Dental Implants Can Address both Functional and Esthetic Problems

July 11, 2014 alexnguyen

This is a follow up of my blog entry dated December 19th, 2013 . In that entry I discussed why lower dentures hurt and what can be done to address the problem. These images illustrate a complete case from preliminary assessment to the final prosthesis in the patient's mouth. I was able to execute this treatment by handling both the surgical procedures and the restorative procedures in my office.

1. CT scan to assess bone condition and location of the nerves:

2. Treatment planning using computerized software and the actual CT Scan.

3. Placement of the planned dental implants in the exact locations as displayed by the stone and model with replica of the soft tissue and the implants.

4. Final delivery of upper full denture and lower fixed zirconia/porcelain hybrid prosthesis.

By keeping the lower prosthesis away from the nerves, the patient regained her chewing function which used to be debilitating from the pain induced by the removable lower denture. Note the difference in esthetic between the lower zirconia/porcelain and the upper denture acrylic.

Images of actual patients of Alex Nguyen, DDS are Copyrighted and Digitally Embedded to track Unauthorized Use.

Dental Implants Require Proper Bone Width and Height

April 16, 2014 alexnguyen

When a tooth is missing in the jaw for an extended period of time, the bone at that location resorbs in both width and height. Proper treatment planning is crucial in determining if ideal bone volume is in place before an implant could be placed with predictable long lasting result. In the case below resorption of the bone in three dimensions is observed, and the ideal treatment protocol requires an additional bone grafting procedure to build up the ridge before the implant can be placed. When required, bone grafting extends the treatment time for dental implant treatments. Nonetheless the long term treatment predictability merits the extra time and effort in treating everything right from the beginning.

Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

Smile ! It's Valentine's Day !!!

February 13, 2014 alexnguyen

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When are Dental Implants Recommended?

January 24, 2014 alexnguyen

Dental implants are recommended only when the root of the tooth can no longer sustain itself in the jaw bone. There are two general scenarios for the problem: 1. The root has lost too much bone around it. Bone loss can be caused by gum disease or excess bite trauma to a particular tooth. Bone loss can happen in both vital teeth and root canal treated teeth. If the bone loss is beyond the minimum volume for a sustainable implant, then bone grafting may be necessary before the implant can be placed.

2. When the root is cracked from bite trauma.

a) A vital tooth can crack from bite trauma, and the crack can extend deep into the root. In this situation, root canal treatment and crown are not viable options because of the extent of the crack or fracture.

b) Root canal treated teeth are essentially dead roots. These roots are very brittle. Even with a crown placed on the root canal treated tooth, that root can manifest a vertical crack line running along the length of the root. In this case, bone loss begins to occur where the crack line exists, and the root is no longer salvageable. Evidence of cracks in root canal treated teeth can be seen as an absess in the gum tissue surrounding the root. Keeping these roots in the jaw for extended periods of time will result in more extensive bone loss, and the destruction can be seen on xrays of the surrounding bone area of the root.

The decision to extract and replace a particular root with a dental implant has to be substantiated by clinical evidence and radiographic evidence.

The following sample cases illustrate situations where the natural tooth root cannot be saved, and a dental implant would be an option to replace the tooth.

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Why Do Lower Dentures Hurt ?

December 19, 2013 alexnguyen

I would like to dedicate this last dental blog entry of 2013 to patients who suffer pain from chewing with dentures. Most people think that the dentures put too much pressure on the gum, and so it hurts when they chew. However, when a patient has very little bone left in the jaw, the nerves which normally run deep inside the lower jaw is usually the the cause of the pain. In the image of my actual patient case below, you can see the two nerves ( in red on each side ) actually sit on the surface of the bone.

This is a severe case of bone loss leading to deficient arch form. When the denture pinches on these nerves, it is impossible to bite down without pain. The chewing efficiency is drastically reduced, and the quality of life is adversely affected for these patients.

It is important to understand the biology of bone as it relates to the chewing pressure. If the bone is not continually stimulated by a tooth root, then the bone will resorb in both height and width. Ideally, every tooth root that is lost should be replaced with an implant in order to preserve the volume of the bone around that root.

What then would be the solution to help denture patients who have inadequate bone, and whose residual nerves interfere with the denture bite force?

With proper comprehensive treatment planning using computerized 3D CT Scan, we can predetermine the exact location and size of the implants that can be placed in the bone. Once the implants are integrated with the bone, a prosthesis can be fixated on those implants to relieve all pressures from the underlying nerves and tissue. In a matter of months, we can completely reverse this patient's years of agonizing pain from trying to chew with a denture on a deficient ridge.

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