Posts Tagged ‘Bridges’
PLAN FOR SUCCESS: CROWNS AND BRIDGES
Wednesday, July 8th, 2009
Here’s some inside information on how to increase the chance of success of dental procedures, based on research by Dr. Gordon Christensen. Our last category is concerning crowns and bridges. A crown covers the entire tooth and is used mainly when the tooth is weakened too much by decay or cracking. The decay is removed, and also the enamel surface of the tooth, so it can be replaced by a custom-made form which is bonded permanently onto the remaining tooth. This holds the tooth together, and it can be made of porcelain, metal, or a combination of the two.
If you’re a tooth grinder, the old school of thought was to make any crowns with a metal biting surface, but now the new, nonabrasive low-fusing porcelain is better. However, it is still a good idea to find out why you’re grinding your teeth and correct that.
So here is your first hint. Whether it’s in preparation for a crown, or just to replace an old filling, have your dentist remove all of the old filling material first. The failure of that filling is the reason you are replacing it or crowning it, and the likelihood that there is further leakage and decay is very high. It is one of the basic lessons we learn in dental school, and yet, more than half the crowns I see, and practically all the failed ones have old filling material underneath them. And when we remove that old filling material it is just loaded with decay which had continued to grow underneath the crown.
Now let’s move on to what is known as the fixed bridge. It is used to replace missing teeth by preparing the surrounding teeth for crowns, and when the crowns are made, the missing teeth are fused in between them and the whole thing is cemented permanently to the remaining teeth. The fixed bridge used to be the gold standard in tooth replacement, but the new implant systems have surpassed them in success rate and they are much more conservative. However, there are still many situations which would favor the use of a bridge, and these tips might help you plan them more successfully.
The chance of failure grows exponentially with the size if the bridge. The bigger the bridge, the more complicated the stresses and the chewing patterns become. The more teeth involved, the more chances you have of one of them failing for an inaccurate fit, recurrent decay, gum disease or fracture, and often one such problem can destroy the whole bridge. Try to keep it down to three to five units per bridge (that includes crowns as well as missing teeth).
Avoid the use if cantilevers. Those are bridges that have one or more missing teeth that are not supported on both sides by natural teeth. They have an extremely high failure rate.
Never splint two teeth together in order to hold one of the crowns in place. That crown will still come loose just as easily, except then you may not realize it until after the tooth has been destroyed by decay and infection because that crown won’t fall off since it is being held in place by the other one.
Finally, be diligent in your evaluation of your treatment options, and in the proper maintenance afterward. There are usually more than one way to treat a particular problem, so if your dentist only gives you one choice, ask a lot of questions to find out what the other options are and what are their expenses, success rates, limitations and aesthetic considerations. For instance, when a nerve becomes infected, you might assume that your only choice is root canal therapy, but if your main concern is longevity, replacing it with an implant could be a much better choice. And when the treatment is completed, many people think that they’re good to go for a long time without any further care, but in actuality, the more involved the treatment has been, the more maintenance is necessary. So protect your investment with regular check-ups and cleanings.
Dr. Moulton’s article was published in the Desert Valley Times, May 2007
Tags: Bridges, cantilevers, Crowns, decay, Dr. Gordon Christensen, enamel, fixed bridge, implant, metal, old filling material, porcelain
Posted in Restorative | No Comments »
The New Order
Tuesday, June 30th, 2009
In the olden days, there seemed to be an order of things that would prompt a person to go see their dentist for care.
The first concern for most patients was pain, followed by appearance, decay, gum disease, and missing back teeth, respectively. Many patients would only seek dental treatment when they were experiencing extreme pain, or if they were not happy with the look of their front teeth. Cavities, gum problems, and spaces where teeth were extracted were often ignored.
With all of the new information we know about gum disease, it is necessary to change our list of priorities.
Pain is still the front-runner and greatest cause for concern. If a patient has a tooth-ache, it often means that there is an infection present, whether it is within the tooth itself, or the gums that surround the tooth. Dental infections can be very serious and should be taken care of immediately.
Periodontal, or gum disease, is the second most important priority. According to recent studies, more than half of all people over 18 have at least the early stages of periodontal disease. Periodontal disease is an infection that destroys the gum surrounding your teeth and also destroys the supporting bone that holds your teeth in place. Unlike most diseases that give us early warning signs, gum disease progresses silently, often without pain. It may develop slowly or progress quite rapidly. Not only is the loss of gum and bone a concern, but studies have proven that gum disease may increase your risk of a variety of health problems, including:
Heart disease
Weakened immune system
Diabetes
Stroke
Lung Disease
Preterm, low birth babies
Respiratory disease
Osteoporosis
Gastric ulcer
If you are already experiencing any of these health concerns, it is very important to maintain good oral health by visiting your dentist regularly.
Tied for third on the new list are decay and appearance. I’m sure most of you know that if decay is not kept under control, it can actually spread to other teeth in your mouth. Also, if decay is left in a tooth long enough, it will eventually reach the nerve of the tooth, often causing an abscess, or infection, in the bone. The tooth will then need a root canal, or may need to be extracted.
We all understand how prominent appearance has become in our society. Everyone wants to have a beautiful smile to share. There are many ways to achieve the smile you have been wanting, including whitening, “invisible” braces,
porcelain veneers, etc. Just remember that a beautiful smile is more than straight, white teeth. It is important to make your entire oral health a priority.
As before, missing back teeth are last on the list. But that doesn’t mean they are less significant than the other things.
When a tooth is lost and not replaced as soon as possible, the remaining teeth can drift out of position and change the bite. This can lead to cavities, gum disease, bite problems, and TMJ (joint problems in the jaw). All of your teeth work together to help you chew, speak, and smile. When teeth are missing, it is difficult to do these things. Even the loss of back teeth can cause your bite to shift and your face to look older. Fortunately, missing teeth can be replaced in several ways, including implants, bridges, and removable appliances.
As you may have noticed, the dental concerns we have discussed can often times be interrelated. Gum disease can cause tooth loss, and tooth loss can cause gum disease. A “tooth-ache” can be caused by gum disease as often as it can be caused by decay. Loss of teeth, swollen, red gums, and decay all affect our appearance.
Evidence shows that it is time to let go of the ‘old school’ mentality and embrace the new order of things. We cannot stress enough how important it is to visit your dentist to have oral examinations and cleanings done regularly. By keeping these recare appointments you will increase your chances of a healthy smile, but most importantly, a long, healthy life.
Dr. Moulton’s article was published in the Desert Valley Times, June 2007
Tags: abscess, Bridges, decay, Diabetes, gastric ulcer, gum disease, heart disease, Implants, infection, invisible braces, lung disease, missing teeth, Osteoporosis, periodontal disease, porcelain veneers, removable appliances, respiratory diesease, root canal, stroke, tooth-ache, weakened immune system
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