When are Dental Implants Recommended?

Dental implants are recommended only when the root of the tooth can no longer sustain itself in the jaw bone.  There are two general scenarios for the problem: 1.  The root has lost too much bone around it.  Bone loss can be caused by gum disease or excess bite trauma to a particular tooth.  Bone loss can happen in both vital teeth and root canal treated teeth.   If the bone loss is beyond the minimum volume for a sustainable implant, then bone grafting may be necessary before the implant can be placed.

2.  When the root is cracked from bite trauma.

a)  A vital tooth can crack from bite trauma, and the crack can extend deep into the root.  In this situation, root canal treatment and crown are not viable options because of the extent of the crack or fracture.

b)  Root canal treated teeth are essentially dead roots.   These roots are very brittle.  Even with a crown placed on the root canal treated tooth, that root can manifest a vertical crack line running along the length of the root.  In this case, bone loss begins to occur where the crack line exists, and the root is no longer salvageable.  Evidence of cracks in root canal treated teeth can be seen as an absess in the gum tissue surrounding the root.  Keeping these roots in the jaw for extended periods of time will result in more extensive bone loss, and the destruction can be seen on xrays of the surrounding bone area of the root.

The decision to extract and replace a particular root with a dental implant has to be substantiated by clinical evidence and radiographic evidence.

The following sample cases illustrate situations where the natural tooth root cannot be saved, and a dental implant would be an option to replace the tooth.

 

........................................................................................

Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry.  For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

Why Do Lower Dentures Hurt ?

I would like to dedicate this last dental blog entry of 2013 to patients who suffer pain from chewing with dentures. Most people think that the dentures put too much pressure on the gum, and so it hurts when they chew.  However, when a patient has very little bone left in the jaw, the nerves which normally run deep inside the lower jaw is usually the the cause of the pain.  In the image of my actual patient case below, you can see the two nerves ( in red on each side ) actually sit on the surface of the bone.

Alex Nguyen DDS.  Deficient Bone. ImplantView Alex Nguyen DDS.  Deficient Bone. ImplantView(1)_2 Alex Nguyen DDS.  Deficient Bone. ImplantView(2)_3

This is a severe case of bone loss leading to deficient arch form. When the denture pinches on these nerves, it is impossible to bite down without pain. The chewing efficiency is drastically reduced, and the quality of life is adversely affected for these patients.

It is important to understand the biology of bone as it relates to the chewing pressure.  If the bone is not continually stimulated by a tooth root, then the bone will resorb in both height and width.  Ideally, every tooth root that is lost should be replaced with an implant in order to preserve the volume of the bone around that root.

What then would be the solution to help denture patients who have inadequate bone, and whose residual nerves interfere with the denture bite force?

With proper comprehensive treatment planning using computerized 3D CT Scan, we can predetermine the exact location and size of the implants that can be placed in the bone.  Once the  implants are integrated with the bone, a prosthesis can be fixated on those implants to relieve all pressures from the underlying nerves and tissue.  In a matter of months, we can completely reverse this patient's years of agonizing pain from trying to chew with a denture on a deficient ridge.

Print Plan of Nguyen Hien - Mandible (Lossy JPEG & (CB)CT Compre

........................................................................................

Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

Is a CT Scan Necessary for Dental Implant Treatments?

In order to place an implant in the patient's jaw, we need to assess several criteria at the location of the planned implant.  Some of the important factors may include: 1.  The patient's bone height

2.  The patient's bone width

3.  The proximity to the nerves in the lower jaw

4.  The proximity of the sinus cavity in the upper jaw

Using a 3D Cone Beam Scan (CT Scan) we can precisely analyze all of the above criteria and predetermine the exact size and location of the implant prior to the surgical placement.

Here is a screen capture of the planning process for two implants to replace two missing molars in our actual patient's lower jaw.  The red line below the two planned implants is a nerve in the lower jaw.  That nerve is often the limiting factor in the lower jaw where some implants for posterior teeth may be needed.

Proper use of technology helps ensure optimum results and safety of dental implant treatment.

Gerardo

........................................................................................

Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

How Come the Color Could Never Match For Crowns on the Front Teeth?

The two front teeth are the most commonly restored teeth.  They erupt into the mouth at about the age of eight, and being positioned in front of the mouth they often sustain the most damage. Color is not the only parameter required to match the two front teeth with the rest of the teeth in the smile.  Among other factors, we have to also match contour, surface texture, and shade variations of different areas of the teeth.  Matching the front teeth is like sculpting a portrait of what they used to look like. That is the only way they will blend in with the natural dentition. Furthermore, the two front teeth serve as a very important guidance for joint stability and function.  We must approach the front teeth in more than one dimension.

When done correctly,  restorations for the front teeth will disappear into the rest of the smile.  Here is a testimony from a recent case I delivered last week.

.......................

Email dated 9/09/2011

Dear Dr. Alex,

I want to personally thank you for the wonderful job you did on my case. Although it took longer than I anticipated, it was worth the wait and I am very pleased with the end result. You definitely have the knack for how teeth should look and function. I really appreciate your thoughtfulness and professionalism. ...Again, I want to thank you for a job well done.

P.S. you will soon have another positive review on Yelp :)

Sincerely,

K

........................................................................................

Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

From a patient who moved to Hawaii

Email dated June 23, 2011 to her parents. Aloha Dad and Momma,

Dr. Jonathan Kam is my dentist who went to college at UCLA and Stanford. He told me that he knew Dr Nguyen from conferences and his excellent reputation. In fact, when Dr Kam examined my fillings, Dr Kam asked me who did my fillings because they were some of the best fillings he had ever seen and reported he was a "filling snob." I told him Dr Nguyen in San Jose did my fillings and Dr Kam said, "Oh my gosh, I know him! He is an excellent dentist and one of the best." Dr Kam told me to tell Dr Nguyen what an excellent job he did with my fillings. So, That's the story:)

 

The waves were huge in Waikiki today! They were about 15 ft and yes, I surfed them! It was really fun and I had a great time surfing because it is very rare that Waikiki has big waves like today. I am really excited for Mom to come and wish you were coming too, Dad:( Hope you have a nice rest of the week and talk to you both soon.

 

I love you,

J

........................................................................................

Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.