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Posts for category: Dental Procedures

By Wing, Mack, Smith & Bang, DDS
October 20, 2018
Category: Dental Procedures
Tags: TADs  
AnchorageDevicesEnableGreaterPrecisionDuringOrthodonticTreatment

As a basic orthodontic appliance, braces are what allows us to move teeth into better positions to improve a person’s bite. In certain cases, though, this treatment application gets a little assistance from Temporary Anchorage Devices (TADs) to improve accuracy and reduce treatment time.

Braces take advantage of our teeth’s natural ability to move. Teeth are held in place within the bone by the periodontal ligament, an elastic tissue that attaches to the teeth with microscopic fibers secured by a hardened substance called cementum. The periodontal ligament is constantly remodeling in response to changes in the mouth. As pressure is placed on a tooth, new bone, ligament and cementum are formed on the “pulling” side of the tooth; on the other side, the bone and ligament dissolve (resorb), allowing the tooth to move in that direction.

Braces allow this natural process to occur with controlled forces applied by thin flexible wires threaded through the small brackets attached to the front of the teeth and then affixed or “anchored” to other teeth. By attaching the teeth to the other teeth by wires running through all the brackets, “anchorage” is created to allow teeth to be moved where the dentist wants them to go. By adjusting the tension on the wires, we can apply light but constant pressure on the “unanchored” teeth to move them into a new desired position.

Teeth we do not want to move are referred to as the anchorage for teeth we do want to move. If, however, the situation calls for more precise isolation of teeth to be moved, TADs can be very useful. TADs are mini-implants imbedded in the bone to serve as anchorage at strategic locations in the mouth. In this way, the group of teeth to be moved receives forces that are applied through the additional anchorage provided by the TADs. That “tension” or “pressure” is applied only to them and not to adjacent teeth that should not move. This increases efficiency for tooth movement and helps reduce the treatment time.

TADs can be placed using local anesthesia and with little discomfort, and are removed when orthodontic treatment is completed. Although the procedure is pretty straightforward, it does require collaboration between orthodontist and surgeon to ensure correct positioning.

In the end, TADs increase our ability to control the forces that move teeth during orthodontic treatment. This lessens discomfort for the patient and helps ensure the end result — a more functional bite and a transformed smile.

If you would like more information on the use of TADs and other orthodontic appliances, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “What are TADs?

By Wing, Mack, Smith & Bang, DDS
August 31, 2018
Category: Dental Procedures
IfYoureConsideringBracesHeresHowTheyWork

If you or a family member has problems with teeth alignment or your bite, you may be considering braces. This tried and true method can straighten out most smiles — but there's more to braces than you may realize.

For one thing, orthodontic treatment wouldn't work if it weren't for the natural mechanism for tooth movement that already exists in the mouth. It may seem your teeth are rigidly set in the jawbone but that's not how they maintain their attachment: that's the job of an elastic connective tissue known as the periodontal ligament that lies between the tooth and the bone. The ligament has tiny fibers that attach to the tooth on one side and to the bone on the other to actually hold the teeth in place, much like a hammock secured between two posts.

The ligament attachment also allows the teeth to move incrementally in response to environmental factors or the aging process. We harness this natural movement ability with braces to move teeth to a more desirable position. We first attach small brackets to the front crowns of the teeth (the visible portion) and then string arch wires through them. We then attach the wires to anchor points where we can adjust the amount of tension they're exerting through the brackets against the teeth. By gradually increasing that tension, the teeth respond as they would when any force is applied against them and begin to move.

By precisely controlling that movement we can transform a patient's smile. But we believe the advantages are more than cosmetic: the teeth will function better and will be easier to care for and keep clean. These benefits, though, have to be balanced with heightened risks for root resorption (something that occurs only about 10% of the time) in which the ends of the roots can shrink, or loss of mineral content in teeth enamel where the hardware makes it more difficult to remove bacterial plaque. These risks can be reduced by closely monitoring dental health during the entire treatment process and through stepped up efforts in daily oral hygiene.

The starting point for deciding on an orthodontic treatment is a thorough dental examination with x-rays or CT scan imaging. Once we have a complete picture of your misalignment problems and any other extenuating circumstances, we can recommend a treatment plan just for you.

If you would like more information on orthodontic treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Moving Teeth with Orthodontics.”

By Wing, Mack, Smith & Bang, DDS
August 11, 2018
Category: Dental Procedures
26MillionFansLikeJustinBiebersChippedTooth

Is a chipped tooth big news? It is if you’re Justin Bieber. When the pop singer recently posted a picture from the dental office to his instagram account, it got over 2.6 million “likes.” The snapshot shows him reclining in the chair, making peace signs with his hands as he opens wide; meanwhile, his dentist is busy working on his smile. The caption reads: “I chipped my tooth.”

Bieber may have a few more social media followers than the average person, but his dental problem is not unique. Sports injuries, mishaps at home, playground accidents and auto collisions are among the more common causes of dental trauma.

Some dental problems need to be treated as soon as possible, while others can wait a few days. Do you know which is which? Here are some basic guidelines:

A tooth that’s knocked out needs attention right away. First, try and locate the missing tooth and gently clean it with water — but avoid holding the tooth’s roots. Next, grasp the crown of the tooth and place it back in the socket facing the correct way. If that isn’t possible, place it between the cheek and gum, in a plastic bag with the patient’s saliva or a special tooth preservative, or in a glass of cold milk. Then rush to the dental office or emergency room right away. For the best chance of saving the tooth, it should be treated within five minutes.

If a tooth is loosened or displaced (pushed sideways, deeper into or out of its socket), it’s best to seek dental treatment within 6 hours. A complete examination will be needed to find out exactly what’s wrong and how best to treat it. Loosened or displaced teeth may be splinted to give them stability while they heal. In some situations, a root canal may be necessary to save the tooth.

Broken or fractured (cracked) teeth should receive treatment within 12 hours. If the injury extends into the tooth’s inner pulp tissue, root canal treatment will be needed. Depending on the severity of the injury, the tooth may need a crown (cap) to restore its function and appearance. If pieces of the tooth have been recovered, bring them with you to the office.

Chipped teeth are among the most common dental injuries, and can generally be restored successfully. Minor chips or rough edges can be polished off with a dental instrument. Teeth with slightly larger chips can often be restored via cosmetic bonding with tooth-colored resins. When more of the tooth structure is missing, the best solution may be porcelain veneers or crowns. These procedures can generally be accomplished at a scheduled office visit. However, if the tooth is painful, sensitive to heat or cold or producing other symptoms, don’t wait for an appointment — seek help right away.

Justin Bieber earned lots of “likes” by sharing a picture from the dental office. But maybe the take-home from his post is this: If you have a dental injury, be sure to get treatment when it’s needed. The ability to restore a damaged smile is one of the best things about modern dentistry.

If you have questions about dental injury, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Porcelain Crowns & Veneers.”

By Wing, Mack, Smith & Bang, DDS
July 22, 2018
Category: Dental Procedures
Tags: cleft lip   cleft palate  
LiporPalateCleftscanbeEffectivelyRepaired

About one American baby in 700 is born with some form of lip or palate cleft—and the percentage is even higher in other parts of the world. At one time this kind of birth defect sentenced a child to a lifetime of social stigma and related health issues. But thanks to a surgical breakthrough over sixty years ago, cleft defects are now routinely treated and repaired.

Oral and facial clefts happen because a child’s facial structure fails to develop normally during pregnancy. This causes gaps or “clefts” to occur in various parts of the mouth or face like the upper lip, the palate (roof of the mouth), the nose or (more rarely) in the cheek or eye region. Clefts can have no tissue fusion at all (a “complete” cleft) or a limited amount (an “incomplete” cleft), and can affect only one side of the face (“unilateral”) or both (“bilateral”).

There was little that could be done up until the early 1950s. That’s when a U.S. Navy surgeon, Dr. Ralph Millard, stationed in Korea noticed after reviewing a series of cleft photos that tissue needed to repair a cleft was most often already present but distorted by the defect. From that discovery, he developed techniques that have since been refined in the ensuing decades to release the distorted tissue and move it to its proper location.

This revolutionary breakthrough has evolved into a multi-stage approach for cleft repair that often requires a team effort from several dental and medical professionals, including oral surgeons, orthodontists and general dentists. The approach may involve successive surgeries over several years with dental care front and center to minimize the threat of decay, maintain proper occlusion (the interaction between the upper and lower teeth, or “bite”), or restore missing teeth with  crowns, bridgework or eventually dental implants.

While it’s quite possible this process can span a person’s entire childhood and adolescence, the end result is well worth it. Because of these important surgical advances, a cleft defect is no longer a life sentence of misery.

If you would like more information on treatment for a cleft lip or palate, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cleft Lip & Cleft Palate.”

By Wing, Mack, Smith & Bang, DDS
July 01, 2018
Category: Dental Procedures
DontBreakItLikeBeckham

During his former career as a professional footballer (that's a soccer star to U.S. sports fans) David Beckham was known for his skill at “bending” a soccer ball. His ability to make the ball curve in mid-flight — to avoid a defender or score a goal — led scores of kids to try to “bend it like Beckham.” But just recently, while enjoying a vacation in Canada with his family, “Becks” tried snowboarding for the first time — and in the process, broke one of his front teeth.

Some fans worried that the missing tooth could be a “red card” for Beckham's current modeling career… but fortunately, he headed straight to the dental office as soon as he arrived back in England. Exactly what kind of treatment is needed for a broken tooth? It all depends where the break is and how badly the tooth is damaged.

For a minor crack or chip, cosmetic bonding may offer a quick and effective solution. In this procedure, a composite resin, in a color custom-made to match the tooth, is applied in liquid form and cured (hardened) with a special light. Several layers of bonding material can be applied to re-construct a larger area of missing tooth, and chips that have been saved can sometimes be reattached as well.

When more tooth structure is missing, dental veneers may be the preferred restorative option. Veneers are wafer-thin shells that are bonded to the front surface of the teeth. They can not only correct small chips or cracks, but can also improve the color, spacing, and shape of your teeth.

But if the damage exposes the soft inner pulp of the tooth, root canal treatment will be needed to save the tooth. In this procedure, the inflamed or infected pulp tissue is removed and the tooth sealed against re-infection; if a root canal is not done when needed, the tooth will have an increased risk for extraction in the future. Following a root canal, a tooth is often restored with a crown (cap), which can look good and function well for many years.

Sometimes, a tooth may be knocked completely out of its socket; or, a severely damaged tooth may need to be extracted (removed). In either situation, the best option for restoration is a dental implant. Here, a tiny screw-like device made of titanium metal is inserted into the jaw bone in a minor surgical procedure. Over time, it fuses with the living bone to form a solid anchorage. A lifelike crown is attached, which provides aesthetic appeal and full function for the replacement tooth.

So how's Beckham holding up? According to sources, “David is a trooper and didn't make a fuss. He took it all in his stride." Maybe next time he hits the slopes, he'll heed the advice of dental experts and wear a custom-made mouthguard…

If you have questions about restoring damaged teeth, please contact our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Trauma and Nerve Damage to Teeth” and “Children's Dental Concerns and Injuries.”