Q: What is the difference between replacing a missing tooth with a fixed bridge and an implant?


Medical Illustration Copyright © 2006 Nucleus Medical Art, All rights reserved www.nucleusinc.com


A: As you can see from the illustrations above, the two teeth adjacent to the missing tooth had to be filed down in order to cement a three-unit bridge in place to restore the missing tooth. The advantage of an implant is that you don’t have to touch the healthy teeth adjacent to the missing tooth.



Q: How long does a crown, veneer, or fixed bridge last?


A: There is no definitive answer to this question. Assuming the crowns, veneers, and bridges have been fabricated and inserted into the mouth with precision and attention to detail (which it always is in my office), you should expect many years from your new dentistry. However, all bets are off if you decide not to floss, brush, and come in for regular checkups. I have crowns, bridges, and veneers in patients for over twenty years. Once the new dentistry is inserted, the longevity of the work is really under the patient’s control.


Q: Why is the health of my gums and bone so important before I have veneers, crowns, bridges, or implants?


A: I usually answer this question with a question. Would you build a gorgeous, new house on a foundation that is rotting away? The bone and gums around your teeth are the units that keep your teeth in your mouth. I will not restore a patient’s mouth if the periodontal status is not healthy. I’ve had patients ask me to overlook this aspect. If they still persist after I’ve stated my case, I will tell them they are in the wrong office. The bottom line is, “the doctor must not allow a patient to convince him to do the wrong thing.”


Q: How much pain will I experience from the surgical placement of my implants?


A: Surprisingly most of my patients experience no pain after the procedure. Today the protocol for placing implants has become less invasive. I try to create a small opening in the gum to have exposure of the bone where the drilling will take place. Most of the time I don’t have to suture the surgical site where the implants were placed. I call every patient the night of the surgery and often they report they are fine. Usually they tell me they didn’t have to take pain medication.


Q: How often should I have my teeth cleaned?


A: There is no specific answer to this question. I’ve had patients come into my office for a cleaning and I informed them to save their money. Their teeth were spotless and there was no benefit to cleaning them. The time schedule for regular cleanings depends on various factors, and each patient has to be evaluated on an individual basis. Most patients should have at least one cleaning a year. Once I get to know a patient I can determine how often they should have this procedure.


Q: Why must you send out for a biopsy every time you surgically remove something from a patient’s mouth?


A: Simply put: “if it’s important enough to remove it from the mouth, it’s just as important to know what it is.” No dentist can be one hundred percent sure what he has removed from your mouth till a pathologist exams it under a microscope. I do not feel comfortable telling a patient a diagnosis of an oral condition till the tissue sample has been examined by an oral pathologist. Oral cancer and many other oral diseases exist and they have to be properly diagnosed. “It’s a matter of life or death in some cases.”


One of my patients presented with a soft tissue growth in her lower jaw. The x-ray shows the area where the bone was missing. The middle photograph was taken during my surgery. You can see how the soft tissue, in the last picture, “ate the bone away.”




Now the question: what is it that I removed? I sent the specimen out to my pathologist and received an accurate diagnosis.


Q: Do I really need to have a CT Scan by a radiology group before my implant surgery?


A: In most instances the answer is yes. Today this protocol is really the best way to determine where to properly place the implant without causing harm to the patient. In addition, the films allow me to pick the best size implant for the patient by measuring the available bone present. There are times when a patient will come in to my office and I can easily determine the correct size implant and its position from a routine dental film. This scenario, however, is rare. Below is an illustration of what can happen when improper pre-operative planning occurs. The implant was placed into a major nerve of the jaw. “This is a problem you don’t want to encounter.”


This has not happened in my office since I started implant surgery, (35 years ago), and I intend to keep it that way!!!!!!!!!




Medical Illustration Copyright © 2006 Nucleus Medical Art, All rights reserved www.nucleusinc.com


Q: I have a mouth full of silver fillings. Do you think I should change them to white fillings?


A: There is no reason to change your fillings unless: they are starting to deteriorate, you don’t like the cosmetic appearance, or you feel like throwing out money. There has not been a conclusive study as of today that states silver fillings are dangerous to your health. I have placed silver fillings in patients that are still fine after twenty years. In fact, silver fillings actually get better with age. White fillings are fine however. The new, white filling materials are far superior to the materials thirty years ago. Their hardness and color stability have been greatly improved upon.
I’m considering the placement of porcelain veneers on my teeth. I hate the color and shape of my teeth. How many veneers do you think I need to have a beautiful smile?


The only way to determine how many veneers you’ll need is to analyze your smile and see how many teeth show when you laugh and speak. Some individuals show few teeth, while others have a broad, revealing smile allowing others to see their teeth far back in the arch. In other words, you want to be able to smile and have others view a harmonious color and appearance when the veneers are inserted. Before starting the procedure, I advise patients to bring in photographs of them. I can use them as a valuable diagnostic aid. In addition, I find that patients who bring in magazine pictures of teeth they love are also helpful. Communication is very important in order for me to develop and deliver a final product meeting the patient’s expectations. In conclusion, some patients can get away with veneering a few teeth and still have a beautiful result, while others have to do a more comprehensive treatment.


Q: What should I expect at my first visit at your office? I need extensive dental care and I would like to know your regimen.


A: First, I will review your past medical and dental history with you. Please bring a complete list of medications you are currently taking. I will need the dosages of each medication as well. Following this discussion, I will usually take a full series of radiographs unless you have a recent set of films available. I will perform an exam of your teeth and gums following the films. After my exam is completed, I will talk at length with you about your concerns and what you are looking for. Prior to your second visit, I will carefully study your radiographs. During the second visit I will do another comprehensive exam(no cost to you) to make sure we have collected all the information we need to fabricate a treatment plan suitable for you. In addition I usually take a set of molds of your teeth and photographs to help me study your situation. THE COLLECTION OF DATA AND THE ANALYSIS OF THIS DATA IS MORE IMPORTANT THAN THE TREATMENT. WHAT GOOD IS PLACING A MOUTH FULL OF CROWNS IN AN INDIVIDUAL, IF THE TEETH ARE READY TO FALL OUT BECAUSE OF GUM DISEASE? Depending on the severity of your case, I will either present various treatment plans during the second visit or delay this until the third visit. I feel that studying my collected data deserves time for a thorough analysis. I want to present you with realistic and affordable alternatives for your treatment plan.


Q: Do you recommend an electric toothbrush?


A: I see no need to invest in an electric toothbrush unless you have limited ability with your hands to perform this task. Some of my patients have arthritis and simply cannot handle a toothbrush. I always recommend a soft brush and replacing this brush every two months.


Q: Why is a CT scan a must before placing an implant?


A: You have to understand that a normal dental radiograph is two-dimensional in nature. You have no concept of the third dimension. This is important because without the third dimension you are not seeing concavities and convexities normally found in a jaw. Without this knowledge, you have a very good chance of violating important anatomical structures that can lead to significant medical complications. You may damage a nerve or a boundary of bone separating the nose or sinus from the mouth, or even enter the floor of the mouth which can really lead to a life-threatening situation. In New York City the CT scan is the standard of care for placing implants. I wouldn’t place a simple implant without a scan. In all my years I never had a patient object to this procedure when they weigh the benefits and risks.