Avoid An Aged Appearance By Keeping Facial Bone Structures Healthy
Posted on Jun 21, 2023 by William J. Claiborne, DDS MS
The aging process can, unfortunately, take quite a toll on appearance. Shoulders may slump, waistlines may widen, and hair may turn gray. As a periodontist in Western NC, I see another telltale sign of aging – resorption. This is the process of bone loss when natural tooth roots are missing from the jaw bones. Facial features affected by resorption can reveal quite a lot, and not in a flattering light.
A natural tooth is held by the upper or lower jaw bone by its roots. Around the base of each tooth, gum tissues wrap snugly to prevent entry of bacteria and protect sensitive tooth roots. These roots help to keep the tooth ‘alive’ by supplying blood and other nutrients to the bone supporting the tooth. Through the presence of these roots, the jaw bones also receive valuable stimulation, which helps the bone retain its mass.
Losing a tooth can trigger a domino effect, of sorts. Statistics show that tooth loss is most likely to occur in an area next to that of a missing tooth. Without the stimulation of tooth roots, the bone in that area will begin to resorb, or shrink in mass. This increases risks for adjacent teeth.
The process of resorption begins slowly the first year. However, the rate of bone loss accelerates more and more each year. For people who wear a denture or partial, the pressure of wearing these appliances can speed up the rate bone loss even more. Eventually, facial features change due to the declining bone structure, changes that tend to age one’s appearance far beyond their actual age.
Initially, the changes may be subtle, such as deep wrinkles around the mouth. The corners of the mouth begin to turn downward, even when smiling. Jowls form as facial muscles detach from shrinking bone structures. As the bone declines further, the chin becomes more pointed and the mouth seems to collapse into the face. The chin moves closer to the nose, creating what’s referred to as a ‘granny look.’
Dental function also takes a hit when it comes to tooth loss. The strength of the bite becomes challenged. Jaw bone breaks are more likely. Wearing a denture or partial becomes challenging due to its declining ‘ridge’ that is relied upon for support. Dental prosthetics begin to slip while eating, or even speaking. Eventually, frequent applications of denture pastes and adhesives are needed. After a time, even relines help very little.
As a periodontal specialist, one of my advanced skills (in addition to the treatment of all stages of gum disease) is in the diagnosis and placement of dental implants. For adults who are missing one or more natural teeth, we recommend dental implants for a number of reasons.
Why should you have your dental implants placed by a periodontist?
There are over 40 different implant systems, each designed to accommodate various needs and goals. For example, one consideration in determining the type of dental implant is in the assessment of jaw bone mass.
An implant needs a particular amount of bone structure to support it. After several years of missing tooth roots, the amount of existing bone may eliminate some types of dental implants or indicate the need for additional procedures prior to placement.
With adequate bone mass to support the implant(s), the choice of implant can be made based upon your needs and preferences. Without the necessary bone mass, we may advise a bone rebuilding process prior to implant placement. Typically, this does not require a bone graft. In many cases, we are able to apply a bone rebuilding material that regenerates ample bone mass. Or, we may advise an implant system that uses unique implant lengths and placement angles (the “All-On-4”) that can function dependably in minimal bone.
The benefits of dental implants are many. These include:
A lifetime solution – When properly selected and placed, dental implants are designed to last a lifetime. This is why a periodontist is an ideal choice for your selection and placement.
A healthy choice for remaining teeth – Although each natural tooth seems to “stand alone”, individually, they provide support for the teeth on each side and the one above or below. This helps to keep teeth in their proper positions. However, dental implants provide stimulation to the bone to help retain bone mass. And, teeth supported by implants do not rely on the support of crowned (or ‘capped’) teeth on both sides. Thus, preserving the integrity of adjacent teeth.
Restoring biting and chewing stability – Because dental implants are anchored by the jaw bone, biting and chewing stability is restored. People who have dental implants are able to eat healthy, fibrous, and chewy foods once avoided due to ill-fitting dentures or partials.
The feel of your “own teeth” – Rather than have clunky dental prosthetics in your mouth, dental implants act like your own teeth. You can brush them in your mouth and eat foods you love and laugh with friends. Unlike dentures or partials, no more sore spots rubbed on tender gum tissues and no more piercing seeds caught between the gums and denture base.
A wise investment – Dental implants, unlike crown-&-bridge, dentures or partials, will not break, develop a cavity, require periodic “relines,” or need a root canal. Made of titanium, an implant will last your lifetime without requiring the upkeep of other types of restorative options.
In our Asheville periodontal dental office, we offer some of the most advanced dental technology available. This allows our patients to enjoy optimal comfort with minimal treatment time. We are also committed to patient comfort through oral and I.V. sedation (“twilight sleep”). These are administered safely with continual monitoring by trained team members.
If you are considering dental implants to replace missing teeth, begin with a consultation appointment. This will take place in a private room where we can discuss your needs and concerns. Call 828-274-9440 to schedule, or tap here for contact information.
Why Missing Teeth Cause Changes To Facial Appearance
Posted on Sep 30, 2022 by William J. Claiborne, DDS MS
The shape of our face is made by the bone structures beneath the skin. Essentially, we inherit our facial appearance from our ancestors. You may have your mom’s nose or your dad’s chin, but how you look is thanks to your genes.
However, facial appearance can also change due to a decline of bone mass. In dentistry, this is typically based on the presence, or absence, of natural teeth. Losing teeth – even when replaced by a denture, partial, or crown & bridge – leaves the upper and/or lower jaw bone susceptible to bone shrinkage. This is known as resorption.
The presence of natural teeth is vital to the health of upper and lower jaw bones. Tooth roots provide stimulation to the bone, stimulating blood flow that helps the jaws to maintain a healthy mass. Without tooth roots, the lack of stimulation causes the bone(s) to slowly decline.
Resorption causes the gum ridge to flatten out over time, giving your denture a continually-declining foundation. Application of denture adhesive becomes more frequent to prevent the denture from moving while eating, which causes uncomfortable rubbing. Laughing and speaking becomes overshadowed by the fear of embarrassing slips.
When dentures are first made, they may feel secure for the first five or so years. However, as resorption continues, relines help only on a temporary basis. As bone loss progresses, relines will last at less frequent intervals each time.
On average, denture wearers experience a 25% bone loss one year after natural teeth have been extracted. Three years later, 60% of the bone is gone. While natural teeth provide a biting force of 250 pounds, the average denture wearer bites with about 5 pounds of force.
Denture wearers are often surprised to learn that the pressure of wearing them actually accelerates resorption. For people who sleep in their dentures, the 24/7 pressure speeds the process of resorption even more.
To see the extent of bone loss you’ve experienced, remove your denture and look in the mirror. You may see deep wrinkles around the mouth and notice the corners of your mouth turn downward. If bone loss is severe, our mouth may appear to be collapsed inward with a pointed chin. Jowls may have formed on the sides of your face as facial muscles detect from the shrinking bone.
As a periodontist, I specialize in the treatment of all stages of periodontal (gum) disease as well as in the diagnosis and placement of dental implants. And, we are adept at placement of all types of dental implants. With over 40 different implant types, each designed to accommodate various needs, understanding the best type – and correct placement of it – can have a significant impact on your overall success rate.
For example, new designs in dental implant systems can overcome even severe bone loss. The All-On-4 dental implant can be placed in minimal bone using just four implants. Using specific angles, All-On-4 can support a full denture that is non-removable. And, because it is supported by implants placed in bone (just as natural tooth roots), biting and chewing stability is restored.
A periodontist can also assist patients prior to implant placement when severe bone loss has occurred. To ensure a sufficient level of bone mass to support the implanted portions, procedures such as bone generating materials or a “sinus lift” may be advised (to increase bone mass between the upper jaw and sinus cavity).
Our Asheville periodontal dental office is also known for our advanced technology and features (including our on-site 3D Cone Beam and laser). Additionally, our patients enjoy a high level of patient comfort through the administration of IV sedation (twilight sleep). This is administered by a Board Certified Anesthesiologist for optimal safety and comfort.
As dental implants have become a more practical and popular option, adults are turning away from dentures, partials, or bridges. In addition to restoring biting and chewing comfort and stability, implants offer a lifetime replacement option that actually enhances the well-being and lifespan of surrounding teeth.
Because of their ability to restore the presence of natural teeth to such a great extent, the dental profession now sees dental implants as the preferred choice for replacement for most patients. Although the overall treatment costs may seem greater initially, over time, it becomes obvious that the benefits far outweigh the expense.
When you consider that dental implants are designed to last a lifetime, the investment is a wise one. There are very little things in this day and age that will last as long as we do!
If you are considering dental implants, increase your potential for a successful outcome by asking a Periodontist to join your dentist in team treatment. Most general dentists have close relationships with periodontal specialists for implant placement and in treating gum disease.
Before you make your decision, you may wish to schedule a consultation to discuss your specific needs and desires. We are always happy to welcome new patients and being referred is not required. Call 828-274-9440.
Dental Implants – Lower Risks Of Failure With These Tips
Posted on Apr 21, 2022 by William J. Claiborne, DDS MS
In our Asheville periodontal dental office, we believe our patients appreciate being fully informed about their oral health status and understanding their options for treatment. For those who have lost natural teeth, our specialty dental services include the diagnosis and placement of dental implants.
The specialized skills of a periodontist provides implant patients with a high level of success in treatment outcome. It also offers patients a wider variety of choices when it comes to implant systems.
This is why many general dentists who offer dental implants refer the placement portion to a periodontal specialist. For their patient, this can mean a higher level of success, especially for complex needs.
For example, a patient who is missing a lot of bone mass (often due to missing natural teeth for many years) benefits from the specialized skills of our Asheville periodontal office. Another example is a patient who has lost teeth due to periodontal (gum) disease. Because a periodontist combines advanced skills in treating gum disease as well as in dental implants, these patients are given a ‘leg up’ when it comes to treatment success.
In making your decision to opt for dental implants vs. crown-&-bridge, dentures or partials, it is important to understand the basics of how dental implants work. Although there are different types of implant systems, all work in in a similar fashion.
An implant is similar to a screw-like cylinder that is hollowed out in the center. This segment is what is placed into the bone to serve as a tooth root replacement.
Selecting the most appropriate type of implant and how many are needed is based on specific needs and goals. Our Western NC periodontal office plans for your placement procedure using computerized technology to determine the precise angles and depths for each implant before the placement procedure begins. This minimizes disruption to the gum tissues and bone structures, which in turn reduces healing time and optimizes comfort.
Once placed, each implant is covered over with gum tissue. For several months after, the implant goes through a process known as “osseo-integration.” During this phase, the bone grows around the implant, securing it into the bone. This recreates the foundation of natural tooth roots to give biting and chewing stability. Throughout this time, you can wear a denture or temporary so you are never without teeth.
Once healing is complete, a post is secured inside the hollow core of the implant. This post (or “abutment”) will support your final replacement tooth or teeth.
An important aspect of implant success also relies on the proper assessment of bone mass. When the upper or lower jaw has insufficient bone to support the implant being placed, there is a risk of failure.
Again, an implant requires careful selection and placement to be able to support the replacement teeth being attached. In some cases, as few as 4 – 6 implants can support a complete arch of teeth. This decision is best left in the hands of a periodontal specialist.
Severe bone loss can require bone rebuilding procedures prior to implant placement. This can be done by bone grafting or the application of a bone-rebuilding material. In some cases, dental implant systems designed with unique angles (such as the “All On 4”) can support a fulll arch of upper or lower teeth using minimal bone depth with no bone rebuilding necessary.
Another perk of the All On 4 is the forces of chewing and biting require only 4 implants on the upper and/or lower. Because implant costs are largely based on the number of implants placed, this can be a great savings for people who are candidates.
Why does successful placement rely so greatly on assessing bone mass? An implant must be placed in adequate bone that does not risk interfering with adjacent structures.
Without proper placement in sufficient bone, an implant risks coming in contact with a nerve that extends horizontally through the lower jaw. Upper implants placed too close to the sinus cavity can, over time, penetrate that area. Removing an implant in either of these situations, of course, is no simple task.
The ability to select the proper implant type for available bone depth is equally important.
Dental implant diagnosis and placement skills can vary greatly from one dentist to another. While some have taken extensive courses in implant dentistry, others may have taken a weekend course here and there. These are typically ‘hosted’ by a particular manufacturer who provides ‘training’ in a limited selection of implant types. In turn, this can limit the patient’s choices when relying on appropriate recommendations for his or her unique needs.
Obviously, a qualified doctor can enhance your potential for a successful outcome, which is where a periodontal specialist is a wise choice. A Periodontist has particular expertise in the diagnosis and placement of all types of Dental Implants. As a matter of fact, many general dentists prefer to have a Periodontist place implants in their patients. The patient then returns to their dentist for the attachment of teeth to the implants.
Rest assured – in our office, comfort is always a priority. For our patients, we offer oral or I.V sedation to accompany many procedures. While both are beneficial to calm anxiety, tension, stress or even intense feelings of fear, each has its advantages as well as limitations.
Oral sedation is in pill form and provides a fully relaxed state. It often erases most memory of the procedure after and has a quick recovery.
While oral sedation provides a very relaxed state, I.V. sedation puts you in a complete sleep state. This is sometimes referred to as “twilight sleep.” I.V. sedation is ideal for people with dental fear or phobia. This sedation is delivered through an I.V. drip, or intravenously. It takes effect rather quickly and patients nod off within minutes. This sedative erases memory of treatment afterward.
Whether given oral or I.V. sedation, comfort and safety are important to us at all times. And, while sedation is helpful when fear or anxiety exist, some people who have no fears at all request sedation for its ability to relax them during lengthy appointments.
While the doctor involved in your treatment is important, much of the potential for a successful result falls into the patient’s hands after the placement process. As a patient, having a successful outcome begins as soon as your implants are placed.
First, closely follow your post-placement instructions. For a few days following placement, most patients are advised to eat only cool, soft foods. This helps to minimize swelling and bleeding, which helps gum tissues to more quickly seal incision sites. This can lower your risk for infection.
Once home, other factors can also place your implants at risk. For example, smokers have a higher risk for implant failure. Because the chemicals in cigarette smoke are very drying to oral tissues, the healing process takes longer. Delayed healing creates a greater risk for infection to occur.
An element of risk that may surprise you is grinding or clenching teeth during sleep, which is typically a symptom of a misaligned bite. Some clenching is so intense the force can be likened to that used to crack a walnut. A sign of night-time clenching or grinding may be worn, chipped or broken teeth. However, even without signs, if you suspect you grind or clench, mention this to your implant dentist prior to treatment. This way, proactive measures can be taken to resolve the problem before complications result.
Most important of all is the patient’s commitment to maintaining good oral hygiene. Although Dental Implants themselves do not experience decay, the gum tissues and bone supporting the implants are as susceptible to oral bacteria as before. When oral bacteria infection (gum disease) penetrates to the implant site positions, the only way to treat the infection may require removing the implant.
In addition to being highly committed to your oral hygiene at home, your dental check-ups may be scheduled for every four months rather than twice a year. During these visits, a hygienist will remove accumulated oral bacteria to reduce risk to your Dental Implants. The condition of your gums will also be assessed.
Dental implants are designed to last a lifetime and are the closest thing to the natural teeth you once had. Too, the restored ability to bite, chew, speak and laugh without worry can be a tremendous boost to one’s self-esteem and self-confidence.
The type of dental implant best suited for you can be determined after an examination and review of x-rays (we use Cone-Beam digital imaging). Call 828-274-9440 to begin with a private, no obligation consultation to discuss your best options.
Some Amazing History & ‘Back Stories” of Dental Implants!
Posted on Mar 11, 2022 by William J. Claiborne, DDS MS
Some “baby boomers” may recall a popular television show, The Six Million Dollar Man. The series ran from 1973 to 1978, with Lee Majors playing the role of Steve Austin, a former astronaut. After a NASA test flight accident, Steve had been rebuilt with bionic implants that gave him a number of superhuman qualities.
When this aired over 40 years ago, it seemed so futuristic; yet today, bionic implants are rather commonplace. One of the reasons is through the refined use of titanium.
Titanium was discovered in Great Britain in 1791 and named after the Titans of Greek mythology. Titanium is 60 percent denser than aluminum, but more than twice as strong. Titanium is non-magnetic, resistant to corrosion and has a strength-to-density ratio that is the highest of any metallic element.
Titanium can be alloyed (combined with additional element(s), such as iron, aluminum, vanadium, and other elements. These combinations can produce strong, lightweight alloys for a vast number of uses. Titanium is used for jet engines, missiles, spacecraft, and in the military, automotive, agriculture (farming) industries. Titanium is often used in medical prostheses, orthopedic implants, dental instruments used in root canals, and dental implants. Other uses range from components in sporting goods (such as golf clubs), jewelry and mobile phones.
Because titanium alloys have a high crack resistance, they are used in aircraft, armor plating, naval ships, spacecraft, and missiles. About two-thirds of all titanium metal produced is used in aircraft engines and frames. Titanium is also used in nuclear waste storage.
Because titanium is resistant to corrosion by sea water, it is used to make propeller shafts, rigging, and heat exchangers in desalination plants; along with many other uses for salt water components. Titanium is used in the housings and components of ocean-deployed surveillance and monitoring devices for science and the military.
The human body has also been given the advantages of titanium as it is biocompatible (non-toxic and not rejected by the body). Titanium is often used in surgical instruments, such as those used in image-guided surgery, as well as wheelchairs, crutches, and any other products where high strength and low weight are desirable. Inside the body, titanium is common in surgical implements and implants, such as hip balls and sockets (joint replacement) and dental implants that can remain dependably positioned for decades.
For orthopedic implants, the use of titanium means that skeletal loads are more evenly shared between bone and implant. This lowers the potential for bone degradation due to stress, reducing the risk of bone fractures, which have a tendency to occur at the boundaries of orthopedic implants.
Patients with titanium implants can be safely examined with magnetic resonance imaging (MRI).
When you think of dental implants – or other implants-in-bone, such as knees, hip joints, etc. – titanium has the remarkable ability to osseointegrate. Osseointegration is a term used when an artificial implant is surgically anchored into bone, in which the bone then grows around the implant. This restores strength and stability to the bone that can offer a lifetime solution.
The bone in which an implant is placed also benefits from the presence of titanium. In the jaw bone, where natural tooth roots are missing, their absence leaves the bone mass without stimulation once provided by the tooth’s roots. This stimulation is what helps the bone to maintain its mass.
Once bone loss begins, the pace of bone shrinkage, known as resorption, accelerates over time. The declining bone mass soon begins to cause a number of problems, including a change in the way a denture or partial fits.
Additionally, losing jaw bone mass causes changes in facial appearance. It may first appear as deep wrinkling around the mouth and as the corners of the mouth begin to turn downward, even when smiling. Jowls form as facial muscles detach from the shrinking bone. Over time, the mouth begins to sink inward and the chin moves closer to the tip of the nose.
Placing a dental implant into the bone halts the process of resorption. It recreates the stimulation once provided by natural tooth roots. And, because of the strength and stability of the implanted portions, patients with dental implants can rely on eating the foods they love again, biting and chewing with confidence.
Having teeth is important for a number of reasons (eating, speech, appearance), which has been recognized throughout history. The first evidence of dental implants is attributed to the Mayan population roughly around 600 AD where they excelled in utilizing pieces of shells as implants as a replacement for mandibular teeth. Radiographs of Mayan mandibles show compact bone formation around the implants. It has also been found that, around 800 AD, a stone implant was shaped and placed in the lower jaw in early Honduran culture.
In addition to being the first U.S. president, George Washington is famous for his “wooden” teeth. History reveals that Mr. Washington suffered from dental problems from his twenties on. As a matter of fact, in his First Inaugural Address speech in 1789, Washington had only a single remaining natural tooth. Over the years, he wore several sets of dentures, but none made of wood. These were fashioned out of materials that included ivory, gold, lead, and human teeth.
In a letter to Washington from dentist John Greenwood (who fabricated dentures for Washington), he pointed out the staining of the dentures, likely due to consumption of Port wine. Dr. Greenwood cited the staining was what gave the dentures a grained, wooden appearance.
Today, most of the “teeth” portions (restorations) are made of porcelain. Porcelain provides the most natural look and feel of “real” teeth with a similar luminosity of that of natural teeth. Porcelain is also highly durable the most resistant to staining.
To clarify a “dental implant”, it is a term that sums up what is actually a combination of components. Dental implants are typically three segments – the implanted portion that is held in the jaw bone, a post (abutment) that is positioned inside the implant and extends above the gums, and the attached replacement teeth (restorations).
A periodontist has have three years of specialized training beyond dental school to make them experts on both soft and hard tissues. Thus, they have the ideal combination of experience and knowledge to make sure you get a dental implant solution that looks and feels like your own teeth.
Because many people have lost one or more teeth due to periodontal disease, periodontists are an ideal choice in helping restore the gums to a healthy state while determining the best type of dental implant, and then placing the implant at the proper angle and depth.
Additionally, a periodontist can perform pre-implant placement procedures, which may be needed in certain cases. These can include:
Sinus Augmentation – The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants.
Ridge Modification – Deformities in the upper or lower jaw can leave you with and inadequate amount of bone in which to place dental implants. To correct the problem, the gum is lifted away from the ridge to expose the void where bone is missing. The void is then filled with bone or bone substitute to build up the ridge. Ridge modification has been shown to greatly improve the jaw’s appearance and increase the chances of successful implants.
Dental Implant Procedures
Once your dental implant(s) is in place, your periodontal specialist can create a plan to help you maintain healthy implants, particularly in the prevention of peri-implant disease.
Peri-implant diseases are inflammatory conditions affecting the soft and hard gum tissues around dental implants. Similar to a natural tooth, bacteria can build up on the base of the implant, below the gum line. Over time, the bacteria irritate the gum tissue, causing it to become inflamed, damaging the tissue and if not caught early, causing the bone structure below the implant to deteriorate.
The history of dental implants is interesting, yet, what people want is to have their smile back and to enjoy the function of “real” teeth. Although the back stories of dental implants are many, what is most important is that we restore your smile and help you enjoy it for your lifetime.
Begin with a consultation in our comfortable Asheville periodontal dental office. Here, we can discuss what may be best for your needs in a private setting. We can discuss comfort options (including sedation), and estimated costs and treatment time. Here, you will be respected and treated with the compassion we would want for ourselves and loved ones.
Call 828-274-9440 to begin. You’ll speak with a member of our staff who will be happy to assist you.