Posts Tagged ‘Dr. Gordon Christensen’

Frequent Failures: Diagnosis and Treatment Planning

Friday, July 10th, 2009

The dental experience is very often and hopefully a routine visit involving your periodic cleaning, some x-rays, a checkup, and maybe a minor correction, such as a filling. However, about every three to five years it is recommended by the American Dental Association that you have a full mouth evaluation with x-rays of all the roots. It’s very tempting to put that off, but I can attest to the fact that this is where we find most of the serious problems. Nobody likes to go looking for trouble, but it will surely gather some buddies and come looking for you otherwise.

It’s good to have an edge, so I thought it might be helpful to be armed with the knowledge of some common pitfalls when faced with the possibility of more involved treatment. These are the most frequent causes of failures based on my experience and a report by a very popular and wise prosthodontist, Dr. Gordon Christensen. This will be a six-part series that we hope might help you avoid any failures.

The first consideration is, of course, the first step in your journey: the exam. Be sure to be very thorough in your approach to making decisions that could mean the difference between a happy or sad outcome. Have your dentist take full mouth x-rays, pictures, study models, periodontal charts, and a current health history. It shouldn’t be too expensive, because most of this work can be done by the assistants, and when the dentist does the exam and makes recommendations, he will be dealing from a full deck. Ask questions, find out about alternatives, and request additional educational materials to familiarize yourself with the situation.

Take an active role in planning your treatment, and when you and your dentist make your plans, remember these hints: Use specialists for the more complicated root canals, extractions, gum surgery, and so forth. Don’t get too heroic in trying to save problem teeth, such as trying to save just one of the roots, or redoing root canals that have failed once or twice. Use posts liberally to strengthen the teeth that have had root canals – especially in areas of stress, such as bridge supports. If you are trying to improve the appearance of teeth with fluoride staining (flourosis) or very dark or striped teeth, you will get a far more aesthetic result with opaque porcelain crowns rather than bleaching or veneers. That will also give you a better success rate because of other factors in badly stained teeth such as bonding problems and weakness from cracking. Speaking of weakness, if you’re planning a filling that is too wide, it would be a much wiser choice to do a crown or an onlay, but not a fired ceramic inlay that has become so popular recently. They break too easily. Use cast porcelain. Finally, if you’re using any metals, stay away from the most allergenic metals, such as nickel, chromium, copper, palladium, and mercury, which by some strange coincidence happen to be the most commonly used metals in dentistry.

Dr. Moulton’s article was published in the Desert Valley Times, March 2007

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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

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Choose Success: Implants

Wednesday, July 8th, 2009

In Dr. Gordon Christensen’s report on how to avoid the most frequent causes of failures in dental procedures, he offers assistance to dentists by pointing out statistics gathered by one of the most unique research organizations in the world. His creation, the Clinical Research Associates (CRA) in Utah, is entirely self-funded. Any profits are either given to charity or reinvested in further research for the benefit if dentists and patients everywhere. Since no manufacturers donate to CRA, they can be totally objective without deference to any company or product. The manufacturers of these products hate the CRA with a passion.

I would like to share this information with you because I believe it’s in the interest of your safety and success. The second of our six-part series deals with dental implants. To me, this is one of the most exciting developments in dentistry. You can get your teeth back! And the prognosis is, on the average, every bit as good as natural teeth. The success rate is higher than any prosthesis in dentistry or medical science for that matter.

Usually, the first question we get is how soon can they be finished? The answer is anywhere from immediately to up to six months, but your success rate drops significantly the sooner you put a tooth on the implant, or “load” it. The bone needs about four to six months to fuse to the special coating on the implant body or root. Depending on its position, type, size, and environment, the success rate after that amount of time is from 95% to 99%, however if it is immediately loaded that figure goes down to 90% to 95%. Dr. Christensen advises against that. Your chance of failure could go up to one in ten if you rush it.

When I started practicing dentistry, the success rate of implants was estimated at an optimistic 80%. That’s one failure in five. I refused to do them and advised my patients against them. If they insisted, I sent them to another dentist. So you can guess how I stand on immediate implants.

Well, if the Supreme Court has their way, I could be guilty of pollution, so let me wrap this up with a few hints. I must be brief but technical, so write these down and discuss them with your dentist. Be sure you have adequate antibiotic coverage when placing the implant body. The direction of the implant should be in the direction of the biting forces. There should be no gum disease around any other natural teeth. Use custom abutments for single implants. Don’t connect implants to natural teeth. Attach the tooth or crown with cement rather than a screw, and make sure the bite isn’t too high. Finally, when doing implant-supported partial dentures and dentures, avoid long cantilevers, rigid retainers, and high noble framework.

Dr. Moulton’s article was published in the Desert Valley Times, April 2007

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