Cosmetic Dentistry

Cosmetic dentistry in San Diego today is different than it used to be. With the technology, science, understanding and art, you aren’t stuck anymore like you used to be. I can still remember patients coming to me years ago saying, “I don’t want that black line up around my gums when I have a dental crown placed in the front.” That was long ago.

You might know someone who is seemingly unaffected by his or her smile, even though it doesn’t look so great. Maybe they could benefit from porcelain veneers, a dental bridge or dental implants. Some people just don’t seem to be bothered by their smile. If you or someone you know doesn’t have a good looking smile and feels okay with it, you may not want to do anything about being smile-challenged. Then again, once you know more, you might want to reconsider.

You may already know that your smile is “challenged.” You may even realize that it’s a handicap, a disability of sorts. It need not be this way.

Why live with this disability when it can be fixed? Why live with it when you can turn that disability actually into an asset?

Your smile can be worth a fortune to you over your lifetime. What kind of fortune? A beauty fortune , a health fortune, a financial fortune, a relationship fortune and a fortune in how you feel about yourself.

Sometimes when placing dental implants other dental implant related procedures may be necessary. These may include:

The videos below help explain these other dental implant related procedures.

Single Tooth Bone Graft Ridge Preservation

The movie below shows the extraction of a broken tooth and the preservation of the ridge for implant placement at a later time.

We start off by creating a flap to access the area. Then we remove the tooth root. The decision was not to place an implant at this time.

We will graft the area for ridge preservation and ridge enhancement. We first fill the defect with bone. There are various bone options that can be used. The defect may then be covered by a resorbable membrane to prevent soft tissue in-growth and to aid in the healing process.

The flap is repositioned, and the patient may wear a partial denture (although not recommended) as a temporary removable tooth replacement during the healing process.

The sutures will dissolve or be removed, and the membrane underneath will then dissolve with time. The added bone will meld with the patient’s bone, and the area will then be a solid ridge comprised of the patient’s bone. At this time the area can be exposed by lifting the flap, and the implant can be placed.

The movie below shows the implant being placed as a single stage kind of placement where the healing cap is placed at the same time as the implant fixture. The patient may need once again where the provisional denture during the second healing time. After sufficient waiting time which may vary, the healing cap is removed, and the implant is fitted with an abutment and a crown as usual.

Sinus Lift with Implant Placement

We can place implants in an atrophied posterior maxilla with the addition of grafting. The lateral window technique involves raising a flap on the buckle side of the ridge and then creating an access window.

The bone is thin in this area and can be prepared without damaging the inner membrane with slow speed round drills. Once the window is created the bone can be pushed into the sinus and the membrane lifted with special sinus lift instruments to create a new sinus floor.

The membrane will fold over itself as it is being lifted creating a barrier as well as covering small perforations. In this situation, we still have enough bone left in the ridge to stabilize an implant so we can place the implants at the same time as the grafting procedure.

The space created is then filled in with different bone substitutes selected by the doctor. This can be the patient’s bone or an allograft. The window access can be covered by a membrane to aid in healing and the flap repositioned. With time, the grafted bone will turn into mature patient bone close to the original.

Block Graft

The movie below shows management of a missing tooth and block grafting. Here we see a broken tooth. The remaining tooth root is removed with an elevator, and there is no replacement with an implant at this time.

Whenever there are missing teeth, there will be bone shrinkage called bone atrophy. We must now graft the area if we want to place an implant in that location.

We start with the flap retraction followed by decortication of the bone. These little holes will allow blood to reach the area more evenly and help with graft maturation. We can place some allograft in the area and then secure a bone block graft with two bone screws. These screws hold the bone in place and will be removed later. Any voids can be filled in with the same allograft. Blood will soak the graft and begin the healing process. If deemed necessary we can then cover the area with a resorbable membrane to further help with the healing. The flap is repositioned and sutured into place.

The patient may wear a partial removable denture during the healing phase as a temporary tooth replacement. The sutures will be removed or dissolve if dissolving sutures are placed. Underneath, the membrane will dissolve while maintaining the area and preventing in-growth from the soft tissues or gums. The bone underneath will mature and become part of the ridge.

At about 5 -7 months the area is again exposed with the flap and the bone screws are removed. The access holes can be left or filled with bone particles.

Now the bone can be prepared for implant fixture placements, and in this situation, a single stage type of implant placement is demonstrated. The healing cap is positioned at the same time as the implant.

During the healing phase, the patient can still wear the removable partial denture. The area heals, and the sutures can be removed or dissolve. With an adequate time of approximately four to six months, we can then restore the implant.

We remove the healing cap, and an abutment is attached to the implant to provide it structure, followed by a crown that will replace the top of the tooth. The gums around this tooth may not fit correctly at first but will mold to fit with time.

Ridge Splitting Technique

The movie below shows the ridge splitting technique to increase the width of the bone during implant placement.

In this procedure, the ridge is cut with a standard bone bur the entire length of the ridge to be expanded. The two halves are then separated with a straight surgical chisel. Now the implant fixtures can be placed and then covered with cover screws.

For increased healing and success, various bone substitutes or even the patient’s bone from another area can be put in the voids. The entire area can be covered with a collagen membrane. The gums are repositioned and sutured into place.

The stitches will dissolve or be removed in about two weeks. It is now allowed to heal for a few months. The membrane under the gum disappears with time, and the bone fill integrates with the patient’s bone.