A New Smile for Linda

Linda wanted a sparkling, white smile. She had old fillings that had turned brown and yellow with decay at the margins. Some of her teeth had broken, others were infected. Her teeth were worn from years of use.  A combination of modern dental techniques gave her the smile she had dreamed about! She looks fabulous and feels great.

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Sharon’s dentures were old – 15 years to be exact – and were worn out.  The teeth were worn and yellow. She was having difficulty chewing and the dentures were loose. We made her a new set of dentures – this took no more than three weeks.  She was thrilled. No adhesives needed.  She was comfortable and she looked great. New teeth took several years off of her age. Note how her lip has filled out, wrinkles diminished.  She can eat again! She was so happy that she decided to add two implants to her lower arch. We attached Locator abutments, creating an overdenture. The attachments on the denture snap into the abutments and create a snug fit.  Now this lower denture was a struggle to remove.

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Old denture, teeth worn flat, stained yellow.

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New upper denture and lower overdenture – lifelike teeth, bright color

This is absolutely my favorite transformation. Rita had smoked for many years – not good for teeth and gums. What happens is that the bone resorbs, leaving long and loose teeth. Eventually these teeth fall out. The process can be delayed or halted with proper dental and periodontal treatment but, like so many people, Rita was afraid of having dental treatment. She also had a serious gag reflex. She was very happy to learn about us and about the care that we take with our patients and their dental health. She was very unhappy with her smile,  with her displaced and missing teeth. She would not smile – and Rita was a beautiful woman. Her teeth were beyond repair, and she was afraid to wear a denture because of her gag reflex.

 

Upper and lower hybrid implant bridges were the best solution to give her a beautiful smile without the embarrassment of removable dentures. The hybrid implant bridge is screwed into bone supported implants and functions like natural teeth. We call it a hybrid because the dentist can remove it, but the patient cannot. Some people call it “teeth-in-a-day” because the teeth are removed, implants are placed and the hybrid can be seated immediately. Sometimes we will seat the hybrid the following day for better cosmetics. This is a temporary hybrid – once the implants are integrated into the bone in approximately three months, we take impressions and measurements for a final hybrid. We give the temporary hybrid to the patient as a spare in case a repair is needed. All-around a wonderful service. Rita did beautifully; the result is spectacular. What you see in her photos below is the temporary hybrid. The final one will look even better! She is thrilled to have teeth again. Read what she says on our testimonials page at https://drterryshapiro.com/testimonials/.

 

Look what we can do in a day to change your smile!

 

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Thursday: Loose and displaced teeth

 

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Friday: Temporary screw retained upper and lower hybrid bridges

Suppose you had lost all of your upper or lower teeth. What are the options?

1. The simplest, least costly but most prone to problems, is the conventional denture.

2. An improvement is the overdenture in which the denture snaps into two or more implant attachments. See my blog entry and video of  April 14, 2015.

3. Even better is the hybrid denture. For the hybrid denture, several implants, (typically six) are placed in the arch.  A prosthesis that is screwed into the implants is constructed. It is a fixed prosthesis as far as the patient is concerned, but the dentist can remove it for maintenance.  Thus we call it a hybrid, or fixed/removable.

     The hybrid is a wonderful service. The teeth function like natural teeth. However the hybrid and surrounding tissues need to be kept clean.  Calculus and plaque can lead to gingival inflammation and peri-implantitis with eventual loss of the implants. I instruct the patient to use a water pic from outside and inside, as well as running floss under the hybrid denture and use of an end tufted toothbrush.  The patient also needs to return to the office at six month intervals so we can professionally clean the hybrid and remove it as necessary.  The acrylic teeth can also chip or fracture. We supply a temporary hybrid so the patient can wear this if the denture needs to be repaired. Acrylic teeth may have to be repaired in five to seven years. If the hybrid opposes natural teeth, we may also make a night guard to protect the hybrid from breakage.

     Alan had upper and lower hybrids that were made seven years ago in another office. The teeth had chipped and they were heavily stained as well as being a vehicle for heavy calculus and plaque.  I removed the hybrids and constructed new ones.  This took several visits but look how wonderful he looks now!  He is more comfortable and can function better too. He promises to return regularly.  He went back to Florida for the winter, his spare hybrids in hand.

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New hybrids

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It is a truth universally acknowledged (thank you Jane Austin) that a lower denture is difficult to stabilize and difficult for the individual to wear comfortably.  In my office I work hard to provide a lower denture that fits well, functions well and is comfortable. But if a person has excessive bone loss or strong musculature, the lower denture may be a problem.  Today the standard of care for a person without lower teeth is really the implant overdenture.  Minimally we place two implants in the lower jaw, let them integrate with the bone for several months, then attach what are called Locators. A housing is then added to the denture base that snaps into the Locators. Since the denture snaps into the Locators, the denture is very stable. It takes some strength to remove! No more wobbly lower denture, no more denture adhesive!

I always discuss the advantages of the overdenture and let the patient make the decision. The implants do add to the cost of the denture service. Sometimes people elect to try to wear the denture and add the implants later, if needed. Often cost is a factor. But when we do add the implants, the “wow” factor is amazing. People love the overdenture and it is a life-changer.

Betty had been wearing dentures for many years and had significant bone loss. She was ready for an overdenture. She had bone grafts, then healing, then placement of the implants, then more healing until we placed the Locators and housing. She is thrilled. For the first time, she has a comfortable, secure lower denture.  Listen to what Betty has to say about her overdenture on our youtube channel.

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A model of four implants on the lower jaw showing how a denture fits over the implants.

It always strikes me that people never seem to be as concerned about losing a back tooth as they are about losing a front tooth. But back teeth also count!!  You need your back teeth so you can chew properly. Back teeth also protect the front teeth, and they help to maintain your facial structure. If even one back tooth is missing, the adjacent teeth will drift to close the space; they may loosen and a pocket of infection may form. The opposing teeth may erupt into the open space. Your bite will start to collapse. The front teeth will begin to splay forward.

The following patient was missing all of her back teeth. She was putting a lot of stress on her front teeth because she didn’t have back teeth for chewing. The front teeth were beginning to splay forward. She elected to have implants placed. We placed four implants on the top and two on the bottom and gave her new front crowns – a great result and a very happy patient:

Posterior Implants Picture

 

The following patient lost her lower back teeth, and consequently the top teeth have super-erupted into the space. This weakens the top teeth and they become susceptible to loss. We did some periodontal crown lengthening and placed five crowns on the top teeth in order to restore them to their proper position. Four implants were also placed on the bottom and will soon be uncovered so implant crowns can be placed:

Posterior Implants before and after picture

When I first met Laurie, she was 15 and in the middle of orthodontic treatment.  Her upper left canine tooth was impacted (hidden in the bone and not in a position to erupt.) We determined that the tooth could not be saved and we elected to extract it and have an implant placed.  The tooth was removed and a bone graft placed. The adjacent teeth were repositioned orthodontically so there would be enough room for the implant.  The implant was placed and it was allowed to integrate to the bone.  During this time Laurie wore a flipper type partial denture to replace the missing tooth.  Once the implant was integrated, the implant was exposed and a screwed in temporary implant crown was placed.

The photos below show the space where the tooth was missing and the temporary crown in place.  The crown looks terrific – but the permanent crown will look even better. Laurie is thrilled not to have to wear the removable denture anymore.  Once further healing of the surrounding gum tissue takes place we will place the final implant abutment and crown.

Laurie just left for college, but she will be back in Coram for Thanksgiving when we will place a permanent implant crown.  This type of dental treatment is complex and cannot be rushed – it takes a lot of planning and coordination among myself as restorative dentist, the orthodontist, the oral surgeon and periodontist.  But is the wait worth it? You bet!

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New dental implant temporary crown

I first met Nancy almost a year ago.  Her front teeth badly needed help.  One front tooth had discolored composite fillings and a fracture.  The other front tooth was short and tipped inward. We extracted the fractured tooth and placed an implant.  After the healing period we placed an abutment (implant post) and porcelain crown.  We restored the other tooth with a porcelain veneer.  Both teeth are now whiter and more evenly situated.  Nancy looks years younger and she just keeps smiling.  She brought us early vegetables from her Selden garden as a thank you.

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What is the greatest concern of the prospective denture wearer?  “I don’t want to have to take my teeth out at night.”  People still have childhood memories of grandma’s teeth floating in a glass by the bedside.  But rest assured – you don’t have to remove your dentures at night.  Well-made dentures today are quite unlike those bulky, loose dentures that your grandmother wore.  The processing is more high-tech.  Custom dentures fit much, much better and look very natural.

Dentures can remain in the mouth overnight.  Just take them out to clean and a short soak in a denture cleanser.  We have many patients whose spouses don’t know that they have lost their teeth and that they wear dentures.  Sure, implants are great and they don’t come out at all – but they are not for everyone.  We still see lots of dentures – their death is greatly exaggerated.

Check out our dentures.  Check out our implants.

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Always looking to keep up with new developments in dentistry, I took two continuing education courses this week.

Wednesday night was a lecture on how periodontal therapy can enhance orthodontic results.  That gummy smile in which too much gum tissue is exposed when the patient smiles can be eliminated with periodontal treatment.  An impacted tooth can be coaxed into position with proper periodontal access.

On Friday I took an all-day course on “All on Four,” in which implants are placed and teeth affixed the same day, thus eliminating a removable denture when all of a patient’s teeth need to be extracted.  This is an amazing service for people who qualify for this treatment.

Recently a woman came into my office with an upper bridge that was failing.  Her teeth could not be salvaged.  But she did not want her husband to know that she was going to lose her teeth.  So we scheduled her for teeth-in-a-day: her teeth were removed, implants placed and a provisional fixed bridge placed.  She looks great and her husband never found out that instead of her own, failing teeth, she now has implants!