You’re ready to have that missing tooth replaced with a dental implant or other life-like restoration. But we may first have to address another problem — moving the teeth around the missing tooth space back to where they should be.
That empty space is the primary reason those teeth are no longer in the right position. Through their attachment to the periodontal ligament that lies between them and the bone, teeth are able to move slightly over time in response to mouth changes. This same mechanism, however, may also cause teeth to “drift” toward each other across the empty space left by a missing tooth; too much drift and there won’t be enough room for the replacement tooth.
A fairly straightforward orthodontic treatment can restore drifted teeth to their original position to make room for the replacement. There is one situation, however, that can complicate this treatment — if you also have periodontal (gum) disease, a plaque-induced bacterial infection. During normal tooth movement bone dissolves (resorbs) in front of the tooth in the direction of movement, while new bone forms behind it to help stabilize the tooth in its new position. Gum disease, however, can weaken the bone around these teeth, inhibiting the natural rebuilding process of bone and connective tissue that could jeopardize the success of the orthodontic treatment.
It’s important, then, to first treat and bring the gum disease under control to restore health to both the gums and bone. It’s also just as important during orthodontic treatment to prevent another infection flare-up through renewed brushing and flossing and regular office cleanings and checkups. Choosing clear aligners over traditional braces to move the teeth could also help — unlike fixed braces that often make oral hygiene difficult, clear aligners can be removed to allow easier cleaning of teeth and gums.
Depending on your situation, the process for preparing your mouth for a tooth replacement can involve several procedures and healing time. But the end result — a brand new tooth that looks amazing — will be something to smile about.
A lot of time and effort goes into straightening your smile. But there’s a possibility it might not stay that way—and all that hard work could be lost. The same natural mechanism that enables your teeth to move with braces could cause them to revert to their old, undesirable positions.
So for a little while (or longer for some people) you’ll need to wear a retainer, an appliance designed to keep or “retain” your teeth where they are now. And while the removable type is perhaps the best known, there’s at least one other choice you might want to consider: a bonded retainer.
Just as its name implies, this retainer consists of a thin metal wire bonded to the back of the teeth with a composite material. Unlike the removable appliance, a bonded retainer is fixed and can only be removed by an orthodontist.
Bonded retainers have several advantages. Perhaps the most important one is cosmetic—unlike the removable version, others can’t see a bonded retainer since it’s hidden behind the teeth. There’s also no keeping up with it—or losing it—since it’s fixed in place, which might be helpful with some younger patients who need reminding about keeping their retainer in their mouth.
There are, however, a few disadvantages. It’s much harder to floss with a bonded retainer, which could increase the risks of dental disease. It’s also possible for it to break, in which case it will need to be repaired by an orthodontist and as soon as possible. Without it in place for any length of time the teeth could move out of alignment.
If you or a family member is about to have braces removed, you’ll soon need to make a decision on which retainer to use. We’ll discuss these options with you and help you choose the one—removable or bonded—that’s right for you.
If you would like more information on bonded retainers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Bonded Retainers: What are the Pros and Cons?”
For whatever reason, you’ve put off replacing a missing tooth for awhile. Now you want to fill that empty gap in your smile with a dental implant restoration.
But if your tooth’s been missing for a long time, there could be a problem with space. This is because the teeth on either side of the space may have gradually drifted into it, leaving no room for the implant. You could need orthodontic work first to return these teeth to their proper position.
We could use braces, metal orthodontic devices with wires threaded through brackets bonded to the teeth that are then anchored, usually to back teeth. The orthodontist uses elastics or springs as well as possibly incrementally tightening of the wire against the anchors. These techniques create pressure or tension on the teeth for the desired direction of movement. The teeth’s natural mechanism for movement does the rest.
But while effective, braces can be quite noticeable, an embarrassing thought for many adults having to wear them over several months of treatment. But there may be an alternative: clear aligners, a succession of slightly different plastic trays usually worn in two-week intervals. Sequentially wearing each tray gradually moves the teeth to their desired positions.
Though not appropriate for all bite situations, clear aligners have a number of benefits when they can be used. They’re nearly invisible to others and can be removed for hygiene tasks or rare special occasions. What’s more, the orthodontist may attach a temporary prosthetic (false) tooth to the trays to camouflage the missing space during treatment.
There’s one other issue you may have to deal with: if your tooth loss was related to periodontal (gum) disease, the gums and underlying bone may be in poor condition. In fact, substantial bone loss could rule out an implant altogether. But we may be able to remedy both gum and bone deficiencies through grafting or plastic surgery. It may be possible to regenerate enough bone to support the implant; and surgically repairing your gums will help ensure the implant appears natural.
If you have problems like these, don’t give up on your restoration goal just yet. With some orthodontic and dental work ahead of time, we may still be able to make implants a reality for you.
Is a chipped tooth big news? It is if you’re Justin Bieber. When the pop singer recently posted a picture from the dental office to his instagram account, it got over 2.6 million “likes.” The snapshot shows him reclining in the chair, making peace signs with his hands as he opens wide; meanwhile, his dentist is busy working on his smile. The caption reads: “I chipped my tooth.”
Bieber may have a few more social media followers than the average person, but his dental problem is not unique. Sports injuries, mishaps at home, playground accidents and auto collisions are among the more common causes of dental trauma.
Some dental problems need to be treated as soon as possible, while others can wait a few days. Do you know which is which? Here are some basic guidelines:
A tooth that’s knocked out needs attention right away. First, try and locate the missing tooth and gently clean it with water — but avoid holding the tooth’s roots. Next, grasp the crown of the tooth and place it back in the socket facing the correct way. If that isn’t possible, place it between the cheek and gum, in a plastic bag with the patient’s saliva or a special tooth preservative, or in a glass of cold milk. Then rush to the dental office or emergency room right away. For the best chance of saving the tooth, it should be treated within five minutes.
If a tooth is loosened or displaced (pushed sideways, deeper into or out of its socket), it’s best to seek dental treatment within 6 hours. A complete examination will be needed to find out exactly what’s wrong and how best to treat it. Loosened or displaced teeth may be splinted to give them stability while they heal. In some situations, a root canal may be necessary to save the tooth.
Broken or fractured (cracked) teeth should receive treatment within 12 hours. If the injury extends into the tooth’s inner pulp tissue, root canal treatment will be needed. Depending on the severity of the injury, the tooth may need a crown (cap) to restore its function and appearance. If pieces of the tooth have been recovered, bring them with you to the office.
Chipped teeth are among the most common dental injuries, and can generally be restored successfully. Minor chips or rough edges can be polished off with a dental instrument. Teeth with slightly larger chips can often be restored via cosmetic bonding with tooth-colored resins. When more of the tooth structure is missing, the best solution may be porcelain veneers or crowns. These procedures can generally be accomplished at a scheduled office visit. However, if the tooth is painful, sensitive to heat or cold or producing other symptoms, don’t wait for an appointment — seek help right away.
Justin Bieber earned lots of “likes” by sharing a picture from the dental office. But maybe the take-home from his post is this: If you have a dental injury, be sure to get treatment when it’s needed. The ability to restore a damaged smile is one of the best things about modern dentistry.
If you have questions about dental injury, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Porcelain Crowns & Veneers.”
If you're currently undergoing orthodontic treatment, you're no doubt looking forward to the day your braces come off. But that won't end your treatment just yet — you'll need to wear a retainer.
Teeth are held secure in the bone of the jaw by an elastic tissue known as the periodontal ligament. As the braces “pull” the teeth to their new position, the ligament stretches and the bone remodels around the teeth. But the ligament also has a tendency to rebound as the tension eases when the braces are removed. The teeth could then return to their original position, especially during the first few months.
To prevent this patients wear an orthodontic appliance known as a retainer. It maintains some of the tension once supplied by the braces to help keep or “retain” the teeth in their new position. Depending on your age and other factors, you'll have to wear one for at least eighteen months; some patients, especially adults, may have to wear one indefinitely.
You may be familiar with a removable retainer, one you can take in and out of your mouth. But there's another type called a bonded retainer that's fixed to the teeth and can only be removed by a dentist. With this retainer a dentist bonds a thin piece of wire to the back of the teeth where it can't be seen. You can feel it, though, with the tongue: an unusual sensation at first, but one easily grown accustomed to.
Unlike their removable counterparts, bonded retainers aren't noticeable, either to others or the wearer. They're especially appropriate for patients who may not be as diligent in wearing a removable retainer.
It does, though, have some disadvantages. The position of the wire running horizontally across several teeth can make flossing difficult. And as with any retainer, removing it could increase the risk of the teeth moving out of alignment.
There are a number of factors to discuss with your orthodontist about which type of retainer is best for your situation. If you do choose a bonded retainer, be sure you work with the dental hygienist on how best to floss the affected teeth. And if you do have it removed, have a removable retainer prepared so you can preserve that smile you've invested so much into obtaining.
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