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Bruxism (also called teeth grinding) – is the habitual, involuntary grinding or clenching of your teeth, usually during sleep, but can also occur during the day. The cause of Bruxism Marielaina Perrone DDSbruxism is unknown but it is often associated with anger, tension, fear, frustration, and stress.

Many people go through periods in their lives where they grind their teeth or clench them from time to time. Bruxism generally does not cause any long term damage when done occasionally. If the problem persists, over time there will be long term damage to the teeth and surrounding tissues in the mouth.

When Does Bruxism Occur?

Bruxism generally occurs during sleep, most people are unaware that they are even grinding or clenching their teeth unless they are told so by their partner or by their dentist . There are signs that should give you pause to think that you may be a bruxer. Usually it is a loved one that notices the grinding as it awakens them at night. Another sign is a dull, constant headache or sore jaw when waking in the morning. Cracked, chipped teeth, and wear facets may be noticed by your dentist. Continuous teeth grinding will lead to dental issues, which can result in  fracturing, loosening, or loss of teeth. Habitual teeth grinding will wear the teeth down, remove the cusps on the teeth,and essentially flatten them. When these issues happen, bridges, crowns, root canal therapy, dental implants, partial dentures, and even complete dentures may be needed. Bruxism can also lead to Temperomandibular Joint Disorder, hearing loss, and even change the appearance of your face.

Treatment Options For Bruxism?

Unfortunately, there is no cure for bruxism. The only way to truly get it under control is to learn to manage stress in our lives better. So what can a dentist do to help? Luckily, dentistry has developed some techniques to protect our teeth from bruxism.

Treatment options include:

-Fabrication of a Custom Mouth Guard. This will act as buffer to protect your teeth during sleep. It does not necessarily cause the bruxism habit to stop, but does protect the teeth from damage.

-Prescription for Muscle Relaxants. This can allow relief from tight muscles surrounding the face.

Other tips to help you stop bruxism include:

-Avoid or cut back on foods and drinks that contain caffeine.

-Avoid alcohol. Grinding tends to intensify after alcohol consumption.

Bruxism Marielaina Perrone DDS

-Do not chew on pencils or pens. Avoid chewing gum as it allows your jaw muscles to get more used to clenching and makes you even more likely to grind your teeth.

-Attempt to train yourself not to clench or grind your teeth. If you notice that you clench or grind during the day, re-position the tip of your tongue between your teeth, or wear a daytime soft guard on your lower teeth. This practice trains your jaw muscles to relax and also is a mental cue for the brain to stop grinding your teeth.

-Relax your jaw muscles at night by holding a warm wash cloth against your face in front of your earlobe.

New Treatment Option For Bruxism

In the past, once damage from bruxism reached the point of needing a full coverage dental crown both dentist and patient understood the treatment would see limited success. This is because of the strength of traditional porcelain crowns or porcelain fused to metal crowns was not up to the task of dealing with the extra forces over the long haul. Recent technology advances in dental materials have allowed the development of a new type of crown called the BruxZir crown.

BruxZir Solid Zirconia is a monolithic solid zirconia restoration with no porcelain overlay. This type of crown when used in patients with bruxism offers a long term restoration built to last. It is virtually chip proof, making it an ideal restoration for patients with bruxism. BruxZir crowns can even be used over a dental implant.

Bruxism Conclusion

Bruxism can be a terrible habit with the develoment of long term issues. While no known cure exists, dental materials advancement has allowed the dentist to maintain the health of your teeth under the extreme pressures and forces of bruxism. Visit your dentist regularly so bruxism can be diagnosed as early as possible to ward off potential issues.

Dental implants in dentistry have become a highly successful dental procedure. Most studies show that dental implants have a success rate of around 96-98% when placed properly. Dental implants have become a highly reliable procedure for the replacement of lost teeth. This means, almost all patients who undergo the procedure for dental

Dental Implants Marielaina Perrone DDS

implants with a highly competent surgeon, will have success. What about the other 2-4%? What can go wrong with dental implants?

Success of dental implants is related to the dentist or surgeons skill, quality and quantity of the bone available at the site, quality of materials used, the patient’s healing ability, and maintenance of good oral hygiene.

Possible Dental Implants Complications

Failed Integration of Dental Implants – This occurs when the bone does not grow and fuse between the threads of the implant. This fusion of bone to dental implant is called osseointegration. If this does not occur, the dental implants will not function properly,will become uncomfortable, become loose, or come out completely. To reduce this risk, your dental surgeon will evaluate the quality and density of the jaw bone prior to surgery. This will help to only place dental implants in areas where there is a highly predictable success rate. If osseointegration does not take place, the dental implants can be removed, and surgery can be attempted again once the area has fully healed.

Infection –  This is the most common complication of dental implant surgery. The surrounding bone and gums can get infected during the surgical procedure. This can happen due to non-sterile technique, a contaminated implant, poor healing ability(diabetic, smoker, osteoporosis medications), pre-existing infection. The most likely time for this to occur would be during the surgical placement of the dental implant into the bone. Implant infection is a condition referred to as peri-implantitis. Peri-implantitis is characterized by inflammation or swelling of the tissues surrounding the implant area. Peri-implantitis can also present as a secondary infection later on is a form of periodontal disease that can lead to inflammation, bone loss and implant failure if not treated quickly and properly. Although implant infections are usually caused by the presence of bacteria during or immediately after the oral surgery for the placement of the dental implants, an implant infection can occur months or years after surgery.

Post Surgical Bleeding – Some bleeding following surgery is normal and should be expected for about 1-2 days. Biting gently on a gauze pad placed over the surgery area for 30 minutes should normally stop the bleeding. Excessive bleeding is not normal and you should notify your dentist immediately if you have concerns about your dental implants.

Damage To Surrounding Tissues – Dental implant complications related with surgical errors affecting adjacent teeth, nerves or sinus are directly correlated with the experience and skills of the dentist or surgeon. An experienced and skilled implant dentist is able to identify potential problems by examining x-rays or CT scan (computer tomography), design the proper surgical plan for ideal location and angle, and execute it successfully without complications. Even with the most skilled implant dentist there is always a possibility of dental implant complications. The complications can be limited by choosing an implant dentist with the skills and experience necessary to handle any complications if they arise.

The following areas could be damaged:

1Surrounding Teeth – During the placement of dental implants, the dentist may damage the crown or the roots of adjacent teeth. Root canal therapy may be needed to repair the injured teeth. The dentist must carefully review the x-rays or CT-scan

Dental Implants Marielaina Perrone DDSbefore drilling because the teeth are not always in ideal positions. A skilled implant dentist will be prepared for any changes necessary.

2. Nerve Damage – While rare, this is a complication of implant surgery in the lower jaw (mandible). There is a nerve (inferior alveolar nerve) that runs through the lower jawbone that can be injured during dental implants placement. Nerve injury may cause pain, numbness or painful tingling in teeth, gums, lips, tongue or chin. Similar symptoms may occur if the implant is placed right on top of the nerve, causing severe pain when chewing down. If the nerve fails to heal and the symptoms persist, the dental implant will likely need to be removed. X-rays and CT scans can help the implant dentist to identify the exact location of the nerve and minimize the possibility of nerve damage.

3. Perforation into Sinus – This occurs during placement of dental implants in the upper jaw. This occurs during implant placement, when an implant is placed into the sinus cavity. With proper planning, the bone around the sinus can be grafted and lifted (sinus augmentation) to allow for the necessary length of the dental implants. To prevent this implant complication, the dentist must check carefully the CT scans and proceed with ‘sinus augmentation’ if needed to provide sufficient bone for successful implant placement.

4. Bone Fracture – Jaw fracture is another possible complication of dental implants placement. If there is not enough bone or bone density, the jaw can fracture under the pressure during the surgical placement of the dental implants (during drilling or implant insertion).

5. Inflammation – Inflammation and swelling of the surrounding tissues is the immediate symptom of implant infection. Improper placement or size of the abutment and crown restoration, that puts under pressure and traumatizes the soft tissues around or beneath it, may also cause dental implants complications. Dental implant inflammation triggers an inflammatory response from the body’s immune system that attacks gum tissues and surrounding bone. This can result in bone loss around the dental implant and if left untreated the dental implants will become loose and will need to be removed. The dentist has to eliminate the inflammation as soon as possible to prevent further bone loss that can cause dental implants failure. The inflammation can be treated by antibiotics and cleaning if caused by implant infection, or by removing or adjusting the defective restoration if caused by trauma.

Other reasons for failure of Dental Implants

-Rejection – An extremely rare complication but it has been noted in the research literature. The dental implants can sometimes be viewed as a foreign body.

Unusable Dental Implants – An implant that has successfully integrated with bone, but the area or extreme angle of placement deem it unrestorable.

Dental Implants Conclusion

Implant dentistry has come a long way. It has become an almost routine procedure. Understand, that just because it is done often does not make it a simple procedure thatDental Implants Marielaina Perrone DDS anyone can do. Implant surgery is an intricate and comprehensive process that involves several stages. Treatment consults, treatment planning, and treatment procedures (which can include multiple surgeries) need to be undertaken with extreme care. General dentists DO NOT have the same training as surgeons, and are generally better at restoring the implants after surgical placement. As with all types of surgery, there are risks involved during both the actual dental implants procedure as well as during the recovery period. While most dental implant complications are quite minor, it is important to be aware of them prior to surgery. These complications can be minimized by choosing an implant dentist with the skill and knowledge to overcome any challenges that may come your way before, during, or after surgery. Choose your surgeon based on skill level and not price, and you will be much more likely to have a long term success.



Dental implants have altered the face of dentistry over the last 20 years for patients and dentists alike. They have been nothing less than a miracle in the replacement of lost teeth whether it be a single tooth, multiple teeth, or as an anchor for a denture. As the technology has matured, new dental technology advancements and techniques have been developed. One of those newer dental techniques includes All On 4 Dental Implants. This procedure allows for the placement of four dental implants (hence the name all on 4 dental implants), and the restoration to be placed on the same day. Patients leave the office with teeth on same day as dental implant surgery. For this reason all on 4 dental implants are also called “new teeth in a day“.

Who Wants All On 4 Dental Implants?

The patients who choose all on four dental implants, they do so for many reasons including, poor fitting existing dentures, terrible trauma causing tooth loss, tooth decay or periodontal disease causing progressive tooth loss. The most common patients to choose all on four, are not necessarily denture wearers. They are patients who have been fighting an uphill battle for a while and know that they are losing their teeth. These individuals have been trying to hold on as long as possible because they do not want to have any time in their life without teeth, and the thought of a removable denture is not an option…..in comes the all on 4 dental implants system to save their smile.

What are All On 4 Dental Implants?

The All on 4 Dental Implants procedure was developed in the middle of the 1990’s. The all on 4 dental implants system has allowed for a variety of patients who, for various reasons, were not considered good candidates for traditional dental implants to now become candidates for dental implants.

The All on 4 Dental Implants procedure uses four dental implants per arch (either upper or lower or can be done on both).  The dental implants in the back are placed on an angle to take maximum advantage of the existing bone structure. Special dental implants were developed and refined that could support the immediate fitting of replacement teeth. This treatment is attractive to those with loose dentures or those in need of full upper and/or lower restorations. With the All-on-4 dental implants procedure, qualified patients receive just four dental implants and a full set of new upper or lower replacement teeth in just one appointment. This usually able to be done without the need for dental bone grafts.  The real attraction to the all on 4 dental implants procedure is how quickly permanent dental implants can be placed. This allows patients the ability to leave the same day with a denture that is fixed in place and stabilized by the dental implants.

Traditionally, the  approach to restoring a full arch of teeth (either upper or lower) usually involved dental bone grafts, six or more dental implants, and as much as 18 months of treatment. In that time, the patient would be wearing an interim denture while the dental bone grafts and dental implants heal and integrate into the bone. This can be very expensive, time consuming, and uncomfortable for a patient to continuously go back for treatment.

What Appointments are Needed for All On 4 Dental Implants?

The All on 4 Dental Implants procedure generally consists of the following visits:

Initial Visit(s) – The initial visit(s) for the all on 4 dental implants procedure is necessary for the dentist to do a proper treatment plan for you. These visits will include gathering pertinent medical history, needed X-rays, dental impressions, photos, and a CAT Scan. The dentist will then be able to review all the information with the patient and develop the proper course of treatment.

Actual All On 4 Dental Implants Procedure Visit – At this visit the patient will undergo the procedure for placement of the 4 dental implants. Following placement of the dental implants, your dentist 89052 will place the denture in and the patient will leave in the afternoon with a beautiful set of fixed, functional teeth.

Follow-up Appointments – The patient will need to return to the dentist for occasional dental examinations over the next several days, weeks, and months to ensure proper comfort and fit. In about 6 months, the patient will return for a final set of dentures. The reason for the 6 month wait is to give the tissues in the mouth time to heal properly, correct anything the patient wishes to change, and to allow the implants to properly integrate into the bone (the technical term for this is osseointegration).

Conclusion on All on 4 Dental Implants

More than 100 million people in the United States alone are missing between 11 and 15 of their permanent adult teeth. By the age of 60, almost 70% of these people are completely without teeth and in desperate need of complete oral rehabilitation. This is where the all on 4 dental implants procedure comes in and is able to restore people’s teeth and change their outlook on life. Call your dentist today if you feel this procedure might be right for you.

 




Dental Implants have changed the way we all look at tooth replacement and dentistry. Dental implants are not just for single tooth or multiple teeth replacement. They can also be used in support and stabilization of removable dentures. Long time denture wearers will tell you that over time the bone remodels and resorbs resulting in loose and ill fitting dentures. When this happens patients used to be forced to grin and bear it using various denture adhesives. Now with the development of dental implant supported dentures those days can be a relic left in the past for many patients.

Dental Implant Overdenture – What is it?

A dental implant supported denture is also called an overdenture. A traditional removable denture rests directly on the gums, and is not supported by dental implants. This is because the denture sits over the dental implants. The dental implants give support and stability to the denture.

A dental implant supported denture is recommended when a person is missing all the teeth in the jaw. The patient needs to have enough bone in the jaw to support the dental implants. The denture is able to stay in place using special attachments that allow the denture to “snap” into place over the dental implants.

Implant supported removable dentures usually are fabricated for the lower jaw. This is because regular dentures tend to be less stable on the lower arch due to tongue and musculature present. Usually, a regular denture made to fit an upper jaw is much more stable and tolerable on its own and doesn’t need the extra support offered by dental implants. If the patient chooses they can receive a dental implant supported denture in either the upper or lower jaw.

Dental implant supported denture should be removed daily to clean the denture and gum area just like traditional dentures. Also, you should not sleep with the dental implant supported dentures at night. Some people prefer to have fixed (permanent) crown and bridgework in their mouths that can’t be removed but this is not always possible in every patient’s case. Your dentist will consider your particular needs and preferences when suggesting fixed or removable options.

Dental Implants with bar supporting denture

Dental Implants with Bar Supporting Denture

Types of Dental Implant Supported Dentures

 

There are two types of dental implant supported dentures:

1) Bar-retained dentures. Your dentist will have a thin metal bar custom fabricated for your mouth. This bar will follow the curve of your jaw and is attached to 2-5 dental implants that have been placed directly into your jawbone. Clips or other types of attachments are fitted to the bar, the denture or both. The denture is then designed to fit directly over the bar stabilized by the attachments. The dental implants along with the bar and attachments gives the denture support and stability.

2) Ball-retained dentures. The dental implants in the jawbone hold a metal attachment(ball) that fits into another attachment(socket) on the

Dental implant supported denture - Ball retained

Dental Implants – Ball Retained Denture

denture. In most cases, the attachments on the implants are ball-shaped (“male” attachments), and they fit into sockets (“female” attachments)

on the denture. In some cases, the situation is reversed and the male attachment is in the denture and female attachment is on the dental implant. This also gives the denture wearer increased stability and retention over the traditional removable denture without dental implants.

In both scenarios, the removable denture will be made of a custom fabricated acrylic base that will look like gingival tissue. The teeth can be made of porcelain or acrylic. These teeth will look very natural. Either type of denture needs a minimum of 2 dental implants to work properly over the long term.

Placement of Dental Implants

The prime location for placement of the dental implants is in the front of the mouth. The reason for this is due to the fact that there is

supporting denture with dental implants

Visualization of dental implants supporting dentures

generally more bone present in this area for the dental implants. This is the case even if the teeth have been missing for a long period of time. When teeth are lost, bone is lost in that surrounding area.  Anatomy plays a role as well. In the front of the mouth there are less nerves orother important structures that could interfere with he placement of the dental implants.

The time schedule to complete the dental implants can be complicated. The general time frame is approximately 5 months for the lower jaw and approximately 7 months in the upper jaw. The process can take much longer if the case is more complicated. Complications can include the need for bone grafting or even sinus lifts.

The procedure generally requires two surgeries. The first surgery is for placement of the dental implants in the jawbone under your gingival tissue. The second surgery is to remove the gingival tissue that has now covered the dental implants. The second procedure comes 3-6 after the first.

There has been increased use of a one stage procedure.

A one-stage procedure is now used sometimes. In this procedure, your dentist places the implants and the supporting bar all at same visit.  The success rate of this procedure is high. if properly treatment planned.

Dental Implant Supported Denture Care

The dentures need to be removed at at night and to clean them. The attachments and/or bar need to be cleaned as well. Your dentist will give you instructions on how to clean these as they can be delicate.

Your dentist will periodically check the parts of your new denture to ensure they are secure and in proper place. Your denture may seem stable but over time these attachments can loosen. If they loosen even slightly it will cause the denture to move when chewing. This movement of the denture can cause sore spots as the denture rubs against your gums. Your dentist will also check to make sure your bite is correct and make any adjustments as needed.

The clip or other attachments on the bar retained denture usually will need to be replaced every 6-12 months. They are made of a plastic material (nylon) and will wear after continued use.

Complications that may Arise From Dental Implants

The actual dental implant surgery carries its own risks but so does a bar retained denture. The fabrication of a bar retained denture needs extra space inside the denture to allow for the bar to fit inside. This means there is less support for the teeth in the denture. Due to this, the teeth sometimes come loose. This is an easy fix but an inconvenience for the patient.

Another important item is that the denture fits on the bar passively. This means that the bar is evenly balanced across all implants. If the fit is not passive, the extra strain can cause the screws holding the bar down to loosen. A special note for teeth grinders or clenchers is that their parts are more likely to break due to the excessive force they are placing on the components and dental implants.

Dental Implant Overdenture Expectations

A denture supported by dental implants will be far more stable than a traditional removable denture. Patients will find everyday tasks easier. They will find speaking easier. They will also not be concerned that their denture may fall out or become loose. Patients report being able to eat foods they have not been able to eat in years. A word of caution is to avoid sticky or very hard foods as you can damage the denture with these types of food.

A big advantage to having dental implants support the upper denture is the dentist can make your denture much less bulky. A traditional denture covers your entire palate whereas a dental implant supported denture does not need that extra material for support.

A whole new world has opened up with dental implants for both patient and dentist. The old compromise and limitations are slowly being worn away. We are entering a new world of dentistry and dental implants are leading the way!

 

Benefits of Dental Implants with Removable Dentures
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