Straightening Teeth with a Missing Teeth

I never had braces as a child. It’s always bothered me. I want to do something about it now that I’m an adult. I keep hearing about invisible braces, which sounds much better to me than those silver ones all my friends in middle-school wore. The one thing that worries me is I have two congenitally missing mandibular bicuspids. Do I need to get dental implants for those spots?

Katherine

Dear Katherine,

A woman putting in her Invisalign aligners in two stacked images

Invisible braces could refer to one of three things. First, they could be referring to the clear braces you can get these days. They still go on your teeth like the traditional metal wire and bracket braces, but it uses a less visible material.

A second possibility is lingual braces. These are also the traditional type of braces bonded to your teeth, but they are placed behind your teeth where no one can see them. Many child stars have worn these when they’re in the middle of filming a series where they didn’t (or couldn’t in the case of a historical series) want the character to have braces. They’re useful for straightening in secret, but they have a couple of drawbacks.

They can be uncomfortable on your tongue which will bump up against them quite a bit. Braces make oral hygiene trickier because of all the materials you have to get around and the food that continually gets trapped in them. Lingual braces are even harder to keep clean because of their location. You could end up with a lot of unnecessary decay if you don’t stay on top of your tooth care.

Invisalign — Your Best Invisible Braces Option

While both of the above options could be considered “invisible braces”, there’s a much better option. Invisalign, though not technically braces, is an orthodontic system which straightens your teeth in significantly less time than traditional braces. These use clear aligners (think teeth whitening trays) instead of wires and brackets. Even at a conversational distance, people will not be able to tell you’re wearing them.

Because you’re talking about your lower bicuspids, it’s not necessary to get dental implants. Invisalign will close the spaces in your lower arch. Though, if you wanted to, you certainly could get implants placed where you’re missing teeth are. To do that, however, you’d need to work with an experienced implant dentist who also understands orthodontics. This way your work can be done in such a way as to preserve the needed space for the implant.

This blog is brought to you by Dr. Randall Burba. Check out his smile gallery.

Can a Diabetic Get All-on-4 Dental Implants

After my husband died I really struggled. I stopped taking care of myself. I gained 100 pounds, developed diabetes, and even developed gum disease which led to losing several teeth. I didn’t care. Then, one day I was at a park and smiled at a little girl and she asked if I was homeless. I realized then, things had to change. I have a full life ahead of me. I started eating right. I joined a gym. I’ve almost completely lost all the weight I gained and I no longer have gum disease. I asked my dentist about what he recommended for my missing teeth and he suggested all-on-4 dental implants. I was super thrilled about the idea of having a full mouth of teeth again. But, I went home to do some research and learned that diabetics shouldn’t get them. I don’t want to pay all that money if it’s not going to work. What should I do? I really want teeth again.

Carra

Dear Carra,

illustration of a dental implant

First, let me add my condolences. Don’t be too hard on yourself regarding how you dealt with your grief in the beginning. It’s almost suffocating to lose a loved one and we all seem to lose ourselves at first too. You should be really thrilled with the incredible progress you’ve made since then. I think the healthy changes you’ve made are remarkable.

For the most part, dental implants have a 98% success rate when done by an experienced implant dentist. There are some factors which make patients more at risk for implant failure. The biggest of these are:

  • Gum Disease
  • Smoking
  • Uncontrolled Diabetes

You’ve already taken care of your gum disease, which is huge. A responsible dentist will NEVER give a patient who has gum disease dental implants. There’s no way for your body to retain them well, just like when you suffered from gum disease, they couldn’t retain your natural teeth. They will fail. Because you’ve already turned that around it’s not a worry for you.

You didn’t mention anything about smoking, which I hope means you’re not a smoker. Smoking lowers your blood flow in your gums which increases your risk of infection, a leading cause of dental implant failure. You also increase your risk of redeveloping gum disease.

Your diabetes is under control, so again, Yay! not a problem for you. I think you’re likely a good candidate for dental implants.

Are All-on-4 Dental Implants the Right Choice for You?

The only real reason to do the All-on-4 procedure rather than traditional implants is bone loss. Sometimes, with gum disease and tooth loss, you lose so much jawbone structure you don’t have enough to retain dental implants. All-on-4 is one way to get around that. However, there is a better, more reliable option.

If you don’t have enough bone to support traditional dental implants, I’d consider getting bone grafting done. It will build back up your bone structure. Then you’re free to get whatever procedure you want. I hope this helps you make your decision.

Best of luck and congratulations on all your hard work!
This blog is brought to you by AACD Accredited dentist Dr. Randall Burba.

Is a Cracked Porcelain Crown a Dental Emergency?

I had several porcelain crowns placed on my front teeth. They’ve served me well for over fifteen years. One has always had a minor defect you couldn’t see just by looking. My dentist told me about it and offered to do a different crown, but she did say that even our natural teeth have minor defects and it shouldn’t be a problem. I appreciated her honesty and her willingness to make an entire new one. I didn’t feel that was necessary and their longevity has born that out. Today, however, I noticed I can both see and feel the defect. I’m sure it needs to be replaced at this point, I’m just wondering if it is a dental emergency or I can wait. The original dentist has since retired and her replacement and I are just getting to know one another so I don’t yet have the same confidence in her.

Lindsey

Dear Lindsey,

A Dental Crown being Placed

It sounds like you and your old dentist had a wonderful doctor-patient relationship. It’s certainly hard to lose a trusted caregiver. Hopefully, her replacement will end up being equally honest and skilled. While this change in your dental crown isn’t necessarily a dental emergency, I don’t want you to get too comfortable and let this slide. You do need to be seen.

The fact that you can now see and feel the defect tells me it’s cracked. It will at some point completely break. Those type of things inevitably happen at the worst possible moments, like when you’re on vacation or out to dinner. It’s much better for you to get this dealt with well before it can become an emergency issue. Plus, it will give you peace of mind knowing it’s no longer at risk of breaking.

Who Should Replace Your Dental Crown?

You’re not familiar with your new dentist yet, so before you allow her to replace your porcelain crown, you will need to research her cosmetic skill. At the very least check out her smile gallery. It’s a collection of before and after pictures of cosmetic work she’s done. You can click here to look at Dr. Burba’s work to get an idea of the type of quality you want. These are front teeth so you want them to be beautiful when you smile.

Some dentists would try to persuade you to replace all the crowns so as to make them easier to match. That’s usually a sign they’re not top-notch cosmetic dentists. The crowns are aging, so if you want to go ahead and replace all of them, that’s fine. But, you mentioned they’re still in good shape. In that case, you really only have to replace the broken one.

Replacing a single crown to your remaining teeth takes an expert cosmetic dentist. I’d suggest you look for a dentist who’s reached accreditation level with the American Academy of Cosmetic Dentistry. AACD accredited dentists are experts in their field both in technical skill and artistry. They’ll match your crown perfectly.

This blog is brought to you by Dr. Randall Burba.

How Do I Find the Best Dentist?

I’ve recently moved and need to find a new dentist. I’ve been to the same one most of my adult life so it feels weird switching. How do I find the best one available?

Burt

Dear Burt,

Woman giving thumbs up in a dental chair
The Best Dentists Leave Us with Smiles

Wouldn’t it be great if there was some independent, objective measurement to tell us who the best dentists were? Unfortunately, especially when it comes to general dental care, there isn’t. That doesn’t mean I can’t give you some guidelines to help you find the best dentist for your particular needs.

The first thing to ask yourself is what type of services do you need? Are you strictly and nuts and bolts guy who just wants his teeth cleaned and maintained as necessary? Or maybe you also want some cosmetic work done? Once that’s decided, it gets a little easier.

Finding the Best General Dentist

For the basics, I’d simply do an internet search for dentists in your area. Then I’d take two additional steps.

  • Check their reviews.

You’ll want a dentist people enjoy seeing. One who makes them feel like family instead of just someone they need to get in and out of the dental chair. Reviews are generally written by those who are thrilled with the service they’ve received or hated it. Either one should give you the information you need.

  • Check their passion

Each state has a requirement for how many continuing education hours a dentist has to do to keep their license. You want a dentist who not only keeps up with the developments in his field but has a passion for it. Make sure they go above and beyond what is required. They shouldn’t be offended to answer a question on how many continuing hours they do.

Finding the Best Cosmetic Dentist

It’s a little easier to find the best cosmetic dentist. Because there isn’t a cosmetic dentistry specialty, there used to be no way for patients to know who would give them a gorgeous smile makeover with porcelain veneers and who would give them a cosmetic horror story.

Fortunately, the American Academy of Cosmetic Dentistry stepped in and created an accreditation program. This tests dentist both with written and oral exams gauging their technical knowledge. Then, it requires them to provide visual evidence of a large number of cosmetic procedures they’ve done to ensure they not only have technical skill but artistry as well.

If a dentist is AACD accredited, that means you will get a stunning smile. In fact, most of them have a beautiful smile guarantee.

This blog is brought to you by Dr. Randall Burba.