Posts for category: Dental Procedures
Ed Helms is best known for his role as the self-absorbed, Ivy League sales rep, Andy Bernard, on television's The Office. But to millions of fans he's also Stu, a member of a bachelor trip to Las Vegas in the 2009 movie The Hangover. In it, Stu and his friends wake up from a wild night on the Strip to find some things missing: the groom-to-be, their memories and, for Stu, a front tooth.
In reality, the missing tooth gag wasn't a Hollywood makeup or CGI (computer-generated imagery) trick—it was Ed Helm's actual missing tooth. According to Helms, the front tooth in question never developed and he had obtained a dental implant to replace it. He had the implant crown removed for the Hangover movie and then replaced after filming.
Helms' dental situation isn't that unusual. Although most of the 170 million-plus teeth missing from Americans' mouths are due to disease or trauma, a few happened because the teeth never formed. While most of these congenitally missing teeth are in the back of the mouth, a few, as in Helms' case, involve front teeth in the “smile zone,” which can profoundly affect appearance.
Fortunately, people missing undeveloped teeth have several good options to restore their smiles and dental function. The kind of tooth missing could help determine which option to use. For example, a bridge supported by the teeth on either side of the gap might work well if the teeth on either side are in need of crowns.
If the missing tooth happens to be one or both of the lateral incisors (on either side of the centermost teeth), it could be possible to move the canine teeth (the pointy ones, also called eye teeth) to fill the gap. This technique, known as canine substitution, may also require further modification—either by softening the canines' pointed tips, crowning them or applying veneers—to help the repositioned teeth look more natural.
The optimal solution, though, is to replace a missing tooth with a dental implant which then has a lifelike crown attached to it, as Ed Helms did to get his winning smile. Implant-supported replacement teeth are closest to natural teeth in terms of both appearance and function. Implants, though, shouldn't be placed until the jaw has fully developed, usually in early adulthood. A younger person may need a temporary restoration like a bonded bridge or a partial denture until they're ready for an implant.
Whatever the method, there's an effective way to restore missing teeth. Seeing us for an initial exam is the first step toward your own winning smile.
Dental implant technology has advanced at such an astounding rate in recent years that you can now walk into a dentist's office with a problem tooth and out the same day with a new one. Unfortunately, not all dental situations allow for this possibility.
For example, you might be considering an implant many years after losing a tooth. But there's a potential problem: there might not be enough supporting bone. While an implant might still be possible, inadequate bone complicates the matter.
Because implants are essentially tooth root replacements, they require a certain amount of bone for stability and the best attractive outcome. As a general rule, implants need to be surrounded by at least 1.5-2.0 millimeters of healthy bone to support an implant. But you might not have enough if your tooth has been missing for awhile, regardless if you have or haven't worn dentures or other restorations.
That's because bone has a life cycle in which older cells die and newer ones form to take their place. As we chew or bite, the force generated travels up through the teeth to the bone to stimulate this new growth. Without a tooth the bone doesn't receive this stimulus, which can slow the growth rate. Over time the affected bone can lose its volume and density.
If we find you've experienced loss to the point your bone won't support an implant, that doesn't automatically mean this popular restoration is out of the picture. But it will require us first performing a procedure known as augmentation or bone grafting to help rejuvenate some of the lost bone.
With grafting, we place processed bone grafting material in the jaw through a minor surgical procedure to form a scaffold for new bone to grow upon. After several months this can result in several millimeters of new growth maintaining the width of the underlying bone, which in turn may be able to support an implant.
Bone grafting is quite common, often performed at the same time as tooth extraction if there's going to be a time lag before installing an implant. Even if performed later, though, it can successfully rejuvenate lost bone and make it possible for you to take advantage of durable, life-like implants.
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 “Dental Implants after Previous Tooth Loss.”
Losing a tooth affects not only your smile but your overall dental health too. A dental implant solves both issues: it replaces the whole tooth, including the root, to merge durability with a life-like appearance.
For teenagers with a missing tooth, however, an implant may not be a good idea, at least until they've physically matured. Although their permanent teeth have usually all come in by puberty, the jaws and facial structure continue to develop into early adulthood. An implant placed too early could appear misaligned when the jaw fully matures.
The best approach for teens is a temporary replacement until they're physically ready for an implant. There are two good options: a removable partial denture (RPD) or a fixed bonded bridge.
Common among adults, an RPD is also a viable replacement for a teenager's missing tooth. An RPD consists of a prosthetic (false) tooth set in a nylon or acrylic base that resembles gum tissue. Metal clips formed in the RPD fit over adjacent teeth to hold the appliance in place; this also makes it easy to remove for cleaning or sleep time. We typically recommend an acrylic base for teens because it's easier to adjust if the RPD's fit becomes loose.
To hold it in place, a traditional bridge uses crowns on either side of the replacement tooth to bond over the natural teeth next to the open socket. Because this requires permanently altering the support teeth, we recommend a bonded bridge that doesn't.
This modified bridge uses wing-like strips of dental material on the back of the false tooth that project outward. With the tooth in place, we bond the extending portions of these projections to the back of the adjacent teeth, which secures the false tooth in place.
Of the two options, the bonded bridge is more comfortable, buys the most time and looks the most natural. But it will cost more than an RPD. Bite issues, teeth grinding, overall gum health or your child's level of hygiene conscientiousness could also nix it as a viable option.
Either choice will effectively replace your child's missing tooth until it's time for a permanent restoration. We'll help you weigh all the factors to determine which one is best for your situation.
While dental implants have become the most popular restoration among both dentists and patients, it’s primarily a tooth replacement — either for a missing tooth or a tooth beyond repair that must be extracted. But what if your tooth is still viable beneath its unattractive exterior? From an oral health standpoint, it’s usually wise to preserve it.
Even so, you still have options for making a tooth that’s spoiling your smile more attractive. One of the most effective solutions happens to be one of the oldest in dentistry: a crown. In effect, a crown is a life-like replica made of metal or dental porcelain that’s bonded over a tooth. And with today’s advanced materials and methods a crown can not only enhance the appearance of the tooth it covers, it can also be made to blend with the color and symmetry of adjacent teeth.
Here are a few dental situations where a crown could provide both protection for a tooth and a more attractive appearance.
Chipped, Damaged or Abnormally Developed Teeth. Teeth often take the brunt of mouth injuries, resulting in chips or even fractures. Also, teeth sometimes don’t erupt fully or develop a normal shape. A crown can effectively cover these missing or abnormal parts of a tooth and restore a more natural appearance.
Following Root Canal Treatment. Trauma or deep decay can damage the interior of a tooth - the pulp and root canals - and endanger its survival. A root canal treatment cleans out and repairs these areas, filling them with a special filling to prevent further infection. A crown is usually necessary to both protect the tooth and restore its appearance.
Discoloration. There’s a difference between outward staining of the enamel, which can usually be brightened with whitening solutions, and staining deep within the tooth from various causes. While there are techniques to bleach “intrinsic” staining, a crown provides another option for covering a heavily discolored tooth for a more attractive appearance.
Excessive Wear. We all experience some teeth wearing as we age; but grinding or clenching habits can accelerate that wear and shorten teeth, resulting in a prematurely aged look. Crowns restore worn teeth to a more normal length that can take “years” off your smile.
If you would like more information on crown restorations, 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 “Crowns & Bridgework.”
Sometimes it seems that appearances count for everything—especially in Hollywood. But just recently, Lonnie Chaviz, the 10-year-old actor who plays young Randall on the hit TV show This Is Us, delivered a powerful message about accepting differences in body image. And the whole issue was triggered by negative social media comments about his smile.
Lonnie has a noticeable diastema—that is, a gap between his two front teeth; this condition is commonly seen in children, but is less common in adults. There are plenty of celebrities who aren’t bothered by the excess space between their front teeth, such as Michael Strahan, Lauren Hutton and Vanessa Paradis. However, there are also many people who choose to close the gap for cosmetic or functional reasons.
Unfortunately, Lonnie had been on the receiving end of unkind comments about the appearance of his smile. But instead of getting angry, the young actor posted a thoughtful reply via Instagram video, in which he said: “I could get my gap fixed. Braces can fix this, but like, can you fix your heart, though?”
Lonnie is raising an important point: Making fun of how someone looks shows a terrible lack of compassion. Besides, each person’s smile is uniquely their own, and getting it “fixed” is a matter of personal choice. It’s true that in most circumstances, if the gap between the front teeth doesn’t shrink as you age and you decide you want to close it, orthodontic appliances like braces can do the job. Sometimes, a too-big gap can make it more difficult to eat and to pronounce some words. In other situations, it’s simply a question of aesthetics—some like it; others would prefer to live without it.
There’s a flip side to this issue as well. When teeth need to be replaced, many people opt to have their smile restored just the way it was, rather than in some “ideal” manner. That could mean that their dentures are specially fabricated with a space between the front teeth, or the crowns of their dental implants are spaced farther apart than they normally would be. For these folks, the “imperfection” is so much a part of their unique identity that changing it just seems wrong.
So if you’re satisfied with the way your smile looks, all you need to do is keep up with daily brushing and flossing, and come in for regular checkups and cleanings to keep it healthy and bright. If you’re unsatisfied, ask us how we could help make it better. And if you need tooth replacement, be sure to talk to us about all of your options—teeth that are regular and “Hollywood white;” teeth that are natural-looking, with minor variations in color and spacing; and teeth that look just like the smile you’ve always had.
Because when it comes to your smile, we couldn’t agree more with what Lonnie Chaviz said at the end of his video: “Be who you want to be. Do what you want to do. Do you. Be you. Believe in yourself.”
If you have questions about cosmetic dentistry, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Beautiful Smiles by Design” and “The Magic of Orthodontics.”