Replace or Save Tooth?

To Save a Tooth or Replace It:  That is the Question

One of the most difficult decisions Periodontal Associates has to make is when to save a tooth and when to remove and replace it.  This is a difficult decision on many levels.  Numerous factors must be considered including the restorability of the tooth, the patient's susceptibility to disease, gingival and papillary conditions, and esthetics in weighing the benefits vs. risks of retaining a compromised tooth.  The decision may be based on one critical issue or on a collection of factors.  In this blog entry, Drs. Versman, Heller and Beckman will discuss these factors which need to be considered in deciding whether to remove or save a tooth.  As always, Periodontal Associates welcomes your comments and suggestions so feel free to comment here, call our Aurora office at (303) 755-4500, or please stop in!

Our goal at Periodontal Associates is to maintain or reinstate good form and function to the dentition with excellent esthetics and health. Fundamental to developing a dental treatment plan, a prognosis must be assigned to each tooth.  Can it be saved?  Should it be removed and replaced with an implant?

Osseointegration and periodontal regeneration are two significant advances in contemporary dental care and each should be utilized when appropriate. The natural dentition responds very well to definitive periodontal treatment.  And there is significant evidence that efficacious periodontal treatment can change the prognosis of a tooth from hopeless to good.  Dr. Versman, Dr. Heller, and Dr. Beckman always try to use periodontal cleanings and treatment first if they believe the tooth is savable. Extracting teeth which had lost supporting periodontium and replacing them dental implants is not always the preferred treatment approach.

Implant replacement is not infallible and does not mean the patient will not experience future complications. While osseointegration has reduced the need to save teeth with a marginal prognosis, there has been a significant rise in the incidence of peri-implant disease and bone loss associated dental implants.

Greenstein et al raise several questions when deciding whether a tooth should be saved or replaced.

These include:
1. Can the tooth be restored effectively?
2 Will endodontic treatment be successful?
3. Is periodontal therapy a reasonable option?
4. What effect will extraction have on the final treatment plan , particularly with respect to esthetics?

Restorative Considerations

Drs. Versman, Heller, and Beckamn know that an effective restoration can return teeth to normal function and acceptable esthetics. Teeth without extensive caries, a favorable crown/root ratio and adequate tooth structure offer the best prognosis for effective restoration.

Fracture and Faulty Restorations.  If a tooth is fractured, Dr. Versman, Dr. Heller, and Dr. Beckman man their best judgement to determine restorability.

Restorations must not infringe on the biologic width which can result in chronic gingival inflammation, pain, and clinical attachment loss.

Problematic teeth in the esthetic zone which require a crown lengthening procedure should be evaluated for replacement because these measures may result in an unesthetic appearance due to excessive tooth length.

Essential to cosmetic success, Drs. Versman, Heller, and Beckman perform a complete evaluation of the smile line and other factors.


Caries.  Decay which extends beyond or to the level of the alveolar bone usually represents a restorative challenge for Drs. Versman, Heller, and Beckman and increased treatment costs for the patient.

If a tooth is restorable, orthodontic extrusion, crown lengthening, or mucogingival surgical procedures may be required to salvage the tooth.  If this is necessary, Periodontal works closely with your general dentist in the Denver area to provide a thorough and individualized treatment plan.

Crown/Root Ratio. Teeth without loss of attachment or destruction of periodontal tissues usually present a favorable crown/root ratio and consequently are good candidates for restoration.

A 1:1 crown to root ratio is the minimum acceptable assuming the periodontium is healthy and the occlusion is controlled.

Remaining Tooth Structure. Teeth with 5mm suprabony structure, 2mm for the biologic width, 2mm for the ferrule and 1mm sulcus depth are candidates for effective restoration.

Often the length of the available tooth structure is insufficient to ensure the preservation of the biologic width and crown lengthening may be required.  Crown lengthening is a routine procedure that periodontists like Drs. Versman, Heller, and Beckman are specialists in.

Depending on if the patient need additional treatment like crown lengthening, this makes the final cost similar change.

The final decision to save the tooth or place an implant is often linked to financial considerations and the concerns for longevity of the results as opposed to the possibility of saving an already compromised tooth. Periodontal Associates prides ourselves in working with our patients to come up with a treatment plan that fits each individual best in terms of finances but most importantly health.

Endodontic Treatment

Survival rates for endodontically treated teeth have been estimated to be as high as 95% when associated with an excellent full coverage restoration -- if the tooth is treated with a well-fitting single-tooth crown with adequate ferrule.

Avila et al suggest the clinician should consider removing the tooth and replacing it with a dental implant if:

• The tooth has a large apical lesion (greater than 5mm).
• The tooth has had apical surgery.
• The tooth needs a large post and core for support.
• The tooth has inadequate ferrule.
• The tooth has an abnormal root anatomy precluding successful endodontic obturation.
• Th tooth has a root which is short or thin which will cause a post to predispose the tooth to post loosening or root fracture.
• There is a misaligned post that will weaken the root structure.

Periodontal Therapy

In deciding whether to save or replace a periodontally involved tooth, the Dr. Versman, Dr. Heller, and Dr. Beckman considers the severity of the periodontal condition and the likelihood of recurrence.  Periodontal Associates in Aurora, CO specialized in treating periodontal or gum disease, and Drs. Versman, Heller, and Beckman are the highest qualified doctors to make this decision.

If the periodontal prognosis is poor and/or the possibility of recurrence of the disease is high, such teeth may be candidates for removal and replacement with dental implants.  However, Periodontal Associates can help treat gum disease better with hygienists who are specifically trained to treat patients with severe gum disease.

 

Drs. Versman, Heller, and Beckman suggest regeneration will most likely be successful in teeth with pocket depths greater than 6mm.  pocket depths are determines by measuring the gums to see how large a pocket is or how far under the gums bacteria is spreading.  Those with pockets depths beginning at 5mm is considered to have periodontal disease and is in need of immediate and frequent periodontal treatment. Do you have gum disease? Click here to see all symptoms and warning signs.

In addition, Avila et al suggest regeneration will most likely be successful in the following cases:

• Teeth with mobility greater than normal and up to 1mm in any direction.   In addition to periodontal regeneration, these teeth can also be considered for splinting in case of secondary occlusal trauma.
• Teeth with no recurrent periodontal abscess.
• Teeth with less than 30% alveolar bone loss.
• Teeth with deep, localized narrow intrabony defects.
• Teeth without invasive furcation involvement.
• Teeth without interproximal bone levels equal to or apical to the level of the furcaton.
• Teeth with no root anomalies.
• Teeth which would benefit from root resection as a conservative, therapeutic option.

Aviva et al suggest teeth should be considered for replacement if:

• Pockets are deeper than 8mm.
• Teeth are extensively mobile.
• Teeth have recurrent periodontal abscesses.
• Teeth have root anomalies -- cervical enamel projections, enamel pearls or root grooves.

Esthetic Considerations

If function and cosmetics can not be maintained or improved, this may be an indication for tooth removal.  The decision to retain a tooth or remove and replace it with an implant is dependent on the ability to achieve a functional and cosmetic results for our Aurora patients.

The Effect of Retention or Replacement on the Final Treatment Plan

The strategic value of a particular tooth is an important parameter to be considered when designing a  treatment plan.  The decision to extract or retain teeth affects adjacent teeth, especially is the plan is for the teeth to function as abutments for a fixed or removable partial denture.

It is essential to determine if a compromised tooth can withstand the functional load anticipated in the future.

Other Considerations

Other factors in the decision to retain or remove teeth are:

• Smoking Habits
• Use of IV bisphosphonates and other drugs
• Patients with uncontrolled systemic conditions such as Type 1 diabetes

Conclusion

Tooth extraction and implant placement may not be the best therapeutic approach in all patients.  The decision to save a tooth or extract it and place an implant must include a consideration of a multitude of factors. 

To help decide what is best for you, Periodontal Associates strongly suggests you stop by for a FREE dental implant consultation in their Aurora, CO office.  As you have read, every individual can experience different needs, wants, and concerns when deciding what is right for them.  A consultation with Dr. Ken Versman, Dr. Doug Heller, or Dr. Eric Beckman allows one on one time and communication to resolve your questions, and provide you with excellent dental care.

Our office is located in Aurora, but we serve patients from all surrounding Denver metro areas.  Our patients respect Drs. Versman, Heller, and Beckman so much that some patients travel from Wyoming and Colorado cities hours away. 

Please contact Periodontal Associates at (303) 755-4500 or click here for an appointment.  Our website may also provide you more information to any questions that you have, and we urge you to to browse our website at www.periodontahealth.com. Drs. Versman, Heller, and Beckman are Denver's premiere providers of dental implants and periodontics.  We look forward to meeting you and providing you with a life changing and beautiful smile!

Tooth Loss Causes

What Causes Tooth Loss?

Losing teeth is a common phenomenon.  Tooth loss can be natural and necessary, especially if you are among the ages of 6 to 12. However, many teenagers and adults reluctantly experience tooth loss due many different causes.  Drs. Versman, Heller, and Beckman want to take some time to discuss these reasons, and whatever your reason for missing one or multiple teeth, Periodontal Associates in Aurora, CO can find a dental implant solution that is right for you!

CONGENITAL ABSENCE Missing teeth does not always mean teeth have been removed; instead, some people are born without a particular tooth.  A nonexistent tooth at birth is called congenital absence.  The population frequency of this occurring is over 5 % (missing of wisdom teeth not included).  After wisdom teeth, second premolars and permanent upper second (lateral) incisors are the most commonly missing teeth due to congenital absence, and frequently the missing teeth are the permanent teeth.  This will be seen as the child ages and the baby, or primary, tooth falls out without a successor sprouting behind it.  Without a permanent tooth, the baby tooth can function for longer periods of time, but they primarily fall out due to dental disease or lack of root support.  Without a strong support system underlying the tooth, some function can be lost.  At this point, the baby teeth need to be removed.

Replacing a primary tooth with a dental implant is a specialty performed by our doctors: Dr. Ken Versman, Dr. Doug Heller, and Dr. Eric Beckman.  It is important to come to Periodontal Associates for this procedure as the site of a congenitally absent tooth could have a cyst-like structure in the jawbone called a tooth bud.  Drs. Versman, Heller, and Beckman specialized periodontists and are able to perform treatments in a soft and gentle manner suitable for kids.

 

TRAUMA For most people, primary and secondary teeth are developed normally.  However, often unfortunate events result in trauma that may take aware those teeth.  Trauma can cause the loss of teeth in many different ways.  Teeth can be ‘knocked out’ immediately due to injury from falling or sports.  In other cases and most frequently seen at our Periodontal Associates office in Aurora, teeth can go through a traumatic incident but not need extraction or fall out until months or even years later.  For example, a blow to the mouth can hit the tooth in such a manner that the root is fractured while the tooth is still implanted in the gum.  When the root of a tooth is fractured, infection can develop.  The body will then begin to break down the root surface.  Without a proper root, again the tooth will eventually fall out or would need extraction and implants.

Another form of trauma consists from mechanical movements while eating or sleeping.  Without knowing it, many may find themselves clenching or grinding their teeth, especially while sleeping. These habits, also called bruxing, can lead to cracking or fracturing teeth sever enough to result in extraction.  This is mostly caused by underlying stress.  Drs. Versman, Heller, and Beckman could diagnose this and help find a way to prevent further damage by use of a mouth guard.

 

DENTAL DISEASE Although Drs. Versman, Heller, and Beckman see many patients for dental implants after trauma, most patients visit Periodontal Associates due to periodontal (gum) disease.  Gum disease is an infection in the gums and the supporting structure responsible for holding a tooth in place. As gum disease progressed, the space between the gums and teeth increase which can lead to the tooth falling out. If the tooth does not fall out, the surrounding gum line can be so damaged that the tooth must be extracted.  Dental decay can lead to the same consequence.  Decay can lead to significant infection on the bone which affects the root of a tooth. Dr. Versman, Dr. Heller, and Dr. Beckman are specialist in periodontics and can offer treatment and prevention for gum disease while also providing dental implants if needed.

No matter the cause of missing teeth, Periodontal Associates can provide you with the best individualized treatment to build a beautiful and long lasting smile. Our Aurora, CO office offers one of the most experienced, caring and dedicated staff members to assist you with your individual needs.  We work closely with your dentist – a key member of our team – to combine our expertise and experience to formulate the best treatment plan for you.  Dr. KenVersman, Dr. Doug Heller, Dr. Eric Beckman keep themselves abreast of the latest advances in the prevention and treatment of periodontal disease and the placement of dental implants. Most people, regardless of age, are good candidates for dental implants. So do not hesitate, call our Aurora office today for your FREE DENTAL IMPLANT CONSULTATION at (303) 755-4500.  Also, please visit our website at www.periodontalhealth.com to learn more about Periodontal Associates and what we stand for. If you have any questions you can call us or click here for questions and/or appointment.

Dads, Be Brave!

Dads, Be Brave!

 

Want your kids to be friendly and fear free at the dentist? It is up to you, Dads!  A new study reveals that parent’s attitude towards oral health and dental visits predict how their children will react in the same situations.  It is a good thing Dr. Doug Heller is a periodontist, his two kids will have some bright oral health futures.  

The University of Madrid conducted a study comparing the views of children versus their parents when it comes to visiting dental offices like Periodontal Associates. Participants included 183 children between the ages of 7 and 12.  Forty-three experimental studies from across six continents were also included in this review. 

The majority of studies confirmed a relationship between parental and child dental fear. This relationship is most evident in children aged 8 and under.  The study then concluded that, yes, there is an association between parental and child dental fear.  This is good to know as many people have anxiety and negative thoughts about dental work, and if we know where it begins, then Drs. Versman, Heller, and Beckman and others can put a stop to the fear.

América Lara Sacido, one of the authors of the study, said that “along with the presence of emotional transmission of dentist fear amongst family members, we have identified the relevant role that fathers play in transmission of this phobia in comparison to the mother.” 

More so than mothers, fathers sway their children in how to react to the dentist.  In fact, the reaction from their dad will often over shadow the mother’s regardless if it is negative or positive.  

 “Although the results should be interpreted with due caution, children seem to mainly pay attention to the emotional reactions of the fathers when deciding if situations at the dentist are potentially stressful,” said Lara Sacido.

To help this cycle, Drs. Versman, Heller, and Beckman strongly suggest finding a steady, primary dental provider that the entire family can bond with and trust like Periodontal Associates.  Then, both parents should be active in the children’s dental appointments to assure they will be in good hands.   Anxiety is a strong consequence of trips to the dentist office; however, as the industry advances routine dental procedures are becoming more and more comfortable.

 “Through the positive emotional contagion route in the family, the right attitude can be achieved in the child so that attending the dentist is not a problem.”

Need a dentist to trust? Call Periodontal Associates today as Dr. Versman, Dr.Heller, and Dr. Beckman are the best doctors in Denver! We provide dental implants, gum grafts, bone grafts, treat gum disease, and even provide regular hygiene cleaning appointments.  Our patients travel from all over Denver, CO to see our specialists here in Aurora,CO, and some of our patients have even been with us for over 35 years!  We can be reached by call (303) 755-4500 or by clicking this link.  Visit our website for more information about common dental practices and more about Periodontal Associates.