Toothaches and Treatment of Dental Pain

So you see a dentist to try to resolve the pain. In most cases, your dentist can diagnose the pain’s source as the tooth. However, toothaches can be caused by a distant source far away from the tooth that you are feeling pain. A good history taking of the pain and a thorough clinical examination with dental X-ray and adjunctive testing are quintessential for coming up with the correct diagnosis of the cause of the pain. Otherwise, misdiagnosis can happen, resulting in unnecessary treatment, while the disease is not treated and can worsen.

Then we may want to ask what can cause toothaches. In most cases, toothaches are caused by some tooth diseases. The diseases can be:

• Cavities
• Fractures
• Chips
• a cracked tooth
• severe enamel wear
• toothbrush abrasion
• pulp exposure
• abfraction
• inflammation in the pulp (pulpitis)
• bacterial infection inside the pulp
• pulp stone
• chronic irritation (from clenching and grinding)
• acute trauma
• high occlusion

But sometimes, a toothache can be caused by the supporting bone and tissues. For example:

• Inflammation in the gums due to food stuck between the teeth can cause the teeth to ache
• abscess in the alveolar bone (the bone surrounding the tooth) at the apex of the tooth
• bone fracture
• cysts in the jaw
• malignant neoplasm in the bone and gums

However, the list of possible causes is not yet exhausted. Toothache can be due to some dysfunction of the nervous system in the following:

• Trigeminal neuralgia (Tic Douloureux)
• Post-traumatic neuropathy (nerve damage due to cutting or compression)
• Burning mouth syndrome

Moreover, orofacial muscles can cause toothache in some instances. When the masticatory muscles are tense and sore, it can also express as toothache and temporal mandibular joint pain (TMJ). Of course, a toothache can also be perceived when there is only a temporal mandibular dysfunction.

Neurovascular pain like migraine can express with toothache together with the typical migraine symptoms.

Paroxysmal hemicrania can be caused by head trauma, a tumor in the brain, or an abnormal tangle of blood vessels. Patients with this disorder can feel pain in a tooth, but the pain usually comes and goes on a periodic pattern.

Sinusitis, heart attack, psychological overlay, and tumors in the central nervous system are all possible factors that can make a patient feel toothache.

A toothache can refer to another tooth. In this case, the patient perceived location of the toothache is actually away from the tooth that causes the pain. It is common to have lower jaw pain or pain from a lower molar, but it comes from an upper molar on the same side, typically a decayed wisdom tooth. This phenomenon is called referred pain.

I usually go to the teeth first to see if there are apparent causes for toothache like cavities, split or cracked teeth, large extensive fillings, fistula, swollen gums, and swollen cheek or face. If there are nothing clinically detectable diseases, then I would do some simple tests like:

• wriggling the tooth with my fingers
• putting pressure on the tooth with my fingers
• tapping the tooth with my mouth mirror handle and placing a cold Q-tip against the suspected tooth to see how the patient feels about the tooth

Reviewing and taking X-rays photos can help to detect some not-so-obvious pathologies and to confirm the diagnosis.

Freezing the suspected tooth can also help confirm whether the pain is indeed from the suspected tooth.

If there is still no definitive evidence to pinpoint the source of the pain, then I will take a good history of the pain and ask the following questions:

• When did the pain first start
• Can you pinpoint the source or show me the general area where the pain is felt
• Is it constant or intermittent
• How does it hurt
• Has the pain changed in intensity, pattern, or location
• Does it get worse at a particular time of the day
• Does pressure, light touch temperature change, or posture bring on the pain or make it worse
• Did it happen before
• Was there swelling before
• Is there something you do can help to make the pain less or go away
• Was there any trauma to the teeth or jaw

Medical history is also essential to shed some light on the possible causes. Taking multiple medications can undoubtedly cause a dry mouth resulting in hypersensitive teeth. Suppose a patient has a history of chronic sinusitis and/or chronic nasal congestion. In that case, I will suspect the toothache in the upper jaw can be possible from an episode of acute infection in the sinus after ruling out the cause is from the teeth. A patient’s history of neurovascular conditions like migraine and neurological issues like trigeminal neuralgia and paroxysmal hemicrania can be the possible reasons for the toothache. When a person has an acute heart attack, it may manifest with a toothache, together with other symptoms. Although dentists are not typically trained in auscultation and doing electro-echocardiograms, we could suspect if there is a good chance that the toothache is indeed caused by an acute heart attack with a detailed medical history, asking the right questions about the signs and symptoms and clinical examinations.

As a holistic dentist, I need to know pertinent medical conditions and their signs and symptoms related to the orofacial region, understand the drug interactions, anatomy in the head and neck area, and their functions and physiologies. Providing total health in collaboration with other dental and medical colleagues is very satisfactory.

Reach out to us to learn more about toothaches and book your consultation today.

Read some of our other blogs for more information on teeth implants, botox in dentistry, and more.

Myofunctional Therapy and Myobrace are treatments that use silicone based oral appliances in effort to fix bad oral habits. As a wholistic and holistic dentist, I believe in treating the causes rather than just the symptoms.

For example, if a patient has a lot of cavities, a good dentist should not just fill the decay and not look at the reasons for having the dental disease. The treating dentist should wonder if the patient has high sugar consumption and does not brush the teeth regularly and correctly. If a dentist fills the cavities only (symptoms) and does not deal with the causes (sugar and poor oral hygiene), the patient will have recurrent cavities all over again without an end. That approach to the dental issue is not holistic at all!

Treating the causes is the best strategy to prevent issues from happening again.

How often have I seen a patient who had an orthodontic treatment done and experienced crowding of the teeth again?

Why were most patients told to wear their retainers for life since the teeth are already straight with enough room for them?

Does it mean the teeth are unstable in their corrected positions and why so?

Have we wondered why the teeth shifted again since there is enough space for all the teeth?

Is it genetic or environmental due to diet?

Could it be aging?

Teeth Stability | Myofunctional Therapy and Myobrace

The teeth locate where they are in our mouth because of the size, direction and strength of the forces exerted on them by our tongues, cheeks, and lips. Those structures (cheek, tongue and lip) consist of muscles and soft tissues in intimate contact with our teeth, pushing on the teeth all the time. Our tongues inside our mouth move the teeth outwards while our lips and cheeks counter-push the teeth inwardly. Simply put, the teeth sit at an equal outward and inward force on them – the equilibrium.

Additionally, orofacial and neuromuscular functions can modulate the magnitude of the force on the teeth by those structures. For someone who clenches and grinds their teeth a lot, the tongue constantly places more substantial pressure on the teeth during the clenching. A big strong tongue can exert more pressure on the teeth versus a small, less muscular tongue.

However, certain habits and myodysfunction can lead to excessive muscle activities and strength (tonicity) of one of the soft tissue groups (lips, cheeks and tongues) that can shift the equilibrium position to another. For example, a chronic sucking motion like thumb sucking would make our teeth move to accommodate the shape of the thumb (because of the thumb’s powerful pushing on the teeth), and the suction would cause the cheeks to squeeze on the teeth on both sides with more force. The teeth then move according to the new equilibrium of the different forces on them. The bad habits or conditions can be: mouth breathing, tongue thrusting, reverse swallowing, thumb sucking, tongue tie and more.

Our head and neck muscles are interconnected through our spines and skulls. Therefore, incorrect upper body postures like hunch and tilt (kyphosis and scoliosis) can affect the orofacial musculature and functions and vice versa. For example, suppose the pose is hunched forward. In that case, specific neck muscles will be overactivated to support our head, and that will cause some tension with some lower jaw muscles resulting in temporal mandibular dysfunctions. If you have chronic trouble with breathing, you will likely lean your head forward and move your lower jaw down and out to improve the airway. That posture will then strain your neck muscles.

Orofacial myofunctional disorders can lead to maladaptive skeletal development in the orofacial region, leading to undesirable facial aesthetics and other abnormal physiological conditions from childhood to adulthood.

The issues include:

• difficulty in breathing
• sleep-related breathing disorder
• obstructive sleep apnea
• heavy snoring
• head and neck tension
• headache
• temporal mandibular dysfunctions
• irregular bite
• difficulties in chewing
• swallowing
• speech
• poor posture
• and more

What are the bad habits and myodysfunction that Dr. Wong at Affinity Dental Care is concerned about? They are mouth breathing, tongue thrusting, reverse swallowing, thumb sucking and tongue tie.

Mouth breathing

This condition is common and can have an extensive negative impact on orofacial development and, in turn, sleep-related breathing disorders.

Because the lips are apart with the lower jaw rotated down and back to keep the mouth open for breathing, the cheek muscles are stretched and exert more force on the upper teeth at the back that squeezes the teeth inward to the centre, resulting in a narrow arch form. At the same time, the tongue rests on the lower teeth to allow air to come in through the mouth, and the lower jaw becomes more narrow.

Patients with chronic mouth breathing tend to have a long and narrow faces. The chins typically are back to form a convex facial profile.The nasal passages typically become more congested; perhaps you lose it if you do not use it. On top, the patients usually have more swollen and red gums from the air desiccation. Their tonsils are likely more inflamed and enlarged. They are also likely to have sleep-disordered breathing associated with teeth grinding and snoring.

Tongue Thrusting | Myofunctional Therapy and Myobrace

Patients with tongue thrusting habit stick their tongue forward between their upper and lower front teeth when they swallow, preventing their upper and lower front teeth from erupting to touch each other. In this case, the opening at the front is called an anterior open bite.

The back molars tend to overerupt. When there is an open bite, the patient must stick the tongue out to fill up the front opening to swallow. Patients with tongue thrust have more protruded front teeth, and their lips are apart when at rest. The speech is impaired with lisping in some cases with particular pronunciation. Their lower faces are usually long with improper bite (crossbite) at the back. Their gums are also red and inflamed in general.

Reverse Swallowing

During swallowing, the tongue should stay at the roof of the mouth, with the tongue rolling the food toward the throat. The process requires the tongue to press against the palate most of the time.

The patients with reverse swallowing keep their tongue down with their lips open, and much activity from their lower lips and mentalis muscles in the chin. The teeth are not together and are usually separated by the tongue. The lower jaw is moved backwards during the reverse swallow. The tongue tip moves down and forwards between the teeth. The tongue body moves down and backward away from the upper jaw. The tongue moves between the anterior teeth causing lower crowding and a backward lower jaw. The temporal mandibular joints are compressed as the joints (condyles) are driven back during each and every swallow. They tend to have temporary mandibular disorders (TMD) as well.

When they swallow, you notice that their lips and surrounding muscles are tight (hyperactive) because they use the orofacial muscles to propel the liquid and foods to the throats instead of the tongues alone.

Thumb Sucking | Myofunctional Therapy and Myobrace

If the kids continue to suck their thumb after three years old, there could be long-term issues with their teeth and orofacial development. The thumb pushes the tongue down and pushes the lower front teeth backwards while pushing the upper front teeth forwards. It can cause significant misalignment of teeth and jaw. It can cause the child to develop a reverse swallowing pattern in adaptation to the deficiencies perpetuating the maxillofacial dysplasia I mentioned earlier.

Tongue tie

A tongue tie is a condition someone is born with that the frenum is too tight that the tongue has limited, overly restricted movements. The frenum is too short, too thick or too broad. The tongue cannot rest properly below the palate and perform the suction during lactation and swallowing (see my previous blog on Tongue Tie).

Patients with severe tongue ties can suffer from small body sizes and other intellectual disabilities. Other ramifications include orofacial myofunctional disorders like chronic nasal congestion, lisping, speech impairment, mouth breathing, facial and maxillomandibular discrepancies, malocclusion, teeth crowding, and reverse swallowing.

How do Dr. Wong and the team treat the conditions? We employ myofunctional therapy and Myobrace to help the patients to adapt the correct orofacial physiology with their breathing, tongue posture and swallowing. We also support the patients in eliminating bad habits like thumb-sucking in children and obstructive sleep apnea in teenagers and adults.

What is myofunctional therapy? It is an exercise training program for the muscles around your face, mouth, and tongue. These exercises improve talking, eating, or breathing by engaging the muscles in the appropriate positions and movement patterns. Myofunctional therapy is equivalent to physiotherapy, except it is for the orofacial region. Myofunctional training and practice are effective and long-lasting, as the brain will acquire the new functions by laying out new neuronal connections that become a natural habit and pattern of proper breathing, tongue positions and functions.

What is Myobrace? Myobrace is a system that incorporates the principles of correct myofunctional that facilitates training for proper nasal breathing, tongue position, swallow pattern and lip seal. The system consists of appliances our patients wear while they receive myofunctional training and exercise. Therefore, the Myobrace system is like the devices (exercise ball, sling and resistance band etc.) that physiotherapists use while you are having therapy.

Affinity Dental Care | Myofunctional Therapy and Myobrace

We are trained and certified at Affinity Dental Care to provide orofacial myotherapy to our patients. We also offer dental sleep medicine screening and therapy to patients diagnosed with obstructive sleep apnea (OSA). OSA and OMD are interrelated. Treatment of one disease modality can help the other. Both can lead to other diseases (comorbidities) in your bodies, leading to poor health and possibly premature death.

Proper diagnosis allows for targeted and effective physical therapy exercises for oral posture retraining to promote better health with goals to improve breathing, reduce pain, and enhance the quality of life. Call Affinity Dental Care to book an appointment for a screening and consultation if you or your children are suffering from chronic mouth breathing, uneven bite with crowed teeth, tongue thrusting with an open bite at the front, excessive sleepiness during the day due to obstructive sleep apnea, and speech impairment due to tongue-tie.

Read some of our other blogs for more information on teeth implants, Myofunctional Therapy and Myobrace, botox in dentistry and more.

Dental Family Practices Owned by Corporate Dentistry

The landscape of corporate dentistry has changed a lot since I graduated in 1990. Back then, there were not a lot of dentists and, equally, dental offices. Dentists practicing were mostly graduates from Canadian dental schools.

The situation has changed significantly as more foreign-trained dentists have been allowed to practise in Ontario, compounded with the rapid expansion of corporation-owned dental clinics.

The other conditions affecting dentistry are the costs of dental education, the prices of establishing a practice and the expenses of keeping a family dental practice viable and up-to-date. Allowing dental hygienists to open a hygiene clinic independently at the end of 1993 also impacted the viability of running a solo family dental clinic.

All those trends can affect the quality of dental services our patients can receive. Let us examine the situation with corporate dentistry more in-depth here. In my estimation, about 8% of dental clinics in Ontario belong to one of the dental corporations. The number has been steadily increasing in the last few years, and the trend will continue.

What are dental corporations?

Dental corporations are for-profit organizations operated by executives with dentistry, financial, marketing, or operational backgrounds. They are generally funded by investors who can be individuals, fund companies, investors, shareholders or banks. There are two large dental corporations and several smaller ones. One organization is traded on the Toronto Stock Exchange. Ultimately, their mandate is for profit to satisfy the investors and debtors.

Practice Ownership

Aside from the corporate-owned dental clinic, there are also the traditional privately owned dental clinics owned and operated by the practicing dentists in their clinics.

Corporate dentistry is attractive to some dentists because of the following factors:

1) Debt to new dental graduates

Getting a dental education nowadays is not cheap. When I attended dental school at the University of Toronto, my tuition was about $1,300 per year, and now it is approximately $50,000 per year at the same school! The students are also responsible for purchasing some small dental equipment and supplies for four years. The total cost can easily be $250,000 after four years, not to mention the cost of living, books, transportation etc. To make the situation worst, they also need an undergraduate degree before they can get into dental school in Canada here.

For those students who were not accepted in Canada and needed to go to the United States to study dentistry, their total costs could reach US $500,000.

Since many new graduates have a high debt load, they prefer to work in an environment

with guaranteed income to manage their debt load. Corporate-owned dental clinics
usually have a high associate dentist turnover rate, so they tend to have more openings
for new graduates to join.

Associate dentists in practice are the ones who have no equity in practice. They are
usually paid by the percentage of their billings.

2) The desire for less interaction with corporate dentistry management and insurance companies

Dental management is getting much more complicated to stay competitive and invisible to the public. There are a lot of rules and regulations that require execution and extensive documentation. With the norm of having a website, social media exposure and digital marketing. Running a dental clinic is ever getting more challenging and time-consuming.

Hiring and maintaining a capable management team for the office is arduous. The amount of time and knowledge knowing how to obtain the correct information and jumping through hoops is an art and skill that not every staff have.

Corporate dentistry has more money to spend on staffing, billing, management and marketing. The dental corporations provide the administration, and the associate dentists can focus on dentistry.

3) Established dentists looking to extend their career while decreasing work hour

Dental corporations constantly seek to buy out well-established offices and offer established dentists incentives like higher purchase prices and, sometimes, a small piece of the ownership.

Because dental corporations can pay above market values, they scoop up many dental offices and maintain their existing names and appearances.

Like real estate, the price of established dental offices is increasing, with multiple bidding for the desirable ones.

4) The high cost to set up a new dental practice and long breakeven time

Due to the extremely high cost of setting up a new family dental practice from scratch, the challenge in this ever-management-focused environment to be successful and the ever-longer time to make the practice break even, the prospect of starting up a new clinic or purchasing an existing practice is too much to most new dental graduates or dentists from foreign countries. They find the associate dentist positions are more attractive and readily available for a corporate-run dental clinic which provides administrative.

Lately, the increasing interest rate will place more wood into the fire, making it even less affordable for a dentist to start a new practice or purchase one.

With the market already strained with an over-supply of dentists, the allowance for hygienists to establish their hygiene practices is tightening the dental market.

The issues with corporate dentistry

1) Corporate dentistry is a business model

Despite many dental corporations’ slogans on their dentist-focused and patient-oriented philosophy, they have investors to pay and answer to. It is a profit-focused business model in which not just the dentists and staff are to be paid. Investors also expect good returns on their investments.

Many clinics have a monthly billing target to meet internally, and the targets are ever-increasing per month.

2) Lack of ownerships

The associate dentists have little or no ownership of the corporate-owned dental practices. They generally do not have strong ownership of patient care because they can leave the practice without strings. The desire for long-term relationships and better patient health care may not be their priority because the treating associate dentists are aware that they may not be the ones treating them next. Billings can be their priority under the pressure of management.

3) Different dentists at different time

The lack of ownership leads to high turnover- patients may not see the same doctor from one visit to the next.

Even the previous dentist owners are only obligated to stay for five years after the buyout. Most of them are close to their retirement age, and most would leave after five years.

4) A corporate dentistry carries less flexibility in keeping up with the latest technologies

The costs and expenses are the major concerns for all practices. However, a corporate-owned clinic may not be as ready to invest in the latest technologies based on a dentist’s desire and want. Adapting to new treatment modalities and purchasing new equipment will take longer time in corporate clinics.

Corporate-owned dental clinics in Ontario are not easily identifiable because they keep their original names and appearances after the buyout. Some previous dentist owners have left the practice, but most have multiple practicing associate dentists working in the dental offices.

I am proud to point out that Affinity Dental Care is based on the traditional healthcare model under my ownership. I am an experienced family dentist focusing on wellness dentistry. I am passionate about providing comprehensive dentistry in my family dental office in Burlington. My focus is on overall care in the long run for my patients, with a strong sense of my patients’ dental health ownership.

Keeping up with the latest knowledge is my affection. My clinical skill in recognizing, assessing and treating sleep apnea using mandibular advancement devices and acquiring myofunctional therapy techniques for young patients are the two latest education my staff and I are learning to master.

Happy to serve clients with a variety of dental issues, Call us to book an appointment today.

Read some of our other blogs for more information on teeth implants, botox in dentistry, and more.

Achieving the Perfect Smile

When it comes to achieving the perfect smile, there can be a broad definition and perception of smiles.

Each of us has a different genetic makeup that delineates our races. We also have diverse cultures, backgrounds, previous encounters, perceptions and preferences called taste.

While the answer to the question of an ideal smile varies with tastes, countries and trends, some basic principles apply.

One of the most essential and universal factors in creating an ideal smile is healthy oral tissues and the cleanliness of the appearance. A pleasant and confident mental status can enhance the radiance of pleasantry and comfort to the onlookers. There are a few other fundamental universal factors that constitute a perfect smile.

1.) Complete front teeth exposure

Almost all your upper front teeth (from the canine to canine) and part of the premolars should be visible in an attractive smile. Men tend to show a little bit more lower front teeth and less of their upper front teeth.

Orthodontic treatment and porcelain veneers – essentially like custom-made fingernails bonded to your teeth – can elongate and change the shape of your teeth to improve your smile.

2.) Symmetry

Teeth on the left or right should be mirror images of each other. The contact of the two central incisors should also coincide with the facial midline, and the occlusal plane of the teeth should be parallel to the line drawn between your eyes.

3) Minimum gums showing

There should be only a bit of the gum showing in a beautiful smile, with no more than 2 mm of gum height. Otherwise, the smile becomes gummy and becomes less attractive. Having healthy supporting gum tissues and morphologies is the key.

If the gummy smile is caused by the overactive muscles that raise the upper lips during smiling, a shot of Botox can be a solution.

If overgrown gums cause it, surgical gum trimming or gingivoplasty can be the solution.

Orthodontic treatment can also be considered intruding or extruding the teeth and gums to achieve more aesthetic results.

4) The Golden rules

There are numerous studies on the measurements of teeth, and the findings are the upper front teeth are about 11 mm long on average, and the width is around 8 mm. That 1:0.73 ratio is vital in designing the dimensions of the central incisors.

The incisal embrasure, the notch where the edge of one tooth meets the edge of the next tooth, is small where the central incisors meet, then wider where the central incisors meet the lateral incisors and even wider where the lateral incisors meet the canines.

The lateral incisors should have about 0.82 of the length of the central incisors, while the canines should be more or less the same length as the central incisors.

The width of the lateral incisors should be smaller than the central incisors at a ratio of 0.76, while the canines are at 0.9 of the width of the central incisors.

5) There should be a little space between the corners of your lips and your upper back teeth. This space is called a buccal corridor. Too little space will show a toothy grin, but too much will make your smile look too narrow. There is a yin-yang balance to be struck when designing a smile.

6) A shade of white and gold

Teeth that are yellow or brown are not attractive. Teeth with a homogenous white shade are considered beautiful, with a slightly darker shade of gold (very light yellow) along the gum line. Dentists can help you to achieve whiter teeth by either providing bleaching treatment to the front teeth or bonding white veneers onto your teeth.

7) Slim shaped

Teeth with round corners and curvy edges are more attractive than square or rectangular shaped-teeth.

8) Smile arc

The curve line of your upper front teeth should roughly follow the curve of your bottom lip to achieve an aesthetic smile line.

As mentioned at the beginning of this blog, I need to emphasize the importance of having and maintaining healthy gums and bones to accompany the beautiful anatomy and arrangement of the teeth. If the foundation and oral hygiene are not good, dentists will not be able to achieve a perfect smile for you.

Happy to serve clients with a variety of dental issues, Call us to book an appointment today.

Read some of our other blogs for more information on teeth implants, botox in dentistry, and more.

This blog will cover one of my patients wearing a fill-fitting upper removable partial denture. The denture was not stable and fell down whenever he opened his mouth. There were no retentions because the patient only had two teeth left that were unable to keep the denture from moving and falling down. His existing denture was severely worn down, and his lower jaw was closing up further, making his lower face height look short. When he smiled, only his lower front teeth were visible resulting in the need for a new implant-supported upper denture.

1 Only two teeth left on the upper

2 The implant-supported upper denture in the month. Note the denture was  broken, teeth were worn down and not occluding with the lower teeth properly

3 The upper teeth not showing when the patient was smiling

The other challenges were his overly long lower front teeth in his fixed bridge and his heavy, powerful bite while chewing. He cracked his upper denture multiple times because of his strong biting force and hard food diet. He expressed his desire to have a more stable set of teeth for the upper arch so that he can do chewing without worrying about falling.

I went through the different options to replace his broken upper denture, namely, no treatment at all, a zirconia hybrid bridge supported by six implants, an implant-supported removable denture, and simply a complete removable full denture using the palate for support and suction/retention. The possibility of repairing and relining his existing denture was also presented and discussed with the patient. If he had chosen the last option, he would always need to use denture adhesive. After thoroughly examining the different options, the patient decided to have four implants placed and a new removable partial denture.

Since the patient was involved in a traumatic accident many years ago that knocked out most of his upper front teeth, the amount of lost jaw bone was severe. The height of the jaw bone at the back was short, as the floors of the sinuses were very low. Not many areas along the upper jaw arch had a sufficient bone to place implants without extensive bone grafting. We decided to do an implant-support denture that is removable yet securely stabilized by the clips or buttons called Locators, after considering numerous factors like suitability, the amount of surgery that the patient is willing to go through, the financial burden, the time involved, and the uncertain outcomes of more complex surgeries to increase bond dimensions.

4 The Pan X-ray shows insufficient bone height on the right side of the upper jaw and decay in some of his lower teeth

Indirect sinus lift and guide tissue regeneration techniques were employed to augment the bone for the four implants. An immediate implant was to replace the canine after it was extracted. The patient elected to keep the other tooth which is a wisdom tooth. Since the tooth is relatively stable with good bone support, it could be used to help stabilize the denture. After a few months of healing, Locators were attached to the implants for future denture engagement.

5 Sinus lift bone grafts and four implants in place

With the Locator attachment housings embedded in the denture in the precise locations and orientation, the denture can clip onto the Locators attached to the implants for resistance to falling during chewing, talking and smiling. 

The patient is happy with the denture. Not just because the new denture can help him eat without fear of falling down, but it also makes his smile more pleasing as he shows his upper front teeth when he smiles naturally.

6 Four locators in the upper arch supported by four implants individually

7 The new upper denture with the locator attachment embedded in the denture

8 A more pleasant smile with the new denture in place

Happy to serve clients with a variety of dental issues, Call us to book an appointment today.

Read some of our other blogs for more information on teeth implants, botox in dentistry, and more.

I would like to present another case of a single implant for upper front teeth that I did recently. The patient was suffering from advanced gum disease with generalized excessive bone loss. His teeth were generally mobile and sensitive to cold. He was unhappy with the status quo of his oral health and wanted to improve his oral wellness.

Upon examination, I noticed a few cavities. The upper left incisor was hopelessly loose and decayed. The patient was missing his molars on his upper right side, and two of his lower molars had post-treatment endodontic disease. The two endodontically treated molars were hopeless in their prognoses. After a couple of excellent and thorough cleaning by my hygienist, his gum disease has improved tremendously. He was also educated on the causes of gum disease, ways to combat the illness, and preventions.

A comprehensive treatment plan was drafted, presented, and discussed with the patient. I like to treat patients holistically, so I modified the plan after considering his inputs like wants, priorities, fears, and finance. With this holistic approach, he accepted the final treatment plan involving fillings, extractions, and implant-supported crowns.

Fortunately, the patient was motivated to keep his mouth healthy, so his periodontal health improved significantly. The cavities were first treated with white composite resin fillings that contained no bisphenol A (BPA). Before I added an implant for upper front teeth, the original upper front tooth had to be extracted. A Straumann implant was then inserted surgically in the same appointment. Bone graft and guided tissue regeneration techniques were also employed to generate more bone around the implant as it was healing, similar to the previous case I presented in my other blogs.

Fig 1 – X-ray, front, and occlusal view of the tooth.

The missing front tooth was temporarily replaced with a bonded resin tooth for the first four months. A new temporary tooth was made chairside using the machined titanium base covered by composite resin by me at four months to replace the bonded tooth. To improve the visual harmony of the front teeth, I filled the chip of the central front incisor beside it and modified the shape to reduce the diastema.

Fig 2 – X-ray of the BLX Straumann implant in place.

Fig 3 – A bonded temporary tooth to replace the missing.

Fig 4 – A temporary tooth attached to the implant.

The gums were allowed to reform and model around the temporary resin crown for about two months before a “permanent” crown was made to replace the resin crown. The permanent crown was made with esthetic lithium disilicate that is strong and life-like.

Fig 5 – A permanent crown supported by an implant integrated into the bone.

The patient was happy with the esthetic result and functionality of the implant-supported front tooth. Since then, I have placed two more implants in his upper right side where he has missing molars, and I will share the progress with you in my future blog.

Contact us with any questions or to book your next appointment.

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Affinity Dental Care – Mini Implants

Where there is periodontitis (infection in the supporting gums and bone around the teeth), the bone disappears and gets smaller. When the teeth are extracted, the jaw bone shrinks and diminishes in dimensions. Both gum disease and extraction can change the shape and size of the jaws. A person with all teeth extracted would eventually display a suck-in look at the lips. This is where mini dental implants come in.

Dental implants can help to maintain and stimulate bone growth when embedded in the jaw bone. The primary material used for implants is titanium, a strong but lightweight metal compatible with the human body and therefore would not prompt a reaction from the immune system.

Dental implants need to be wholly embedded within the jaw bone for proper healing and osteointegration, but when the dimensions of the jaw bone become too small and thin after years of shrinkage, the traditional implants can be too big in diameter, too long for the available jaw bone.

What Are Traditional Implants?

Traditional implants have diameters bigger than 3.25 mm and up 5 mm. There are extra-wide implants that are up to 9 mm in diameter. The traditional and extra-wide ones are made of at least two pieces – the implants (the fixtures in the bone) and the pieces attached to the implants (called the caps or abutments). When the jaw bone is not wide enough, a bone graft and guided bone regeneration (GBR) can be performed to gain more bone. However, not all patients and situations are suitable for these procedures before placing an implant. Mini dental implants (MDIs)can be an option for some instances with insufficient bone.

What Are Mini Implants?

They have the same structure as the traditional implants but are smaller than 3 mm in diameter and include a ball-shaped end that protrudes from the jawbone as one structure. Because of their smaller size, mini implants are also called narrow diameter implants or small diameter implants (NDIs and SDIs).

MDIs are smaller and, therefore, can fit in the narrower jaw. The procedure to place the mini implants is much less involved. Since the amount of bone and dimensions are dramatically different at different locations along the jaw, in most cases, I would order a 3-dimensional cone beam tomography X-ray of the jaw first to locate the suitable and safe areas (away from some vital tissues and structures) before the implant placements.

After careful planning and fabrication of a surgical guide for the implant placements, the implant surgical procedure is done without cutting gums as is the traditional way to expose the underlying bone. No suture is needed, and minimal bleeding ensures afterward. Post-surgical pain is usually very minimal.

Why Mini-Implants?

Because of the simplicity and quickness of the procedure, the use of mini dental implants can be considered in cases the patients:

• Have compromised health to undergo invasive surgery
• Do not have enough bone in the jaw for a full-sized implant
• Do not have enough time to go to repeat dental visits
• Wants minimal pain and faster recovery time
• Do not have enough money for the conventional implants and hybrid dentures or bridges

Who is a Good Candidate for Mini Dental Implants?

Mini-implant is indicated for patients with missing teeth (partial edentulous with some natural teeth), who will have partial dentures (removable plates) or wearing existing dentures. The MDIs with ball attachments can help stabilize and retain the dentures, making the wearer feel comfortable and secure.
Patients with certain health conditions like diabetes, vascular disease, or blood thinner can benefit from mini-implants. Some lifestyle factors like being a smoker but decent oral hygiene can succeed better with mini-implant.

However, mini dental implants are not for everyone. If there is excessive bone loss (the width of the bone is less than 4.5 mm and the length is less than 10 mm), even mini-implants would not have enough bone for them. If the density of the bone is too low, like in patients with osteopenia to osteoporosis, mini-implants would not have good stability. They are unsuitable for patients who grind and clench their teeth excessively. They are not indicative of supporting crowns or bridges. Straumann makes the mini-Implant I use in patients at Affinity Dental Care. Besides being less invasive, the reasons I only use Straumann mini-implants are because:

They are made with Roxolid, which has higher mechanical strength than titanium. Roxolid is a proprietary alloy with ~85% titanium and ~15% zirconium. The combination of the properties of these two metals leads to higher tensile and fatigue strength than comparable titanium implants. The higher a material’s tensile strength, the lower the risk for forced rupture. Higher fatigue strength is more critical in small implants, meaning the implants have a lower chance of fracture. Sandblasted, large grit, acid-etched implant surface, (SLA) is a type of surface treatment that creates surface roughness intending to enhance osseointegration through more significant bone-to-implant contact (BIC). This specially treated surface enhances osteointegration rate and high consistent survival rates.

Other Benefits Include:

• They can be made to fit your existing dentures
• Easy cleaning
• Firmer denture fit
• High success rate
• Good long-term results

Care and Maintenance

Mini dental implants just need the same care as natural teeth. If you have mini dental implants, brush your teeth twice daily, floss once a day, and visit your dentist regularly.

Past Results

The photo shows a Straumann Roxolid mini-implant right after it was placed by Dr. Wong recently.

The second photo shows the healing of the same implant after a week.

To make an informed decision, talk to a dentist experienced in both mini and standard implants.

Contact us today

– 686 Walkers Line, Burlington ON L7N 2E9
– Phone: (289)-861-5111
– Email: info@affinitydentalcare.ca

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