Michigan Dental Implants | Cosmetic Dentistry Birmingham Bloomfield Hills Area | Bone Grafting

We've Moved!

2010-08-24T13:09:00.000-07:00

The Gum Disease Michigan Blog Has Moved!

In an effort to consolidate numerous blogs into one comprehensive, all-inclusive blog, we've moved our blog. It now resides at http://blog.drnemeth.com . Please visit us at our new address and re-subscribe to stay up to date on all the latest news from Michigan Periodontists and Dental Implant Specialists, Drs. Joseph Nemeth and Amar Katranji. We will look forward to seeing you there!

Joseph R. Nemeth, DDS and Associates Now Offers All-on-4 Dental Implant Treatment

2010-04-14T08:28:00.000-07:00

Are you a patient who has lost all your teeth and are fed up with ill-fitting dentures that slip around and cause constant sore spots on your gums? Have your dentures been relined over and over again while you continue to lose height and width of your jawbone? Is your face starting to look "sunken in" because your dentures don't fit well, prematurely aging your face? Are you tired of not being able to eat the foods you love because your dentures don't fit? Have you been told that alternative treatments involving implant-retained dentures are too expensive?

The All-on-4 Dental Implant Concept may be the answer you've been looking for. A proven and successful concept for edentulous patients, the All-on-4 technique allows Southfield Periodontists, Drs. Nemeth and Katranji to provide patients like you with an efficient and effective, more permanent restoration using only four implants to support an immediately loaded full-arch prosthesis, like an implant-retained denture or bridge.

Angled posterior implants
During the procedure, the two dental implants toward the back of your mouth are tilted, allowing the surgeon to use longer implants in minimum bone volume, thereby increasing bone-to-implant contact. This reduces the need for vertical bone to be built through bone grafting processes, often reducing the cost of surgery. In addition, the angled posterior implants can be anchored in the better quality bone near the back of the jaw, improving support of the prosthesis by reducing cantilevers (prosthetic with an unsupported end).

Good clinical results
Biomechanical measurements show that tilted implants, when part of prosthetic support, do not have a negative effect on the load distribution. The angulation of implants has been used in clinical practice for more than ten years and has shown positive results.

Overall published data on the All-on-4 concept shows cumulative survival rates between 92.2% and 100%. The concept is supported by good clinical outcomes from studies using protocols in which four implants have been placed to support a full-arch prosthesis.

Planning with NobelGuide
All-on-4 can be planned and performed using the NobelGuide treatment concept, ensuring accurate diagnostics, planning and implant placement. The NobelGuide Software allows for comprehensive diagnostics including the detection of available bone, virtual implant placement according to your anatomy and restorative needs, and the ordering of distinctive surgical templates custom made for each patient. NobelGuide works with minimally invasive techniques as well as surgical techniques utilizing mini-flaps and full-flaps, with the surgical template ensuring exact implant placement through a guided surgical technique.

All-on-4 in Summary

Enables the Michigan periodontist to restore your entire upper or lower dentition with only four implants
Reduces the need for the dental implant surgeon Michigan to complete expensive bone grafting procedures
Allows for immediate placement of prosthetics without the wait time associated with two-stage dental implant procedures
Facilitates the placement of fixed or removable final prosthetics
Diminishes the stress patients face because the results are documented and proven effective

Would you be interested in learning more about the All-on-4 dental implant concept or other dental implant procedures? Visit Michigan Periodontists, Drs. Nemeth and Katranji on the web at http://www.drnemeth.com or call 248-357-3100 to schedule a consultation appointment today. Don't wait another minute to take the necessary steps to having the beautiful smile you deserve!

*source: NobelBiocare, Inc.

Placement of Dental Implants Michigan Results in Minimal Bone Loss

2010-03-03T10:21:00.000-08:00

Source: Chicago- May11, 2009

The American Academy of Periodontology

www.perio.org/consumer/implant-placement.htm

According to the American Academy of Periodontology (AAP), Michigan Dental implants, frequently used as a replacement for missing teeth, can actually help prevent bone loss. Dental Implants Michigan can be used not only as a replacement for missing teeth in or order to restore the patient's tooth function but also to improve a patient's appearance. Previous research shows that placing a dental implant disrupts the host tissue in the area of the implant, so Michigan oral surgeons often focus their treatment planning to carefully maintain the patient's bone and gum tissue surrounding the implant. A more recent study published in the Journal of Periodontology discovered that most of the bone remodelling occurrs in the time between when the implant is placed and when the final restoration is seated.

Close observation of the same patients in the five years following the implant placement showed little bone change, regardless of the type of restoration or implant length. This study, conducted at the University of Texas Health Science Center at San Antonio, evaluated 596 dental implants placed in 192 patients over the age of 18. Patients were screened for adequate oral hygiene and bone volume. Exclusion criteria included heavy smoking, chewing tobacco use, drug abuse, and untreated periodontal disease, amongst others.

Study author Dr. David Chochran, DDS, PhD, Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio, and President of the AAP, believes that this study provides additional supporting evidence for the use of dental implants Michigan to replace missing teeth. Because the patient's host tissue surrounding the dental implant largely remains uncchanged in the five years following placement, the dental team is free to focus on periodontal assessment and treatment of other areas in the patient's mouth, confindently knowing that the Dental Implants Michigan are doing their job of acting as a viable substitute for that patient's natural tooth.

When Your Sinus Gets in the Way of Successful Implant Placement

2010-01-12T12:03:00.000-08:00

When Your Sinus Gets in the Way of Successful Dental Implant Placement
Successful placement of implants in the posterior maxilla could potentially be compromised by the lack of vertical dimension between the alveolar crest and the floor of the maxillary sinus. Typically, 10mm of vertical bone is required for predictable implant success (Misch 1987) although success can be achieved with less than 20 mm (Fugazzoto 2007). Moreover, bone density in the posterior maxilla is often poor, which could lead to complications during implant fixation. To address these problems, maxillary sinus elevation surgery was developed to increase the amount of bone available for implant placement.
Lateral Window Sinus Lift: A Sinus Augmentation Technique

Implant placement can be performed simultaneously with the sinus elevation procedure or following a healing period that can last
6-9 months. Immediate placement during sinus elevation reduces overall healing time and eliminates another surgical procedure, which can be desirable to patients. The decision to place an implant during sinus augmentation is dependent on the presence of adequate bone volume and quality to provide for initial stability of the implant. Rosen and colleagues (1999) recommended at least 5mm of native bone for immediate implant placement during sinus augmentation. However, more recent studies have found that implant stability can be achieved with less than 5mm (Peleg 2006).

Lateral Window Sinus Augmentation: The lateral approach involves a modified Caldwell-Luc operation to gain access to the sinus cavity. A bony window is created in the lateral maxillary wall, the Schneiderian membrane is elevated, and bone grafting material is a combination of autogenous bone and allograft. An absorbable collagen membrane is placed between the bone graft and the membrane as well as over the bony window.

This technique is usually the preferred method of sinus elevation in situations of poor bone quality and minimal residual bone height because it allows for direct visualization and accurate bone placement and volume at the position of the implant. Also, tearing of the membrane can be easily treated, minimizing contamination of the graft during healing.
For more information about Sinus Augmentation (Lift) procedures or Dental Implant Procedures, contact Joseph R. Nemeth, DDS and Associates at 248.357.3100 or via email at jodi@drnemeth.com. You may also want to visit the practice website at http://www.drnemeth.com.

Dental Implant Composition

2009-12-29T15:07:00.000-08:00

Dental Implant Composition

A dental implant is a man-made tooth root constructed from titanium. Titanium is a lightweight, soft, noncorroding metal. The surface of the titanium forms a natural ceramic coating when exposed to oxygen which enables bones cells to attach to it (a process called osseointegration). Since bone cells react better to titanium surfaces that are rough, most implants are put through a roughening process by the manufacturer.

To enhance bone healing, implants are sometimes coated with a calcium derivative found naturally occurring in human teeth and bones to jump start the osseointegration process called hydroxyapetite.

Implants are often threaded. In order to enhance implant placement and stability, thread shape and pitch are carefully calculated to help transfer biting force to the surrounding bone.

To learn more about Michigan Dental Implants, call Drs. Nemeth and Katranji at 248.357.3100 or email jrn@drnemeth.com or visit us on the web at http://www.drnemeth.com.

Ridge Modification Prior to Dental Implant Placement

2009-11-16T07:43:00.000-08:00

The American Academy of Periodontology (AAP)
http://www.perio.org/

The AAP Reports:

Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. This defect may have been caused by periodontal disease, wearing dentures, developmental defects, injury or trauma. Not only does this deformity cause problems in placing the implant, it can also cause an unattractive indentation in the jaw line near the missing teeth that may be difficult to clean and maintain.

To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Your periodontist can tell you about your options for graft materials, which can help to regenerate lost bone and tissue.

Finally, the incision is closed and healing is allowed to take place. Depending on your individual needs, the bone usually will be allowed to develop for about four to 12 months before implants can be placed. In some cases, the implant can be placed at the same time the ridge is modified.
Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come. Ridge modification can enhance your restorative success both esthetically and functionally.

To learn more about Michigan dental implants, call Joseph R. Nemeth, DDS and Associates at 248.357.3100 or visit us on the web at http://www.drnemeth.com/. You can also visit the AAP website at http://www.perio.org/.

Michigan Dental Implant Impression Comparisons

2009-10-07T08:05:00.001-07:00

Taking an impression is the first step in producing a model to indicate the positioning of Michigan dental implants and/or abutments in a patient's mouth. A device which facilitates the replication of implant positions on the study models is called and impression coping and is often required during the impression stage of placing dental implants.

Impressions may be taken in one of two ways: at the implant level or at the abutment level. Placement of an implant analog, a device which mimics the implant on the study model, must occur during an implant-level impression, while abutment level impressions require placement of an abutment analog or a device which mimics the abutment.

Which impression technique is used depends on the preference of the restorative dentist and also varies by implant system. With nonfriction implant systems, impressions can be taken at either the implant or abutment level. With internal friction abutments, delivery of the abutment to its final position is necessary before the final impression is taken.

Comparison of Implant-Level and Abutment-Level

	Implant-Level Impressions	Abutment-Level Impression
Ease of localization	Requires subgingival placement of copings	Easier, because margins are often supragingival
Impression copings	Necessary	Conventional impression without copings is available in some cases
Abutment selection and preparation	On a model in the laboratory	Can be done in the mouth, chairside
Abutment modification	Not needed once delivered	May be needed in the mouth
Custom abutment	Available	Not available (unless an implant-level impression was taken first).
Interim and final crown fabrication	Can be performed in the laboratory, together with the abutment selection and preparation	Chairside relines of provisional restorations and final impressions often necessary

*Source: http://online.lexi.com

Implant-level Impressions

Implant-level impressions are similar for any type of prosthesis. There are two main types of impression copings – closed tray and open tray. Closed tray or transfer impression copings remain on the implant complex after the impression is removed and need to be placed into the impression manually. Open tray or pickup impression copings are automatically retained in the impression after removal. This usually requires the manipulation of a long screw that is not present in transfer copings.

For more information on implant impression comparison, call (248) 357-3100 and talk to an implant specialist. If you're a general dentist who would like to see a demonstration of taking implant impressions in the Oakland, Wayne, or Macomb County Michigan area, feel free to contact Joseph Nemeth, DDS & Associates by phone or email jrn@drnemeth.com. Also look for us on the web at www.drnemeth.com.

A 3-Unit Bridge or Dental Implant

2009-10-01T06:16:00.000-07:00

A 3-Unit Bridge or Dental Implant - Which is Right For You?

Each and every patient deserves a magnificent smile. Due to the incredible advances in aesthetic dentistry, there's no need for anyone to settle for less. With dental implants, missing teeth can now be easily, comfortably and most importantly, permanently replaced.

3-unit Bridge - The Traditional Option
Traditionally, a bridge has been the standard of care for replacing a missing tooth. Constructed of metal sub-frames and tooth-colored porcelain, bridges are fabricated to approximately match the natural shade of your existing teeth.

A bridge uses the teeth on either side of the missing tooth as support for the artificial tooth that replaces the missing natural tooth. The goal of a bridge is to restore chewing function while achieving an acceptable aesthetic outcome.

Unfortunately, since the jawbone under the replacement tooth is no longer being stimulated by being involved in the chewing function, bone is often resorbed into the body. This process creates a slowly-growing gap between the replacement tooth and the gums.

Key Features

Slightly less expensive than a dental implant
Achieve acceptable cosmetic outcome
Restores chewing function

Drawbacks

Requires healthy adjacent teeth to be ground down
Potentially increases risk to the teeth that have been ground down
Bone resorption results in compromises cosmetics over time
Life span of only 5 to 7 years traditionally
May contain metal

Single Tooth Implant - The State of The Art Solution

Dental implants can provide a more advanced replacement option for replacing a missing tooth than a traditional bridge, while preserving adjacent teeth.

Dental implants are small titanium screws designed specifically to replace a natural tooth root. Dental implants provide a highly biocompatible surface that encourages bone to attach to the implant during healing through a process called osseointegration. This process of bone attachment ensures long-term results.

Dental implants do not require adjacent teeth to be ground down or modified in any way. The implant also provides the added benefit of creating stimulation to the underlying bone.

Restoration with all-ceramic components can produce a beautiful, natural looking, translucent replacement tooth that looks almost identical to the tooth that is being replaced!

Key Features:

Adjacent teeth remain untouched - no grinding down required
Underlying bone integrity is preserved because stimulation is restored
Helps to maintain long-lasting, cosmetically pleasing results
Titanium is strong and is naturally accepted by the body resulting in a high level of osseointegration

Drawbacks

Slightly higher cost than a bridge

When deciding between a dental implant and a three unit bridge, it is important to be educated about all of the benefits associated with choosing a dental implant. When you lose a tooth, your jawbone can shrink, aging your appearance prematurely. Implants help to prevent this premature aging.

Like natural teeth, your newly restored dental implant will be strong, stable and secure so you can comfortably eat all your favorite foods. Dental implants are a long-lasting solution - often lasting an entire lifetime.

And perhaps most importantly, your beautiful new teeth can give you back the confidence you may have lost when you lost a tooth. They can transform your daily life and can lead to a happier you!

If you'd like to know more about deciding between a dental implant and a three-unit bridge, visit implant manufacturer, Nobel Biocare on the web at www.nobelsmile.com. For an implant dentist in the Oakland County, Wayne County, or Macomb County, Michigan area, visit Dr. Nemeth and Associates on the web at www.drnemeth.com or call (248) 357-3100 to schedule a consultation visit.

Implant Supported Overdentures - Another Tooth Replacement Option

2009-09-28T12:12:00.000-07:00

Guidelines for Recommending Implant Supported Overdentures

Does the patient have complaints of soreness, instability or decreased function with his/her current denture?
Is the patient's dissatisfaction or desire for additional function a result of the original appliance design or inadequate retention?
Has the patient been infomred of the benefits of implant-supported overdentures: increased prosthesis retention, increased chewing ability, improved nutritional status, and reduction of future bone loss?
Is there adequate interocclusal space in the anterior segment to accommodate the prosthetic attachments on the implants? Posts extend about 3-4 mm coronal to the tissue level. Attachments add an aditional 1-2 mm of height. The retentive device occupies 3-5 mm of buccolingual space.
Is there adequate mandibular height for implant placement? In patients who have recently lst their teeth, the alveolar ridge may actually need to be reduced to provide adequate interocclusal space for the implants and the prosthesis. Often ridge height reduction is necessary to have enough buccolingual bone width. Optimally, a 13 mm implant is employed in the antierior mandible. The mandibular residual ridge can be assessed for height with a panoramic film.
Is the current denture adequate in height and width to retain implant overdenture attachments? The height and width of the appliance must be adequate, the borders properly extended, and the occlusion balanced.

Two Main Categories of Michigan Dental Implants

2009-09-25T06:34:00.000-07:00

Dental implants can be divided into two main categories: 1.) root-form implants and 2.) periosteal and blade implants.

Root-Form Dental Implants
The most widely used implants today are root-form implants. While they may resemble a cylinder or a screw, the screw type root form implant is the most common. These implants are manufactured in varying lengths and diameters so that most clinical situations can be accommodated. Most root-form implants have an attachment that is utilized in the final restoration process, i.e., a place for the crown to attach to the dental implant. These replacement crowns can attach to the dental implants in one of two ways: with an internal connection or an external connection.

External Connnection
The attachment rises approximately 1 mm above the implant when there is an external connection. The shape of the attachment may be a hexagon or a castle-like design depending on the type of root-form dental implant used and will have a screw hole in the center of the attachment for the abutment or crown. In cases where the abutment contains the screw in one piece, the implant attachment is non-engaging. For example, the head of the dental implant may be a hexagon but the abutment is round allowing rotation into place.

Internal Connection
If there is an internal connection, the attachment lies inside the implant and the shape of that internal space varies. Abutments might be threaded and screw-retained into the dental implant Michigan or, in systems known as "internal friction systems", abutments may be retained only by friction against the inner walls of the dental implant. Abutments might be shaped like a tooth prepared for a crown (for cemented restorations), or they may have a built-in hole for a screw (screw retained restorations). The implant platform may be flat or have beveled edges, although the beveled-edge type is becoming the most popular type of dental implant.

One-Stage vs Two-Stage Implants
Another major division of root-form dental implants is between one-stage implants and two-stage implants. On the day of surgery, a one-stage implant is exposed to the oral cavity immediately following placement while two-stage implants are covered by gingiva after surgical placement. With two-stage implants, a second surgery is necessary to expose them to the oral cavity. When surgical stability is good, two-stage implants can be purposely exposed at initial implant placement, thus eliminating the need for later re-entry. This is done by placing a healing abutment.

Periosteal and Blade Implants
A much less common type of root-form dental implant is the periosteal/blade implant. Periosteal implants are flat, mesh-like framewords that lie on the bone surface and cover a large portion of the bone, wrapping around buccally and lingually. Blade implants are small, flat plates that are inserted into a thin cut in the bone. With both of these types of root-form dental implant, the abutment is generally inseparable from the implant, but instead forms an inseparable part of the implant itself.

To learn more about root-form implants or any type of Michigan dental implants, call Joseph R. Nemeth, DDS, MaCCS & Associates at 248.357.3100 or visit us on the web at http://www.drnemeth.com/.

Systemic Influences May Affect Michigan Dental Implants Prognosis

2009-09-15T13:35:00.000-07:00

Certain systemic influences may interfere with osseointegration and adversely affect implant prognosis. As a patient's systemic condition changes for the worse, negative influences on local etioloy and the physiologic response of the surrounding soft tissues and bone are not unusual. Smoking and many medications also affect oral flora, soft tissue and bone metabolism.

Common systemic diseases such as diabetes and osteoporosis have been demonstrated to affect the bone-to-implant contact. It is will known that medications such as calcium channel blockers and immunosuppressants may have a profound effect on the inflamatory response of the peri-implant environment. Bisphosphonate drugs used to treat a variety of bone metabolism disorders can also lead to bisphosphonate-related osteochemonecrosis (BROCN) of the jaws following tooth extraction. As with any patient, a regular, updated medical history is of critical importance.

Finally, home care of implants must be excellent. There must be an absolute patient commitment to keeping the implants and the rest of the mouth clean. That includes regular maintenance visits to identify any problems before they can cause implant loss. Excessive alcohol consumption and a poor diet also affect implant success.

Dental implant maintenance is not often mentioned in dental literature, but like regular prophylaxis for natural teeth, its importance cannot be underestimated.

To learn more about dental implants Michigan or if you are interested in having a consultation with a Michigan dental implant specialist, call 248.357.3100 today or visit http://www.drnemeth.com/.

Basic Principles of Michigan Dental Implants

2009-09-01T10:11:00.000-07:00

Understanding the basic principles of Implant Dentistry can make your decision about whether or not a Dental Implant is right for you much simpler. A well informed patient will know how to ask the right questions and better make an informed decision.

General Considerations:

An implant is a man-made replacement for a tooth root.

Because of their very unique design, they become securely attached to the jawbone through a process called osseointegration.

After a waiting period that allows the bone to heal around the implant, final restorations are screwed or cemented onto the implant or implant component.

The final restoration is made utilizing procedures that are very similar to traditional crown and bridge dentistry.

With Michigan Dental Implants, it is possible to replace a single tooth, multiple teeth, or an entire arch of teeth.

For patients who are faced with losing all of their teeth, implant dentistry provides a tooth-replacement option that is much more stable and permanent than removable dentures or partials.

Implant Composition

Implants are constructed from titanium.

Titanium is a lightweight, soft, noncorroding metal.

The surface of the titanium forms a natural ceramic coating when exposed to oxygen which enables bones cells to attach to it.

Since bone cells react better to titanium surfaces that are rough, most implants are put through a roughening process by the manufacturer.

To enhance bone healing, implants are sometimes coated with hydroxyapatite.

Implants are often threaded. In order to enhance implant placement and stability, thread shape and pitch are carefully calculated to help transfer biting force to the surrounding bone.

Osseointegration

Osseointegration describes the attachment of bone to the surface of an implant.

Observation of an osseointegrated implant under a microscope reveals that bone attaches to the implant surface, but not in a continuous fashion. There are areas of direct contact separated by marrow spaces; therefore, only 40%-50% of the implant is in contact with bone.

Surface treatment, such as a hydroxyapatite coating, work to increase the bone/implant contact.

Under clinical observation, an osseointegrated implant will feel solid with no present mobility.

When an implant fails to osseointegrate, slight mobility is noted. In such cases the bone surface is separated from the implant surface by a thin fibrous membrane which may be visible with careful x-ray analysis.

A waiting period is required for successful osseointegration to occur because a complex series of events must occur.

For more information about Michigan Dental Implants visit the Joseph R. Nemeth, DDS & Associates website and submit your question online. The American Academy of Periodontology is also a helpful resource when deciding if you are a candidate for dental implants. Visit them on the web at http://www.perio.org/. Call (248) 357-3100 to schedule an appointment with our Dental Implant Specialist.

Dental Fear and Anxiety: Don't Let Your Fear Keep You Out of the Chair

2009-08-25T07:54:00.000-07:00

AAP Patient Page, March/April 2001
Volume 2, No. 2

If your palms start sweating and your heart starts pounding at the thought of visiting the dentist, you are not alone. The vast majority of individuals experience some anxiety toward dentistry. However, about 10 to 15 percent of the population suffers from high anxiety, which has been associated with avoidance behaviors and adverse outcomes to dental health. It’s important to find ways to “unlearn” this dental fear because when dental professionals can catch a problem in your mouth early, it minimizes expense, time and discomfort. Here are some ideas:

The first step is to identify where your fear came from. According to a recent AAP survey, periodontists report that the two most common origins for patient fear are family and friends or personal bad experience more than 10 years ago. Discuss your fear with family members, friends and your dental professionals. In many cases, the fears are no longer realistic because of advances in dentistry.

Next, find ways to feel more in control of your experience. Ask your periodontist to explain any procedures being considered. Knowledge can be empowering. Your perio dontist can also explain your options for techniques to control pain and stress, such as medications, anesthesia, sedation and relaxation techniques that can make your treatment virtually pain-free. And, you and your periodontist can agree on a signal, such as a raised hand, that will stop the procedure and allow you the opportunity to deal with your anxiety.

Choose times for your appointments when you won’t be rushed or stressed by other issues. If you feel tense when you get into the dental chair, try relaxation techniques such as rhythmic breathing or visualizing calming scenarios such as relaxing on a beach. Or, distract yourself with an mp3 player or by focusing on something in the room.

Once the dental visit is over, congratulate yourself for your courage and treat yourself to a special reward.

Most importantly, remember that your dental professionals are your allies. Enlist their help in overcoming your fear by not being embarrassed to talk with them about it and by asking any questions you may have.

Don't let your anxiety keep you out of the dental chair any longer. If you want to learn more about curbing your dental fears, visit the American Academy of Periodontology Website. To read about sedation dentistry techniques, visit the website of Joseph R. Nemeth, DDS & Associates. Submit your questions directly to Dr. Nemeth by emailing jrn@drnemeth.com.

The Importance of the Provisional Restoration in Michigan Dental Implants

2009-07-16T10:28:00.001-07:00

The important role of provisional restorations is often underestimated. That may be because they are left until the end of an appointment when time is short or because they generally do not need to last long. However, not only can good provisional restorations help to produce better final restorations, they can also save a lot of time and expense at subsequent appointments. Time spent in their construction is more than repaid in time saved doing additional procedures, adjustments, and remakes later on.

As you know, provisional or temporary restorations may be used for dental implants Michigan, fixed bridges, partials, or even dentures. They may be fixed or removable and are made of a variety of materials including acrylic, nylon, other flexible materials, or cast metal. Commonly, provisional restorations may take the form of a removable temporary partial or "flipper" that provides interim aesthetics and prevents pressure on a ssurgical site. The decision to use a provisional restoration and which type to use depends on the patient's dental needs and preferences.

The use of provisional restorations in implant therapy is an important clinical step and should be carefully planned prior to the surgical phase. Well-conceived provisional restorations protect the surgical site from occlusal forces during the healing process and can be used to shape the soft tissue during the maturation phase. These advantages are particularly helpful in the management of the aesthetic zone. Indeed, the provisional restoration provides both the prototype and the blueprint for the final prosthesis.

Various techniques are available to achieve optimal function and aesthetics with provisional restorations. Working together, both the restorative dentist and the periodontist should determine the proper techniques that fulfills the specific requirement of each case. Proper management will contribute to satisfying patients' expectations and the success of osseointegration.

Provisional prostheses should:

Restore and enhance aesthetics and phonetics.

protect the underlying gingival tissues.

not exert direct occlusal load on the underlying implants or bone-grafted sites.

Determine the future position, support, shape, and shade of the final prosthesis.

A well-designed provisional restoration is predicated upon four factors: the ultimate restorative plan, the number and location of the implants, the bone quality, and the needs and desires of the patient. The most common forms of temporary restorations are fixed bridges supported by retained natural teeth, resin-bonded bridges, and removable interim prostheses.

The treatment objective is to protect the healing surgical site, to provide aesthetics and to prevent micro-movement of the implant and grafted site.

The objective of an implant-supported prosthesis is to provide a functional and cosmetically acceptable form of tooth replacement. An interim provisional restoration is critical during the integration phase of the implant.

A well-conceived appliance, produced by the restorative dentist and laboratory and designed in partnership with the periodontist, provides protection of the surgical site and continued function without compromising aesthetics.

The surgeons at Joseph R. Nemeth, DDS & Associates take special care when deciding which type of provisional restoration is appropriate for their patients. Using state-of-the-art treatment planning software, the implant doctor is able to communicate with the patient's general dentist and the dental laboratory at all phases of the implant process. The software enables the three professionals to work together to design the best provisional restoration available for the implant patient. If you'd like to know more about any phase of the dental implants Michigan process, visit Dr. Nemeth and Associates on the web at http://www.drnemeth.com/ or call (248) 357-3100 with questions. You can also submit your questions via email to jrn@drnemeth.com.

The Realities of Dental Implant Maintenance

2009-06-15T08:23:00.000-07:00

Implant dentistry can effectively meet the restorative needs of both partially and fully edentulous patients. The five-year success rate is currrently in the 95 percent range for most implant cases. However, both the implants and the restorations they support can fail in response to local and systemic etiologic factors.

The ability to assess the reaction of the peri-implant tissues and to maintain their health is linked to improvements in the biology and mechanics that affect implant dentistry.

Implants are being fabricated from a variety of materials, and their surfaces are being modified to enhance integration . Furthermore, the restorative components are being revised to facilitate clinical procedures and to improve esthetics.

Traditional implant maintenance has in the past consisted of clinical assessment of placque control and radiographic evaluation of crestal bone levels. Additionally, it was important to determine the integrity of the connection of the prosthesis to the abutment to the implant body. However, the advent of single tooth and cemented restorations, early and immediate loading, the variety of abutment designs, and a shift in focus to more cosmetically-acceptable restorations has necessitated the development of changes in implant maintenance concepts.

To ensure the continued maintenance of optimum intraoral health, the dental team must understand how to assess the health of the peri-implant tissues, the alveolar bone housing, and the common restorative components associated with dental implants.

To learn more about dental implant maintenance, call 248.357.3100 or visit Dr. Joseph Nemeth & Associates on the web at http://www.drnemeth.com/.

Sinus Augmentation for Implant Planning in the Posterior Maxilla

2009-06-08T11:59:00.000-07:00

Successful placement of implants in the posterior maxilla could potentially be compromised by the lack of vertical dimension between the alveolar crest and the floor of the maxillary sinus. Typically, 10 mm of vertical bone is required for predictable implant success (Misch, 1987) although success can be achieved with less than 10mm (Fugazzoto 2007). Moreover, bone density in the posterior maxilla is often poor, which could lead to complications during implant fixation. To address these problems, maxillary sinus elevation surgery was developed to increase the amount of bone available for implant placement.

Anatomy of the Maxillary Sinus

The maxillary sinus is pyramidal in shape and borders the nasal wall, floor of the orbit, and alveolar processes. The maxillary ostium, a non-physiologic drainage port, lies high on the medial wall and opens into the nasal cavity between the middle and lower nasal conchae. The average volume of a fully developed sinus is about 15ml, but the volume expands with age as the sinus pneumatizes. The sinus is lined with pseudostratified ciliated columnar epithelium that covers a loose, highly vascular, connective tissue. Beneath the connective tissue lies the periostium, which tightly approximates the bony wall. These structures - epithelium, connective tissue, and periosteum - are collectively referreced to as the Schneiderian membrane.

Indications and Contraindications for Sinus Augmentation

Prior to tooth loss, the sinus membrane maintains its position above the roots of the posterior maxillary teeth. Upon extraction, the sinus pneumatizes or expands unimpeded, reducing the over-all bone volume in the area. If less than 10mm of bone height remains after tooth loss, sinus augmentation should be considered to prevent implant placement from extending through the Schneiderian membrane. Contraindications may include uncontolled medical conditions, sinus pathology, acute or chronic sinusitis, heavy smoking, history of radiation therapy, and blood disorders. These patients may be at high risk of complication such as delayed wound healing or graft infection.

When used appropriately, sinus augmentation is an important tool for implant planning in the posterior maxilla. Predictable implant placement and restoration is possible for patients with minimal bone height, allowing for ideal treatment.

Interested in learning more about sinus augmentation? Contact the author of this article, Southfield Periodontist and Dental Implant Specialist, Dr. Amar Katranji at 248.357.3100 or visit Joseph R. Nemeth, DDS & Associates on the web at http://www.drnemeth.com/.

If you are a dentist and would like information about the Michigan Implant Study Club or any upcoming continuing education courses sponsored by Joseph R. Nemeth, DDS & Associates, visit the for dental professionals page of the website at http://www.drnemeth.com/forprofessionals.html.

Michigan Dental Implant Patient Seeks Guidance From Southfield Periodontist

2009-06-04T11:54:00.000-07:00

Patient Question: I have been missing a tooth in the back upper right area for quite a while and would like to have it replaced. I would prefer not to have to cap the teeth on either side so an implant seems like the way to go. I was told I would need to "grow bone" in that area. How is that possible?

Anonymous, Farmington Hills, MI

Answer: It sounds like what your doctor is concerned about is getting enough bone in the area requiring the implant. Sometimes when an implant is needed in the posterior areas of the maxilla (upper jaw bone), the sinus cavities get in the way. The sinus is nothing more than a space for air, but if the sinus is very large, it minimizes the amount of bone available to secure an implant; therefore, we need to grow bone.

The procedure, called a sinus augmentation or sinus lift, involves raising a small amount of the membrane lining the sinus (like the membrane inside an egg shell) and filling the empty space with a bone grafting material. We then let this bone grow or mature for approximately six months. At that point the patient will most likely have grown enough bone to support the implant.

Have a similar question? Contact the Michigan Dental Implant Specialists at Joseph R. Nemeth, DDS & Associates at 248.357.3100. Our team of Doctors, Hygienists, Assistants and Business staff are all highly knowledgable in the fields of Periodontics and Dental Implants and will be pleased to answer any and all of your questions or address any concerns. Submit your question online at http://www.drnemeth.com/patientinfo_asktheperiodontist.html.

The Newest Key to Longevity is Good Oral Health

2009-05-13T10:38:00.000-07:00

The Michigan periodontal practice of Joseph R. Nemeth, DDS & Associates is striving to make Michigan healthier one smile at a time. Click on the image on the left to view a short video about the link between oral health and systemic health which gives helpful tips on how to live a longer, healthier life by taking better care of your teeth and gums. This group of Southfield periodontists are working hard to educate not only their patients but the public as well about gum disease and other related diseases.

For more tips on maintaining good oral health and avoiding the dangers of gum disease, visit these Michigan periodontists on the web at www.drnemeth.com.

Ridge Augmentation

2009-04-20T18:37:00.000-07:00

Ridge Augmentation procedures are used to correct concavities in the jawbone where natural teeth are missing. They can correct depressions in your gum line that are unnatural looking and sometimes make you appear older that you are. They can be used to prevent the jawbone from collapsing following tooth extraction. Ridge augmentation is also used to even out replacement teeth that may seem too long compared to adjacent teeth.

If you would like to learn more about ridge augmentation or any other Michigan dental implants topic, call the office of Dr. Joseph Nemeth & Associates at 248.357.3100 or submit your questions online by clicking on this link www.drnemeth.com/asktheperiodontist.

What are Dental Implant?

2009-04-16T17:21:00.000-07:00

Dental implants are tiny titanium posts that fill the role played by a tooth’s roots. The implants are placed in the jawbone, and bone grows around them, providing a strong foundation for the replacement teeth. Dental implants provide significant long-term advantages: They help stop the bone loss that occurs over time after a tooth is lost, often creating a “sunken” facial appearance in people who have lost all of their teeth. They enable people to eat and chew whatever they like, avoiding compromises to health because of poor nutritional intake. They give patients the confidence that they had with their natural teeth, freeing them to smile, talk and chew without embarrassment.

Dental implants allow people who have lost teeth to enjoy the function, appearance and permanence that their natural teeth once provided. They can be used to replace a single tooth, a partial, a bridge, or full dentures.
What are Dental Implants?

To find out more or see case studies, visit www.drnemeth.com.