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Cosmetic Dentistry – QUICK LINKS
Our practice specializes in helping patients maintain the health and beauty of their smiles through the latest general, implant, and cosmetic dentistry procedures.Time, Value, Beauty– we understand that these are important to you. That’s why we’re different. Dr. Lopez works with you to design the treatment plan that’s perfect for you. Dr. Lopez can perform every stage of your restorative or implant dentistry treatment within our one location here in Tucson, AZ.
Cosmetic Dentistry has come a long way, utilizing dental implants we can restore your smile and provide function while maintaining your bone and facial structure. Allow us to help you get back to eating the foods you love.
Dental Implants are artificial tooth replacements that were first developed half a century ago by a Swedish scientist named Per-Ingvar Branemark. Implants arose from the patient’s need to secure loose fitting dentures. Since the advent of the implant, engineering and enhancements to the implant have enabled dentists to expand the implant’s usefulness, including the replacement of missing or lost teeth. Today, implant techniques provide a wide range of tooth replacement solutions including:
- Single Tooth Replacement
- Anterior Replacement
- Posterior Replacement
- Full Upper Replacement
- Full Lower Replacement
Traditionally, several missing teeth would be replaced with a partial or full denture. Dentures may cause discomfort, and do not stimulate the jaw bone as regular teeth do. Without stimulation, the jawbone degrades, causing a caved-in appearance that is often associated with age. Placing implants can stop this process and give you back your functional, confident smile.
For well over a century, complete maxillary (upper) and mandibular (lower) dentures have been the traditional standard of care. If you are one that has a removable upper or lower denture you know that there are certain limitations with this option. There can be lack of retention, stability, and inability to chew and eat certain foods. Dentistry has come a long way. Now we can help eliminate all of those limitations with an over denture. This type of prosthesis is primarily tissue-borne with implants providing retention and stability. On the lower arch the minimum number of implants needed is 2. Minimum for the upper arch is 4. For more retention you can add more implants. To move away from something removable more implants are required. If any of these options interest you, come in to see Dr. Lopez. He listens to your desires and makes them a reality.
Removable lower 2 Implant Retained Denture:
Fixed Lower Prosthesis with 5 Implants:
Bridge vs. Implant
When patients asks us what are the differences of a bridge verses an implant, most times the real question they want answered is how long will each one take and how much? These are very important questions, however, Dr. Lopez would pose the question: What are the risks between choosing a bridge vs. an implant in the long run?
A bridge is constructed of 3 or more crowns that are fused together covering the open space as well as the teeth on either side of the missing tooth, hence, “bridging” the gap. To place a bridge Dr. Lopez must reduce the adjacent teeth (as seen below). Once the teeth are reduced there is no getting the tooth structure back. Any time you drill on a tooth there are risks involved. Studies show that placing a crown on a tooth increases the risk of needing a Root Canal by 10%. Research as also shown that 10 years out if/when a bridge fails (due to periodontal disease, fracture, or decay) it takes a tooth with it, no longer allowing Dr. Lopez to just replace the bridge. As noted above in the ‘What are dental implants’ section, whenever you have a missing tooth you will continue over time to loose bone in that area. With a bridge you cannot floss as normal. You must use a floss threader to get under the fixed bridge. The major draw of the bridge option is the instant gratification of having a tooth within 3 weeks (in most cases). We do a lot of bridges in our office- our goal is to make sure patients know, understand and accept the risks.
An implant – by far, the most popular- is the most effective because it mirrors the size and shape of the patient’s natural tooth. This implant is often as strong as the patient’s original tooth. The benefits are that our patients can brush and floss as normal, no change in diet, fakes the body into believing a tooth is still there and preserves the bone in the area, and does not affect the adjacent teeth in a negative way. The process does take from average 6 to 9 months. This is a surgical procedure and we are restricted on how fast we may proceed, this is dictated by the body and the natural healing that must take place between phases.
The cost between these two options is actually a complex question, there are many variables that need to be taken into account. If you are interested in finding out your options, give us a call. It would be our pleasure to make an individualized treatment plan for you based on your desires and needs.
Removable Partial vs. Implant retained Bridge
The advantages of a removable partial is that is takes less planning and appointments in the short term. The disadvantages are expedited bone loss due to the unsupported bone and the hard material of the partial pressing on the bone. With a partial there are diet restrictions. The clasps on a partial can act as a collector of food and plaque. Looking at the long term health of the tooth or teeth the partial is clasped to may have a profound negative effect. Future appointments needed to refit partial as bone continues to melt away- this is an additional cost to keep in mind.
The advantages of an implant retained bridge are that it preserves the bone, there are no dietary restrictions, and it is not removable (no embarrassing moments). The disadvantages are that there is a surgical procedure involved and that it will take more planning and appointments.
View of Removable Partial vs. Implant retained Bridge:
What is osseointegration?
Once an implant is placed the bone surrounding the area attaches directly with the implant. This process is why we need to phase treatment. Unlike when you place a screw in wood and you only have that initial stability, with an implant over a 3 month period of time the bone cells grow into any crevice not initially engaged.
Are Dental Implants for me?
-How do I know if I am a suitable candidate for dental implants?
Call us! You’ve found the right place. It is important that Dr. Lopez completes a comprehensive examination and takes a full set of x-rays to make sure there is nothing to hinder the success of your implant(s).
-What can I expect to happen during the examination process?
Your initial exam will last approximately one hour. In this hour, you will have a highly trained technician review and discuss with you your medical and dental history, along with any concerns or desires you have at this time. There will also be a full mouth series of digital x-rays taken (18 films), which you’ll be able to see immediately on the computer monitors mounted in every operatory. A panoramic x-ray will be taken at this time. After all documentation has been compiled, Dr. Lopez will extensively asses all collected data and complete a full comprehensive exam. This exam will take a detailed look at what we call the ’Four Main Food Groups’ of dentistry:
- Periodontal = Gum/Bone
- Biomechanical = Tooth Structure
- Functional = Joint, Bite and Chewing
- Dentofacial = Smile Characteristics
Based on information found and treatment diagnosed, follow up appointments will be discussed fully with you and then scheduled according to your specific needs.
Our friendly dental team is looking forward to meeting you.
-Dental I-Cat Scan
All x-rays taken at the preliminary examination are 2 dimensional. When surgery is involved, we want to make sure there are no surprises for you or Dr. Lopez. Surprises could mean more money because of unexpected complications or inability to successfully place implant that day. To keep these unpleasant surprises away we recommend for all our patients interested in implants to get a dental I-Cat Scan taken prior to surgery. The dental cat scan, unlike a medical cat scan, takes about 20 seconds. This view allows Dr. Lopez a 3 dimensional look at the site(s).
-How are they placed?
A medical grade titanium post is surgically placed in the jaw bone under local anesthesia, then allowed to heal and integrate with the bone. For patient that would like that extra touch of comfort we do offer nitrous and oral sedation. The implant will be plaved in the bone below the gum tissue. We have several options if you desire something temporary while going through the healing stages.
-How do you phase the treatment?
The first step after determining there is sufficient bone, is to place the implant. We are then in a holding pattern for a minimum of 3 months. After the implant has integrates with the bone we place a healing abutment that will be raised above the gum tissue, to allow the tissue to heal natural around the contours of the abutment. The patient will wear the healing abutment for about 1 ½ weeks then return for the impressions that will be sent to the lab to fabricate the custom abutment and implant crown. The total treatment takes an average of 6 to 9 months.
-Why would I want a custom abutment over a stock abutment?
First, what is an abutment? An abutment is the portion that gets placed above the gum tissue and mimics a natural tooth after it has been prepped for a crown. The abutment should help preserve gingival integrity and maintain papilla. When looking at a natural tooth you will notice that the gum tissue is not the same height all around the tooth.
A stock abutment has 3 standard sizes: small, medium, and large. The stock abutment lacks natural contours. The narrow, cylindrical shape of the stock abutment forces the crown to appear like a mushroom cap on its stem. You can see in the picture below that this relationship creates an undercut area. These areas can certainly be maintained, but not with the ease of simple flossing.
The custom abutment is more consistent with natural anatomy. The health benefits for choosing a custom fit that will help maintain soft tissue and even interproximal bone height are well documented. Because of these benefits, Dr. Lopez only offers custom abutments.
(Image courtesy of AstraTech)
-What is the overall success rate for dental implants?
In our office the success rate is about 98%. Depending on a patients overall health, age, and hygiene, dental implants can last a lifetime for most people. Following post-operative care instructions, daily oral hygiene, and regular dental visits for cleaning and a check up are key.
Healing and Treatment Care
-How long does it take for implants to heal?
As mentioned above for the osseointegration process it takes about 3 months. Healing of the surgical site varies with each patient. Generally about 2 to 3 weeks. Most patients comment that the day after the procedure there is a little tenderness in the area but nothing that ibuprofen wasn’t sufficient to take care of.
-How do I care for my implants?
They require the same “maintenance” as real teeth, including brushing, flossing and regular dental check-ups.
There are several reasons why a patient may need a bone graft: Restore the bone to its previous form following tooth loss, gum disease, trauma, or to maintain bone structure after a tooth extraction. There are several different sources available for grafting material. Based on the desired treatment we can determine what source is best. There are 3 bone grafts that we work with in our office. Allograft, Autograft, and Xenograph. In one sense, which one is chosen doesn’t matter, they all accomplish the same goal. The difference between the 3 different grafts is how quickly they transition into your own bone. The body acts like a PAC-man, and eats the graft we’ve placed and grows your own bone. The autograft transitions the quickest since it’s the most compatible with your body, however, this does not make for great bone to place an implant. The bone is not dense enough. Xenograft takes the longest to transition into your own bone, it can take years. Autograft takes about 3 months to mature into dense bone that is perfect for implant placement. There are times Dr. Lopez may use a combination or sandwich technique.
Allograft:Taken from an organ donor and processed to ensure its safety. Each donor is extensively screened before the bone is accepted for processing. Testing for infectious diseases is performed and then packaged into single-patient doses that are sterility tested and ready for implantation to help the body regenerate bone.
Autograft:Patients own bone. Bone can be harvested from patients hip, mandibular symphysis (chin area) or anterior mandibular ramus (portion of lower jaw all the way in back). With this process it does mean there would be an additional wound site.
Xenograft:Bone substitute has its origin from a species other than human, such as bovine.