County Lines Magazine
Friday, 24 March 2017 05:05

Dental Implants

A Modern solution to tooth loss


As a young dental student some 30 years ago, I was told about a new procedure on the horizon—it was still in its infancy, but it had the potential to revolutionize dentistry. My classmates and I kept our eyes and ears open.

Well, as predicted, dental implants became a part of modern dentistry and are here to stay.

And as I know from my own experience, they’re a godsend.


Why Choose Dental Implants?

There are many reasons we may lose a tooth and need a replacement—cavities, trauma, fracture, gum disease, failed root canals, or just never developing an adult tooth. Replacing a tooth is important because an empty space can alter your bite—increasing wear and tear on your remaining teeth—and can lead to bone loss in your jaw.

In the past, a tooth replacement was either a removable denture or a cemented bridge. For a bridge, a dentist would cut down the teeth next to the space and make a replacement that’s cemented in place. That’s still recommended in many situations.

But if the adjacent teeth have no or only minimal fillings, then the dentist has to cut away part of a perfectly healthy tooth. And if there’s a problem later with the supporting teeth, the whole bridge must be replaced, cutting out the problem, but also cutting out more of the healthy tooth.

A dental implant may be a better solution to restore the area of the missing tooth to the proper form and function without altering the surrounding teeth.


What Is an Implant?

An implant replaces a lost tooth or teeth with an artificial tooth root, usually made of titanium, which over time fuses into the bone of the jaw.

There are three parts to the implant: the implant (tooth root), abutment and crown. The implant is placed after the broken or diseased tooth is removed and the bone is determined to be healthy and strong enough for it. The implant needs time to integrate into the jaw—three to six months—and your dentist or oral surgeon will confirms when it’s stable.

The next step is to create the abutment, a permanent but removable connection to the implant in the bone. This will be the framework and support the final piece, the porcelain or ceramic dental cap or crown—a beautiful, white new tooth.


How Do You Care for an Implant?

Implants require the same care as your natural teeth—brushing, flossing and routine check-ups. Although an implant can’t decay like a natural tooth, bacteria can still cause gum disease around the implant. It’s very important to keep an implant as well as your teeth as clean as possible so everything in your mouth remains stable and healthy for a very long time. 

Remember if you ignore your teeth or implant … they will go away!


What’s the Future of Dental Implants?

With today’s 98% success rate, dental implants will become even more widely available and less complicated as time goes on. Dental insurance, which often lags behind dental research and developments, often pays part of the cost of placing and restoring implants. The cost for a simple implant—$3,000 to $6,000—is comparable to the cost of a dental bridge.

Theresa M. Smith, D.D.S.Like many patients, I have a tale to tell. While having dinner with a friend, I took a nibble of an appetizer and felt something crunch in my mouth. Back at my office and a few x-rays later, it was obvious my tooth, in perfect view when I smiled, fractured right down the middle and had to be removed.

Given the severity of my fracture, an implant was the right solution. The implant process, all done with a little novocaine, was pain free, effortless and much easier then I expected.

Today I’m able to smile with confidence and be reminded that a smile is a gift that keeps on giving.  

Dr. Smith received her D.D.S. from Georgetown University and did a residency at Einstein Medical Center in Philadelphia. She’s a member of the ADA and PDA and a volunteer dentist at Community Volunteers in Medicine in West Chester. She practices family and cosmetic dentistry with her husband, Dr. Carlos Vila, in Paoli, where they’re raising three children.

Published in Being Well
Thursday, 31 March 2016 19:42

Root Canal Treatment

“I’d rather give birth than have a root canal.”

After 25 years of doing root canals, I’ve heard everything from my patients, including that.

Misconceptions about root canals make them among the most feared procedures. This sad reputation comes from years of antiquated therapy, old-fashioned instruments and ineffective local anesthetics.

But today, during the over 16 million root canals performed each year, dentists hear their patients say things like: “ Wow! Are you done already?” “That didn’t hurt a bit.” “I can’t believe I was so nervous about this!” and “That’s as easy as the filling I just had.”

Root canals don’t cause pain—they relieve it! So, what’s changed to make root canals so much better for patients?


What’s a Root Canal?

In short, root canal treatment repairs and saves a badly damaged or infected tooth instead of removing it. (The name comes from cleaning the canals inside a tooth’s root.) When a tooth is cracked or has a deep cavity, bacteria can enter the pulp, causing a serious infection or abscess, leading to pulp death, bone loss and potential loss of the tooth. Symptoms may include swelling—inside your mouth and around your face or neck—a hole in your tooth, and a toothache. Patients may also experience extreme sensitivity to hot and cold temperatures.

During the procedure, your dentist drills down into your tooth, removes the diseased tissue (pulp), cleans the area, fills and seals the tooth’s root canals and pulp chamber, sometimes ending with a temporary filling. The final step is for the tooth to have a crown or another type of permanent restoration.

The treatment, generally done in one or two visits, takes an hour or two, so bring some tunes or a podcast. You’ll generally return for a six-month, follow-up appointment. Costs for simple root canals range around $1,000-$1,500—less for front teeth, more for molars and complicated cases. Cared for properly, your repaired tooth can last a lifetime.


Modern Improvements

Be grateful for modern dentistry. Today’s local anesthetics work more quickly and better than older types. Patients leave dental offices saying they felt nothing—a great sign.

Root canals are performed under a rubber dam—a latex barrier that protects the patient and allows the dentist to work in a clean, sterile environment, without chemicals or debris going into a patient’s throat. Also, most endodontists (specialists in root canals) work under a microscope, allowing better and more accurate access to affected areas of the tooth, and thus preserving tooth structure to support a filling or crown on a tooth.

Plus, modern drills spin faster than ever, cutting through the tooth or crown without excess vibration so patients are comfortable. Other advancements have revolutionized treatment, such as instruments made of nickel titanium—a flexible metal that maintains the natural shape and curvature of the root canal, without damaging tooth structure.

Better anesthetics and instruments allow for better outcomes.

About 85 percent of root canals are done by general practice dentists. Endodontists typically do the more difficult cases—working on molars, retreating an old root canal that became re-infected, doing a surgical approach to remove an infection from the bone. The rate of success for root canal treatment is around 95%.


Why Save My Tooth?

If a root canal can’t save a tooth, the main reason a tooth is lost is if it’s cracked or fractured. Extracted teeth can be replaced by a dental implant, bridge or removable denture with great success. But that’s another article.

Adults have 32 permanent teeth (including four wisdom teeth that are often removed). About 20 years ago, dental implants became very popular, and teeth were being extracted that could have been saved. Now, the pendulum is swinging back in favor of saving natural teeth, especially with the high success rate of root canals.

Also consider if a root canal fails and the tooth cracks, an implant is an excellent alternative. But what if an implant fails? That’s more difficult to fix.

When patients ask if they should get a root canal and save their teeth or get implants, my advice is that your teeth are God’s implants, so save them. And retire the cliché about the pain of root canals. ©

Dr. Sam Kratchman, Exton and West Chester EndodonticsDr. Sam Kratchman received his D.M.D. at Tufts University and certificate in endodontics from the University of Pennsylvania, where he’s an Associate Professor of Endodontics and Assistant Director of Graduate Endodontics, in charge of microsurgery. He lectures nationally and internationally and practices in Exton and West Chester, along with three partners.  

Published in Being Well