Boise Dentist Blog

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.

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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.  

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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.

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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

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! 

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!

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!

 

 

 

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

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!

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!

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.

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.

 

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.