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I’m missing a tooth! Now what? – Part IV (Dental Implants)


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The final option to replacing a missing tooth is to get a dental implant.

A dental implant is, essentially, a titanium screw (some are made out of zirconium or a mix of titanium and zirconium).  It is meant to replace the root or roots of the missing tooth.  It is, in my opinion, the best option available to replacing missing teeth.  They can be used to replace a single missing tooth, to support a bridge, or to provide increased retention for a removable denture. They have a very high success rate of approximately 92-96% (depends on the area of the mouth that the implant is placed).  Getting an implant is usually a longer process, compared to the bridge or partial denture, but it is well worth the wait.

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The implant is composed of several parts.  For an implant crown, or bridge, you have the implant, an abutment (the intermediary piece) and the crown.  The implant is the part that is placed in the bone and replaces the missing tooth root.  Once the implant has integrated with the bone, it is ready to be restored.  You can get 2 kinds of crowns on top of that implant.  You can get a “cement-retained crown” or you can get a “screw-retained crown”.  The cement-retained crown is very similar to the crowns people get on natural teeth.  First, a part called an “abutment” is placed on top of the implant.  This is the intermediate piece that the crown will sit on.  After delivering the abutment, the crown is “cemented” on top, just as a conventional crown is cemented on top of a tooth.  The screw-retained crown is a crown where the abutment and crown are made as one piece.  There is a hole on the top of the crown where a screw is placed to screw down the crown into the implant.  After torquing the screw down, a tooth-colored filling is placed in the hole.  The difference between the 2 crowns is that the cement-retained crown is a little bit more esthetic.  However, if you ever have an issue with the crown, it may have to be cut off, in which case new moulds will have to be made in order to make a new crown.

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If there is an issue with the screw-retained crown, the dentist can just go in and unscrew the crown, correct the problem, and then screw the crown back into place.  It is retrievable.  The downside is that, sometimes, the screw access hole can be seen even with a tooth-colored filling covering it.  It doesn’t matter on upper teeth because the hole cannot be seen, but they can potentially be visible on lower teeth.  The screw-retained crown is also dependent on the position of the dental implant.  If the implant is not placed close to the center of the proposed crown, then a screw-retained crown may not be an option.  There is also a downside with cementing the crowns in place, in that sometimes the cement may seep down towards the implant fixture.  If cement is not completely removed, it can lead to bone loss around the implant, and ultimately the loss of the implant itself.  There are many things that can be done to minimize this risk, but having a screw-retained crown eliminates that risk completely.  If given a choice, I recommend getting a screw-retained crown, mostly due to it’s retrievability.

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How is replacing a single missing tooth better than getting a bridge or removable partial denture?  Well, a dental implant replacing a missing tooth is better than a removable partial denture because implants are fixed and do not come in and out.  They are better than a bridge because an implant is a single tooth and not 3 teeth splinted together.  Therefore, you are able to floss around an implant crown as you would all the other teeth in your mouth, as opposed to having to thread floss under the dummy tooth like you would have to do with a bridge.  The implant and the crown placed on an implant are all artificial.  There is no natural tooth structure supporting it like you have with a bridge or removable partial denture.  Therefore, you don’t have the risk of getting cavities on them.  Getting a cavity on a tooth supporting a bridge typically requires having to replace the bridge with a new one.  Getting a cavity on a tooth holding a partial denture in place would require a filling, at the very least, which could change the shape of that tooth and the way it holds a partial denture in place.  However, just like natural teeth, you can still get bone loss around an implant.  So oral hygiene is still very important.  But as I mentioned earlier, oral hygiene is easier to maintain because of the ability to floss around an implant “normally”.


There are usually 2 reasons for getting an implant-retained bridge.  These are treatment planned when the empty space is too long for a traditional bridge, which means only 2 options are available to these patients; a removable partial denture or implants.  The second reason is if a the patient is missing posterior teeth and there isn’t a tooth in back to hold a traditional bridge in place. Getting an implant to replace every missing tooth is unnecessary, but up to the patient.  If there are any financial constraints, or if additional surgery or grafts are needed for 1 spot, then an implant-retained bridge is a good option.  It allows for a shorter span bridge to be made; essentially, a empty space is about 2 teeth shorter when utilizing implants.  Again, the bridge is fixed and does not come in and out like a partial denture.  However, it is still a bridge, which requires a little more effort to floss under it.


Patients who are missing all their teeth in an arch, and want to have something fixed, will usually get implant-retained bridges as opposed to an implant for every single missing tooth.


Implants can also be utilized to help retain a removable partial denture in place, or a complete denture.  In regards to a partial denture, an implant would be placed next to a tooth that would normally be used to hold the partial denture in place.  A clip is placed on the implant, so the partial denture “clips” on top of it.  This eliminates the need for clasps around the tooth (which could be unsightly if made in metal and is visible), as well as takes the load off of the supporting teeth as well.  Not placing the partial denture on natural teeth gives these teeth a longer life span because they aren’t taking a lot of torque from the partial denture.


Similarly, implants are utilized with a complete denture to provide more retention.  These are also typically used with clips.  Lower complete dentures are notorious for being loose.  Unlike the upper complete denture, where you have the roof of the mouth to help attain retention/suction, the lower jaw is horseshoe-shaped and has the tongue and cheek moving around, making the denture more prone to becoming loose.  It is not a requirement, but a highly recommended treatment option for the lower jaw is to get 2 implants, minimum, which clip onto the complete denture. This provides the retention that many patients wish their conventional dentures had.  It also provides more mental security, knowing that the denture isn’t going to fly out of the patient’s mouth as they’re talking or laughing.  The quality of life improves significantly with these patients.  The upper jaw usually requires a minimum of 4 implants, and that is due to the quality of the bone on the upper jaw.


Another option for a patient who is missing all their teeth in an arch (or both arches), is what is known as hybrid dentures.  Some may know them as All-on-4 hybrids, or “teeth-in-a-day” hybrids.  There are several variations, but they all work on the same principle.  A hybrid denture is basically a denture that is screwed into the implants (as opposed to being held in with clips).  It is, technically, removable, but only by the dentist.  So, to the patient, the prosthesis is a fixed restoration (does not come in and out), and is made from the same material used to make conventional dentures (nowadays, complete zirconium hybrids are available as well).  The sides of the dentures that go over the jaw are eliminated, so the hybrid is a lot narrower and much more comfortable. These are placed on 4-6 implants.  As mentioned earlier, in regards to dentures with clips, the lower jaw requires 2 implants and the upper jaw requires 4 implants.  By adding 2 more implants on the lower jaw, or none on the upper, you are able to transition into a hybrid denture.  The cost is significantly more, but you are going from a removable prosthesis to a permanent/fixed one.  There is a huge difference and those who “upgraded” their existing dentures have commented at what a big difference it has made.  These patients have a greater sense of confidence with the hybrids, better ability to chew foods, and the luxury of NOT having to take their dentures out at night.



As you can see, implants have opened up the treatment possibilities for patients.  It can get overwhelming choosing between all the options, but that’s a good thing.  There are options for patients in all types of situations.  For example, a patient who only had a removable partial denture as an option, now has the option to get something permanent.  That patient can get an implant-retained bridge, or an implant to replace each missing tooth.  If that patient cannot afford the permanent option, then an implant can make a partial denture much more secure and esthetic.  Or the patient who comes in with several sets of complete dentures, all of which are loose or ill-fitting, now has the option to get something fixed and something that doesn’t come in and out.  These patient’s have their quality of life turned completely around for the better.

In fact, with the popularity of implants today, more and more insurance companies are starting to cover portions of the implant crown or bridge, as well as the surgeries themselves.  It wasn’t long ago when insurance companies would not cover any portion of implants because they would just say to get a bridge or partial denture.  That is no longer the case.  Implants have made a great difference in our field and in the lives of many patients.

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I’m missing a tooth! Now what? – Part III (Bridges)


The second option to replacing missing teeth is what’s called a fixed partial denture; most commonly known as a “bridge”. Some people confuse the term and call partial dentures, bridges. There is a big difference. The main one being, bridges are permanently cemented in your mouth, whereas a partial denture is removable.

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In order to get a bridge, the most important thing is there needs to be teeth on both sides of the empty space. A bridge is, basically, a crown (cap) on each tooth next to the empty space, with a “dummy” (false) tooth attached to them. This is then cemented into place; it does NOT come in or out. Like a real bridge, there is support on both ends and the bridge spanning between them. If there is only 1 tooth next to an empty space, USUALLY a bridge is not an option.


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Also important is the span of the empty space. If the empty space is too long, then either more teeth are going to be needed to help support the bridge, or a bridge may not be a good option to get. The longer that span is, the more the bridge can flex in the middle, which can compromise the integrity of the supporting teeth.  Whether or not an area can be restored with a bridge will be determined by the dentist, who will evaluate the length of the empty space, the amount of vertical space available, any supererupted teeth on the opposing arch, any parafunctional habits (grinding, clenching), etc.  All of these factors play an important part into the “restorability” of an empty space as well as the future prognosis of the fabricated bridge.  For example, if a patient comes in with an empty space that is on the longer side (several teeth missing) with a grinding habit that is significant, then that patient may be a candidate for a bridge, but the prognosis may be guarded afterwards; meaning, there is a higher chance that that bridge may fail sooner than a bridge replacing a shorter span empty space on a non-grinder.

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So, what are the pros and cons of bridges?

The pros are:

  1. They are a “permanent” restoration.  This does not mean that they are meant to last forever, but rather, that they do not come in and out like a removable partial denture.  There is no fear that this will accidentally pop out of your mouth as you’re speaking to someone.
  2. They are stronger than removable partial dentures.  Porcelain is a much stronger material than acrylic used in dentures.  Most people are able to chew and function as they had when they had natural teeth.
  3. There is no bulkiness or metal clasps as there are with removable partial dentures.  There is no lisping or learning curve as there would be with a removable partial denture.
  4. If the adjacent teeth need crowns anyway, a bridge can solve 2 problems at once.  It fills in the empty space and crowns the problematic adjacent tooth at the same time.
  5. Probably the most common method to restore a missing tooth.
  6. Success rates are pretty good, as long as hygiene is maintained.
  7. Can achieve very esthetic results, as compared to a denture.bridge collage


The cons are:

  1. Bridges, like crowns, are supported by natural teeth.  The problems you can have with natural teeth are the same type of problems you can have with teeth supporting a bridge.  You can still get cavities on these teeth and you can still get bone loss around them.  Having a bridge, or crown, on these teeth do not make them invincible to cavities and bone loss.  If you get cavities, you will likely have to replace the whole bridge.  If you get bone loss to the point where that tooth needs to be extracted, then you will need a new bridge that is longer.
  2. The teeth/crowns on a bridge are splinted together.  You cannot floss “normally” in-between them.  There is a special technique to floss under a bridge.  This technique tends to be more cumbersome and, ultimately, a lot of people end up not flossing under bridges at all.  However, hygiene with a bridge is very important since they are being held up with natural teeth (as mentioned earlier).  Issues with supporting teeth could lead to the need for a new bridge or a longer bridge.
  3. The porcelain could chip on a bridge.  This is the same risk you would have with a single crown.  The risk increases if you have a parafunctional habit, such as grinding or clenching, and the type of diet you have (hard foods, like almonds, hard candy, etc).  The only way to fix a chipped bridge is to get a new bridge.
  4. The preparation of the teeth for a bridge is determined by the angulation of these teeth.  The more parallel they are to each other, the better.  However, sometimes one of the supporting teeth may be angled/tilted too much.  Preparing the teeth to get them parallel to each other may end up involving the nerve of the tooth.  Therefore, in order to get a bridge, a root canal may have to be performed just to be able to get the preparations parallel to each other.
  5. The adjacent teeth may be perfectly fine teeth.  I like to call these teeth “virgin” teeth, meaning there are no fillings or cavities or anything wrong with the adjacent teeth.  If you want to get a bridge, you would have to prepare (or grind down) perfectly good teeth.
  6. The bone in our jaws pretty much has 1 purpose, and it’s to keep our teeth in place.  When we lose a tooth, the bone that was once holding that tooth in place TENDS to resorb away.  This resorption process differs in every person.  For some, this process may be fast.  In others, this process may be slow.  It is not something that can be predetermined.  So, although a bridge covers the empty space with a false tooth, there isn’t actually a tooth IN the bone.  There is a possibility that that bone could resorb (shrink) over time.  If this occurs, the space between the false tooth and the gums could become larger and larger.  This becomes an area where food can get caught more easily.  The more food that gets caught, the more flossing that needs to be done.  If not, more bone loss could occur on the adjacent teeth, which in turn, could cause more bone resorption as well.  It becomes this vicious cycle.  Again, the only way to correct this would be to get a new bridge that closes up the space between the false tooth and the gums.  Bone-Loss-under-bridgeThis bone loss could be vertical, but it could also be horizontal; meaning, you could have a concavity on the bone (see photo below).  So, if you move your finger along your gums, from the back of your mouth to the front, you will notice that, for the most part, it is pretty flat.  If there are some “bumps”, that is usually the root of your tooth pushing the bone out.  This is normal. However, if you’re missing a tooth, you may notice that as you move your finger across your gums, there may be a concavity or dimple in the area where you are missing a tooth.  This is caused from bone loss or resorption.  However, instead of lossing bone vertically, or away from your false tooth, you are losing bone horizontally.  This can also lead to more food trapping under the bridge, if the bone loss is significant enough.  This is a more difficult situation to correct, but one I will not get into just yet; mainly because getting a new bridge will not resolve the issue.       dsc_0644


I, personally, feel the pros outweigh the cons, and find that this is a very common, successful restoration to obtain.  However, it is still important to have all the facts available to make an informed decision for your future treatment.

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NEXT:  Part IV – Dental Implants

I’m missing a tooth! Now what? – Part II (Removable Partial Dentures)


I previously discussed the risks and complications of doing nothing to treat a missing tooth. For a patient who decides that they DO want to treat the missing tooth, there are several options. One option to treat missing teeth is a removable partial denture.

A removable partial denture (RPD) is a prosthesis that comes in and out of your mouth, and it replaces any missing teeth you may have. A single removable partial denture can replace 1 tooth or almost all the teeth on a single arch. They are typically the cheapest treatment option available. However, many find that having to take it in and out can become annoying.

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nesbit RPD

The removable partial denture is traditionally made with a metal framework with pink plastic or acrylic. The metal framework goes across the roof of your mouth (upper jaw) or around the backs of the teeth (lower jaw), and hooks onto some of the remaining teeth. These hooks, or clasps, help the partial denture stay in place, so it is important to have these placed on healthy, stable teeth. The denture teeth are then placed in pink acrylic, which replaces any missing teeth the patient may have.

Typically, before getting removable partial dentures, the dentist has to prepare some of the remaining teeth with dimples and grooves, which are made so that the metal framework can slide into the teeth. The dimples and grooves are called rest seats. This is where the denture sits on top of the tooth to prevent the dentures from pushing down into the patient’s gums and makes the dentures very stable.

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There are a couple disadvantages to getting metal framework partial dentures. One such disadvantage is that there may be situations where the clasp is going to be visible when a patient smiles, which will not be esthetic (as shown in the photo below). Another issue is that some patients may have allergies to the metal used in the framework, or to the acrylic.


A newer, more esthetic, removable partial denture option is the “flexible” removable partial denture. These are made of a thermoplastic material. They are usually all pink, but some can be clear. There is no metal framework, and the prosthesis itself is usually thinner and lighter than the traditional, metal type. Also, since they are flexible, they do not break as easily as the traditional dentures.


However, although they are more esthetic, they do have some downsides. Some issues that typically arise with these types of dentures are that they tend to push into the gums upon biting more often than compared with the metal types. The main reason for this is because flexible dentures do not have rests to stop the denture from pressing into the gums. This, in turn, causes sore spots and irritations. Therefore, flexible dentures usually require more adjustments in order to get them comfortable.

Flexible dentures are also harder to tighten around supporting teeth. In other words, over time, partial dentures tend to get loose. This is because the constant insertion and removal of the dentures loosens up the clasps holding them in place. With the metal partial denture, simply tightening the metal clasps makes the denture much more secure. However, with flexible dentures, it is harder to tighten the clasps due to the nature of the material. They CAN be tightened, just not a lot. This makes them more limiting than the metal clasps.


Finally, relining or fixing broken teeth or adding more denture teeth to the flexible dentures are much more difficult. The special material they are made of requires the dentist to have to send the dentures to the lab in order to correct problems. This means that the patient has to go around without teeth for a few days (if they don’t have a backup set), which can be especially stressful if the removable partial denture is replacing front teeth. Now, sometimes the metal dentures have to be send back to the lab as well, but there are more procedures that can be performed IN the office as opposed to the flexible kind.

There is also a third kind of removable partial denture. This is more of a hybrid of the two kinds mentioned above. These “hybrid” partial dentures combine the benefits of the metal framework partial denture with those of the flexible partial denture. As mentioned earlier, of the 2 kinds of removable partial dentures, the metal framework provides the better support (due to the rest seats). The hybrid type of partial denture also has a metal framework with rests, but the clasps (which can be an eyesore in certain areas, and therefore a disadvantage of the metal frameworks) are made of the same type of thermoplastic material the “flexible” removable partial dentures are made of. They can be gum-colored, or tooth-colored or clear. This provides the patients with the support of the traditional partial denture, but the esthetics of the “flexible” partial denture. However, not all denture labs are able to perform this “linking” of the two different materials.

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The final type of removable partial denture is the interim partial denture. Some people know these as “flippers”. They are made of acrylic and are meant to be used on a temporary basis only. Some will have thin, metal clasps to help hold them in place. Usually, you will see these when a patient gets a tooth extracted and then an implant placed. These are used to help with esthetics (front teeth) or the bite (back teeth) as the implant is healing. These may also be used to transition a patient into complete dentures. It gets them slowly used to wearing dentures until they are ready to lose the rest of their teeth.


These interim dentures are made completely of acrylic so they are more prone to breaking. The metal clasps tend to be thin and distort easily as well. However, they are very affordable and can be made quickly. But, as I mentioned earlier, they are meant to be temporary only.

So, what are the pros and cons of removable partial dentures?

The pros:

  1. They are the most cost effective treatment option to replacing missing teeth.
  2. Only 1 partial denture is needed per arch, no matter how many teeth are missing (of course, all the teeth cannot be missing). So, if you’re missing some teeth on your upper left jaw and some on your upper right side, one removable partial denture will replace all those missing teeth. With a bridge, you would need 2 different bridges to replace the teeth on both sides of the jaw (as will be discussed in the next section).
  3. They improve chewing function as well as esthetics (as opposed to doing no treatment).
  4. If a tooth is extracted after getting a removable partial denture, a dentist can usually add another tooth in it’s place, still utilizing the same denture.

The cons:

  1. They are removable. They come in and out. It is highly recommended dentures be taken out at night (or 8 hours during the day), so that the gums are given a chance to rest from being under the dentures all day. Otherwise, the patient runs the risk of getting fungal infections under the dentures. Many patients find this cumbersome and annoying; in fact, many end up just keeping them in their nightstands and not wearing them at all. There are some patients who don’t want their significant others to know they’re missing teeth and refuse to remove these dentures, which can lead to other issues. Others are constantly worried that the dentures are going to fly out of their mouths while they talk or laugh.
  2. Patients have to get used to having something going over the roof of their mouths or around their teeth, as well as the bulkiness of the dentures. This causes lisping in most patients (although most start to talk normally after approximately 10 days).
  3. Denture teeth are not as strong as natural teeth. There can be a limitation to the types of foods a patient can eat.
  4. Can be unesthetic.
  5. They put more stress on the supporting teeth, which could potentially expedite tooth loss.
  6. They tend to accumulate more plaque in areas where the denture meets the supporting tooth, again, putting more stress on those teeth.
  7. They require relines over time. Peoples’ jaws tend to shrink when there is no longer any teeth. As the jaw shrinks, the denture doesn’t fit as well as it did originally, therefore needing relines. If the fit becomes really bad, then a new denture will have to be made.

These are all things that should be taken into consideration when thinking about getting into a removable partial denture.

SEE: I’m missing a tooth! Now what? – Part I

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    I’m missing a tooth! Now what? – Part I


    After having worked 9 years or so as a dentist, there are some questions I am asked numerous times; throughout the day, even. One of those questions is “what are my options to fill this empty space” or some variation of that question. Patients come in after having a tooth extracted (pulled) and want to know what their options are to replace that now-missing tooth. Or they have a tooth that has been missing for years and now want to do something about it. Or they may have several missing teeth or all their teeth missing and want replacements for those teeth.

    There are several options to replacing teeth. And each of these options have different choices within them. So, for this one question, I will answer it in several parts. Each part will discuss a different option. I have broken them up into different parts because writing about all the options would make for a very, VERY long read.

    Learn more about: Dental Implants, Dentures and Bridges

    So, the first choice a patient has after having a tooth removed is to do nothing. Yes, that is an option. We don’t recommend that option, of course, but it is an option patients have. And an option that patients have chosen more than we would have liked. I find most patients who choose this option, do so because, one, they really could care less about replacing that missing tooth and are doing fine without a tooth there; two, have limited finances; or three, have had bad experiences with other options and are wary about getting those same options again.

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    Whatever reason a patient chooses to NOT do anything, there are several potential consequences. Basically, these are the RISKS of not doing anything to replace a missing tooth/teeth. As with most risks, these COULD happen or they may NOT happen. They could happen quickly, or they may happen slowly over a long period of time. Everyone is different as to how they respond to these conditions. Biology is difficult in that sense; we cannot say that EVERYONE will definitely experience these consequences, and we cannot predict who will exhibit these consequences and who will not. We can only say that these are things that USUALLY happen, so decide not to do any treatment option at your own discretion.

    Now, whether you are missing one tooth or several teeth, the risks are pretty much the same. Basically, teeth like it where there is no stress. So, if you’re missing a tooth, the opposing tooth can start to drift down into that new space (a process called supereruption), or the teeth adjacent to that missing space will want to drift into that area.  What happens if your tooth starts to drift? Well, one thing that could happen is that that tooth and an adjacent tooth will now have less contact with each other. In other words, there will be more space between that tooth and one that is next to it. If you look at the figure below, you can see in the lower jaw there is a tooth depicted with an arrow pointing to the right.  There is a space forming between this tooth and the tooth to its left.  This space will allow for more food to get caught between them. Food getting caught in between teeth causes irritation to the gum tissue and leads to more inflammation of that gum tissue. More inflammation could lead to more underlying bone loss. More bone loss leads to more tooth mobility (loose teeth), which can lead to even more movement of the tooth into the empty space. It’s a vicious cycle.

    Not only that, but more food getting caught in between your teeth is just more annoying as well. It means having to constantly go and floss food out from between those teeth every time you eat a meal. This may not necessarily be a bad thing because it usually gets patients to finally commit to treatment of that empty space. Patients come in fed up with having to pick food out from between their teeth, and want to proceed with whatever option will prevent that from happening again.

    And, if enough food gets caught, it can actually get painful. Many patients have come into my office thinking they have a toothache when, in actuality, it is just a lot of food impacted between certain teeth. Again, this tends to get patients to decide on treating their problem and not letting things linger as is.

    Another issue that arises when teeth drift into the empty space is that a patient’s bite slowly changes. When a tooth moves to a different position, their bite is going to be different. Some people notice this change, but most people do not realize a change in their bite has occurred. The movement is slight enough and slow enough, that our bodies accommodate to this new position without us even realizing it. However, that initial small change in their tooth position can lead to a cascade of events. Now, patients have unknowingly changed the way they bite into food, or change the way they bite down in general. This change in bite could ignite a grinding habit or clenching habit. That change in their bite could also alter the way that their temporomandibular joint (TMJ), or jaw joint, is positioned or rotating.


    If that joint is in an unideal position, it can lead to wear of the joint or the cushion between that joint and the skull. Patients may start to notice a pop or click in that joint. Eventually, that pop or click can start to cause discomfort or pain. Now the patient has developed temporomandibular disorder (TMD), a condition that can lead to severe pain in the joint itself, and even to headaches and neck, back and shoulder pains as well. All of which can lead to a diminished quality of life.  And if this condition is a result of excessive wear from severe grinding or clenching, then the typical treatment is full mouth rehabilitation.


    Again, this is worst case scenario, but still a potential to happen.  And if it does happen, it doesn’t necessarily happen all-of-a-sudden, in a matter of days.  It could take years to develop.  However, these are situations that can easily be avoided by treating the initial issue; the missing tooth.  As I mentioned earlier, there are patients who come in after having done nothing, to finally get treatment done to replace the missing tooth.  Timing is important though.  I have seen situations where a patient comes in and states that they have been having food get stuck between his teeth for years and they’ve finally had enough of it.  The patient comes in finally wanting to get treatment so that he doesn’t have to constantly pick food out from his teeth after each meal or bite.  However, some patients wait so long that a tooth has supererupted so much that it has drifted down into the space of the missing tooth and almost filling in the gap, or the adjacent tooth to the missing space has drifted so much that it is almost tilted at an angle greater than 45 degrees.  Now the patient is in a situation where if they want to “fill in the missing tooth”, they will need to extract, get root canal treatment, or get braces to correct the supererupted tooth in order to gain room for the restoration.  Or they will need to extract, get root canal treatment, or braces to correct the excessively tilted tooth in order to get a new restoration.  Basically, they have to treat more than just the missing area.  Timing is important.

                                    ccd36_02 download

    So, although “doing nothing” is a treatment option, it is definitely not one that is recommended in most cases.  And, although there are times when none of these consequences occur and patients  live many, many years without any issues, more likely than not some type of complication arises.  If it does, it is important to treat these issues sooner than later.

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    NEXT:  Part II – Removable Partial Dentures

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    The Birth of Premier Smiles

    So, this is the very first blog post of Premier Smiles. In fact, it is also the very first blog post for me personally. Having never blogged before, I hope I do this correctly (can these even be done INcorrectly?)
    I sat here for a while, trying to figure out what topic our first blog should be about. I finally came to a decision that I should write about Premier Smiles and how it came to fruition. Numerous patients have asked already, so why not blog about it.
    After dental school and the prosthodontics residency, I went to work in private practice. Things were going well but the commute was a little bit of a killer. At the time, the Woodrow Wilson bridge project was ongoing, and didn’t help matters at all. Completion of the project improved situations, but didn’t make things any more pleasant. So, why would I continue working at a place so far away for so long? A great staff and business partner, and the relationships built with the patients. It’s hard to leave a good thing, even if the commute is horrendous.
    So, several years later, my business partner and I decided to open up another office in Bethesda, Maryland. This was a much shorter commute (especially when using the Express lanes) and took away 2 days of having to commute to Southern Maryland. Things were good.
    Then there was the greatest life changing event that occurred in my life. The birth of my son, Ryan. Priorities changed instantly. Once things normalized (as much as things can “normalize” with a new child), and I was back to my normal routine, I started to realize how little time I was able to spend with Ryan. Wake up in the morning and get him ready for my wife to take to her mother’s place. Work. Come home. Feed Ryan dinner. Get him ready for bed. And repeat the next day. My wife and I had several discussions about this and how my commute gives me little time to really spend playing and interacting with my son. By the time I get home, it’s almost time to put him to bed. I needed to be closer to home so that I can spend more time with Ryan. And this, I guess you can say, was the initial spark that ultimately lead to the culmination of Premier Smiles.
    I came upon the future site of Premier Smiles pretty quickly. Our broker showed us several locations the first go-round, and I quickly narrowed down the options to our current location and 2 others. The current location used to be a dental office, so this became the more ideal choice for me. Clean things up here. Refine a few things there. I would be able to quickly and easily set up and start working. Unfortunately, things didn’t turn out as easy as I thought it would be. It turns out that treatment areas were going to be very cramped. And the setup of the other rooms were not ideal. Since this was going to be our new home for many years, I wanted to make sure we were going to be comfortable and that the patients would be comfortable as well. This, of course, meant I had a complete rebuild at hand; completely tear down the original office and start from scratch. Here are some “before and after” pictures of the new office!


    before & After breakroom


    Before & After hallway

    Patient Operatory:

    Before & After operatory

    Patient Lounge:

    Before & After waiting room

    Although this became a lot more time-consuming, and required a lot more planning, I believe that this was a blessing in disguise. Starting from scratch allowed us to make treatment rooms more spacious, not only for ourselves, but for our patients as well. It allowed us to design an office that “flowed” better. I want Premier Smiles to be a place where patients come in and feel comfortable and at-ease. Hopefully we were able to achieve that.

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