Cosmetic Dentistry

Your leading source for cosmetic dentistry
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    • About Dental Implants
    • Am I a Dental Implant Candidate?
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    • Facial Collapse
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  • Dental Implants
    • About Dental Implants
    • Am I a Dental Implant Candidate?
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Search Results for: facial collapse

Facial Collapse

Many people don’t realize that once all your teeth are extracted, your jawbone senses that it isn’t needed anymore, and your body begins to dissolve away that bone in order to use the minerals elsewhere in your body. This jaw shrinkage is called Facial Collapse, which takes about ten or twenty years to occur.

This pictureshrunk jaw illustration shows the progression of facial collapse. It is taken from the textbook, Dental Implant Prosthetics by Dr. Carl E. Misch. In the top model, the teeth are all present. As time passes, the jaw changes as shown, until after about ten or twenty years it looks like the model at the bottom.

When a patient has a jawbone that looks like this lowest model, their face looks shriveled, and they will find it very difficult to wear a conventional removable denture. The problem is that when there is such a short ridge of bone left, the tongue and the cheeks will attach close to the crest of that bone, leaving no stable surface on which to rest the denture. Almost all the tissue is movable tissue, so the denture will move around with the tongue and cheeks. With little stable surface to rest the denture on, that surface has to bear all the pressure of the teeth, so it becomes sore, even painful to wear the denture.

The effect is more serious in the lower jaw for a couple of reasons. First, you have the tongue attached on one side and the cheeks on the other, leaving only the thin ridge of bone on which the denture can rest and making it so the denture will move around a lot. Second, that bony ridge often becomes so thin that it is actually sharp, leading to painful sores when the patient wears the denture. The patient has become a dental cripple.

Facial Collapse DiagramOn the right is an illustration of the effect of facial collapse on the patient’s appearance. The distance between the nose and the mouth shrinks, as well as the distance between the mouth and the chin. The lips begin to pucker more because the upper and lower jaws are closer together. All of this causes the face to appear more shriveled, with deep creases. The face definitely ages rapidly. Remember, that it only takes about ten years for these changes to become serious.

Once all the teeth are extracted, the bone loss will begin. Unfortunately, placing removable dentures actually accelerates bone loss, because of the pressure on the bone by the dentures.

The placement of dental implants not only will anchor the teeth so that wearing teeth becomes possible and even comfortable, but it also prevents bone resorption. Each dental implant sends a signal to the bone that Dr. Misch calls a piezoelectric signal. The bone around each implant will be stabilized. The more dental implants you have placed, the more bone will be retained.

What to do when facial collapse has already occurred

It is by far better to intercept this process before it occurs by having dental implants placed soon after teeth are extracted. But if you are already a dental cripple because of facial collapse, you can still be helped. In the hands of a skillful surgeon and restorative dentist, your jawbone can be rebuilt and you can enjoy eating once more. The process is expensive and can be lengthy, but it is definitely worth it. Here are some points I’d like to mention about this rebuilding process.

  • Bone grafting – A surgeon can build up the bone you have lost using bone products or bone from your own hip.
  • Denture/Implant Hybrid restoration – An implant hybrid uses dental restorative materials to replace lost bone and gum tissue. This will increase the dimensions between your jaws and help fill out your face.
  • Precise placement of dental implants – When you don’t have much bone left, it becomes even more important than usual to have the fixtures placed precisely, using careful three-dimensional x-ray techniques (CAT scans) combined with careful analysis and planning. Be sure you’re in the hands of an experienced implant team.

On the rightFacial Collapse photographs we have two photographs of actual patients illustrating facial collapse. Notice the shortened distance between the nose and chin, the shriveled appearance of their faces, and see how the upper lip appears to be sunken in each case. If their mouths were properly restored, they would not only be able to eat properly, but they would look much younger.

If you would like to be referred to an expert cosmetic dentist who would be able to help you with problems like facial collapse, please see our cosmetic dentist referral page.

This content was written by Dr. David Hall.

Dental Implants

Dental implants are a reliable and long-lasting replacement for missing teeth.

A dental implant consists of two parts. First there is a root form that is placed in the jaw. It is approximately the same size as a tooth root, and it takes the place of the root of the missing tooth.

Usually a healing period is required for the process known as osseointegration—during which the bone grows in tightly around the root form so that it is solidly anchored. By tightly adapting the surgical site to the root form, this healing period can be shortened. Some practitioners offer what is called “teeth in an hour,” where the dental implant is placed into function immediately. This can be done, but there may be a trade-off between risk and patience here. When the healing time is rushed, there could be increased risk of failure.

The visible part of the dental implant is the crown. An abutment is screwed into the root form and the crown is placed over it.

If the process is done well, the end result is very functional, long-lasting, and highly esthetic.

dental implant diagram

Situations Where Dental Implants Are Used

  • If you are missing all your teeth, dental implants are far preferable to removable complete dentures. Removable dentures not only have poor chewing efficiency (less than 50% of normal chewing efficiency), but they will lead to gradual bone resorption ending up with facial collapse and the inability to reasonably fit any kind of a denture.
  • If you have one or two teeth missing, and the adjacent teeth are intact and healthy, dental implants are a good idea. They eliminate the need for placing crowns on adjacent healthy teeth.
  • If your missing tooth or teeth are in the very back of your mouth, you may not have the option of having potential supporting teeth on both sides. In this case, the only solutions would be dental implants or a uncomfortable removable appliance. The same is true if you have a number of missing teeth.
Illustration of dental implant

A diagram showing the root form and a crown placed over the root form. In an actual case, the root form is embedded in the bone and not visible. (see actual clinical photograph below).

Advantages and Disadvantages of a Dental Implant

As compared to a dental bridge, for replacing a single tooth

Disadvantages:

  • There is usually a healing time required.
  • They may be more expensive than other methods of tooth replacement.

Advantages:

  • It isn’t required to prepare the adjacent teeth. The old-fashioned method for replacing a missing tooth is with a dental bridge. A dental bridge requires preparing the adjacent teeth for crowns, and then the false tooth is suspended between those two crowns. It’s nice to avoid this aggressive treatment of otherwise healthy teeth.
  • Maintenance is less expensive. If a dental bridge has any trouble with any one of the three or more teeth involved, the entire restoration usually has to be replaced. Additionally, cleaning it properly requires the use of floss threaders, which most people find troublesome. A dental implant, however, can be brushed and flossed normally, and in the unlikely event that there is trouble with it later, no other teeth need to be involved in the treatment of the problem.
  • They preserve the bone. When a tooth is extracted, the body senses the loss and begins to resorb the bone that used to support that tooth. In the case of multiple missing teeth, this can lead to facial collapse, inability to wear even removable teeth, or jaw fracture. This is in addition to the esthetic problems. The presence of a dental implant signals to the body that this bone is still needed, and these difficulties are prevented.

For patients with no natural teeth left, dental implants are really the only treatment that will yield a satisfactory result.

This content was written by Dr. David Hall

Dentistry Study

for Infinity Dental Web content writers from David Hall

This page indexes the information on mynewsmile.com that you need to know in order to write our dental websites. Study it carefully. You may want to take notes. You need to know all of this very thoroughly to be able to write content for our websites. And so that there is no misunderstanding, this is considered “schooling” that helps you prepare for writing, and not paid time. So our expectation is that you study this on your own time. But the better you master it, the better you will write, which will translate into better pay. We want this investment of time you make to be a show of good faith on your part that you intend to do this and stick with it, because we want writers that we’ll be able to rely on over the long term. Plus, I make a sizeable investment in time in your training, and we want that investment to pay off.

After you read through this material, there is also a 20-page content writers manual we have you study, and a two-hour video to watch, and a quiz on those materials. Those materials focus on marketing strategies. You will learn that marketing a dentist is very different from most other kinds of marketing. One of our strengths as a company is our understanding of that, and it will be important for you to learn the fundamentals of that strategy. The manual also explains on-page search engine optimization.

This reading material, however, is actually only the beginning of your training. After you begin getting paid for your writing, for your first couple of projects, I will spend many hours instructing you further on the clinical aspects of your writing as well as the marketing. We want that investment that we make in you to pay off, and it will only do so if you continue with us over the long term. The system appears to work well, and most of our team of dental writers have been with us for a number of years.

When you take the test, we ask you that you not refer back to this website, but rather to answer only from your memory. This is important, because only then will you and I know if you have yet mastered the material. The test is challenging, and you will likely miss 20 to 30% or more of the questions. But as long as you have made a genuine and careful attempt to learn the material, I will walk you through all the questions you miss. For those questions, I will either suggest pages for you to review and then have you re-answer those questions, or I will simply give you the correct answer and explain why. But if you refer back to the website during the test, you will appear to be more ready than you really are, and you run the risk of bombing on your first project and exposing your lack of preparation.

The test is short answer, which helps me evaluate not only if you have the “right” answer, but if you’re giving the right reasoning that demonstrates whether or not you understand the material. If the comprehension seems to come quickly for you, go ahead and move quickly through the material. If you are uneasy about that, take your time going over it. We’re more interested in quality of preparation than in speed.

When you are writing content, you may certainly refer back to mynewsmile.com for help with writing and answering questions. However, you may not copy any content. Google severely penalizes copied content, and so every page for each site that you create must be written from scratch with unique wording. If we ever discover that you are copying content, even just paraphrasing other writing, we will not give you any more projects.

And when you do begin to write for us, remember that the focus of the mynewsmile.com website is very different from the focus of our clients’ websites. Mynewsmile.com is brutally honest and not politically correct, and so would be inappropriate for a dentist’s practice website. For example, it is blunt in its statement that only a few dentists are good at cosmetic dentistry. We would not want to be that blunt on a client’s website. Your reading here is to provide background information so that you understand the dentistry. When you actually begin to write, we have another website that is dedicated to helping train content writers, and one of the features of that website is a list of sample pages on all of the search terms that we typically target. Pattern your writing after those pages, not after mynewsmile.com, and it will be easier to stay out of trouble.

Start by reading all these main menu items:

  • Find a cosmetic dentist
  • Porcelain veneers
  • Laser tooth whitening
  • Dental implants
  • White fillings
  • Invisalign
  • Invisalign dentists
  • Dental bonding
  • Smile design
  • Porcelain crowns
  • Crowns and bridges
  • Beautiful dentures
  • Cosmetic dentistry cost
  • Cosmetic dentistry mistakes – Read the first three paragraphs, then you’ll come back to this page later and read the whole page and the links.
  • Teeth stains

Now go back through for more detail:

  • Cosmetic dentists
    • Fixing Botched Cosmetic Dental Work
  • Porcelain veneers
    • Smile Makeovers
    • Fix Crooked Teeth
    • Porcelain veneers cost
    • Lumineers and other brands
      • DURAthin veneers
      • DaVinci Veneers
      • Lumineers over Crowns
      • CEREC veneers
    • Removing stains on porcelain veneers
    • How long do porcelain veneers last?
    • Care of Porcelain Veneers
    • Porcelain Veneer Procedure (Go over this very carefully – you need to have these steps down pat.)
    • Photos of work by porcelain veneer dentists
    • Pictures of porcelain veneers
    • Extreme dental makeover
    • Cosmetic dental work maintenance
  • Tooth whitening
    • Laser Tooth Whitening
    • Tooth whitening
    • Teeth whitening procedure
    • Zoom Whitening
    • Discolored Teeth
    • Laser Tooth Whitening Procedure
    • How well do whitening toothpastes work?
      • Toothpastes for cosmetic dental work
  • Dental Implants
    • Aesthetic Dental Implants
    • Dental Implants Cost
    • What’s New in Dental Implants
    • Facial Collapse
    • Cheap Dental Implants
    • All on Four Dental Implants
    • Dental Implant Mistakes
    • Dental implants and insurance
  • White composite fillings compared with amalgam fillings
    • Silver fillings
    • How much do white fillings cost?
    • Pain in the teeth after white fillings
    • Photos of white composite fillings
    • Amalgam versus composite fillings
  • Invisalign
  • Dental bonding
    • Tooth Gap
    • Broken front tooth
    • Composite veneers
    • How cosmetic tooth bonding is done
    • Photographs of dental bonding work
    • Wedding cosmetic dentistry
  • Smile design
    • Beautiful Smile
    • Computer imaging for your smile
    • How to design a smile
  • Porcelain crowns
    • Porcelain onlays explained
    • Porcelain fused to metal crowns
      • All-porcelain crowns
      • Porcelain Crown Chipped
    • Temporary Crown
    • Ovate Pontic
  • Crowns and bridges in cosmetic dentistry
    • Maryland Bridge
    • Porcelain crowns for front teeth
    • CEREC crowns
    • Dental bridge
    • Gold crowns
    • Why you need a cosmetic dentist to do your implant.
    • Porcelain crowns explained
  • Cosmetic dentistry costs
  • Cosmetic dentistry mistakes
    • Porcelain veneers gray
    • A porcelain veneer cracked
    • Karen’s teeth bonding is the wrong color
    • Can you whiten porcelain veneers?
    • Dentist replaced one porcelain veneer and it’s too opaque
    • Porcelain veneers turning yellow
    • Bleaching teeth after bonding
    • Tooth bonding with discoloration.
    • Uneven color after teeth bleaching
    • Chris wants Empress crowns, not porcelain to metal
    • A porcelain veneer and porcelain crown don’t match
    • Porcelain veneers falling off
    • Porcelain veneers damaged
    • A bad experience with Lumineers
    • Porcelain veneers don’t match
  • Teeth stains
    • Tooth bleaching
    • How white are bleached teeth?
    • Coffee stains on teeth
    • Porcelain veneers turning yellow
    • Peridex stains
    • Tobacco stains on teeth
    • Tetracycline Stains on Teeth
    • Yellow tooth bonding
  • General Dentistry Info
    • Baby Teeth
    • Bad breath
      • What causes bad breath?
      • Bad Breath Cure
      • Bad Breath Mints
      • Tongue Cleaning
    • Braces
      • White Spots around Braces
      • Braces and Bad Breath
      • Adult Braces
      • Adult Tooth Movement
      • Invisible Braces
    • Chewing Gum Is Good for Your Teeth
    • Dental Crowns
    • Dental Insurance
      • Cosmetic dentistry | dental insurance
      • Delta Dental Insurance
      • Dental insurance | cosmetic dentistry
      • Dental Plan
      • Preferred Provider
      • Will dental insurance pay for a tooth gap?
      • Usual and Customary
    • Dental Questions
      • Pain after root canal treatment
      • Need a root canal?
      • Dead Tooth
      • Pain in jaw
      • Broken tooth piece left in jaw
    • Dentures
      • Dental flipper
      • Denture reline
      • Dentures repair
      • Immediate Dentures
      • Partial dentures
      • Cosmetic dentures
    • Snoring
  • Frequently asked questions about cosmetic dentistry
    • Whitening Porcelain Veneers
    • Staining of porcelain veneers
    • Gum irritation around Lumineers
    • An awful smell coming from between my porcelain veneers
    • Porcelain veneers for small teeth
    • Fake-looking porcelain veneers
    • Cost of Lumineers
    • Lumineers Cracked
    • Cavity with porcelain veneers
    • Over-the-counter teeth whitening products
    • Crest Whitestrips
    • Teeth whitening while pregnant or nursing
    • Can you bleach teeth with tetracycline stain?
    • Treating tetracycline stains on teeth
    • Bleaching and teeth sensitivity
    • Tooth whitening with a crown or other dental work.
    • Does bleaching damage your teeth and gums?
    • Porcelain crowns costs
    • Black Triangles
    • Gum contouring
    • Putting a composite filling over an amalgam filling
    • My cosmetic dentistry bonding is too translucent.
    • Should I have cosmetic dentistry done while I’m pregnant?
    • Am I too young for tooth bonding?
  • More cosmetic dentistry questions
    • Porcelain veneers for crooked teeth
    • Stains on the backs of my teeth.
    • Bulky Lumineers
    • MAC Veneers
    • Tooth whitening and fillings
    • Discolored tooth
    • My lip is catching on my Lumineers
    • Tooth whitening relapse
    • Black line at the gumline
    • Color match for a porcelain crown
    • Zirconia Crowns
    • Chipped porcelain crown
    • Brown Spots on Teeth
  • When does a tooth need a crown?
  • If your tooth is sensitive to cold
  • Questions about porcelain veneers –  Follow all the links on this page, even though the pages linked not listed here.
  • Dental laboratories and porcelain veneers
  • Front Tooth Broke Off
  • Then re-read the page on the porcelain veneer procedure. You need to understand this particularly well in order to properly explain it to visitors. Be prepared for a question asking you to list the steps in this procedure, in order, by memory. You need to know this backwards and forwards.
    • Porcelain Veneer Procedure

Dentures

While in strict dental terminology the word “dentures” means any tooth replacement, it is usually used to refer to removable appliances that replace missing teeth. There are two kinds of dentures—full and partial.

Complete removable dentures should be a treatment of last resort. It is always preferable to have your own natural teeth. But in some cases, patients get so frustrated and discouraged with maintaining their teeth that they give up on them, get them extracted, and have a complete set of false teeth made. In some cases, particularly with advanced gum disease, there is no way to save the teeth.

Some patients view this as a matter of economics—they feel they can’t afford to maintain their teeth any more. However, removing the teeth and placing dentures isn’t cheap either. I once calculated the cost of a complete set of false teeth, upper and lower, including the cost of the tooth extraction surgery and the additional surgery required to prepare the patient’s mouth for the denture. Instead of getting the dentures, if the patient were to put all that money into a mutual fund that earned a modest 8% annual return, they could have routine checkups and cleanings and a filling or two every year on the dividends. At the end of ten years they would still have their own teeth and also have the full original value of the mutual fund.

However, in cases where the teeth need extensive work, complete dentures will likely be more economical. And if finances are limited, they may be the only option. But it is not ideal treatment.

 A lower denture

It is a fallacy to think that complete dentures mean the end to troubles with your teeth. Lower dentures are particularly problematic. Surveys show that about three-fourths of the people with lower dentures are unhappy with them. About half of those with upper dentures are unhappy with them. Upper dentures are held in place with suction and tend to be more stable. Lower dentures are held in place by gravity. They can be dislodged by the tongue or by the cheeks, so they tend to move around. But the unhappy patients are usually embarrassed about having dentures, so you don’t hear their complaints.

Bottom line—try to save your own natural teeth if you can. If you lose them, look into dental implants and avoid dentures.


Other useful information:

  • “Cosmetic dentures” is a term used to refer to false teeth where extra attention is paid to their appearance. When they are done by an expert cosmetic dentist, it can make a big difference in their appearance.
  • When all the teeth are extracted, the jawbone will shrink. When a patient is young, say in his or her thirties, and has all the teeth extracted at that young age, by the time he or she reaches the age of fifty or sixty the jawbone will be so thin that the patient may end up being a dental cripple who can’t wear a denture comfortably. This condition is called facial collapse.
  • Soft dentures can be an answer for these people with a shrunken jawbone. The soft liner makes them more comfortable and a little more snug. Read about the pros and cons here.
  • When your dentures need repair, it’s important to see a dentist right away. Home repairs can make it more difficult and more expensive, or even impossible for a dentist to make the permanent repair. These repair procedures are generally not very expensive – much less expensive than a complete new denture.
  • Oral yeast infection can occur under your plates if you never take them out.
  • Immediate dentures are placed in your mouth on the same day your teeth are extracted, so that you don’t need to go for weeks with no teeth. They work very well, and are generally recommended for all patients.

Read Dr. David Hall‘s blog posts about dentures, where he answers questions from visitors.
Click here to ask Dr. Hall a question.

Pictures of Porcelain Veneers

The work below was done by Dr. David Hall, author of this site and accredited cosmetic dentist who practiced in Cedar Rapids, Iowa.

We have another page of photos of porcelain veneers by some of our mynewsmile.com referral network dentists, and another page of porcelain veneer pictures.

Click here for basic information about porcelain veneers.

Before image

Before

After porcelain veneers

After

The patient above is a professional singer who wanted to get her career back on track. Cielle felt inhibited in her singing for fear of showing her chipped, discolored teeth. Dr. Hall did eight porcelain veneers on the upper, replaced all of the amalgam fillings in her mouth with beautiful composite fillings, restored and bleached the lower teeth, to give her this lovely result. After this work was completed, we wished her well as she moved back to Hollywood to revive her dream. Below, the close-up pictures show how real the work looks.

Before - Chipped and discolored teeth

Before

After - Porcelain veneers

After

This work was performed by Dr. David Hall, the author of this site, when he was a practicing cosmetic dentist in Cedar Rapids, Iowa.


Before - Chipped and eroded teeth

Before

After - Porcelain veneers make for a beautiful smile makeover

After

The “before” picture above shows a patient with chipped and eroded teeth. Her smile seems hesitant. After placing porcelain veneers, not only does she have a beautiful smile, but her smile is more spontaneous. This is why we enjoy so much performing this kind of service for people. This work was performed by Dr. David Hall.


Before - Large spaces

Before

After - Incredible transformation with veneers

After

You may think these pictures above were doctored, but they’re not. Tashia, above, was very unhappy with her smile. She had us bleach her teeth and place eight porcelain veneers, beautifully crafted by master ceramist Uri Yarovesky and placed by Dr. David Hall. She hardly looks like the same person! Some dentists think that we must have moved the teeth orthodontically to be able to get these results, but we didn’t. There were only three appointments: a preparation appointment, a short try-in to verify that we would be obtaining the results Tashia wanted, and a longer bonding appointment two days later.


Before - Tooth wear and facial collapse

Before

After - Mouth reconstruction and smile makeover

After

Kitteile was suffering from severe tooth wear and resultant facial collapse. We re-built her entire mouth, restoring her normal facial height, and gave her a new smile. She’s tremendously happy with the results. The porcelain work was done by master ceramist Solomon Abezis, who was working with Uri Yarovesky in Agoura Hills, California.

Results similar to these pictures can be obtained by accredited and trained cosmetic dentists across the country. For a list of dentists trained in these procedures, please see our referral page.

Click here to ask Dr. Hall a question.

This content was written by Dr. David Hall.

Dental Implants and Porcelain Veneers

It requires a considerable amount of artistic talent to do a combination case of dental implants and porcelain veneers. There is always metal underneath a dental implant crown, where the porcelain veneer on the front of a natural tooth has natural translucency and is usually made of a different type of porcelain.

Here is some combination dental implant and veneer work by Dr. Richard Champagne.

before - porcelain veneers

Before
There are tooth gaps, and the teeth are different colors. Because of gum disease, some of these teeth are going to need to be extracted. Click on the photo to see a close up picture of her smile.

after - porcelain veneers

After
After placing dental implants plus porcelain veneers on the remaining teeth that show when she smiles, her smile is much more relaxed and natural.
Click on the photo to see a close up picture of her smile.

Related Links:

  • GlamSmile is a new shortcut technique for doing porcelain veneers. Read why Dr. Hall doesn’t recommend this technique.
  • Lumineers are popular, but there is a lot of “hype” in their promotion. Read more by clicking the link.
  • Vivaneers are another new product that are just like Lumineers.
  • Read information about what porcelain veneers cost.

All-on-4 Dental Implants
Cheap Dental Implants
Dental Implants Cost
Dental Implant Candidate
Dental implants and insurance
Dental Implant Mistakes
Facial Collapse
What’s New in Dental Implants
Reviews of ClearChoice Dental Implants Centers

Click here to ask Dr. Hall a question.

This content was written by Dr. David Hall.

Three Ways to Replace Missing Teeth

There are three basic ways to fix a missing tooth or teeth.

  • A fixed bridge
  • A removable appliance
  • A dental implant

Here are the pros and cons of each treatment:

  • A fixed dental bridge (See the page on this site devoted to bridgework and how we make bridges look like real teeth.)

dental bridge
Having a bridge is like having three crowns. The teeth on either side of the missing tooth are prepared for crowns, an impression is made, and the case is sent to a dental laboratory. The laboratory then makes the crowns and fastens a false tooth between the two crowns—this is a bridge.
The advantages of a bridge are that it is fixed, stable, and feels like your own teeth. In most cases it can be made to look just like you never had a tooth missing. The disadvantage is that you have to treat two teeth besides the one that was extracted—these teeth may otherwise be perfectly sound with nothing wrong.

An Encore bridge is a special type of bridge that is exceptionally esthetic. A Maryland bridge is the least expensive type, but has some esthetic problems.

Using the ovate pontic technique with a dental bridge can create the illusion that the false tooth is growing out of the gum.

  • A Removable Appliance

Something removable can be used to replace a missing tooth. This can be anything from a budget “dental flipper” (a piece of plastic with a false tooth attached) or a Nesbit (a single back tooth clipped to the adjacent teeth), to a more sturdy metal and acrylic removable partial denture.

The advantages of the removable partial denture appliance are that it is a more economical way to replace missing teeth than a fixed bridge. Also, you can replace multiple teeth with one appliance. If the span of missing teeth is three or more, or if there are not solid teeth on both sides of the missing teeth, a fixed bridge may not work.

The disadvantages are that it may not be as esthetic as a bridge. Clasps will be required to retain the removable partial, and it may not be possible or practical to entirely conceal those (though that problem can be avoided often with a “precision attachment” partial). Also, there may be some discomfort with wearing removable hardware in your mouth, and it is not as stable as a bridge.

Here is a sample case from Dr. Blaine McLaughlin in Cedar Rapids, Iowa, showing how, in the hands of a competent cosmetic dentist, a removable appliance can be made quite esthetic. Terri had crowns in the front and a removable appliance to replace her back teeth.

Terri Before

Terri Before

Terri - After

Terri After

  • A Dental Implant

A dental implant is an artificial “root” that is implanted in your jaw after a tooth extraction, and then a tooth is placed on it. Biologically, it is like placing an entirely new artificial tooth in your mouth.

The advantages of an implant are: No teeth on either side have to be prepared for crowns, so there is no grinding on “good teeth”—you just fix the missing tooth. Implants can also span the space of multiple missing teeth. There is no limit to the span they can cover, as long as the patient’s health is good and there is healthy and adequate bone to support the implant. An implant also is fixed and feels just like your own teeth. Read our more thorough discussion of implants, plus see before-and-after photographs, on our cosmetic dental implant page.

Dental implant diagram

A diagram of an implant tooth between two natural teeth.

The disadvantages of implants are that they can cost more and be more time-consuming, and the cost may not be covered by dental insurance. You will likely have to deal with two dentists—the dentist who does the surgery to place the implant, and the dentist who puts the false tooth on top of the implant. There is also a delay in getting the false tooth or teeth—a healing interval of several months may be required before the artificial root can have a tooth placed on it. There is also surgery involved with its attendant discomfort and healing period.

However, if you are missing multiple teeth or all your teeth, there is a strong advantage to dental implants in that they will preserve the jawbone. Sometimes dentists don’t explain the negative long-term consequences of missing teeth, which are that your jaw gradually shrinks until you can’t wear any removable appliance. To read more about this, please see our page about facial collapse. So if you want to still be able to eat when you’re 80, you may want to consider investing in dental implants to replace those missing teeth.

This content was written by Dr. David Hall.
Click here to ask Dr. Hall a question.

Dental Implants

Dental implants are becoming the option of choice for tooth replacement. They are the closest thing to a natural tooth. And they are getting more and more popular every year.

There are two main parts to a dental implant:

  1. A root form that is surgically placed in your jaw
  2. The replacement tooth that is placed on the root form.

Sometimes dental implants are used to support complete dentures. In those cases, the root form isn’t attached to a single tooth, but there may be anywhere from two to eight root forms that are used to anchor a denture.

Usually there is a healing period between the surgical placing of the dental implants and restoring them with replacement teeth. As technology and techniques improve, this healing period is shrinking. There is a highly sophisticated technique called Teeth in an Hour in which the teeth can be placed in the same appointment. Click the link to learn more.

As we said, having dental implants is the closest thing to having natural teeth. They function just like your own teeth.

And if the appearance of your teeth is important to you, and they are done by an expert cosmetic dentist, they will also look like natural teeth. Click here to find a cosmetic dentist. Click here to see smile makeover pictures of a dental implants case done by one of the cosmetic dentists in our referral network.

Properly placed and diligently maintained, they can last a lifetime. This means conscientious home care, and you need to regulary visit a dental hygienist who will remove tartar and other deposits. Lifespans of these restorations have increased greatly as technology has improved.

Advantages of Dental Implants over Other Tooth Replacement Techniques (such as fixed bridges or removable dentures):

  • They look and feel like your own teeth. They are anchored in the bone the same as natural teeth.
  • Their presence in the bone prevents the normal bone resorption that otherwise always occurs after teeth are missing. This jaw shrinking is a serious long-term problem for patients who have all their teeth extracted. It takes only about ten years for serious bone resorption to occur, which leads to shriveling of the face and the complete inability to wear or use a conventional removable denture.
  • Done well by a true cosmetic dentist, no one will ever know that you have a false tooth.
  • They don’t require any work on adjacent teeth. By contrast, a dental bridge requires preparing the adjacent teeth for crowns. Removable partial dentures require some grinding of adjacent teeth and the fitting of clasps and rests on them, which can catch food and promote tooth decay in those places.
  • They build confidence. Since dental implants are permanently anchored in the bone, there is no risk of slippage, or losing or being caught without your teeth.

Disadvantages:

  • They may be more expensive than other types of tooth replacement, and if there is extra cost it often won’t be covered by dental insurance.
  • If you only have one or two missing teeth and if the teeth adjacent to those spaces already need dental crowns, there is less advantage to a dental implant.
  • Extra visits are usually required, and you may have to see a specialist in addition to your regular dentist. The specialist (an oral surgeon or a periodontist) places the implant root form and your regular dentist places the crown, bridge, or denture on top of it. Some dentists, however, are trained in both procedures.
  • There can be a healing delay of several weeks before you get your new tooth or teeth. However, some newer techniques (see Teeth-in-an-Hour) can give you your false tooth immediately, though these techniques may not be appropriate for your situation, may be too expensive for you, or your surgeon may not be experienced with them. In these cases, you will usually be given a temporary crown or a dental flipper to wear while you wait for your permanent teeth.

Click here to ask a question of a dentist about this topic.

Are You a Candidate for Dental Implants?

If you are in good oral and general health, you could be a candidate for this procedure. This means that you can tolerate the surgery.
You also need to have adequate bone present at the site of the missing teeth to support this device. In the absence of adequate bone, your surgeon can place bone grafts.

Pictures of dental implants work

We have photographs of dental implants from one of our mynewsmile.com network dentists. Look at them and see how real they look. We also have some photographs of a combination of implants and porcelain veneers from New Jersey cosmetic dentist Dr. Richard Champagne.
Here is a sample of the kind of work done by dentists in our referral network:

Close-up of missing tooth - before

A missing front tooth can be an extremely difficult cosmetic
problem for a patient.
Click on the photo to see an enlarged version.

Single tooth replacement - after

Here the single front tooth has been replaced with a dental
implant and perfectly matched to the companion tooth.
Click on the photo to see an enlarged version.

Cosmetic Considerations

If your missing tooth is in the front of your mouth and shows prominently when you smile, we recommend being seen by an expert cosmetic dentist. Cosmetic dental implants require special artistic training and ability that aren’t generally possessed by general dentists or prosthodontists. This case pictured just above is an excellent illustration of the kind of perfect match that only an expert cosmetic dentist can achieve.

Types of Dental Implants

Endosteal: This is by far the most common type. Endosteal means inside the bone. This type is placed within the bone rather than on top of it. Each implant can hold one or more false teeth.

Subperiosteal: These involve a metal framework that is placed on top of the bone with posts that poke through the gum to hold the false teeth, usually a full denture. These types are used for patients who had all their teeth extracted long ago so that their jaw has shrunk, making it difficult or impossible for them to wear a conventional denture. This is used very infrequently.

Other Treatment Options

If a tooth is broken at the gumline, it isn’t necessary to have it extracted. It may be possible to save this tooth, which eliminates the need for any replacement tooth. Click the link to read more.
For a single missing tooth, a dental bridge is another treatment choice.
For multiple missing teeth, a removable partial denture is a possibility.
If all your teeth are missing, you can have a complete removable denture, but shrinkage of the jaw with facial collapse is an inevitable result of this treatment option.

Quality Dentures

There are lots of ways a dentist can trim the cost of a removable denture, and I don’t want to disparage here the efforts of dentists who want to try to bring down the cost of dentures for those patients who have difficulty affording them. But for the benefit of those who are looking for a quality denture, let me explain here what a dentist can do to enhance that quality.

Materials

There are various grades of materials that can be used to make a denture.

In the selection of teeth, there are three basic types. Acrylic teeth are the cheapest and the easiest to work with, but they are soft and susceptible to wear and staining. Porcelain teeth are more expensive. They are stain resistant, very hard, and have excellent esthetics. They used to be the choice for premium teeth, but their drawback is that they tend to come loose from the denture base easily. With the development of composite technology, composite has become the material of choice for quality teeth. Not as hard or as stain resistant as porcelain, they are much more durable than acrylic and develop a secure bond to the denture base.

There are similar differences in the quality of the denture base. The base is almost always made of acrylic, but there are many grades of acrylic. Cheaper acrylics will tend to shrink and distort as they cure, compromising the accuracy of the fit.

Lab Quality

There are large variations in what dental laboratories charge the dentist for a set of dentures. The dental technicians at more expensive laboratories will pay more attention to details and will produce a more lifelike and esthetic product. Also, cheaper labs will use the cheaper base materials and teeth as explained above.

Technique

The technique for making dentures as taught in dental school involves many steps, several of which can be skipped in an effort to economize.

Impressions

For the most accurate replication of the dental arches, dentists will use a multiple-impression technique. A first impression with an inexpensive and easy impression material like alginate can be used to make a preliminary model of the arch. This model will then be used to make a custom tray specifically for the particular patient being treated. Some dentists skip this step by using specially constructed moldable trays and say that this produces results that are as good. The dentist will then go to a more expensive and more technique-sensitive material such as polyether or polyvinysiloxane. A second impression with a heavy-bodied version of this impression material can be used to record the peripheries of the arch, and then a final impression with a light-bodied wash will record all the detail. Dentists can use the first preliminary model to construct the denture, but accuracy will be sacrificed.

Vertical Dimension

With no teeth present, the patient has lost all reference points for how far apart the upper jaw should be from the lower jaw. Still, there is an optimal distance. If the dentist uses a measurement that is too small, the patient will end up with a face that looks collapsed and saggy, and will be overclosed, straining the jaw muscles and causing complications with speech. Similarly, a measurement that is too large will open the bite and also be uncomfortable and cause speech problems. The dentist also has to determine how much of the upper front teeth will show when the patient smiles. All of this is usually obtained by constructing what are called wax rims on temporary acrylic bases and testing different vertical dimensions for comfort and function.

Speech

If these dimensions and the positions of the teeth are incorrect, it can cause difficulty in pronouncing certain letters. Some people with dentures can develop a lisp or a whistling sound as they speak, an embarrassing consequence of a poorly designed denture.

Wax Try-in

To check whether all the dimensions and the positions of the teeth are correct, the dentist will do a wax try-in of the denture. The laboratory technician takes over at this point and, using the positions marked by the dentist with the wax rims, will place the teeth in the wax on the temporary baseplate. These will be the actual teeth that will be incorporated into the denture. Trying in the teeth gives the patient an opportunity to evaluate the esthetics of the case as well as to check again the comfort of the vertical dimension. The dentist may also ask the patient to pronounce certain words to make sure that the patient’s speech sounds natural.

It isn’t considered advisable for the patient to take home this wax try-in. The wax used to hold the teeth is soft, so it is easy to knock the teeth out of position. One patient who was given this opportunity also found that drinking coffee melted the wax and caused an awful mess.

Balanced Bite

During the wax try-in, the dentist will also make a final check of the bite to make sure it is balanced. This is a critical part of the denture construction, and the dentist will often used a sophisticated articulator instrument to replicate all the movements of the jaw in the laboratory. At the time of the construction of the wax rims, measurements of the positions of the jaw joints on either side and their relationship to other facial features will be made, and those measurements will be transferred to the articulator. The bite needs to be carefully calibrated because if it is uneven at all, it will create tipping forces when the patient chews, making chewing more difficult and possibly tending to dislodge the denture.

 

With all of this care, the dentist can make a set of dentures that will look natural, will be durable, and will be comfortable. It is unrealistic, however, for the false teeth of a removable denture to function like natural teeth. The upper denture will function the most naturally because, while it isn’t solidly anchored in the jawbone as teeth are, it is held in place by suction and its movement is somewhat limited. The lower denture, however, will float around somewhat, and the patient will have to learn how to control it with the cheeks and tongue. If the patient wants to replicate the feel and function of natural teeth, anchoring the denture with dental implants is the way to go.

How Complete Dentures Make Your Jaw Shrink

Many people don’t understand the effect of complete dentures on the jaw.

There is a natural reaction of the body when a tooth is extracted. When a tooth is gone, the body perceives this and causes the bone that had supported that tooth to be resorbed—dissolved away. The body senses that this bone is no longer needed, and the calcium and phosphorous are taken into the bloodstream and used other places in the body.

This shrinking takes place in any area of the jaw where there are missing teeth. Its effects are most dramatic in the lower jaw. When all the lower teeth are gone, the entire mandible (lower jawbone) is affected. Over a period of about twenty years, as this dissolving of the bone goes on, the shrinking of the lower jaw can become severe. This causes several problems:

  • As the bone becomes thin, it becomes difficult to rest a complete denture on it. The denture will be unstable because it has nothing to hang onto.
  • When the teeth are gone, the bone will develop a sharp ridge. When a denture is rested on this ridge, it can easily become sore. When jaw resorption is severe, it becomes very difficult to make a comfortable denture that stays in place.
  • The risk of breaking this lower jaw can become great, because it is so thin.
  • The jaw shrinking tends to give your face a collapsed look. The distance between your nose and your chin gets smaller and smaller, and your chin begins to look more pointed. To the right is a famous drawing of an old man by Leonardo daVinci. This is the typical collapsed face look of a person who has had no teeth for a long time.
an illustration of a shrinking jaw

The Collapsed Jaw

One option for people who have had dentures for a long time so that their jaw has shrunk is to get soft dentures, with a soft liner that is more comfortable. Another option is dental implants. The presence of dental implants will actually prevent jaw shrinkage.

This content was written by Dr. David Hall.
Click here to ask Dr. Hall a question.

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