Teeth Extractions- What Patients Should Know...

Extraction of a tooth is is an emotionally traumatic experience, but the actual procedure does not have to be. If performed by an experienced oral surgeon, the procedure can be done easily and quickly with minimal complications and optimal comfort. IV sedation is a marvelous anesthesia option making the experience great.

Teeth require extractions for several reasons. These include:

• Severe caries (decay)
• Significant periodontal disease
• Significant pain due to infection / inflammation of the pulp (nerve of the tooth)
• Non-restorable due to position or significant caries
• Non-responsive to endodontic therapy (root canal procedure)

With modern day techniques and skills, teeth extractions can be done with minimal invasiveness and time. In fact, surgical removal of teeth takes only 5-10 minutes in most situations. The initial healing takes place in 48-72 hours and typically stable in 5-7 days. Complete healing of any extraction site takes about 6 weeks. Dental implant replacement can be done in 6-8 weeks after an extraction. It is crucial that at the time of extraction the supporting bone is inspected for any defects. The bone undergoes significant resorption and loss following a tooth extraction resulting in defects that are unsightly and difficult to maintain proper hygiene. Also, they create a poor site for implant placement later.

Therefore a site preservation grafting is recommended in the following situations:

• Augmentation of bone loss due to periodontal disease or abscess
• Enhancement of the tissue architecture in the upper front area (Aesthetic zone) to optimize aesthetics and smile line
• Preservation / Augmentation of bone necessary to allow placement of dental implants or other prosthesis at a later time

A transitional prosthesis may be fabricated and placed in the extracted site on the same day.

So here are the key information to remember about a tooth extraction:

1) Best performed by experienced oral surgeons

2) IV sedation is the preferred anesthesia option

3) Always replace the missing tooth with an implant to maintain oral health and condition of other teeth

4) Consider grafting procedures to preserve your jaw bone and maximize on function and aesthetics once restored

For more information, contact Dr. H. Ryan Kazemi at hkazemi@facialart.com

Visit our website: www.facialart.com

Office Telephone: (301) 654-7070

Office location: Bethesda, MD

Visit our video podcasts on:
1) iTunes: search word- 'dr. kazemi'
2) Vimeo.com: search 'dr. kazemi's oral surgery channel'
3) YouTube: search 'implantguru'

Computer-Assisted Planning For Placement of Dental Implants

Dental implants have become the optimal treatment option for replacement of missing teeth. They have 98% + success rate and have allowed many patients achieve normal eating and smile without the irreversible damaging effect of other alternatives such as bridges or dentures.

To achieve optimal functional and aesthetic results with dental implants, it is crucial that the patient has adequate bone and gum tissues and the implants are positioned properly in all dimensions. Utilizing readily available office CT scans, it is now possible to obtain cost effective cross sectional images of the patient's jaws that can then be converted to 3-dimensional images. These images reveal accurately the dimensions of the existing bone as well as the vital anatomical structures in proximity, such as nerves and sinuses. Often, the dentist first makes a special prosthesis (embedded with barium sulfate) that takes into account the final bite and teeth positions. Patient then wears this prosthesis during the CT scan creating radiological marks on those images. These marks represent the future sites of the crowns and the proposed positions of the dental implants, a critical tool in initial diagnosis and planning.

Utilizing a special software, we then convert the obtained CT scan into 3-dimensional computer images that give us a 360 degree view of the patient's jaw, available bone, its anatomy, and the surrounding vital structures. Next we place virtual dental implants in their previously determined and planned positions guided by the marked sites on the CT. The result is a computer model demonstrating the the existing bone anatomy, vital structures, and accurately positioned dental implants that will eventually support the patient's teeth.

This 3-dimensional computer model is then used to fabricate a surgical guide or stent that translates the implant positions in the computer to a working jig that will be used by the oral surgeon during placement of the implants. These custom made gigs are extremely well fitting allowing the surgeon to easily and accurately place the implants in their appropriate positions. Once healed, the implants can easily be restored by the patient's dentist knowing the foundations (i.e. dental implants) are in the right place and orientation.

We are utilizing this cutting edge technology on many patients allowing us better diagnosis, less complications, more accurate implant positioning, shorter and less invasive surgeries, and enhanced results that meets the patients' goals.

Dr. H. Ryan Kazemi is a board certified oral and maxillofacial surgeon in Bethesda, Maryland. He is a clinician and lecturer on the topic of dental implants, bone grafting, and other oral surgery procedures. He also produces video podcasts on dental implants and oral surgery to educate dentists and patients for making better and more engaged decisions about their oral health.

To reach Dr. Kazemi for this story and others:

Email: Hkazemi@facialart.com
Tel: (301) 654-7070

web: www.facialart.com

Visit our video podcasts on:
1) iTunes: search word- 'dr. kazemi'
2) Vimeo.com: search 'dr. kazemi's oral surgery channel'
3) YouTube: search 'implantguru'

Dental Implants in the Smile Zone- Keys for Success

Loss of a front tooth, whether due to an accident or decay, can be a very traumatic experience for a person. Dental implant is a great treatment option for replacement. However the front teeth and the surrounding smile zone present unique challenges that make therapy in this area amongst the most difficult to do. It requires the most expertise in both diagnostic and technical protocols. Here are the 5 key principles every patient should know, on how to achieve great results with Dental Implants in the Smile Zone.

Historically, patients had either a bridge or denture to replace their missing teeth. While a bridge offered satisfactory aesthetic results, it was too invasive and damaging to adjacent teeth due to the required preparation or ‘cutting down’. And a denture was aesthetically unpleasing, and difficult to wear and chew with; and often resulted in further damages to other teeth and supporting bone.

Dental implants have 98% + success rate, and are now the mainstay in teeth replacement therapy. But the aesthetic zone in the upper front area presents unique challenges which must be carefully addressed by the clinicians for optimal results.

Here is the problem: Loss of a tooth results in significant shrinkage of bone and overlying gum tissue in the region of the front incisors and canines. Also there can be additional remodeling and shrinkage after implant placement or grafting procedures . All of this, if not addressed, will result in an uneven gum line, poor aesthetics, difficult cleansing, and even failure of the implant in the long run. So here are the 5 key principles in achieving a result that you will love:

1) ‘Fail to Plan’; ‘Plan to Fail’

During the Initial Diagnosis and Planning, both the surgeon and the restorative dentist must collaborate closely and evaluate the following: Bone and Gum tissue level and thickness; Periodontal health; Smile line; and the position of other teeth. This requires x-rays or other imaging techniques, detailed examination, and study models which are all vital to a proper diagnosis. Study models can further be used for simulation of the final crowns, fabrication of a temporary prosthesis for the patient and making a special guide aiding the surgeon during implant placement. The surgeon and the restorative dentist, each with expertise in their field, should then review the gathered information and design a collaborative detailed plan to achieve a patient’s realistic goals. This plan, along with impending challenges, possible solutions, and associated risk factors should be throughly be discussed with the patient. Team communication is vital to executing the plan and ultimate success.

2) Preserve the foundation

Extraction of a tooth consistently results in loss of bone and the overlying gum tissue . This can easily be prevented by making sure that the surgeon grafts the site at the time of the extraction. Preserving the bone also maintains the overlying gum tissue, therefore creating a healthy foundation for the implant and its crown. The graft materials most often used for this type of procedure are calcified granules supplied in individual containers and it is rarely necessary to obtain it from the patient in form of actual bone. These materials promote bone healing in an extraction socket and minimize its shrinkage. Another way to preserve the foundation is placement of the implant at time of the extraction. This is known as ‘immediate implant’ and can be done predictably in appropriate sites. Finally, the temporary prosthesis, whether removable like a flipper or fixed like a bonded temporary crown, needs to be carefully shaped to guide the gum tissue during its healing.

3)Precise positioning of the implant by surgeon

With a healthy foundation, the surgeon can now place the dental implant. But it is most crucial that the implant is positioned properly in all dimensions including Height, width, and depth, and angulation. A poorly positioned implant is grounds for disaster and results in poor aesthetics and function. A simple rule is “To Never Place an Implant in Wrong Position”. This is accomplished by using a surgical guide made on study models or by using Cat scan generated computer planning. While the actual placement of a dental implant is simple, safe positioning and handling of the supporting tissue can be complex and should be performed by an experienced and skilled clinician.

4) Shaping the gum tissue

During the implant healing, the gum tissue architecture is further designed by placement of a temporary crown on the implant. This is one of the most crucial steps and is often overlooked or rushed. It is the only way to create the desired gum tissue level and shape as well as providing a patient a ‘glance’ of what the final crown will look like. In some situations and if appropriate, an immediate temporary crown may be placed on the same day as the implant. Otherwise it maybe placed several weeks later. Either way, the temporary crown should be left in place for 3-4 months to ‘design’ the proper gum tissue architecture as well as give patient the opportunity to provide feedback on its appearance and comfort.

5) Final Crown

The temporary crown provides a lot information that can be used to make the final crown look more natural, comfortable, and pleasing to the patient. Depending on the smile line, gum tissue thickness, and its shape, the restorative dentist may decide to use metal or ceramic extensions to support the final crown. Known as abutments, these extensions must have proper contour to create a natural and healthy gum line and crown. In the smile zone, it is crucial to use customized abutments that are fabricated in a laboratory, and not use ‘off-the-shelf’ abutments which are reshaped chair side by the restorative dentist. It is the use of customized abutments that allow optimal gum tissue architecture, aesthetics, and crown fit. The final crown itself may be made of either porcelain with underlying metal or completely out of ceramic material. This decision must be made by the restorative dentist based on aesthetic requirements of that specific patient. Finally it is important to use a quality laboratory and technicians who understand the demands of implants in the aesthetic zone and can work closely with the restorative dentist to make high quality crowns.

Losing a front tooth is a devastating experience for most people altering their self image, confidence, and social interactions. Dental implants offer a great solution for replacement however must be performed carefully by clinicians who have in-depth understanding of its challenges, biology, and the strict protocols required for optimal success.

For the video podcast of this blog, go to itunes (search word dr. kazemi) or vimeo.com (Dr. Kazemi's oral surgery channel), or visit our website: www.facialart.com (To-The-Point Multimedia Platform- 10 minute updates)