Posts for: October, 2016
We treat most malocclusions (bad bites) with braces or clear aligners. But not all malocclusions are alike — some can require extra procedures to achieve successful results.
One such example is when incoming teeth crowd other teeth and cause them to erupt abnormally. The crowding also reduces the space needed to move the misaligned teeth to better positions. To make more room we'll often remove some of the teeth before undertaking orthodontics.
The key is to extract the right teeth. The best candidates are those whose absence will have minimal effect on both appearance and dental function. That's commonly the bicuspids, located right on the edge of the “smile zone” (the teeth most visible when we smile) between the cuspid (eye) teeth and the back molars.
Once we choose and remove the teeth our next concern is to protect the bone at the extraction site.Â The bone in our jaws benefits from the pressure created when we bite or chew. This stimulates new bone cells to form and replace older cells. Without it, as when we have a missing tooth, the amount of bone can diminish over time and affect the success of any future orthodontics.
To prevent this, we take care not to damage the gums and bone removing the tooth. We may also install a graft under the empty socket to encourage bone growth.
If we've removed teeth outside the smile zone, the resulting orthodontics will move teeth into the opened space. In the end, you won't even notice they're gone. Teeth lost or congenitally missing in the smile zone, though, may eventually require a replacement tooth. A dental implant is the best choice, but it should be put on hold for a younger person until their jaw has fully developed.
In the meantime, we can install a spacer or a temporary restoration to hold the empty space and prevent other teeth from drifting into it. This can be incorporated into braces or aligners, or with a removable partial denture or a temporary modified bridge.
Extracting teeth to aid orthodontics first requires a well-laid plan that could encompass several years. The end result, though, can be well worth the time and effort — better function and a new, attractive smile.
If you would like more information on the process of straightening teeth, 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 “Tooth Removal for Orthodontic Reasons.”
In real life he was a hard-charging basketball player through high school and college. In TV and the movies, he has gone head-to-head with serial killers, assorted bad guys… even mysterious paranormal forces. So would you believe that David Duchovny, who played Agent Fox Mulder in The X-Files and starred in countless other large and small-screen productions, lost his front teeth… in an elevator accident?
“I was running for the elevator at my high school when the door shut on my arm,” he explained. “The next thing I knew, I was waking up in the hospital. I had fainted, fallen on my face, and knocked out my two front teeth.” Looking at Duchovny now, you’d never know his front teeth weren’t natural. But that’s not “movie magic” — it’s the art and science of modern dentistry.
How do dentists go about replacing lost teeth with natural-looking prosthetics? Today, there are two widely used tooth replacement procedures: dental implants and bridgework. When a natural tooth can’t be saved — due to advanced decay, periodontal disease, or an accident like Duchovny’s — these methods offer good looking, fully functional replacements. So what’s the difference between the two? Essentially, it’s a matter of how the replacement teeth are supported.
With state-of-the-art dental implants, support for the replacement tooth (or teeth) comes from small titanium inserts, which are implanted directly into the bone of the jaw. In time these become fused with the bone itself, providing a solid anchorage. What’s more, they actually help prevent the bone loss that naturally occurs after tooth loss. The crowns — lifelike replacements for the visible part of the tooth — are securely attached to the implants via special connectors called abutments.
In traditional bridgework, the existing natural teeth on either side of a gap are used to support the replacement crowns that “bridge” the gap. Here’s how it works: A one-piece unit is custom-fabricated, consisting of prosthetic crowns to replace missing teeth, plus caps to cover the adjacent (abutment) teeth on each side. Those abutment teeth must be shaped so the caps can fit over them; this is done by carefully removing some of the outer tooth material. Then the whole bridge unit is securely cemented in place.
While both systems have been used successfully for decades, bridgework is now being gradually supplanted by implants. That’s because dental implants don’t have any negative impact on nearby healthy teeth, while bridgework requires that abutment teeth be shaped for crowns, and puts additional stresses on them. Dental implants also generally last far longer than bridges — the rest of your life, if given proper care. However, they are initially more expensive (though they may prove more economical in the long run), and not everyone is a candidate for the minor surgery they require.
Which method is best for you? Don’t try using paranormal powers to find out: Come in and talk to us. If you would like more information about tooth replacement, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Crowns & Bridgework,” and “Dental Implants.”