ADVANCED PROCEDURES

CROWNS
Crowns are full coverage restorations that are used to cover a tooth that is likely to break or is too broken down to be restored with a filling. They are most commonly done after root canal treatment, or when a large filling wears out. The larger the hole made by a cavity that has to be treated, the more likely a crown will be needed. Even after a filling is put in a large cavity, a tooth is more likely to break. Keep in mind that the jaw muscles are the strongest in the human body. Teeth are subjected to tremendous pressures. Crowns ride over the weakened tooth, providing strength and protecting the tooth against breakage. A broken or cracked tooth is a far more serious matter and much more difficult to treat. Crowns prevent this, as well as making for a nice smile.

As most experienced patients know, one needs two appointments to restore a tooth with a crown.  One visit to prepare the tooth for the crown, make a temporary crown and take an impression for the laboratory.  A second was then required two weeks later to fit and cement the crown.  In our office, we offer Cerec metal free all-ceramic crowns.  This is a revolutionary CAD/CAM system that requires one single visit.  The same crown preparation as always is performed but instead of taking messy impressions we use a 3D infrared camera to capture a precise picture of your prepared tooth.  The software is then used to create and customize your crown in the computer.  A high-end milling machine is then used to create your crown from a block of Empress or E-Max ceramic chosen to match the color of your teeth.  The crown is polished and bonded to your tooth that very same visit without the need for a temporary or a second visit (that typically also needs another shot of anesthetic).  It's a win-win!

DENTURES
There are different types of dentures, but they share their common function. They replace teeth that have become loose or have been lost due to bone loss or trauma. When bone loss around the roots of teeth is great enough to loosen them or let them fall out, it's time for dentures. Relax. No one enjoys losing their natural teeth, but you can still eat and talk regularly.

The entire mouth is examined and a determination is made as to which teeth will have to be removed, and which will remain.  The loose teeth are then extracted.  Dentures are fitted to go over or around whatever teeth remain in the mouth, depending on the type. There is an adjustment period after dentures are placed in the mouth.  Once accustomed to the dentures, all the normal functionality and appearance return and one just carries on as usual.  Dental implants are often recommended to further stabilize the dentures.

IMPLANTS
A dental implant is an option to replace a missing tooth or multiple teeth.  In this procedure, a small titanium post is placed into the site of the missing tooth or teeth and allowed to heal. The bone grows around it forming a tight connection, which additionally slows or stops the bone loss that occurs when the root of a natural tooth is missing. Once the implant is firmly set in the mouth, the dentist then works to attach the replacement tooth onto the top of the shaft. This permanent solution has the advantages over bridge work that it does not stress the surrounding teeth for support, and, should the tooth wear out, another can simply be replaced on the shaft.

Implants can also be used as support as part of an implant bridge. This is an alternative to partial dentures, and has several advantages. First, there is no adjustment period for the patient who, once the work is done, only feels teeth, not metal supports intruding into the mouth. Second, this slows the bone loss one experiences over time from missing teeth. Third, there is no discomfort or difficulty in eating.  Best of all, they don't have to be taken out all the time.

ROOT CANAL TREATMENT
Root canal treatment (also referred to as root canal therapy or endodontic therapy) is made necessary when the nerve of a tooth becomes irreversibly irritated and infected.  Deep cavities, stress fractures from old fillings or acute trauma to a tooth may cause the nerve to be damaged to the point it needs root canal therapy.  Once this occurs the nerve becomes infected.  This infection can extend through the root tip and begin to eat away at the surrounding bone (this is an abscess).  By the time the nerve is infected it must be treated and cannot heal on its own.  It can even weaken the entire immune system. This is dangerous, not to mention, very painful. Symptoms that the nerve has become infected may include sensitivity to hot, cold or sweets, pain, swelling, pain to biting or pressure, and a bad taste in the mouth. Sometimes, however, no symptoms are apparent and the person is unaware of any problem until a checkup.

A root canal cleans out the infected tooth nerve and disinfects the canals of the tooth. The only other treatment would be to extract the tooth. Once the infection is resolved, the canal(s) are filled in to prevent any further infection. Usually a core build-up and crown is recommended for restoring a tooth that has had root canal therapy as the tooth becomes more fragile.

BRIDGES
This is an option for filling the space created by a missing tooth. It is formed to look like the missing tooth.  The sides of a bridge use the two surrounding teeth for support, hence the name.  A bridge replaces the missing tooth, both functionally and cosmetically.  Bridge work is as much an art as it is an exact science. The materials used may be gold alloys, porcelain bonded to metal alloy, or all ceramic materials. The choice of material depends on requirements for strength, wear and esthetics.

It is important that a missing tooth be replaced as soon as possible for several reasons.  If not treated, the teeth surrounding the gap begin to shift inward.  This creats a whole chain reaction of bad things.  Teeth use their neighbors for support, and, with one missing, they start to "fall." As this worsens, the bite changes in response to the pressure. This can eventually result in problems with the entire jaw, e.g. TMJ.  The surrounding teeth deteriorate and it is just a matter of time before they, too, are lost. Gum disease becomes a serious problem, with the difficulty of treatment increasing as the neglect continues.

TMJ TREATMENTS
TMJ stands for temporal-mandibular joint. Temporal, as in temple area of the skull; mandibular as in the lower jaw (mandible); joint as in its where the skull and jaw meet. Problems in this joint may be caused by a misalignment of the teeth, trauma, or excess muscle tension. The TMJ is a very complex joint.  Aside from the two bones that meet there, there is a fluid-filled capsule and cartilage that buffers them and five muscles that are involved in the area.  If something goes wrong a good deal of trouble can result.

Problems in this area can cause:

• Headaches
• Ear aches
• Trouble/soreness in opening and closing the mouth
• Clicking or popping of the jaw
• Pain in the jaw muscles
• Soreness in the area, sometimes extending to the face and neck

Dental treatments for the condition can include replacing missing teeth, moving teeth, adjusting the bite, filling gaps between teeth, etc. There is no one solution that is right for all cases. Sometimes an acrylic mouthpiece is used to prevent clenching or grinding that is contributing to the problem.  If untreated and taken to extremes, surgery may be required to repair a badly damaged joint.  As with all health care, prevention is the key!