Tag Archives: Dental Implants

Invisalign

Dealing with Congenitally Missing Lateral Incisors

My daughter never received one of her adult lateral incisors. When the baby one fell out, our dentist said not to worry about it because the adjacent teeth would shift to fill in the spot. While they did, it left a bit of a gap, which leaves my daughter feeling embarrassed by her smile. This is her senior year and I’d like her to be able to go off to college feeling good about her smile. I spoke to another dentist and they recommended we open up the space and then place a dental implant there. I don’t think she’d be too keen with a mouth full of braces during her senior year of high school. Is there another option?

Laurie

Dear Laurie,

a smile with missing lateral incisors
A smile with canine teeth where the lateral incisors would normally be.

The above image shows a smile with missing lateral incisors. In the place of them are her canine teeth. As you can see, the smile doesn’t look normal. Instead, it is almost vampiric. Your daughter’s smile would look even stranger with one canine tooth. The advice her childhood dentist gave you was horribly bad.

The second dentist’s advice is sound. Your daughter has other choices aside from a full mouth of metal. Her first option is Six-Month Smiles which will allow her to fix her front teeth quickly. A second option is for her to get Invisalign. These use clear aligners instead of wires and brackets. Most responsible teenagers do very well with these. Then, when that is ready, a dental implant will be a fantastic idea.

What Her Original Dentist Should Have Done

Ideally, when her baby tooth came out and there was no adult lateral incisor, her dentist should have provided her with a dental flipper. This would have held the spot open so when she was old enough you could have just placed the dental implant. Now, because of his bad advice, you are having to add orthodontics to the mix.

I say this as a cautionary measure to others reading this post in two ways. First, in giving them the correct way to handle this situation. Second, in knowing that anytime you have a major dental decision to make, there is never any harm in getting a second opinion before moving forward.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Maryland Bridge

A maryland bridge between two crowns

I have two dental crowns that are on top of dental implants. I am now losing the tooth between them. Is it possible to have a Maryland Bridge placed there and attach it to porcelain crowns?

Kay

Dear Kay,

Diagram of a Maryland Bridge
A Maryland Bridge

While technically the answer would be “Yes, you can place a Maryland Bridge between two porcelain crowns.” it is not easy. Ideally, you would want to bond the wings of the bridge to tooth enamel, which would give you your strongest bond. Bonding to porcelain crowns is tricky, Very few dentists even know how to do that and it may not hold up.

Hopefully, your dentist had foresight. Realizing you had two dental implants with a tooth between them, he or she should have thought about what to do if the middle tooth needed to be replaced.

Planning ahead, you would place the implants in a way that the abutments are parallel to one another. Then, instead of cemented crowns, you would use screw-retained crowns. That way, when the middle tooth needs to be replaced, your dentist would simply unscrew the two crowns and replace them with a single dental bridge.

If your dentist didn’t plan ahead for that, you always have the option of having a third dental implant placed there.

Whatever you decide, it is going to take a dentist with advanced skills, so choose who does your procedure carefully.

This blog is brought to you by Lafayette Dentist Dr. Mike Malone.

Dental Bridge

a Maryland bridge is not a temporary tooth replacement

My daughter had a gymnastics accident which damaged a tooth. Three failed root canal treatments later and we need to extract the tooth. My plan is to eventually replace the tooth with a dental implant when she is old enough. In the meantime, we need a temporary replacement. My dentist suggested a Maryland Bridge. I just wondered what you’d think about that. I asked about a partial flipper, but he said she’d lose them because they’re removable and this will bond to her teeth in the back.

Patricia

Dear Patricia,

First, I want to say your choice of doing a dental implant for her permanent replacement is a fantastic idea. It will serve her very well. I’m glad you realize she will have to wait until her jaw is fully developed. Some parents mistakenly think they can get a dental implant right away, while their child is still a teenager.

dental flipper
Dental Flipper

As for a temporary replacement, your idea is better than your dentist’s suggestion. While a dental flipper is removable and, yes, there is always a chance that your daughter will lose her flipper. In all honesty, though, you could replace several of them for the price of one Maryland Bridge.

With a traditional dental bridge, a false tooth is suspended between two crowns. That requires grinding down the two adjacent teeth, which is definitely not something you’d want to do to healthy tooth structure.

While a Maryland Bridge does not require damaging the adjacent teeth, it is not the temporary tooth replacement your dentist is saying it is.

tooth preparation for a Maryland Brdige
Tooth preparation for a Maryland Bridge

While the Maryland Bridge has two metal “wings” which will bond to the back of the adjacent tooth, without cutting a little groove in the tooth for it to hook into, the bonding is not going to stay. Whenever you are doing any removal of tooth structure, that is not a temporary replacement.

Go with your original idea and get a dental flipper for your daughter.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Invisalign

Fixing long teeth

My two front teeth are insanely long. They also stick out a bit from the rest of my teeth. I feel like a beaver and hate all of my pictures. I’m trying to find a cosmetic solution but can’t find one. Do you think the only solution is for me to have my front teeth removed and have dental implants placed? I’m desperate.

Lucy

Dear Lucy,

Invisalign aligner
Invisalign can straighten teeth without anyone knowing.

Please don’t remove your front teeth!! There are always solutions. I am going to make a suggestion, but want to preface it with the precaution that I haven’t examined you. This is a solution based on my understanding of your description.

Your front teeth can be trimmed by an expert cosmetic dentist using diamond burrs and diamond strips. They can be filed down on the sides to narrow them and on the biting surfaces to make them smaller.

Once they’re a size you’re pleased with, Invisalign can be used to align them properly. An added benefit of Invisalign is the aligners can double as teeth whitening trays. This lets you get a mini smile makeover.

Depending on how much structure has to be removed, you may need porcelain veneers to cover any exposed dentin.

You Need an Expert Cosmetic Dentist

None of my suggestions matter, though. You need to see an expert cosmetic dentist and let them tell you what is the best solution. They’ll give you a smile you’ll be proud to share.

The best cosmetic dentists in the country are accredited by the American Academy of Cosmetic Dentistry. These are the top cosmetic dentists in the country.

This blog is brought to you Lafayette, LA Cosmetic Dentist Dr. Mike Malone.

Lafayette LA Dentist

dental filling disaster

I had never had a cavity until I switched dentists. My insurance changed so we needed to go to a different practice. On my very first appointment, he said I had a cavity, which surprised me. I went ahead and had it filled. The filling caused continual pain even after he adjusted it. It got to the point where he said I’d adjust to it. I waited out the full year with my insurance than switched to one that allowed me to go back to my old dentist.

When I did, he said I likely didn’t even need the filling at all. He said there’d been a spot on my x-ray for years that hadn’t changed. He said he’d replace the filling to make it better. The pain was instantly better, but the filling was uneven I guess and food would get trapped in it.

He decided to adjust that because he said it would become an issue. Since he’s adjusted it I’ve had problems with a serious sensitivity to hot and cold. Now my dentist is talking about extracting the tooth. I don’t want that so I’m afraid to go back. Is there anything I can do?

Betty

Dear Betty,

A blonde woman hodling her left cheek and jaw in pain

It’s unusual for a dentist to fake diagnose a single filling. It’s not a financial gain for him or her. In all honesty, it is more of a hassle. So, I don’t think you were taken for a ride by the new dentist. I’m actually more concerned that your original dentist saw a spot on your x-ray for years and never even mentioned it.

The trouble I’m seeing here is you have two incompetent dentists working on your teeth. The dentist who did your filling couldn’t do it correctly and rather than repair it he said, “You’ll adjust”. That’s dental speak for, “I don’t know what to do.”

When a dental filling is done right, you don’t even notice it.

Then, when you went back to your original dentist, he couldn’t get the filling right either. Now he’s talking about extracting the tooth?! I don’t think so.

My guess is your insurance has a preferred provider list. They do that to keep the fees cheap. But, the better dentists won’t sign on to plans like that. So often (not always) preferred provider means less than adequate dentist.

I’m going to suggest you go to an out of network dentist who has good reviews. You need this fixed. Don’t let your dentist extract your tooth.

The last thing you need after all of this is another expensive procedure and, believe me, tooth replacements cost a pretty penny.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone

Lafayette LA Dentist

Dental bridge before implant?

I’m a little concerned about what my dentist is recommending for a missing tooth on my 15-year-old daughter. We’re planning on getting her a dental implant when her jaw is developed enough for one. I was looking at some temporary replacements. I thought a flipper would be a good option, but my dentist wants to give her a dental bridge. I think that’s a bad idea, but he said flippers are too temporary. What do you think?

Mandy

Dear Mandy,

woman smiling with a dentist
It’s always okay to get a second opinion from another dentist

I’m glad you wrote about this. While a dental bridge is a more secure fit, I don’t think it is a good fit for a teen aged girl. There are two reasons for this.

First, just like her jaw is still developing for her dental implant, she will need new bridges. That is too expensive to keep replacing as she grows.

Even though the flippers are meant to be temporary, you can replace those in a much more affordable way than the bridge.

There is another reason too which has nothing to do with cost. A dental bridge requires her adjacent teeth to be crowned in order to support and suspend the false tooth. That will mean those teeth will always have to be crowned for the remainder of her life.

If those teeth are healthy, you won’t want to grind down the healthy structure.

It’s Okay to Get a Second Opinion from Another Dentist

A good dentist will give you all of your options. Even then, they will make a recommendation. if you don’t like their recommendation and they’re pressuring you to go with their option, I recommend getting a second opinion.

If your dentist refuses to do the treatment you want you can go to another dentist for that procedure. That means you could get your daughter a dental flipper elsewhere. You don’t have to switch dentists to do that, unless you want to.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Cosmetic Dentist

Cosmetic Dentistry Tourism Disaster

I had porcelain veneers placed on my top teeth and a dental implant and crown on my bottom arch. In the U.S. it would have cost me over $60,0000 but I was able to get it done overseas for around $11,000. At first, I was pleased as punch, but now I’m four months out and the veneers are falling off. I’ve been cutting up the food the way he showed me and not eating with my front teeth at all. In fact, the last one fell off while eating spaghetti. That’s hardly anything to stress about. Three of the veneers have fallen off. They’re all intact. Do I need to have these re-done or can another dentist put them back on?

Catrina

A single porcelain veneer being held up by a dental tool

So, here’s the thing. Those instructions your dentist gave you about eating are a huge red flag to me. There is absolutely no reason why you should have any restrictions at all on what or how you eat. When properly bonded on, porcelain veneers will allow you to eat anything.

This dentist doesn’t know proper bonding technique. That alone, makes me question the skill of the rest of his work. For health and safety reasons, I’d like you to get a second opinion on the dental implant and crown you had done. This is especially important about the implant. If an infection develops it can lead to serious consequences.

Regarding your fallen porcelain veneers. You mentioned they’re still intact. In that case, it is possible an expert cosmetic dentist could clean them up and get them bonded back on properly. However, this is beyond the skill of almost all cosmetic dentists. You will need someone in the top 2%.

Finding an Expert Cosmetic Dentist

Cosmetic dentistry isn’t really taught in dental school so you’ll need to look for someone who invested the time and training into doing it well. In your place, I’d look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are in the top 1% of dentists. You can find them listed on aacd.com. Just make sure they’re accredited. They will know the right procedure to help you with your porcelain veneers.

The cost to get them bonded back on properly shouldn’t be too bad, if they can be saved. If they can’t be, these dentists will give you a list of options and let you determine which way you want to go.

This blog is brought to you by Louisiana Cosmetic Dentist Dr. Mike Malone.

CEREC

Are CEREC Crowns Better for Anxious Patients?

I have never been crazy about going to the dentist. I had a toothache and decided to go in because it means something is wrong. It turns out I have a large cavity. Now I have to have a dental crown. I’m really nervous about this. What can I expect?

Belinda

Dear Belinda,

A tooth receiving a CEREC crown

It’s good that you went in. The fact that you did despite your dental anxiety means you are courageous. If you’d allowed your fear to get the better of you, you would have ended up with a dental infection. That would have meant an additional procedure of a root canal treatment. Or, possibly your tooth would not be able to be saved and you’d need to have it extracted and replaced. To get a great replacement, like a dental implant, requires surgery. Obviously, you made the right decision.

What to expect depends on the type of dental crown you’re getting. Did your dentist mention whether you’re getting a traditional crown or a CEREC crown?

What to Expect with a Traditional Crown

If you’re getting a traditional crown, it takes two visits. First, your dentist will have to remove any decay as well as grind down enough tooth structure to make room for the dental crown. You can see how small your natural tooth has to be in the image above. After that, your dentist will make an impression of your teeth and fit you with a temporary crown. The impression will be sent to the lab to make your permanent crown.

It takes a couple of weeks for the permanent crown to be made and sent to your dental office. Then your dentist will call you, fit you with the permanent crown and bond it on.

What to Expect with a CEREC Crown

Given your anxiety, this will be a better option for you. First, they can be done in just one appointment. That minimizes how often you have to come in. Second, many patients hate having to do impressions. The goo is messy and bad tasting. With CEREC crowns, you just have a digital image made and a computer designs the crown. Not only is this less nerve-racking, but it’s also faster and more accurate.

While you’re at the office, the computer will mill the crown immediately and your dentist can then bond it on before you leave.

This is a must simpler procedure. Plus, if you’re still nervous, it’s very compatible with a sedation such as nitrous oxide which can relax you.

A Front Tooth Requires an Expert Cosmetic Dentist

You didn’t mention which tooth is being crowned. If it’s a front tooth, there’s an additional consideration. It’s very challenging to match a single crown to a front tooth. You will need to find a dentist with both technical expertise and artistry.

In your place, I’d look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. Simply go to aacd.com and look for an AACD accredited dentist in your area. They can give you a beautiful crown that blends in perfectly with your other front tooth.

This blog is brought to you by Louisiana Cosmetic Dentist Dr. Mike Malone.

Invisalign

Is Orthly Equal to Invisalign?

I told a friend the other day that I wish I could afford Invisalign. I’ve spent a lifetime embarrassed about my teeth. She sent me this link to a company called Orthly. It looks like Invisalign, but it’s 70% cheaper. I just want to make sure it’s safe to do it and it’s similar to Invisalign.

Ellen

Dear Ellen,

Image top: A woman putting on her Invisalign aligners. Image bottom: a woman smiling with Invisalign on her teeth

It sounds like you have a friend who cares about you. It’s lovely to have friends like that. If you won’t hate me, I’m going to help you understand the differences taking you back to High School. Do you remember geometry class where you had similar triangles versus congruent triangles? As you recall, congruent triangles were completely equal to one another in both sides and angles. But, similar triangles were only that, similar but not equal. They had the same angles but not the same lengths.

That’s how I would describe Orthly to Invisalign. Similar but not equal. It will save you money. Unfortunately, it could also cost you some teeth.

The first thing you should know is it wasn’t founded by dentists or anyone with dental knowledge. The idea came to two students who wanted to get Invisalign but couldn’t afford it. Their company is very straightforward about that. They say, “Orthly does not practice dentistry nor do any employees in the company.” That alone wouldn’t make it dangerous. I’m sure they consulted with dentists and orthodontists as they followed through on their idea.

Where Does Orthly Fall Short of Invisalign?

The way Orthly saves money is by avoiding orthodontic appointments. You see a dentist a total of two times. They can request photos through the app, but that’s the extent of the “looking after” you get. You may think that’s no big deal, but here’s what worries me about that.

The reason dentists keep an eye on you throughout the treatment is to measure things like mobility, root absorption, periodontal disease, and oral hygiene. None of these can be tracked through a photo. If they don’t catch any one of these problems in time, it could lead to the patient losing their teeth.

Then you’re talking about a much greater expense then they’d have had if they’d done the best treatment to begin with. They’ll need to replace their teeth.

So, in your place, I’d weigh the benefits with the risks before you decide.

You could always talk to your dentist about your desire and ask if there’s a way he’d let you pay out “the real deal” in installments you can afford.

This blog is brought to you by Dr. Mike Malone.

Invisalign

Did the Oral Surgeon Lie to Me?

When I turned 18 my wisdom teeth began to bother me. We checked them and my dentist said, they don’t have to be removed, but if I wanted to remove them she’d give me a referral to an oral surgeon. We decided to just see what he had to say. He told me I really needed to removed them, otherwise, I’d need braces from crowding. If I had them removed, I’d not have to face that. I’m almost 40 now and suddenly my teeth are crowding. Did he lie to me or is something else going on? What can fix them at this point? I’m a little old for a mouth full of metal. Heck, I didn’t want that when I was young.

Tabitha L.

Dear Tabitha,

A woman placing in her Invisalign aligners

I don’t think the oral surgeon intentionally lied to you, though, admittedly I don’t know who he is or anything about his practice habits. He was, as we’re giving him the benefit of the doubt, overly generous of the benefits of removing your wisdom teeth. While it did prevent your wisdom teeth from causing crowding, it can’t stop other causes of crowding.

Reasons Teeth Can Crowd

There are numerous reasons for crowding aside from wisdom teeth which don’t fit. Here are just a few which could pertain to your situation:

  • Grinding

Most people who grind their teeth don’t even realize they’re doing it. Generally, it’s the dentist who first recognizes the signs of teeth wearing down due to the grinding. Believe it or not, that back and forth pressure can shift your teeth. A simple mouthguard can protect your teeth in these situations.

  • Sucking

I’m assuming you’re well past the pacifier and thumb sucking stage, but even some adults have an oral fixation. You see it when they always seem to need something in their mouth, pens and other things.

  • Losing a Tooth

If you lose a tooth and don’t get it replaced, your teeth will shift to close in the gap. This shifting can cause problems for the remaining teeth. At the very least, things will start to look off. This is one of the reasons it’s quite important to replace a missing tooth with something like dental implants.

  • Shoddy Dental Work

There are unskilled dentists out there. Poorly shaped crowns, bridges, and other work may change the bite or begin to push teeth out of alignment. Often the patient ends up with a serious case of TMJ Disorder.

  • Tooth Trauma

When there is an injury to your teeth it can affect them in a variety of ways, including shifting.

  • Tumors

Don’t panic about this if you get regular checkups with x-rays. Your dentist would have noticed this. But, if you have sudden huge changes in your bite, it’s worth getting another x-ray. It’s rare, but tumors can significantly change your jaw, teeth, and bite.

Repairing a Bite without Braces

There is a simple solution in your case. If it’s just a matter of your teeth shifting and crowding Invisalign is a perfect solution. This uses clear aligners to straighten your teeth. No one will know you’re wearing them, even at a conversational distance.

Talk to your dentist. Let he or she know what’s going on. They’ll help you get the smile you’ve always loved back.

This blog is brought to you by Dr. Mike Malone.