Boise Dentist Blog

Single tooth anterior implant using a 3d CT scan

Fri, 17 Feb 2012 00:42:00 GMT

This week I was able to complete a long treatment process that started with a cracked front tooth. Jeff originally had a root canal on his front tooth 25 years ago after trauma to the tooth. He then had a crown which matched fairly well, but not perfectly. Also, notice that the crown is wider than the adjacent central incisor and there are gaps near the gumline. Finally, he had some recession around the front of the gumline. Last year, the tooth started to hurt to biting and we noted a periodontal defect on the front of the tooth. After consultation with our endodontist, it was determined that the tooth had a vertical root fracture and was not savable.

The only choice was to extract the tooth and place a bone graft in the socket and where the portion of bone was due to the fracture of the tooth. In the meantime, we bonded the original crown with a metal wire we imbedded into the crown. This way the patient did not have to wear a retainer and the crown was used to adapt the soft tissue to the ideal contours. When then had Jeff get a CT scan using the Galileos 3D scanner. This scanner uses minimal radiation and allowed us to create a guide for placing the dental implant exactly where we wanted. The implant was digitally placed in the best bone, with the best emergence profile. A guide was made that fit to the patient's teeth and to guide the surgical drill to the precise depth and position we wanted.

After placing the implant, a temporary abutment was placed with a crown to contour the gingiva. We also placed small bonded composite fillings in the adjacent teeth to make them proportionally the correct shape. We waited 5 months while the implant integrated to the bone. During this time the temporary was completely out of Jeff's bite and we warned him not to eat anything with his front teeth. Notice how the temporary is shorter than the original to keep it out of harm's way.

Finally, we took an impression and had Jeff go to our lab technician for a customized shade match. We used a white zirconia abutment to attach the crown to the abutment. Zirconia is strong and will not show through the tissue like a titanium abutment will. It is also very biocompatible so we did not get any inflammation near the gingiva. Below are the 2 pictures of the final crown. The gums have adapted very well. The color looks a little bit whiter in the one of the photos, but I believe it is because of the way the light bounces of the porcelain when we take a picture. The smile photo is very indicative of the true color. Jeff is very happy with the result and given the situation, I think it turned out fantastic! By the way, those are Jeff's fingers in the photos--We would obviously be wearing gloves.

-Dr. Dan Bruce

Give Kids a Smile, Boise, Idaho

Mon, 06 Feb 2012 06:05:00 GMT

Friday, February 3rd was the national Give Kids a Smile day. This is a national program which provides free dental care and education for children that need it. So far, just under 10,000 dentists and almost 30,000 volunteers participated in the program. It is estimated that more than 400,000 kids were seen. Check out the ADA link for the latest information: http://www.ada.org/givekidsasmile.aspx.

This is a great way to kick off National Children's Dental Health Month. Since childhood caries is preventable, this gives us a chance to educate children and parents and treat many of the dental problems that can keep kids out of school and in pain.

I am very proud that we had many of our office staff members volunteer to take part in this event at our Ustick location. We have a great team at our office who collectively cares about the community they live in. Way to go everyone!

Boise-Dentist.com recent comments

Wed, 21 Dec 2011 18:12:00 GMT

Below are three different comments we received over the last month from recent patients at our Bay Pointe office, which is located on the Boise Bench.

"Incredible! I have not been as rested and have not had the resulting energy after a night's sleep until using the Somnomed! Not even from my CPAP maching--not even close. Finally!! Great sleep. Thanks, Dr. Dan!" - Rodney, who recently switched from a different oral appliance to a Somnomed.

"I could tell a difference immediately. I now dream every night, multiple times. I feel more rested and my blood pressure has been reduced" - Melissa, treated by Dr. Dan Bruce with a Somnomed oral appliance.

...and one of my personal favorites, "my teeth feel so clean I think I can talk faster!" - Dennis, after his periodontal maintenance (cleaning) visit.

Thank you to our wonderful patients for the kind words!

A brand new smile!

Fri, 02 Dec 2011 15:16:00 GMT

This patient had several problems she wanted to address. She felt her teeth were too dark, too short and she showed too much gum when she smiled. She has had dental work as needed over the years and ended up with different materials and colors in her mouth (see upper right photo). At first, we decided to just restore the upper front teeth and then address some of the other discolored crowns later. We started with models and creating the new shape of the teeth in wax. I could also then plan for future work and make sure her bite was idea with this diagnostic work-up. After some minor gum re-contouring with a laser and 6 porcelain crowns, she is very happy with her new smile!

Healthy mouth = healthy body (The proof)

Thu, 06 Oct 2011 04:28:00 GMT

There have been a number of potential links between oral hygiene and general health. This blog post is a report of a health survey in Scotland that looked at the link between oral hygiene and cardiovascular disease events. The survey was of 11,869 men and women with an average age of 50. The survey then measured cardiovascular disease events and the self-reported frequency of tooth brushing.

The results positively correlated poor oral hygiene with a higher risk for a cardiovascular disease event. Also, those with poor oral hygiene had increased levels of C reactive protein and fibrinogen, which are both markers of cardiovascular disease risk.

In short, brushing your teeth daily does decrease the chances a person will have a cardiovascular disease event.

Here is the link to the published survey: http://www.bmj.com/content/340/bmj.c2451.full

How an Ally Bank commercial applies to dental marketing

Thu, 21 Jul 2011 00:58:00 GMT

Out of the corner of my ear I heard an advertisement for Ally Bank. They use interactions with kids to show how ridiculous some of the marketing tactics used in everyday life are. I think this is a pretty good illustration for dentistry.

There are a lot of free whitening, free exams, and free "whatever" for new patients. I think it is very important that whatever we offer to new patients is offered to every other patient we see. Existing patients are extremely important to us.

So here is our marketing plan: As an existing patient, refer a patient to our practice who comes in for a comprehensive examination, necessary x-rays and the appropriate cleaning and you will receive a gift card for one of 5 local businesses.

Thanks to our existing patients! We appreciate you and the friends and family you refer to our practice!

Predictible Cosmetic Dentistry, day 1 report at the Dawson course

Fri, 22 Apr 2011 14:08:00 GMT

I just finished the first day of the "Predictable Cosmetic Dentistry" course in Denver. This course is put on by the Dawson Institute in St. Petersburg, Florida. The Dawson Institute focuses on functional and esthetics when doing dentistry. When we, as dentists, work on front teeth there are many factors that need to be taken into consideration. Speech, color, tooth contours and having a correct bite are just some of the things we look at to make sure our patients are happy with their new teeth. One of the main things the speaker said was, "measure twice, and cut once." When doing dental work, we are cutting on teeth and it is very important to make sure we have the end in mind so everything is done predictably. Great course!

Sleep Apnea Success Story

Fri, 22 Apr 2011 14:04:00 GMT

This blog post is meant to provide an example of how a typical patient with sleep apnea who wants an oral appliance goes through the process. I will call this patient "Jane." Typically our sleep apnea patients are referred to see us by their sleep physician, general physician, a friend, through their medical insurance or via online research. Jane found us online and had been using a CPAP for years. She had moderate sleep apnea and although the CPAP was tolerable at first, she was having problems with mask leaks and getting comfortable. After attempting to get a mask that fit, she decided to try an oral appliance. She found our office online and scheduled a complimentary consultation.

At her consult, we reviewed her health history and went through some simple tests to see if she was a candidate for oral appliance therapy. She was a good candidate, so we requested a referral from her physician to fabricate the appliance. After receiving and verifying medical insurance coverage, we completed the rest of the diagnostic tests and selected a Somnomed appliance. This appliance was selected because the patient had mild claustrophobia and did not want to have her jaws stuck together.

We just finished her take home sleep study to test the success of her appliance. Although the take home sleep test is a screening test, it gives us an idea of how well the appliance is working before we send her back to her physician. She went from moderate sleep apnea to normal. Also, there was marked improvement in her energy and restfulness. We have now sent her back to her physician for either a lab sleep study or to follow up with her.

Of course, oral appliances are not totally effective for every person. There are certain characteristics we look for that show us if an appliance may be successful. According to one study, oral appliance therapy is successful for 77% of patients with mild to moderate sleep apnea and about 50% for patients with severe sleep apnea. It is important that the dentist and physician work as a team to decide the best course of treatment to ensure this very serious disease is treated as best as possible.

Anterior Dental Implant

Fri, 22 Oct 2010 15:27:00 GMT

This patient had a previous root canal treated tooth that failed and became loose. The tooth had been splinted to the other two teeth. We extracted the tooth and placed an implant with a ceramic crown. Note the discoloration in the other central incisor. The patient may decide to correct this in the future so all the front teeth match perfectly.

Sleep apnea symtoms

Fri, 22 Apr 2011 14:10:00 GMT

It appears that football player Percy Harvin, who has been unable to play due to migraines, has sleep apnea. This is just one of the many symptoms of sleep apnea, which occurs when a person stops breathing at night. Although the most common symtoms are snoring and daytime sleepiness or fatigue, other signs and symptoms include morning headaches, short-term memory loss, irritability, depression, reduced sex drive and impaired concentration.

Many patients I see for oral appliances have had these symptoms for most of their life and think they are "normal." They are not and the good news is that treatment is available and often effective.

The other interesting thing about this article is that Percy Harvin is a professional athlete and in excellent shape. Sleep apnea is very prevalent in the NFL due to the increased muscle mass in players necks, but sleep apnea can strike many different types of people.

How snoring and sleep apnea affects bed partners

Fri, 27 Aug 2010 19:54:00 GMT

A recent article in Sleep and Breathing studied "the hypothesis that obstructive sleep apnea/hyponea syndrome and snoring affect not only the patients but also their bed partners." The study used 3 tests to determine depression, anxiety and sleepiness in bedpartners of patients with snoring and obstructive sleep apnea. The tests where taken preoperatively and then again after radio-frequency tissue ablation (removal of excessive tissue in the throat). This procedure decreased the severity of obstructive sleep apnea/hypopnea, but not by very much.

The important finding in this study was that depression scores significantly decreased, which suggests that snoring does have an affect on quality of life of bedpartners. Of course, if you happen to be a bedpartner of someone who snores, this probably does not come as a surprise at all!

Another finding I found to be interesting was that the radio-frequency tissue ablation treatment only improved obstructive sleep apnea scores by about 20%. CPAP and oral appliance therapy both show better results.

Medical vs. Dental Radiation

Mon, 14 Jun 2010 20:16:00 GMT

This morning I came across an article on Yahoo! News discussing the overuse of radiation in medical patients, http://news.yahoo.com/s/ap/20100614/ap_on_he_me/us_med_overtreated_radiation. I am relieved that this subject is finally getting some mainstream attention, because hopefully risk-assessment will be used more in determining who gets radiographs and who doesn't. Taking high exposure films provides an unprecedented level of diagnostic capability, but at what cost? Higher cancer risks in the future are likely the higher cost, but the risk is so far in the future and there is no way to know if cancer is due to the radiation dosage. I really think a protocol should be put into effect discussing the risks/benefits of these scans. All doctors want the best care for their patients now and in the future. If you have questions about any procedure you are about to receive, talk to your doctor beforehand!

This article also discusses dental radiographs and exposure. The article states that, "A chest or abdominal CT scan involves 10 to 20 millisieverts, versus 0.01 to 0.1 for an ordinary chest X-ray, less than 1 for a mammogram, and as little as 0.005 for a dental X-ray. Natural radiation from the sun and soil accounts for about 2 millisieverts a year." In relative terms, dental radiographs are some of the safest images that can be used. The risk of not have dental radiographs is that decay or other pathology could be present and cause a large problem if not detected early. That said, I think risk analysis in my patients is very important. If we have a patient who has not had decay for 5 years, has no fillings or simply doesn't want radiographs, then I have a discussion about the risks/benefits of pushing the frequency of the radiographs out longer. But the key is education. Patients must realize that there may be undiagnosed disease if the standard radiograph procedure is not followed.

Finally, digital radiographs do require less radiation than conventional films. This is due to intensifiers in the sensor. Also, digital films do not require environmentally-harmful processing chemicals, making them a great alternative for both patients and the environment.

The value of free whitening and free cleanings to new patients

Fri, 14 May 2010 21:55:00 GMT

I believe I have posted on free whitening before, but I thought I would visit the subject again. In light of the current economy, I hear many dental consultants recommending free whitening, $1 exam and cleanings, free kittens with examination, etc. I made that last one up, but the idea is to get people in the door and then they will stay as patients. There are two concerns I have with this tactic.

1. I have a hard time giving away from whitening to a new patient when there may be a patient in the next room who has been faithfully coming in to the practice for 10 years. I want to reward the patients we have and treat them the best I can. Happy patients will refer other patients. So instead of free whitening for new patients, our whitening is affordable for everyone. Currently, whitening for both arches is $133 for any person in our practice. We feel this is a good way to say "thank you" to the patients we have.

2. Second, when you offer something free to someone, there is temptation to feel bad if that patient doesn't stay with the practice or doesn't want any recommended treatment. When a new patient comes in, has a new patient exam and has no cavities I get excited for them. My job is to obtain information from an examination, give treatment options and make the same recommendation I would to a member of my family. That is easier when a patient is coming to you based on your skill than based on something free.

Marketing is everywhere in our society, including dentistry. I think if you educate patients (which includes this website) on the value of good health and the way my services can improve their lives, that is the best marketing you can do for your practice. Many dental offices provide great service and work using free incentives, we have just decided this is not the method for us.

How to get the most out of your dental insurance

Fri, 30 Apr 2010 14:56:00 GMT

You've heard the phrase, "if you don't use it, you lose it." This is never more true than with dental insurance. Whether you have a policy that is provided by your employer or you have a personal policy, you are paying for dental insurance every month. And unlike car insurance (where if your car is totaled you receive a new car), if your mouth has multiple problems due to wear, decay, periodontal disease, or other pathologies, your insurance will only pay up to a certain yearly maximum. This really puts dental insurance in the category of a benefit and is something that should be used yearly to take full advantage.

So how do you make the most of the insurance benefit you have? From personal experience with our patients, here are some tips:

- Get cleanings, x-rays, and examinations as recommended by your dentist. This is usually covered at a high reimbursement rate (sometimes 100%). If you are average risk for dental problems, this may mean 2 cleanings a year and 1 periodic exam. If you are above average risk, this may mean more frequent cleanings and examinations.
- Take care of problems as they arise. This also falls in the category of preventative maintenance and can mean anything from restoring decay when it is small to having a crown placed on a cracked tooth before it breaks and needs to be extracted or have root canal treatment.
- Read your policy when you buy it - If you have dental problems, make sure you have coverage that can adequately take care of these problems. Many patients just choose a policy, but don't know what it covers. If you have questions, we can help!

If you don't have insurance, don't worry. There may be a plan out there that fits your needs. Or, you can get a health savings account or just pay as you go. If this is the case, you will save time and money by having regular preventative care and taking care of restorations when they first come up.

Finally, I have a few patients who admit to delaying treatment because they are "afraid" the the dentist will find something. I consider it my job to report what I find, give options and make recommendations. An option is always to do nothing, although I really consider it better to know if there is a potential problem than to have something happen when you least expect it.

As a note, our office is a preferred provider for Delta Dental, Blue Cross, and Blue Shield. We will help you process any insurance and are always available to answer questions about dental insurance as it relates to our office.

"Save 90 a day," by turning off the tap water while brushing

Mon, 22 Mar 2010 05:31:00 GMT

I spent some time today looking at the website ecodentistry.org. One heavily promoted part of their site is the "Save 90 a Day" campaign. The premise is simple - Turn off the tap water while brushing your teeth and save 90 glasses of water each day. Pretty easy, isn't it? Our family has turned off the tap water for years now while we brush, but I didn't think about letting my patients know about this. Most people are not averse to saving water and money, so this should be another easy step to take to help the environment. So brush and floss daily, and don't forget to turn off the water!