oral hygiene like reduced brushing, heavy smoking may influence the long term life of dental implants. The dental implant crown or bridge may also fail in a small number of cases however this is usually due to mechanical failure or similar problems. Fracture of porcelain on dental implants may be corrected by simply changing the dental implant crown or bridge. Fracture of porcelain may occur for no apparent reason but usually this may indicate some heavy biting forces on the implant crown or bridge.

If one googles lifespan of dental implants its difficult to therefore get an accurate answer as to how long dental implants last. As we have discussed dental implants may last varying lengths of time depending on the implant placement and the maintenance of the dental implant over the time after the implant was placed. In practice we have seen some dental implants last more than 25 years so hopefully if you consider dental implants they will last as long as 25 years or even longer.