By Alexander Germanis
Most historic locations in the world are not without signs of repairs. Ancient buildings and columns begin to crumble without the occasional reconstruction.
However, those repairs are often not done with the same grade of materials originally used, and the mends themselves require replacement and repairs of their own in order to continue to preserve the authentic structure.
Our teeth are no exception to this pattern of wear and repair. And just like with the building repairs, the materials used in dental reconstruction are sometimes not as good or as strong as the original tooth.
At least, that used to be the case. As in the dental journal last month, Emil Verban, Jr. DDS, shares an example of how the worn teeth and worn repairs that naturally come with age can be improved and rebuilt.
One such patient had four upper front teeth, all with root canals and crowns. Those original repairs were 20-years old or more and were in dire need of replacement. Rather than simply redo the repairs, however, Dr. Verban set out to change her whole smile so she would finally be happy with the shape and size of her teeth.
“We took a 3D X-ray to decide which teeth we could keep and which we had to extract,” Dr. Verban begins. “Then we got a full analysis of her teeth with a diagnostic wax-up—where the existing teeth are changed in size and position.”
Before the provisionals could be placed, however, it was determined the four original problem teeth had to be extracted. “We placed two dental implants,” he continues, “allowed them to heal, and then made her provisionals, splinting her eye teeth. In this particular case, she always had teeth and never had to wear any removable appliance, which is very critical for some people. She had to deal with the public and was always concerned about that.”
Her provisionals were actually what is called a fixed temporary bridge. In a normal, permanent bridge, the adjacent, healthy teeth would be pared down in order to accommodate crowns that would then fit over them—the crowns themselves connected to the new “bridge” tooth. Since the advent of dental implants, those good teeth no longer need to be altered. The temporary bridge can be removed once the implants heal and the healthy teeth remain untouched.
Before finishing with this patient’s provisional bridge, however, the doctor and patient felt her provisional teeth were too far forward and too bulky. “So, we changed and slenderized the teeth in the finals,” he says.
“Dental implants have been a great addition,” Dr. Verban continues. “[They are one of] a combination of ways you can satisfy not only appearance but function. They don’t develop nerve issues and they don’t decay.”
But with every new improvement, new dilemmas often arise. “If there is associated destruction being caused by gum disease, at what point in time do you intervene and remove the teeth to preserve any further deterioration of the bone so you can have a good foundation to place your dental implants?” the doctor queries. “If you wait too long, you don’t have the foundation without getting involved with augmentation or bone grafting. We used to wait until the teeth were very loose and then we would extract them. Whereas today, we will sometimes extract them sooner to preserve the bone that will give a healthier foundation for the placing of the implants.”
Although the dental implants have been a beneficial addition to his field, Dr. Verban cautions, “You have to look at the overall picture of the person’s health and how you’re going to implement, preserve, and try to keep them functioning over the years. You don’t want to get involved with dental implants and not have those implants as part of the overall longterm plan for their health.”
For more information, you may contact Emil Verban, Jr., DDS at 309-662-8448 or visit www.mcleancountydental.com. McLean County Dental is located at 2103 E. Washington Street in Bloomington. Dr. Verban provides his patients both general dentistry expertise and the ability to provide specialized services such as cosmetic procedures and dental implants.
Photo courtesy of McLean County Dental