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  • Known for Outstanding Results
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Creating Beautiful Smiles
Call Us Today!
210-696-9877
Call Us Today!
210-696-9877

Procedures

Whether your dental needs are a complete exam and cleaning, a full-mouth restoration, or anything in between, we promise to provide you with exceptional care as we enhance the natural beauty of your smile. Below are just some of the many procedures and services we regularly provide to our patients – with a gentle touch, and stunning results.  Your smile is our first priority, and we’ll give you something to smile about.


Cleanings-Exams-X-rays
Tooth-Colored Crowns
All Porcelain Crowns
Tooth-Colored Fillings
Veneers-Lumineers
Invisalign Clear Braces
ZOOM! One Hour Whitening
Rootcanals
Extractions
Dentures & Partials
Bridges
Implant Crowns
NightGuards
SnoreGuards
If you have any questions, concerns, please contact us today.  We look forward to providing you with the personal care you deserve.
Sincerely,
Dr. Roger Schultz
Your San Antonio, TX Dentist

Cleanings & Prevention

A preventive program is a cooperative effort by the patient, dentist, and dental staff to preserve the natural dentition and supporting structures by preventing the onset, progress, and recurrence of dental diseases and conditions.
Preventing dental disease starts at home with good oral hygiene and a balanced diet.  It is continued in the dental office by the efforts of your dentist and dental hygienist to promote, restore, and maintain your oral health.
Prevention also includes regular dental exams, cleanings, and x-rays. Sealants and fluoride are also great preventive treatments that help protect the teeth.
Prevention helps avoid serious and costly dental problems and is the key to having a healthy, confident, beautiful smile.
Dental Exams & Cleanings
Dental Exam
A comprehensive dental exam will be performed by your dentist at your initial dental visit.  At regular check-up exams, your dentist and hygienist will include the following:
  • Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.
  • Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
  • Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
  • Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
  • Examination of existing restorations: Check current fillings, crowns, etc.
Professional Dental Cleaning
Professional dental cleanings (dental prophylaxis) are usually performed by Registered Dental Hygienists.  Your cleaning appointment will include a dental exam and the following:
  • Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line and can only be removed with special dental instruments.
  • Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
  • Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.
    Dental X-Rays
Dental radiographs (x-rays) are essential, preventative, diagnostic tools that provide valuable information not visible during a regular dental exam.  Dentists and dental hygienists use this information to safely and accurately detect hidden dental abnormalities and complete an accurate treatment plan.  Without x-rays, problem areas may go undetected.
Dental x-rays may reveal:
  • Abscesses or cysts.
  • Bone loss.
  • Cancerous and non-cancerous tumors.
  • Decay between the teeth.
  • Developmental abnormalities.
  • Poor tooth and root positions.
  • Problems inside a tooth or below the gum line.
Detecting and treating dental problems at an early stage can save you time, money, unnecessary discomfort, and your teeth!
Are dental x-rays safe?
We are all exposed to natural radiation in our environment.  The amount of radiation exposure from a full mouth series of x-rays is equal to the amount a person receives in a single day from natural sources.
Dental x-rays produce a low level of radiation and are considered safe.  Dentists take necessary precautions to limit the patient’s exposure to radiation when taking dental x-rays.  These precautions include using lead apron shields to protect the body and using modern, fast film that cuts down the exposure time of each x-ray.
How often should dental x-rays be taken?
The need for dental x-rays depends on each patient’s individual dental health needs.  Your dentist and dental hygienist will recommend necessary x-rays based on the review of your medical and dental history, dental exam, signs and symptoms, age consideration, and risk for disease.
A full mouth series of dental x-rays is recommended for new patients.  A full series is usually good for three to five years.  Bite-wing x-rays (x-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are recommended once or twice a year to detect new dental problems.

Home Care
A beautiful, healthy smile that lasts a lifetime is our ultimate goal when treating patients.  Your personal home care plays an important role in achieving that goal.  Your personal home care starts by eating balanced meals, reducing the number of snacks you eat, and correctly using the various dental aids that help control the plaque and bacteria that cause dental disease.
Tooth brushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.
  1. Place the brush at a 45 degree angle to the gums and gently brush using a small, circular motion, ensuring that you always feel the bristles on the gums.
  2. Brush the outer, inner, and biting surfaces of each tooth.
  3. Use the tip of the brush to clean the inside of the front teeth.
  4. Brush your tongue to remove bacteria and freshen your breath.
Electric toothbrushes are also recommended.  They are easy to use and can remove plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.
Flossing – Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.
  • Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
  • Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
  • Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.
Floss holders are recommended if you have difficulty using conventional floss.
Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.
Use other dental aids as recommended by your dentist or dental hygienist: Interdental brushes, rubber tip stimulators, tongue cleaners, irrigation devices, fluoride, medicated rinses, etc., can all play a role in good dental home care.

How to Properly Brush & Floss
Brushing and flossing are of paramount importance to oral hygiene.  Though bi-annual professional dental cleanings remove plaque, tartar and debris, excellent homecare methods are equally valuable.  Proper brushing and flossing can enhance the health of the mouth, make the smile sparkle and prevent serious diseases.
Reasons why proper brushing and flossing are essential:
  • Prevention of tooth decay – Tooth decay is one of the leading causes of tooth loss, and its treatment often requires complex dental procedures.  Tooth decay occurs when the acids found in plaque erode the natural enamel found on the teeth.  This phenomenon can easily be prevented by using proper home hygiene methods.
  • Prevention of periodontal disease – Periodontal disease is a serious, progressive condition which can cause tooth loss, gum recession and jawbone recession.  Periodontal disease is caused by the toxins found in plaque, and can lead to serious health problems in other parts of the body.  Removing plaque and calculus (tartar) from the surface of the tooth using a toothbrush, and from the interdental areas using dental floss, is an excellent way to stave off periodontal problems.
  • Prevention of halitosis – Bad breath or halitosis is usually caused by old food particles on or between the teeth.  These food particles can be removed with regular brushing and flossing; leaving the mouth healthier, and breath smelling fresher.
  • Prevention of staining – Staining or the yellowing of teeth can be caused by a wide variety of factors such as smoking, coffee and tea.  The more regularly these staining agents are removed from the teeth using brushing and flossing techniques, the less likely it is that the stains will become permanent.
The Proper Way to Brush
The teeth should be brushed at least twice a day; ideally in the morning and before bed.  The perfect toothbrush is small in size with soft, rounded-end bristles and no more than three months old.  The head of the brush needs to be small enough to access all areas of the mouth, and the bristles should be soft enough so as not to cause undue damage to the gum tissue.  The American Dental Association (ADA) has given electric toothbrushes their seal of approval; stating that those with rotating or oscillating heads are more effective than other toothbrushes.
Here is a basic guide to proper brushing:
  1. Place the toothbrush at a 45-degree angle where the gums and teeth meet.
  2. Use small circular motions to gently brush the gumline and teeth.
  3. Do not scrub or apply too much pressure to the teeth, as this can damage the gums and tooth enamel.
  4. Brush every surface of every tooth, cheek-side, tongue-side, and chewing surfaces. Place special emphasis on the surfaces of the back teeth.
  5. Use back and forth strokes to brush the chewing surfaces.
  6. Brush the tongue to remove fungi, food and debris.
The Proper Way to Floss
Flossing is a great way to remove plaque from the interdental regions (between the teeth).  Flossing is an especially important tool for preventing periodontal disease and limiting the depth of the gum pockets.  The interdental regions are difficult to reach with a toothbrush and should be cleansed with dental floss on a daily basis.  The flavor and type of floss are unimportant; choose floss that will be easy and pleasant to use.
Here is a basic guide to proper flossing:
  1. Cut a piece of floss to around 18 inches long.
  2. Wrap one end of the floss around the middle finger of the left hand and the other end around the middle finger of the right hand until the hands are 2-3 inches apart.
  3. Work the floss gently between the teeth toward the gum line.
  4. Curve the floss in a U-shape around each individual tooth and carefully slide it beneath the gum line.
  5. Carefully move the floss up and down several times to remove interdental plaque and debris.
  6. Do not pop the floss in and out between the teeth as this will inflame and cut the gums.
If you have any questions about the correct way to brush or floss, please ask your dentist or dental hygienist.

Cosmetic Dentistry

Cosmetic DentistryIn the past decade there has been a dramatic interest in cosmetic dentistry.  We all realize that having a healthy, bright, beautiful smile enhances our appearance and allows us to smile with confidence.  Thanks to the advances in modern cosmetic dentistry, we are able to improve our teeth and smiles with quick, painless and surprisingly affordable treatments.
Cosmetic dental treatments can:
  • Change the size, shape, and alignment of certain teeth.
  • Fill in unattractive spaces between teeth.
  • Improve or correct bites.
  • Lighten or brighten the color of teeth.
  • Repair decayed, broken, cracked, or chipped teeth.
  • Replace missing teeth.
  • Replace old, unattractive dental treatments.
Remember, your smile speaks before you even say a word!

Composite Fillings
A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc.  The decayed or affected portion of the tooth will be removed and then filled with a composite filling.
There are many types of filling materials available, each with their own advantages and disadvantages.  You and your dentist can discuss the best options for restoring your teeth.  Composite fillings, along with silver amalgam fillings, are the most widely used today.  Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.
As with most dental restorations, composite fillings are not permanent and may someday have to be replaced.  They are very durable, and will last many years, giving you a long lasting, beautiful smile.
Reasons for composite fillings:
  • Chipped teeth.
  • Closing space between two teeth.
  • Cracked or broken teeth.
  • Decayed teeth.
  • Worn teeth.
How are composite fillings placed?
 
Composite fillings are usually placed in one appointment.  While the tooth is numb, your dentist will remove decay as necessary.  The space will then be thoroughly cleaned and carefully prepared before the new filling is placed.  If the decay was near the nerve of the tooth, a special medication will be applied for added protection.  The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.
It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.
You will be given care instructions at the conclusion of your treatment.  Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.
Porcelain Crowns (Caps)

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.
Although there are several types of crowns, porcelain (tooth colored crown) are the most popular, because they resemble your natural teeth.  They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced.  Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.
Reasons for crowns:
  • Broken or fractured teeth.
  • Cosmetic enhancement.
  • Decayed teeth.
  • Fractured fillings.
  • Large fillings.
  • Tooth has a root canal.
What does getting a crown involve?
A crown procedure usually requires two appointments.  Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown.  A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.
While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown.  Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.
At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.
You will be given care instructions and encouraged to have regular dental visits to check your new crown.

Porcelain Fixed Bridges
A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.
There are several types of bridges.  You and your dentist will discuss the best options for your particular case.  The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal.  Porcelain fixed bridges are most popular because they resemble your natural teeth.  This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.
Dental bridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear.
Reasons for a fixed bridge:
  • Fill space of missing teeth.
  • Maintain facial shape.
  • Prevent remaining teeth from drifting out of position.
  • Restore chewing and speaking ability.
  • Restore your smile.
  • Upgrade from a removable partial denture to a permanent dental appliance.
What does getting a fixed bridge involve?
Getting a bridge usually requires two or more visits.  While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown.  Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated.  In addition, a temporary bridge will be made and worn for several weeks until your next appointment.
At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit.  Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge.  The new bridge will be permanently cemented at a later time.
You will receive care instructions at the conclusion of your treatment.  Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.

Porcelain Veneers
Veneers are very thin pieces of durable, tooth shaped porcelain that are custom made (for shape and color) by a professional dental laboratory.  They are bonded onto the front of teeth to create a beautiful and attractive smile.
Veneers can completely reshape your teeth and smile.  They can often be alternatives to crowns and the ideal solution in treating many dental conditions.
As with most dental restorations, veneers are not permanent and may someday need replacement.  They are very durable and will last many years, giving you a beautiful long lasting smile.
Lumineers:
Lumineers are a different type of veneer which is made of a harder porcelain that can be made thinner, therefore in many cases we would not have to shave of modify your teeth. This way you will not need anesthesia and will have an overall more comfortable appointment. 
Reasons for porcelain veneers:
  • Cosmetically, to create a uniform, white, beautiful smile.
  • Crooked teeth.
  • Misshapen teeth.
  • Severely discolored or stained teeth.
  • Teeth that are too small or large.
  • Unwanted or uneven spaces.
  • Worn or chipped teeth.
What does getting porcelain veneers involve?
Getting veneers usually requires two visits to complete the process, with little or no anesthesia required during the procedure.  The teeth are prepared by lightly buffing and shaping the surface to allow for the thickness of the veneer.  A mold or impression of the teeth is taken and a shade (color) will then be chosen by you and the dentist.
On the second visit the teeth will be cleansed with special liquids to achieve a durable bond.  Bonding cement is then placed between the tooth and veneer and a special light beam is used to harden and set the bond.
You will receive care instructions for veneers.  Proper brushing, flossing and regular dental visits will aid in the life of your new veneers.

Procera Crown
IMPROVING EXISTING TEETH
If a tooth is damaged or of poor quality, a new ceramic crown is probably the best solution. Installation is fast. The end result is fantastic.
The all-ceramic Procera crown has many advantages over traditional crowns. Besides its high esthetic qualities, the function and longevity of the crown is excellent as well.
Benefits of a new Procera crown:
  • Superior esthetic result, compared to traditional crowns
  • Easy installation, quick results
  • Short and convenient treatment
Treatment: 
In the best case, the new crown is installed in two dentist visits in one week's time. The inconvenience and after-effects will be minimal.
COURSE OF TREATMENT
PLACING A NEW CROWN – STEP-BY-STEP
The course of treatment described here is one of several options available. Consult your dentist to find out what the best solution is for you, given your specific condition.
             
1: Before the procedure
The dentist makes a first evaluation and makes an impression of the existing crown. The impression is used as the prototype for the new crown.       
2: Preparing the old tooth
The natural tooth is given minor preparation or adjustments. A temporary crown is attached.
     
3: Placing the new crown
A week or so after the first visit, the permanent crown is securely fitted. Normally, it will serve its owner for life.         
4: End result
The end result is a new tooth that should blend in perfectly with the others. Brush and floss as recommended by your dentist or dental hygienist.
 
 
ALTERNATIVES TO AN ALL-CERAMIC CROWN
Porcelain fused to metal
Simply put, a new all-ceramic Procera crown is esthetically superior to any other type of crown. You just can't get the same finish and natural, living look with a traditional metal core crown. However, the latter is an established and well-known solution. This is probably why it is still commonly used, even though function, installation and price are normally equal to that of a ceramic crown.

Tooth Whitening
Tooth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel and is an ideal way to enhance the beauty of your smile.
Because having whiter teeth has now become the number one aesthetic concern of most patients, there are a number of ways to whiten teeth.  The most popular method is using a home tooth whitening system that will whiten teeth dramatically.  Since tooth whitening only works on natural tooth enamel, it is important to evaluate replacement of any old fillings, crowns, etc.  Replacement of any restorations will be done after bleaching so they will match the newly bleached teeth.
Tooth whitening is not permanent.  A touch-up maybe needed every several years, and more often if you smoke, drink coffee, tea, or wine.
Reasons for tooth whitening:
  • Fluorosis (excessive fluoridation during tooth development)
  • Normal wear of outer tooth layer.
  • Stained teeth due to medications (tetracycline, etc.).
  • Yellow, brown stained teeth.
What does tooth whitening involve?
The "Take-Home" type of tooth whitening usually requires two visits.  At the first appointment, impressions (molds) will be made of your teeth to fabricate custom, clear plastic, trays.
At your second appointment, you will try on the trays for proper fit, and adjustments will be made if necessary.  The trays are worn with special whitening solution either twice a day for 30 minutes or overnight for a couple of weeks depending on the degree of staining and desired level of whitening.  It is normal to experience tooth sensitivity during the time you are whitening your teeth, but it will subside shortly after you have stopped bleaching.
The "In-Office" Type we use is The "ZOOM" Whitening System.  As seen on the tv show "Extreme Makeovers" ZOOM can whiten your teeth in as little as 45 minutes of whitening time. The whole appointment only takes a couple of hours plus you also get more take home whitening gel to keep or continue to whiten your teeth.

Periodontal Disease

Periodontal Disease

Periodontal Disease
The word periodontal means “around the tooth”.  Periodontal disease attacks the gums and the bone that support the teeth.  Plaque is a sticky film of food debris, bacteria, and saliva.  If plaque is not removed, it turns into calculus (tartar).  When plaque and calculus are not removed, they begin to destroy the gums and bone.  Periodontal disease is characterized by red, swollen, and bleeding gums.
Four out of five people have periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless in the early stages.
Not only is it the number one reason for tooth loss, research suggests that there may be a link between periodontal disease and other diseases such as, stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy.  Researchers are determining if inflammation and bacteria associated with periodontal disease affects these systemic diseases and conditions.  Smoking also increases the risk of periodontal disease.
Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.
Signs and symptoms of periodontal disease:
  • Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
  • Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
  • New spacing between teeth – Caused by bone loss.
  • Persistent bad breath – Caused by bacteria in the mouth.
  • Pus around the teeth and gums – Sign that there is an infection present.
  • Receding gums – Loss of gum around a tooth.
  • Red and puffy gums – Gums should never be red or swollen.
  • Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

    Signs & Symptoms of Periodontal Disease
    Periodontal disease (also known as periodontitis and gum disease) is a progressive condition and the leading cause of tooth loss amongst adults in the developed world.  Periodontal disease occurs when the toxins found in plaque begin to irritate or inflame the gingiva (gum tissue).  The resulting bacterial infection often known as gingivitis, can eventually lead to the destruction of the gum tissue and underlying bone.  If periodontal disease is not treated, it can also lead to loose teeth or tooth loss.
    There are many common types of periodontal disease including aggressive, chronic, necrotizing periodontitis, and periodontitis associated with systemic diseases.  Each of these types of periodontal disease has its own distinct characteristics and symptoms, and all require prompt treatment by a dentist to halt subsequent bone and tissue loss.
    Common Signs & Symptoms
    It is extremely important to note that periodontal disease can progress without any signs or symptoms such as pain.  This is why regular dental checkups are exceptionally important. Described below are some of the most common signs and symptoms of periodontitis.
    If you have any of these signs or symptoms, the advice of a general dentist or periodontist should be sought as soon as possible:
    • Unexplained bleeding – Bleeding when brushing, flossing or eating food is one of the most common symptoms of a periodontal infection.  The toxins in plaque cause a bacterial infection which makes the tissues prone to bleeding.
    • Pain, redness or swelling – A periodontal infection may be present if the gums are swollen, red or painful for no apparent reason.  It is essential to halt the progression of the infection before the gum tissue and jaw bone have been affected.  It is also critical to treat the infection before it is carried into the bloodstream to other areas of the body.
    • Longer-looking teeth – Periodontal disease can lead to gum recession.  The toxins produced by bacteria can destroy the supporting tissue and bones, thus making the teeth look longer and the smile appear more “toothy.”
    •     Bad breath/halitosis – Although breath odor can originate from back of the tongue, the lungs and stomach, from the food we consume, or from tobacco use, bad breath may be caused by old food particles which sit between the teeth and underneath the gumline.  The deeper gum pockets are able to house more debris and bacteria, causing a foul odor.
    • Loose teeth/change in bite pattern – A sign of rapidly progressing periodontitis is the loosening or shifting of the teeth in the affected area.  As the bone tissue gets destroyed, teeth that were once firmly attached to the jawbone become loose or may shift in position.
    • Pus – Pus oozing from between the teeth is a definitive sign that a periodontal infection is in progress.  The pus is a result of the body trying to fight the bacterial infection.
    Treatment of Periodontal Disease
    It is of paramount importance to halt the progression of periodontal disease before it causes further damage to the gum tissues and jawbone.  The dentist will initially assess the whole mouth in order to ascertain the progress of the disease.  When a diagnosis has been made, the dentist may treat the bacterial infection with antibiotics in conjunction with nonsurgical or surgical treatment or both.
    In the case of moderate periodontal disease, the pockets (under the gumline) of the teeth will be completely cleared of debris using a procedure called scaling and root planing.  The pockets may be filled with antibiotics to promote good healing and kill any bacteria that remain.
    Severe periodontitis can be treated in several different ways, such as:
    • Laser treatment – This can be used to reduce the size of the pockets between the teeth and the gums.
    • Tissue & bone grafting – Where a considerable amount of bone or gum tissue has been destroyed, the dentist may elect to graft new tissue by inserting a membrane to stimulate tissue growth.
    • Pocket elimination surgery – The dentist may choose to perform “flap surgery” to directly reduce the size of the gum pockets.
    If you have any further questions about the signs and symptoms of periodontal disease, please ask your dentist.

    Causes of Periodontal Disease
    Periodontal (gum) disease, which is also known as periodontal disease and periodontitis, is a progressive disease which if left untreated may result in tooth loss.  Gum disease begins with the inflammation and irritation of the gingival tissues which surround and support the teeth.  The cause of this inflammation is the toxins found in plaque which cause an ongoing bacterial infection.
    The bacterial infection colonizes in the gingival tissue and deep pockets form between the teeth and the gums.  If treated promptly by a periodontist, the effects of mild inflammation (known as gingivitis) are completely reversible.  However, if the bacterial infection is allowed to progress, periodontal disease begins to destroy the gums and the underlying jawbone; promoting tooth loss.  In some cases, the bacteria from this infection can travel to other areas of the body via the bloodstream.
    Common Causes of Gum Disease
    There are genetic and environmental factors involved in the onset of gum disease, and in many cases the risk of developing periodontitis can be significantly lowered by taking preventative measures.
    Here are some of the most common causes of gum disease:
    • Poor dental hygiene - Preventing dental disease starts at home with good oral hygiene and a balanced diet.  Prevention also includes regular dental visits which include exams, cleanings, and x-rays.  A combination of excellent home care and professional dental care will ensure and preserve the natural dentition and supporting bony structures.  When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacteria toxins and can cause gingivitis or periodontitis, which can lead to tooth loss.
    • Tobacco use – Research has indicated that smoking and tobacco use is one of the most significant factors in the development and progression of gum disease.  In addition to smokers experiencing a slower recovery and healing rate, smokers are far more likely to suffer from calculus (tartar) build up on teeth, deep pockets in the gingival tissue and significant bone loss.
    • Genetic predisposition – Despite practicing rigorous oral hygiene routines, as much as 30% of the population may have a strong genetic predisposition to gum disease.  These individuals are six times more likely to develop periodontal disease than individuals with no genetic predisposition.  Genetic tests can be used to determine susceptibility and early intervention can be performed to keep the oral cavity healthy.
    • Pregnancy and menopause – During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.
    • Chronic stress and poor diet – Stress lowers the ability of the immune system to fight off disease, which means bacterial infections may possibly beat the body’s defense system.  Poor diet or malnutrition can also lower the body’s ability to fight periodontal infections, as well as negatively affecting the health of the gums.
    • Diabetes and underlying medical issues – Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis and osteoporosis.  Diabetes hinders the body’s ability to utilize insulin which makes the bacterial infection in the gums more difficult to control and cure.
    • Grinding teeth – The clenching or grinding of the teeth can significantly damage the supporting tissue surrounding the teeth.  Grinding one’s teeth is usually associated with a “bad bite” or the misalignment of the teeth.  When an individual is suffering from gum disease, the additional destruction of gingival tissue due to grinding can accelerate the progression of the disease.
    • Medication – Many drugs including oral contraceptive pills, heart medicines, anti-depressants and steroids affect the overall condition of teeth and gums; making them more susceptible to gum disease.  Steroid use promotes gingival overgrowth, which makes swelling more commonplace and allows bacteria to colonize more readily in the gum tissue.
    Treatment of Gum Disease
    Periodontists specialize in the treatment of gum disease and the placement of dental implants.  A periodontist can perform effective cleaning procedures in deep pockets such as scaling and root planing, and also prescribe antibiotic and antifungal medications to treat infection and halt the progression of the disease.
    In the case of tooth loss, the periodontist is able to perform tissue grafts to promote natural tissue regeneration, and insert dental implants if a tooth or several teeth are missing.  Where gum recession causes a “toothy” looking smile, the periodontist can recontour the gingival tissue to create an even and aesthetically pleasing appearance.
    Preventing periodontal disease is critical in preserving the natural dentition.  Addressing the causes of gum disease and discussing them with your dentist will help prevent the onset, progression, and recurrence of periodontal disease.
    If you have any questions or concerns about the causes or treatments pertaining to gum disease, please ask your dentist.

    What is Periodontal (Gum) Disease?
    The term “periodontal”means “around the tooth.”  Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding soft tissues of the tooth; also the jawbone itself when in its most advanced stages.
    Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue.  A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues.  Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat.  Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone.  If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss.
    Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.
    Types of Periodontal Disease
    When left untreated, gingivitis (mild gum inflammation) can spread to below the gum line.  When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue.  There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue.  Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease.
    Here are some of the most common types of periodontal disease:
    • Chronic periodontitis – Inflammation within supporting tissues cause deep pockets and gum recession.  It may appear the teeth are lengthening, but in actuality, the gums (gingiva) are receding.  This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.
    • Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically healthy individual.  It is characterized by rapid loss of gum attachment, chronic bone destruction and familial aggregation.
    • Necrotizing periodontitis – This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppression and malnutrition.  Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone and gingival tissues.
    • Periodontitis caused by systemic disease – This form of gum disease often begins at an early age.  Medical condition such as respiratory disease, diabetes and heart disease are common cofactors.
    Treatment for Periodontal Disease
    There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone.  A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.
    Here are some of the more common treatments for periodontal disease:
    • Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed.  The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection.  A prescription mouthwash may be incorporated into daily cleaning routines.
    • Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures.  A membrane may be inserted into the affected areas to assist in the regeneration process.
    • Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums.  Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.
    • Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.
    Ask your dentist if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.

    Diagnosis
    Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination.  This type of exam should always be part of your regular dental check-up.
    A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums.  The depth of a healthy sulcus measures three millimeters or less and does not bleed.  The periodontal probe helps indicate if pockets are deeper than three millimeters.  As periodontal disease progresses, the pockets usually get deeper.
    Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:
    Gingivitis
    Gingivitis is the first stage of periodontal disease.  Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.
    Periodontitis
    Plaque hardens into calculus (tartar).  As calculus and plaque continue to build up, the gums begin to recede from the teeth.  Deeper pockets form between the gums and teeth and become filled with bacteria and pus.  The gums become very irritated, inflamed, and bleed easily.  Slight to moderate bone loss may be present.
    Advanced Periodontitis
    The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed.  Unless treated, the affected teeth will become very loose and may be lost.  Generalized moderate to severe bone loss may be present.

    Treatment
    Periodontal treatment methods depend upon the type and severity of the disease.  Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.
    Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues.  When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!
    If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended.  You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.
    If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended.  It is usually done one quadrant of the mouth at a time while the area is numb.  In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing).  This procedure helps gum tissue to heal and pockets to shrink.  Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.
    If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean.  Your dentist may also recommend that you see a Periodontist (specialist of the gums and supporting bone).

    Maintenance
    It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)!  Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.
    Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year.  At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy.  Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.
    In addition to your periodontal cleaning and evaluation, your appointment will usually include:
    • Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.
    • Examination of existing restorations: Check current fillings, crowns, etc.
    • Examination of tooth decay: Check all tooth surfaces for decay.
    • Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
    • Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
    • Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.
    Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

Restorations

Restorations
It’s great news that the incidence of tooth decay has significantly diminished over the years due to the use of fluorides and an increase in patient awareness.  However, teeth are still susceptible to decay, infection, and breakage and sometimes need to be restored back to health.  Through improved techniques and modern technology, we are now able to offer more options for restoring a tooth back to its normal shape, appearance and function.
Should your teeth ever require a restorative treatment, you can rest assured knowing we will always discuss with you the available options, and recommend what we believe to be the most comfortable and least invasive treatment.  Providing you with excellent care is our number one priority when creating your beautiful smile.
Reasons for restorative dentistry:
  • Enhance your smile.
  • Fill in unattractive spaces between teeth.
  • Improve or correct an improper bite.
  • Prevent the loss of a tooth.
  • Relieve dental pain.
  • Repair damaged and decayed teeth.
  • Replace missing teeth.
  • Replace old, unattractive dental treatments.
  • Restore normal eating and chewing.
Remember to give your teeth the attention they need today!

Bruxism
Bruxism refers to an oral parafunctional activity which occurs in most humans at some point in their lives.  The grinding of the teeth and the clenching of the jaw are the two main characteristics of this condition, which can occur either during the day or at night.
Bruxism is one of the most common known sleep disorders and causes most of its damage during sleeping hours.  The clenching and grinding which accompanies bruxism is symptomatic of a malfunctioning chewing reflex, which is turned off in non-sufferers when sleeping.  For sufferers, deep sleep or even naps, cause the reflex nerve control center in the brain to turn off, and the reflex pathways to become active.
Typically, the incisors and canines (front 6 upper and lower teeth) of opposing arches grind against each other laterally.  This side to side action puts undue strain on the medial pterygoid muscles and the temporomandibular joints.  Earache, depression, headaches, eating disorders and anxiety are amongst the most common symptoms of bruxism; which often accompanies chronic stress, Alzheimer’s disease and alcohol abuse.
Bruxism is frequently misdiagnosed or not diagnosed at all, because it is only one of several potential causes of tooth wear.  Only a trained professional can tell the difference between bruxing wear and wear caused by overly aggressive brushing, acidic soft drinks and abrasive foods.
A BiteStrip® is an economical device used to diagnose bruxism at home.  The device itself is a small electromyography which senses and monitors any activity in the jaw muscles during sleep.  The frequency and severity of the condition can then be assessed and the best treatment plan can be formulated.
Reasons for the treatment of bruxism
Here are some of the main reasons why bruxism should be promptly treated:
  • Gum recession and tooth loss – Bruxism is one of the leading causes of gum recession and tooth loss; firstly because it damages the soft tissue directly, and secondly because it leads to loose teeth and deep pockets where bacteria can colonize and destroy the supporting bone.
  • Occlusal trauma – The abnormal wear patterns on the occlusal (chewing) surfaces can lead to fractures in the teeth, which may require restorative treatment.
  • Arthritis – In severe and chronic cases, bruxing can eventually lead to painful arthritis in the temporomandibular (TMJ) joints (the joints that allow the jaw to open smoothly).
  • Myofascial pain – The grinding associated with bruxism can eventually shorten and blunt the teeth.  This can lead to muscle pain in the myofascial region and debilitating headaches.
Treatment options for bruxism
There is no single cure for bruxism, though a variety of helpful devices and tools are available.  Here are some common ways in which bruxism is treated:
  • Mouthguards – An acrylic mouthguard can be designed from tooth impressions to minimize the abrasive action of tooth surfaces during normal sleep.  Mouthguards should be worn on a long-term basis to help prevent tooth damage, damage to the temporomandibular joint and help to stabilize the occlusion.
  • NTI-tss device – This device is fitted by a health professional and only covers the front teeth.  The goal of the NTI-tss is to prevent the grinding of the rear molars by limiting the contraction of the temporalis muscle.
  • Botox® – Botox® can be injected into the muscles to relax and weaken them.  Botox® is an excellent treatment for bruxism because it weakens the muscles enough to prevent the grinding, but not enough to interfere with everyday functions like chewing and speaking.
Other methods of treatment include relaxation exercises, stress management education and biofeedback mechanisms.  When the bruxing is under control, there are a variety of dental procedures such as crowns, gum grafts and crown lengthening that can restore a pleasant aesthetic appearance to the smile.
If you have questions or concerns about bruxism, please ask your dentist

Composite Fillings
A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc.  The decayed or affected portion of the tooth will be removed and then filled with a composite filling.
There are many types of filling materials available, each with their own advantages and disadvantages.  You and your dentist can discuss the best options for restoring your teeth. Composite fillings, along with silver amalgam fillings, are the most widely used today.  Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.
As with most dental restorations, composite fillings are not permanent and may someday have to be replaced.  They are very durable, and will last many years, giving you a long lasting, beautiful smile.
Reasons for composite fillings:
  • Chipped teeth.
  • Closing space between two teeth.
  • Cracked or broken teeth.
  • Decayed teeth.
  • Worn teeth.
How are composite fillings placed?
 
Composite fillings are usually placed in one appointment.  While the tooth is numb, your dentist will remove decay as necessary.  The space will then be thoroughly cleaned and carefully prepared before the new filling is placed.  If the decay was near the nerve of the tooth, a special medication will be applied for added protection.  The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.
It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.
You will be given care instructions at the conclusion of your treatment.  Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

Crowns (Caps)
A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.
Although there are several types of crowns, porcelain (tooth colored crown) are the most popular.  They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced.  Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.
Reasons for crowns:
Broken or fractured teeth.
Cosmetic enhancement.
Decayed teeth.
Fractured fillings.
Large fillings.
Tooth has a root canal.
What does getting a crown involve?
A crown procedure usually requires two appointments.  Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown.  A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.
While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown.  Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.
At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.
You will be given care instructions and encouraged to have regular dental visits to check your new crown.

Dental Implants
Dental implants are a great way to replace missing teeth and also provide a fixed solution to having removable partial or complete dentures.  Implants provide excellent support and stability for these dental appliances.
Dental implants are artificial roots and teeth (usually titanium) that are surgically placed into the upper or lower jaw bone by a dentist or Periodontist - a specialist of the gums and supporting bone.  The teeth attached to implants are very natural looking and often enhance or restore a patient’s smile!
Dental implants are very strong, stable, and durable and will last many years, but on occasion, they will have to be re-tightened or replaced due to normal wear.
Reasons for dental implants:
  • Replace one or more missing teeth without affecting adjacent teeth.
  • Resolve joint pain or bite problems caused by teeth shifting into missing tooth space.
  • Restore a patient’s confident smile.
  • Restore chewing, speech, and digestion.
  • Restore or enhance facial tissues.
  • Support a bridge or denture, making them more secure and comfortable.
What does getting dental implants involve?
The process of getting implants requires a number of visits over several months.
X-rays and impressions (molds) are taken of the jaw and teeth to determine bone, gum tissue, and spacing available for an implant.  While the area is numb, the implant will be surgically placed into the bone and allowed to heal and integrate itself onto the bone for up to six months.  Depending on the type of implant, a second surgery may be required in order to place the “post” that will hold the artificial tooth in place.  With other implants the post and anchor are already attached and placed at the same time.
After several weeks of healing the artificial teeth are made and fitted to the post portion of the anchor.  Because several fittings may be required, this step may take one to two months to complete.  After a healing period, the artificial teeth are securely attached to the implant, providing excellent stability and comfort to the patient.
You will receive care instructions when your treatment is completed.  Good oral hygiene, eating habits, and regular dental visits will aid in the life of your new implant.
Dentures & Partial Dentures
A denture is a removable dental appliance replacement for missing teeth and surrounding tissue.  They are made to closely resemble your natural teeth and may even enhance your smile.
There are two types of dentures - complete and partial dentures.  Complete dentures are used when all of the teeth are missing, while partial dentures are used when some natural teeth remain.  A Partial denture not only fills in the spaces created by missing teeth, it prevents other teeth from shifting.
A Complete denture may be either “conventional” or “immediate.”  A conventional type is made after the teeth have been removed and the gum tissue has healed, usually taking 4 to 6 weeks.  During this time the patient will go without teeth.  Immediate dentures are made in advance and immediately placed after the teeth are removed, thus preventing the patient from having to be without teeth during the healing process.  Once the tissues shrink and heal, adjustments will have to be made.
Dentures are very durable appliances and will last many years, but may have to be remade, repaired, or readjusted due to normal wear.
Reasons for dentures:
  • Complete Denture - Loss of all teeth in an arch.
  • Partial Denture - Loss of several teeth in an arch.
  • Enhancing smile and facial tissues.
  • Improving chewing, speech, and digestion.
What does getting dentures involve?
The process of getting dentures requires several appointments, usually over several weeks.  Highly accurate impressions (molds) and measurements are taken and used to create your custom denture.  Several “try-in” appointments may be necessary to ensure proper shape, color, and fit.  At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring a natural and comfortable fit.
It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulty, however this will subside as your muscles and tissues get used to the new dentures.
You will be given care instructions for your new dentures.  Proper cleaning of your new dental appliance, good oral hygiene, and regular dental visits will aid in the life of your new dentures.

Fixed Bridges
A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.
There are several types of bridges.  You and your dentist will discuss the best options for your particular case.  The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal.  This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.
Dental bridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear.
Reasons for a fixed bridge:
  • Fill space of missing teeth.
  • Maintain facial shape.
  • Prevent remaining teeth from drifting out of position.
  • Restore chewing and speaking ability.
  • Restore your smile.
  • Upgrade from a removable partial denture to a permanent dental appliance.
What does getting a fixed bridge involve?
Getting a bridge usually requires two or more visits.  While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown.  Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated.  In addition, a temporary bridge will be made and worn for several weeks until your next appointment.
At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit.  Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge.  The new bridge will be permanently cemented at a later time.
You will receive care instructions at the conclusion of the procedure.  Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.

Procera Crown
IMPROVING EXISTING TEETH
If a tooth is damaged or of poor quality, a new ceramic crown is probably the best solution. Installation is fast. The end result is fantastic.
The all-ceramic Procera crown has many advantages over traditional crowns. Besides its high esthetic qualities, the function and longevity of the crown is excellent as well.
Benefits of a new Procera crown:
  • Superior esthetic result, compared to traditional crowns
  • Easy installation, quick results
  • Short and convenient treatment
Treatment: 
In the best case, the new crown is installed in two dentist visits in one week's time. The inconvenience and after-effects will be minimal.
COURSE OF TREATMENT
PLACING A NEW CROWN – STEP-BY-STEP
The course of treatment described here is one of several options available. Consult your dentist to find out what the best solution is for you, given your specific condition.
             
1: Before the procedure
The dentist makes a first evaluation and makes an impression of the existing crown. The impression is used as the prototype for the new crown.         
 2: Preparing the old tooth
The natural tooth is given minor preparation or adjustments. A temporary crown is attached.
        
3: Placing the new crown
A week or so after the first visit, the permanent crown is securely fitted. Normally, it will serve its owner for life.         
 4: End result
The end result is a new tooth that should blend in perfectly with the others. Brush and floss as recommended by your dentist or dental hygienist.
 
ALTERNATIVES TO AN ALL-CERAMIC CROWN
 Porcelain fused to metal
Simply put, a new all-ceramic Procera crown is esthetically superior to any other type of crown. You just can't get the same finish and natural, living look with a traditional metal core crown. However, the latter is an established and well-known solution. This is probably why it is still commonly used, even though function, installation and price are normally equal to that of a ceramic crown. 

Root Canal Therapy
Root canal therapy is needed when the nerve of a tooth is affected by decay or infection.  In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function.
Having a root canal done on a tooth is the treatment of choice to save a tooth that otherwise would die and have to be removed.  Many patients believe that removing a tooth that has problems is the solution, but what is not realized is that extracting (pulling) a tooth will ultimately be more costly and cause significant problems for adjacent teeth.
Root canal treatment is highly successful and usually lasts a lifetime, although on occasion, a tooth will have to be retreated due to new infections.
Signs and symptoms for possible root canal therapy:
  • An abscess (or pimple) on the gums.
  • Sensitivity to hot and cold.
  • Severe toothache pain.
  • Sometimes no symptoms are present.
  • Swellingand/or tenderness.
Reasons for root canal therapy:
  • Decay has reached the tooth pulp (the living tissue inside the tooth).
  • Infection or abscess have developed inside the tooth or at the root tip.
  • Injury or trauma to the tooth.
What does root canal therapy involve?
A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).
While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva.  An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria.  If tooth decay is present, it will also be removed with special dental instruments.
Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.
At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials.  A filling will be placed to cover the opening on top of the tooth.  In addition, all teeth that have root canal treatment should have a crown (cap) placed.  This will protect the tooth and prevent it from breaking, and restore it to its full function.
After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.
You will be given care instructions after each appointment.  Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.

Dental Implants

Improved Quality of Life

Implant-supported replacement teeth look, feel and function like natural teeth.

For patients, dental implants provide comfort, convenience and confidence. For dentists, dental implants provide patient satisfaction, enhanced reputations and more stimulation… as well as increased revenue opportunities.

Besides featuring 'The Original' dental implant system, the Brånemark® System, which has provided us and our customers with outstanding knowledge and understanding, Nobel Biocare's implant solution offering also includes the brands NobelPerfect™, NobelDirect™ and Replace® Select to cater to all levels of experience and all indications.

We are the market leader and we are driving the development of new dental implant standards and protocols.



Multiple Teeth Replacement
SEVERAL TEETH MISSING
Benefits with fixed bridge on implants:
In this case, when replacing three teeth in the far back of the mouth, a fixed bridge anchored to dental implants is the only fixed alternative. Traditional dentures can't offer the same stability or function.

Having dental implants replacing your lost back teeth will give you  new, unparalleled strength and stability that allows you to eat what you want. It will also preserve your jawbone and facial appearance.
  • The only fixed alternative in this situation.
  • A stable, secure solution that lets you eat what you want
  • Preserves your facial appearance and prevents bone loss
Treatment:
After the initial examination, you can expect 4-5 additional visits until the final fixed bridge is permanently attached. It is normal to experience some minor bruising and swelling in the gum and soft tissue afterwards. Any discomfort is usually treated with an ordinary painkiller. You should expect to be able to work the next day.

>> View Treatment Procedure
 
COURSE OF TREATMENT
INSTALLING THE FIXED BRIDGE– STEP-BY-STEP
The course of treatment described here is one of several options available. Consult your dentist to find out what the best solution is for you, given your specific condition.
             
1: Before the procedure
Three teeth at back end of the mouth are missing. The only real replacement alternative is installing a fixed bridge. The bridge contains all teeth in one piece and is anchored on dental implants.        
 2: Installing the implant
First, the implants are installed. This is normally done in a single session. A temporary bridge may be placed at the same time, making it possible for you to function like normal almost immediately after leaving the dentist
       
3: Attaching the bridge
The implants need to integrate with the jawbone before the permanent bridge is attached. This is normally done 1-2 months after the implant installation. The time will vary, depending on the teeth affected and the esthetical demands.         
4: End result
The new bridge will handle all the pressure that your strong, natural back teeth did. You will have a stable and secure solution that allows you to eat what you want.
 
ALTERNATIVES TO FIXED BRIDGE
Removable partial denture
This alternative is often perceived as uncomfortable and a bit complicated to use. Function can’t be compared to that of a bridge. This denture is made of plastic and metal, which affects its look. It is quite expensive to fabricate due to its many parts. However, the installation process is simple, and natural teeth are spared.

Single Tooth Replacement
SINGLE TOOTH MISSING
Benefits of an all-ceramic crown on implant:
When both the tooth and root are damaged, the best permanent replacement is a dental implant in conjunction with a ceramic crown. This solution both looks and functions just like a natural tooth.
In this case, a so-called one-piece implant is used. This means that all components are installed as a single unit, resulting in immediately full functioning teeth, shorter treatment time and minimized pain.
  • Immediately functioning teeth
  • Excellent esthetic result
  • Life long, stable solution
Treatment:
This procedure normally includes four visits to the dentist. You should expect to be able to work the day after having the implant installed.
>> View Treatment Procedure
COURSE OF TREATMENT
INSTALLING THE NEW TOOTH – STEP-BY-STEP
The course of treatment described here is one of several options available. Consult your dentist to find out what the best solution is for you, given your specific condition.
             
1: Before the procedure
The dentist makes a first examination and takes one or more x-rays of the area to prepare for the procedure.         
 2: Installing the implant
The implant is installed. At this time, a temporary tooth is provided that allows you eat and function like normal almost immediately.  The implant will need a few months to integrate with the jawbone before the next step is taken.
             
3: Attaching the new crown
The final step is the placement of the permanent ceramic tooth. The new tooth is installed for life. No additional treatment is needed.             
4: End result
You should expect the new tooth to fit and function just like a natural tooth. Do your usual dental hygiene to keep the tooth and gum around it clean and healthy.
 
ALTERNATIVES TO AN ALL-CERAMIC CROWN ON IMPLANT
Tooth-supported fixed bridge
A traditional bridge involves grinding down adjacent teeth to support the bridge. It is a stable solution with good esthetics and function that is fairly easy to install. However, this alternative has two main disadvantages: continuous bone resorbtion in the edentulous area, and sacrificing healthy teeth on behalf of the bridge.
Removable partial denture
This is not a permanent alternative to a lost tooth. It is unstable and loosely attached, which affects both function and comfort. A removable partial denture is made of plastic – a material that can't create the same esthetic result as a ceramic crown. The benefits are few but do exist: adjacent teeth aren't affected. It is easily and quickly installed and relatively inexpensive. 
Resin-bonded bridge
This alternative has some clear advantages: it is quickly installed, functions well and, since it is made of ceramic, it gives a high esthetic result. Moreover, natural healthy teeth aren't affected. But it is not very permanent. The resin-bonded bridge will eventually come off – probably after just a couple of years – and will then have to be reinstalled.

Oral Surgery


Wisdom Teeth Extractions
Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt (surface) in the mouth, generally making their appearance between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat. The term “wisdom” stems from the idea that the molars surface at a time typically associated with increased maturity or “wisdom”.
In most cases, inadequate space in the mouth does not allow the wisdom teeth to erupt properly and become fully functional. When this happens, the tooth can become impacted (stuck) in an undesirable or potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth, and possibly cysts or tumors.
There are several types, or degrees, of impaction based on the actual depth of the teeth within the jaw:
Soft Tissue Impaction: The upper portion of the tooth (the crown) has penetrated through the bone, but the gingiva (gum) is covering part or all of the tooth’s crown and has not positioned properly around the tooth. Because it is difficult to keep the area clean, food can become trapped below the gum and cause an infection and/or tooth decay, resulting in pain and swelling.
Partial Bony Impaction: The tooth has partially erupted, but a portion of the crown remains submerged below the gum and surrounding jawbone. Again, because it is difficult to keep the area clean, infection will commonly occur.
Complete Bony Impaction: The tooth is completely encased by jawbone. This will require more complex removal techniques.
Reasons to remove wisdom teeth
While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventative measure to avoid serious problems in the future. If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:
  • Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease) and possible bone loss.
  • Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
  • Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and danger.
  • Tooth Crowding: It has been theorized that impacted wisdom teeth can put pressure on other teeth and cause them to become misaligned (crowded or twisted). This theory isn’t universally accepted by all dental professionals, and it has never been validated by any scientific studies.
Wisdom teeth examination
As with any dental procedure, your dentist will want to initially conduct a thorough examination of the wisdom and surrounding teeth. Panoramic or digital x-rays will be taken in order for your dentist to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems. The x-rays can also expose additional risk factors, such as deterioration or decay of nearby teeth. Early evaluation and treatment (typically in the mid-teen years) is recommended in order to identify potential problems and to improve the results for patients requiring wisdom teeth extractions. Only after a thorough examination can your dentist provide you with the best options for your particular case.
What does the removal of wisdom teeth involve?
Wisdom teeth removal is a common procedure, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia by a specially trained dentist in an office surgery suite. The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication (if necessary), to help manage any swelling or discomfort.

Bone Grafting
Periodontal disease is the leading cause of bone loss in the oral cavity, though there are others such as ill-fitting dentures and facial trauma.  The bone grafting procedure is an excellent way to replace lost bone tissue and encourage natural bone growth.  Bone grafting is a versatile and predictable procedure which fulfills a wide variety of functions.
A bone graft may be required to create a stable base for dental implant placement, to halt the progression of gum disease or to make the smile appear more aesthetically pleasing.
There are several types of dental bone grafts.  The following are the most common:
  • Autogenous bone graft – In this type of graft the bone is removed from elsewhere in the body and implanted in the mouth.  Common donor sites for bone grafting include the iliac section of the pelvis, the chin and the posterior third molar areas of the jaw.  If large amounts of bone need to be harvested, the hip or the shin bone (tibia) is generally used.
  • Allograft – Synthetic bone (man made) can be created in the laboratory and used in the bone grafting procedure.  Bone can also be obtained from a bone bank (cadaver bone).
  • Xenograft – This is the implantation of bovine (cow) bone.  A xenograft is perfectly safe and has been used successfully for many years.  Ample bone can be obtained and no secondary donor site is necessary.
Reasons for bone grafting
There are a wide variety of reasons why bone grafting may be the best option for restoring the jaw bone.
Dental implants – Implants are the preferred replacement method for missing teeth because they restore full functionality to the mouth; however, implants need to be firmly anchored to the jawbone to be effective.  If the jawbone lacks the necessary quality or quantity of bone, bone grafting can strengthen and thicken the implant site.
Sinus lift – A sinus lift entails elevating the sinus membrane and grafting bone onto the sinus floor so that implants can be securely placed.
Ridge augmentation – Ridges in the bone can occur due to trauma, injury, birth defects or severe periodontal disease.  The bone graft is used to fill in the ridge and make the jawbone a uniform shape.
Nerve repositioning - If the inferior alveolar nerve requires movement to allow for the placement of implants, a bone grafting procedure may be required.  The inferior alveolar nerve allows feeling and sensation in the lower chin and lip.
What does bone grafting treatment involve?
Bone grafting is a fairly simple procedure which may be performed under local anesthetic; however if large amounts of bone area need to be grafted, general anesthetic may be required.
Initially, the grafting material needs to either be harvested or prepared for insertion.  A small incision is made in the gum tissue and then gently separated from the bone.  The bone grafting material is then placed at the affected site.
The bone regeneration process may be aided by:
  • Gum/bone tissue regeneration – A thin barrier (membrane) is placed below the gum line over the grafting material.  This barrier creates enough space for healthy tissue to grow and separates the faster growing gum tissue from the slower growing fibers.  This means that bone cells can migrate to the protected area and grow naturally.
  • Tissue stimulating proteins – Enamel matrix proteins occur during natural tooth development.  Emdogain is a matrix protein product which is usually placed on the affected site before the gum is sutured.  It mediates the formation of accellular cementum on the tooth which provides a foundation to allow periodontal attachment to occur.  Tissue stimulating proteins help to create lost support in areas affected by periodontal defects.
  • Platelet-rich growth factors –A high platelet concentration liquid can be used to create a blood clot at the site of a wound.  It has recently been discovered that PRGF also stimulates bone growth – meaning a denser graft in a shorter time period.
The gum is sutured in place and a follow up appointment will need to be made within 10 days to assess progress.  Bone grafting is a highly successful treatment and a good base for further periodontal restorations.
If you have any questions about bone grafting, please ask your dentist.

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DeZavala Dental Care
5015 De Zavala Road
Suite #104
San Antonio, TX 78249-2052
Phone: 210-696-9877
Fax: 210-696-3945
Email: dzdc@sbcglobal.net

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