Pi DENTAL CENTER BLOG

Can This Tooth Be Saved?

Posted by Chris Raines on Apr 13, 2017 11:03:39 AM

Illustration presents various choices when considering whether to save a painful tooth

What happens when a tooth becomes painful? Can this tooth be saved?

When a tooth is painful, the decision whether to save or remove a tooth must be determined. If this tooth can be saved, we determine whether the patient wants to save it. Time constraints and financial concerns are just two of the variables that affect this decision.

Is a damaged tooth always painful?

Dr. Glenn Wolfinger, board certified prosthodontist at Pi Dental Center, was asked if a damaged tooth is always painful. He said, “Not always. A damaged tooth is usually initially uncomfortable. Pain will increase with swelling. But sometimes the pain goes away and the patient mistakenly believes the tooth has gotten better. However, this may mean that the nerve has died inside the tooth, which is a source of infection.”

What about an infected tooth?

Dr. Tom Balshi added, “An infected tooth can lead to medical and heart problems and can go into the blood stream and eventually lead to the brain.” Daryl Weiss, dental assistant, mentioned, “Bone loss can occur and the infection can spread to adjoining teeth.”

What if a tooth is mobile?

Wolfinger continues, “Not every mobile tooth needs to be extracted. All teeth have some level of mobility. Periodontally compromised teeth tend to be more mobile. Increased mobility is a sign that a tooth needs to be evaluated.”

How do we decide if a tooth should be saved or extracted?

“Restorability is the most important part of the decision.  We determine if the tooth can be restored with a filling or a crown. Sometimes root canal is needed.”

“There are times when a tooth is not restorable. At that point a root canal would not be indicated. If the tooth cannot be restored properly, an extraction is the only option.”

“If a tooth is restorable, then it is up to the patient to decide if they want to save the tooth.”

How do patients feel about losing a tooth?

Losing a tooth can be very traumatic. The decision to extract a tooth can be very difficult, even when it is necessary. But it is important to understand that treatment options, like dental implants and AvaDent Digital Dentures that effectively provide healthy, esthetic, and functional results.

What are the criteria?

If decay approaches the bone level, then restoration may not be possible. If there is a root fracture, extraction is indicated.

Can this tooth be saved? Illustration of healthy tooth, tooth with some bone loss, tooth with advanced bone loss

What about extracting the tooth and leaving an open space?

Leaving an open space is not always the best solution. While the actual fee for an extraction is inexpensive, the long term cost is not cheap. Adjacent teeth can shift and make restoration more difficult later on. Missing teeth present an esthetic and functional deficit for the patient.

Is there more than one choice treatment?

There are several options for treatment. During the evaluation, the doctor and patient discuss several aspects of treatment to learn the patient’s most important priorities and explore all available options. Comprehensive treatment plans that outline each option in detail are provided.

To make the best decision, we consider:

  • What is the best choice in terms of dental health?
  • Which option will last the longest?
  • Which will feel the most comfortable?
  • Which choice will allow the patient to eat and speak adequately?
  • Which is the most strong and durable?
  • Which is the most attractive?
  • Which can be achieved most quickly?
  • How does the cost of each choice compare?

How can a patient avoid tooth extraction?

“If the patient maintains a regular oral hygiene schedule and allows us to adequately evaluate the health of the mouth, including radiographic examination as needed, tooth extraction can usually be avoided. Small problems become big ones when they are undiagnosed.”

So what should you do if you suspect a problem?

Try not to wait until a problem becomes an emergency. Schedule an oral hygiene visit at least every 6 months. Contact us as soon as you suspect a problem. Provide the scheduling coordinator with as much information as possible when you schedule your appointment.

Visit Pi Dental Center's YouTube Channel to learn more about dental implant treatment options.

If you have questions, feel free to call us at 215-646-6334.

Pi Dental Center’s mission is to go beyond the preservation and maintenance of teeth to provide the best functional and esthetically ideal treatment. Our aim is to make your dental experience painless, convenient, and comfortable. Our supportive team helps to make your decision painless, straightforward and uncomplicated.

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Tags: dental implants, bone loss, dental pain, tooth loss

Blending digital dentistry and implant prosthodontics

Posted by Dr. Thomas Balshi and Joanne Balshi on Jan 30, 2017 4:41:16 PM

ACP Messenger (Winter 2017)

 

3-soccer.jpgBlending digital dentistry and implant prosthodontics

Thomas J. Balshi, DDS, PhD, FACP
Joanne Balshi

Blending digital dentistry and implant prosthodontics

I first met Michael Frank on a job site where he was artistically and meticulously setting tile for a designer kitchen. Mike exuded energy and had an admirable work ethic. He had a good technician’s eye and measurable pride in accomplishment, but the first time I saw him smile, I knew I could contribute something very valuable to the rest of his life. 

At the age of thirty-three, Mike had a lot going for him. Besides his talent; he was a vivacious athlete with a great sense of humor and an uncommon warmth. Married with two young daughters, he worked a sixty-hour week and played soccer in his spare time. A smile was the only part of his signature that simply did not fit. 

It was not difficult to convince Mike to allow me to evaluate him clinically and present him with a treatment plan. His evaluation revealed advanced periodontitis with extensive bone loss around his remaining teeth in the maxilla and mandible, most likely the result of his heavy smoking and excessive consumption of soda for quite a few years.

Mike's clinical presentation demonstrated extensive flaring of the mobile anterior teeth. Diagnostic casts were made and articulated at the appropriate vertical dimension. These models were scanned digitally and the data files transmitted to a milling center for the construction of the fully milled monolithic PMMA resin provisional dentures. The anterior teeth were repositioned vertically in the 3-D planning software prior to production.

Fig 1: Before -- Fig 7: AfterOn the day of surgery twenty cc's of blood were drawn and Platelet Rich Plasma (PRP) was produced for use during surgery. Local anesthesia was administered to both maxilla (upper jaw) and mandible (lower jaw), and all remaining teeth were extracted. Alveoloplasty was performed in preparation for future implant placement.

In the mandibular arch, full tissue flaps were reflected to identify the mental foramina. The anterior loop of the mental nerve was measured and noted. Beginning with the posterior implant placements in the mandibular right and left sides, a precision drill introduced the initiation of osteotomies (bone drilling). These were placed at a forty-five degree angle posterior tilt.

 Four implants were coated with PRP and installed according to the All-On-4®treatrnent concept protocol. Autogenous (host) bone was gathered during all of the osteotomy preparation procedures and reintroduced into the extraction sites. Angulated multi-unit abutments were installed on the posterior tilted implants and 1mm straight abutments were placed on the anterior axially placed implants.

Following the Teeth in a Day® procedure, special multifunctional copings were installed with guide pins on all four abutments. The rubber dam was then installed to the base of the copings. Using autopolymerizing acrylic resin, the monolithic conversion prosthesis was connected to the multifunctional copings. It was then removed and refined chairside.

2xrays.jpg

 

 

 

Figures 4, 5, and 6

Fig 4: All-On-4® implants to support non-removable teeth in the lower jaw.

Fig 5: Three months after implant surgery, the final digital upper denture and the All-On-4® monolithic fixed (non-removable) prosthesis for the lower jaw ready for delivery to the patient.

Fig 6: Completion of treatment changes Mike's life.


Flap closure took place with multiple interrupted sutures. The Teeth in a Day conversion prosthesis was then installed using prosthetic screws. The upper monolithic fully milled removable denture was relined, adjusted, and delivered at the same time.

Mike was given post-operative instructions and medications. One week following surgery, he returned for suture removal and minor adjustments to the maxillary immediate complete denture. At ten weeks post-surgery the patient presented for final impressions, initiating the construction of his mandibular fully milled implant-supported prosthesis reinforced with a milled titanium frame. New occlusal records were made and a reline impression made in the maxillary removable immediate digital complete denture.

Both arches were scanned and the data transmitted for the construction of a new fully milled monolithic maxillary removable digital denture and an All-On-4® final prosthesis with milled titanium framework for the mandibular arch. 

Three weeks following the impressions, the final prostheses were delivered to an ecstatic patient whose sparkling personality and boundless energy went up still another notch, proof that at any age, a healthy, esthetic smile is a priceless asset.


Thomas J. Balshi, DDS, FACP / Joanne BalshiThis article was published in the ACP (American College of Prosthodontists) Messenger (Winter 2017) and written by Dr. Thomas and Mrs. Joanne Balshi.

Dr. Thomas J, Balshi maintains a private practice in Fort Washington, Pennsylvania, where he blends clinical care with scientific research, education, and philanthropy. 

Joanne Balshi has served as Director of Marketing and Public Relations for the Pi Dental Center over the last thirty years. She is a freelance writer and authored Smile Your Heart Out, a coffee table book about the value of a healthy smile and dental makeover.

 

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Terminology: 1acpmessenger.jpg

  • All-On-4 Dental Implant Treatment - uses a prosthesis strategically supported by four dental implants that are biomechanically positioned for maximum stability. 
  • Anterior teeth - front teeth
  • Conversion prosthesis - An interim fixed-prosthesis that the patient wears from the time of uncovering of implants until the final prosthesis is completed. This prosthesis is made from the removable denture or temporary prosthesis that the patient has been wearing since first stage surgery. This removable prosthesis is modified into a fixed prosthesis. It allows the patient to experience the benefits of dental implants immediately after the implants are uncovered.
  • Digital dentistry - dental treatment that includes utilization of CAD/CAM software enabling the dental specialist to visualize the patient's dental structures in 3D format
  • Mandibular - referring to the lower jaw
  • Maxillary - referring to the upper jaw
  • Monolithic - formed of a single large block of material.
  • Occlusal record - a record of the way teeth come together - a registration of the opposing occluding surfaces of the teeth
  • PMMA - Poly(methyl methacrylate) - a clear plastic
  • Provisional denture - a temporary removable denture
  • Posterior Teeth - back teeth
  • Teeth In A Day® - Click here

 

Tags: bone loss, Teeth In A Day, All-On-4 dental implant treatment, digital dentistry

The Slippery Slope of Dental Bone Loss

Posted by Chris Raines on Jun 22, 2016 2:45:15 PM

Illustration of Destruction of a Home from Beach ErosionErosion of the earth and dental bone loss in the human mouth share some similarities.  Both are devastatingly damaging; both are financially costly; and both have similar solutions.

We have all seen images of hillside homes toppling from cliffs in California and heard about the destruction of beaches at the New Jersey shore.  Erosion has frequently been reported in the news.  Watch Dramatic Video Showing Effects of Erosion

Erosion of the Earth:

The word erosion comes from the Latin word "erosionem" which means "a gnawing away."  Erosion is the process by which the surface of the earth gets worn down. There are many different forces in nature that cause erosion. The three main forces that cause erosion are water, wind, and ice.

Water is the main cause of erosion and is one of the most powerful forces on the planet. Rainfall can cause erosion both when the rain hits a surface, called splash erosion, and when raindrops accumulate and flow like small streams. Rivers can create a significant amount of erosion over time. They break up particles along the river bottom and carry them downstream. Ocean waves can cause the coastline to erode. The shear energy and force of the waves causes pieces of rock and coastline to break off changing the coastline over time. Large floods can cause erosion to happen very quickly acting like powerful rivers. Beach erosion occurs when waves and currents remove sand from the beach system. The loss of sand causes the beach to become narrower and lower in elevation. Storm waves carry the sand offshore, depositing and storing the sediment in large sandbars.

An eroded stream bankA Solution to Soil Erosion:

One way to limit erosion is by planting trees and vegetation. Watch this YouTube Video demonstrating how erosion occurs and how the process is reduced when plants are present. (https://youtu.be/im4HVXMGI68). Notice that roots keep the water from eroding the soil by holding it in place. The deeper the roots reach into the soil, the more effectively they reduce erosion.

Dental Bone Loss:no-bone-solution.jpg

Periodontal diseases are infections of the structures around the teeth, including the gums, periodontal ligament and alveolar bone. A healthy mouth includes bones and teeth surrounded snugly by connective and gum tissue. In the case of periodontitis, bacteria gradually eat away at the underlying jawbone and at the periodontal ligaments that connect tooth to bone.

Bone loss occurs when lost teeth are not replaced. The jawbone melts away with removable dentures or no teeth at all. In the first year after tooth extraction a whopping 25% of bone is lost, and this bone loss continues as each year passes.

Replacing teeth with removable dentures doesn’t solve the problem of bone loss. This is because dentures exert less than 10% of the chewing pressure on bone compared to that of natural teeth. People who wear removable dentures can experience another severe consequence of bone loss: collapse of the lower third of their face.

Removal of the molars in the upper jaw can cause additional resorption of the bone due to expansion of the sinus cavity. With no teeth in place, the air pressure in the sinus cavity causes resorption of the bone lining the sinuses.

A Solution to Bone Loss:Illustration of the similarities between a natural tooth and a dental implant

A proactive approach can help to ensure a healthy mouth.  “Preventing bone loss with good oral hygiene and follow-up is more ideal than trying to rebuild the defective site,” states Dr. Glenn Wolfinger, a board certified prosthodontist at Pi Dental Center.

Bone loss can be prevented by replacing a tooth with a dental implant because an implant acts like a natural tooth root exerting similar pressure as real teeth. An implant can be placed during the same surgical procedure as the tooth extraction.  By replacing single teeth with dental implants or by using a fixed implant-supported bridge, bone loss is minimized.

A single-tooth implant, or a dental bridge supported by dental implants, provides a chewing power that can exceed the bite force of natural teeth.  A prosthesis, secured with dental implants, such as our Teeth In A Day® procedure, provides significant biting force and helps considerably in preventing bone loss.Illustration of facial collapse due to bone loss and restoration of facial proportion following dental implant treatment

While maintaining our beaches, streams and properties supports a healthy Earth, preserving bone in the jaw helps to preserve a healthy mouth and maintains a healthy appearance.

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Terminology:

Alveolar Bone: The bone of the upper jaw or lower jaw that surrounds and supports the teeth.

Dental Implant: Dental implants are replacements for your natural teeth. Natural teeth are connected to biologic roots inside the gum and bone tissue. When they become decayed or compromised and unable to function properly, the best solution is recreating teeth that most closely resemble nature. Dental implants are synthetic roots. The scientifically proven ones are made from titanium, a substance that is compatible with bone tissue and in just a few months’ time, bone actually bonds to the titanium surface of the implant. They become the sub-structure for a whole new set of non-removable teeth.

Edentulous: Without teeth. Patients may be described as fully edentulous when they are missing all their teeth, or partially edentulous when they are missing some of their teeth.

Bone Resorption: Resorption is the process or action by which something is lost or taken away. Bone resorption is a process by which areas of bone structure are lost due to activation of the body's innate capacity to remove mineralized tissue, as mediated via cells such as osteoclasts.

One More Cool Video:

Erosion Video with Bill Nye the Science Guy:    https://youtu.be/J-ULcVdeqgE

View Scientific Articles about Bone Loss, Dental Implants, and More.

 By Christine Raines
Web Site Administrator
Information Systems Manager
at Pi Dental Center

Tags: dental implants, No Bone Solution, bone loss, maxillofacial prosthodontics, periodontics

Pi Dental Center Holds Photo Caption Contest

Posted by Chris Raines on Jan 25, 2016 10:19:54 AM

Pi Dental Implant Center Photo Caption Contest Winners

Pi Dental Center recently held a photo caption contest. Patients, social media followers from Facebook, Twitter and newsletter readers were invited to submit captions for a photo featuring a Budweiser horse. Over thirty-four humorous, creative and imaginative captions were submitted.

Our Pi team voted for their favorite captions. First place winning clever quote, “Just say "Neyyyy" to Tooth Decay.......!!!,” was submitted by Darren Rapp. Honorable mention went to Tammy Eichelberger for her whimsical music reference, “Watch me NAE NAE..Watch me..Watch me.” Each winner received a prize package in the mail.

OTHER SUBMITTED CAPTIONS:

  • I'd sure look better if I had my teeth cleaned at Pi Dental!
  • I Got My New Smile At The Pi Center.....And It Didn't Hurt A Bit!!!! Ha! Ha! Ha! Ha!
  • Hey Doc, You forgot my side teeth.
  • No Horsing Around....go to PI Dental for Your Beautiful Smile!
  • What do you mean I should make an appointment with Pi Dental!!
  • Dr. B., Thanks so much for the implant supported smile. Though I think I misunderstood you when you said I'd be a little hoarse afterwards.
  • Toothless happiness, forever!"
  • Holy Horses! Hope you have a Happy Holiday!
  • Seasons Greeting from our Stable to Yours
  • Straight from the horse’s mouth wishing everyone a "Happy New Year
  • Pi Dental Center has given me my confidence back. I can laugh again!
  • Giddy Up! Let’s go!
  • Look, Ma, no cavities!!!! (Remember that old TV commercial??? LOL)
  • NEW TEETH..IN ONE DAY
  • I said BAH HUMBUG!!
  • Vertical Maxillary Excess • You said 'Open wide'!
  • Look at my new choppers, aren't they grand!!!!
  • I LOVE PI DENTAL :) • Of course I floss!
  • Just check 'em and be done with it!
  • Dr. Balshi has patients in every state -- Now it's time to have patients in every STABLE!"
  • No horsing around get your dental exam at "Prosthodontics Intermedica" it the greatest place around!
  • Ma! The hay! Now!!
  • HEY!! Don't be horsing around with your dental care or you'll look like this!! Get on over to Pi and let Dr. Balshi and his staff make you proud to smile like this!!
  • Someone needs to tell this horse--that he overdue for dental hygiene visit ---looks like he needs a good cleaning!!!
  • Maybe some implants too!!!
  • Poster Horse for Zoom Whitening…
  • Look Ma, no cavities now that I've been to PI Dental • I should have gone to PI.
  • Steve Harvey is announcing the next Kentucky Derby? Now that is as funny as me going somewhere other than PI to get my molars replaced! • I believe, I believe!
  • Loving my all-on-16 procedure!

The photo (above) was taken in December, when the famous and majestic Budweiser Clydesdale horses paraded through nearby Ambler.

Thank you to all who participated in this awesome event. We hope that you enjoyed it as much as we did. Please stay tuned for upcoming contests and activities at Pi Dental Center.

Pi Dental Center offers progressive, innovative dental solutions giving patients of all ages beautiful smiles. "We build attractive, custom smiles…no horsing around!" Call us if you are looking to find a dentist or need dental care at 215-646-6334 or email piteam@pidentalcenter.com to learn more.

 

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Tags: tooth whitening, bone loss, dental surgery, dentures, smile makeover, oral hygiene, fresh breath, dental health

The No Bone Solution of Dental Implant Treatment

Posted by Thomas Balshi, DDS FACP on Dec 20, 2012 3:34:00 PM

A healthy smile is achieved using the No Bone Solution Dental Implant Protocol

Patients, who have been told that they do not have enough bone for successful dental implant treatment, feel discouraged and overwhelmed by the limited number of options presented to them by their dentists.  Many of these patients are presented with a choice of removable dentures or lengthy and invasive treatment protocols.

Some of the dilemmas denture wearers experience include sore spots on the gums from rubbing, a decrease in bite force and an inability to eat many foods. Loose dentures move around and cause embarrassment in public. Some denture wearers have difficulty speaking with whistling or clicking of denture teeth.  Many people who wear dentures also complain that food tastes bland.

Successful dental implant rehabilitation of the upper arch depends on the quality and quantity of bone.  The term used to describe an upper jaw with very little bone is called a severely atrophic maxilla.  Rehabilitation of the severely atrophic maxilla presents significant challenges for treatment.  Inadequate bone volume often results in the use of bone grafting procedures that can lengthen treatment time and delay delivery of the non-removable prosthesis.

The No Bone Solution is a special treatment protocol developed at the Pi Dental Center. It combines unique computer guided implant surgery with precision screw retained fixed prosthodontic rehabilitation of the severely atrophic maxilla. The protocol eliminates the need for invasive bone grafting and extensive procedures.

This summer, The Journal of Cosmetic Dentistry published, A “No Bone” Treating the Atrophic Maxilla with Immediate Implant-Supported Fixed Prosthesis. Dr. Thomas Balshi and Stephen Balshi MBE wrote the article, which provided CE credits for dental professionals.

This article identified patients who might be candidates for this type of treatment.  It discussed zygomatic and pterygomaxillary implants and described minimally invasive timesaving benefits of this protocol in comparison to sinus lift procedures.

The No Bone Solution protocol provides a restorative option for patients with severely atrophic maxillary bone. This protocol does not require bone augmentation and significantly reduces total treatment time for the patient compared to alternative procedures.

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The No Bone Solution?

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Tags: dental implants, dental implant treatment, No Bone Solution, bone loss, severely atrophic maxilla, sinus lift

Dental Implant Treatment Using The "No Bone" Solution

Posted by Pi Dental Center on Aug 10, 2012 3:23:00 PM

No Bone Solution Dental Implant Treatment

Rehabilitation of the severely atrophic maxilla presents significant challenges for the restoring dental team.   Inadequate bone volume often results in bone grafting procedures that delay treatment and delivery of the final prosthetic solution.  This article discusses the use of implant anchorage in maxillary sites for the support of an immediately loaded screw-retained prosthesis.

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Tags: dental implants, No Bone Solution, bone loss, dental treatment