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Posts for category: Dental Procedures

By Andrew I. Pupkin, D.D.S., P.A.
January 15, 2015
Category: Dental Procedures
Tags: oral surgery   orthodontics  
ExposingandPreservingImpactedCanineTeeth

The final emergence of permanent teeth in late adolescence marks the end of a long process beginning in the womb with the formation of our primary or “baby” teeth. Permanent teeth form in a similar way as buds high in the jaw, continuing to grow until the primary teeth ahead of them fall away. The crowns of the new adult teeth eventually break through the gum tissue and emerge (erupt) into view.

At least, that’s normally what should happen; sometimes, though, a tooth may only erupt partially or not at all, a condition known as impaction. The crown remains partially or fully submerged below the gum line, causing the tooth to press against other teeth, potentially damaging them. It can also make periodontal (gum) tissues adjacent to the area more susceptible to disease. Wisdom teeth are especially prone to this kind of impaction, to the extent they’re often surgically removed (extracted) to avoid future problems to adjacent teeth or the bite.

Upper canines (the “eye teeth” normally located directly below the eyes) are also subject to impaction. But because of their highly visible position, extracting them could have an adverse impact on the patient’s smile. In this case, we often attempt instead to expose and ultimately save the tooth.

Before taking any action, however, an orthodontic examination is conducted first to pinpoint the exact position of the impacted tooth and determine how that position might affect moving teeth into a more desired alignment. If we find the impacted canine is in a workable position, the next step is to surgically uncover the tooth from the gum tissue (a minor procedure usually performed by an oral surgeon or periodontist). Once exposed, an orthodontic bracket with a small attached gold chain is bonded to the tooth. The gums are then sutured back into place with the chain exposed and allowed to heal.

At some future point an orthodontist will attach the chain to orthodontic hardware that will pull the impacted tooth into proper position over several months. As a result, the upper canine becomes “un-impacted”; the dangers to surrounding teeth and tissues are also reduced. And, just as important, we can preserve the tooth and with orthodontics achieve an attractive, normal smile.

If you would like more information on the effects and treatment of impacted teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Exposing Impacted Canines.”

By Andrew I. Pupkin, D.D.S., P.A.
December 16, 2014
Category: Dental Procedures
Tags: x-rays   oral health  
ConeBeamX-RayscanImproveOutcomesinManyDentalSituations

For decades, dental x-rays have helped us accurately diagnose and treat a wide array of dental diseases and conditions. But even with recent advances in digital imaging, the traditional x-ray does have one drawback: its two-dimensional view doesn’t always provide the “big picture” that a three-dimensional viewpoint can provide.

But a new type of x-ray technology can do just that: known as cone beam computed tomography (CBCT), these machines record hundreds of digital images as a cone-shaped beam of x-ray energy is projected through a device that rotates around a person’s head. A computer then assembles the images into a single three-dimensional image that can be manipulated on screen to view from various angles. Not only does this provide greater context and detail, it does so with no more radiation exposure than a standard 20-film digital full-mouth x-ray series.

While CBCT hasn’t replaced the traditional x-ray, it’s making its mark in a number of specialized areas of dentistry. The following are just a few of the ways CBCT is improving both accuracy and treatment outcomes.

Orthodontics. CBCT can provide a much more detailed view of the entire jaw; this can help us determine the best locations for realigning teeth safely and effectively.

Dental Implants. With a CBCT scan we can precisely locate nerve canals, sinuses and adjacent teeth before implant surgery to locate the best position for the implant.

TMD Treatment. To help develop the best treatment approach for alleviating the pain and dysfunction of temporo-mandibular joint disease (TMD), a CBCT scan can provide us detailed information on how the disease is affecting a patient’s joints, teeth, sinuses and airway.

Impactions. An impacted tooth can exert damaging pressure against the roots of neighboring teeth. A CBCT scan allows us to observe the impacted tooth from various vantage points to determine the best treatment approach for neighboring teeth, nerve canals and sinuses.

If you would like more information on CBCT technology, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Getting the Full Picture With Cone Beam Dental Scans.”

By Andrew I. Pupkin, D.D.S., P.A.
September 04, 2014
Category: Dental Procedures
MarthaStewartSharesToothTouch-UpSecrets

Here’s a quick quiz: What recent activity did domestic guru Martha Stewart share via social media for the first time? Need a hint? Was she following the lead of other celebrities like rapper 50 Cent (AKA Curtis James Jackson III), actress Demi Moore and country music star LeAnn Rimes?

Give up? The answer is… she live-tweeted her visit to the dentist! Not only that, she also posted pictures of her mouth as she was undergoing an in-office whitening procedure.

Now, we understand that some might feel they don’t need to see close-ups of Stewart’s teeth under treatment. But we have to admire her for not trying to hide the fact that she’s had the same procedure that has benefited so many people, whether famous or not. Plus, her pictures actually provide a good illustration of how the treatment works.

In-office whitening treatments are the fastest way to brighten up your smile. In a single one-hour visit, your teeth can be lightened by three to eight shades — and that's a big difference! How can we achieve such dramatic results? When you’re under our direct supervision in an office setting, we can use the most concentrated bleach solutions safely and effectively. You can get similar results with custom-made trays and take-home lightening solutions we can prepare for you, but then the process will take longer.

If you look closely at her photos, you’ll see that Stewart’s lips, gums, and face are covered up to prevent any contact with the bleaching solution. She’s also wearing protective eyewear, which not only keeps chemicals away, but also guards her eyes against strong lights, which are sometimes used in conjunction with bleach. When we perform in-office whitening procedures, we use safeguards like these for all of our patients — not just celebrities!

We also perform a complete oral examination before starting any whitening procedure, to be sure you don’t have any underlying conditions that need to be treated before teeth whitening begins. That’s something you just can’t get from an over-the counter whitening product.

Teeth whitening is an effective and affordable way to give your smile a quick boost. But whether you decide to live-tweet your procedure — or keep your fans guessing about why your smile looks so good all of a sudden — that’s up to you.

If you would like more information about the teeth whitening, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Teeth Whitening” and “Important Teeth Whitening Questions Answered.”

By Andrew I. Pupkin, D.D.S., P.A.
August 20, 2014
Category: Dental Procedures
Tags: composite resins  
CompositeResinsareaViableRestorationOptionforMildlyDefectiveTeeth

No matter how damaged or decayed your teeth may have become, there’s a restorative solution for it. From porcelain veneers that cover unattractive teeth to dental implants that permanently replace missing teeth, we have the means to give you back a beautiful, life-like smile.

But what if the problems with your teeth are relatively mild — a chipped tooth or a cavity in a highly visible place? Porcelain veneers and bridgework involve extensive tooth preparation that permanently alters the tooth. Is there a less intrusive option that still results in a life-like restoration?

The answer is yes. Composite resins are tooth-colored materials that are bonded directly to tooth surfaces. Made of a plastic-based material matrix with inorganic glass-like filler, composite resins require very little tooth preparation and are often applied in a single visit.

They’re an excellent way to address imperfections or defects with an otherwise healthy tooth, while still preserving the majority of its remaining structure. In the hands of a skilled dentist, composite resins can be used to fill, repair and reshape teeth. They’re also an ideal choice for younger patients whose dental arches are still in development — restorations that require extensive tooth preparation might compromise the tooth’s long-term health. A composite resin treatment could serve as a transitional bridge until a more extensive restoration can be performed after the patient’s mouth structure has fully matured.

Composite resins do have some disadvantages. Because the resin material isn’t as strong as the tooth structure it replaces (although there have been great improvements in the last few years in resin strength), it may not stand up to biting pressures over time if there isn’t enough remaining tooth structure available to support it. They material can also dull and stain with use.

Still, for moderate imperfections or as an interim solution until another restoration can be undertaken, composite resins are a good choice.

If you would like more information on restorations with composite resin, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Artistic Repair of Front Teeth with Composite Resin.”

By Andrew I. Pupkin, D.D.S., P.A.
July 11, 2014
Category: Dental Procedures
MarthaStewartShowsOffRenovationWork-InHerMouth

Martha Stewart has built a flourishing career by showcasing the things she’s designed and made — like floral arrangements, crafts, and even home renovations. Just recently, she was showing off her latest restoration project: a new dental bridge. In fact, she live-tweeted the procedure from her dentist’s office… and she even included pictures of the bridgework before it was placed on her teeth!

OK, it’s a departure from paper crafts and home-made pillows… but why not? We can’t help feeling that there’s just as much craftsmanship — even artistry — in dental bridgework as there is in many other custom-made items. If you learn a little more about what goes into making and placing bridgework, perhaps you’ll understand why we feel that way.

Bridgework is one good solution to the problem of missing teeth (another is dental implants). A fixed bridge is anchored to existing teeth on either side of the gap left by missing teeth, and it uses those healthy teeth to support one or more lifelike replacement teeth. How does it work?

Fabricated as a single unit, the bridge consists of one or more crowns (caps) on either end that will be bonded or cemented to the existing teeth, plus a number of prosthetic teeth in the middle. The solid attachment of the crowns to the healthy teeth keeps the bridge in place; they support the artificial teeth in between, and let them function properly in the bite.

Here’s where some of the artistry comes in: Every piece of bridgework is custom-made for each individual patient. It matches not only their dental anatomy, but also the shape and shade of their natural teeth. Most bridges are made in dental laboratories from models of an individual’s teeth — but some dental offices have their own mini-labs, capable of fabricating quality bridgework quickly and accurately. No matter where they are made, lifelike and perfect-fitting bridges reflect the craftsmanship of skilled lab technicians using high-tech equipment.

Once it is made, bridgework must be properly placed on your teeth. That’s another job that requires a combination of art and science — and it’s one we’re experts at. From creating accurate models of your mouth to making sure the new bridge works well with your bite, we take pride in the work we do… and it shows in your smile.

If you would like more information about dental bridges, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Fixed vs. Removable Bridges” and “Dental Implants vs. Bridgework.”