Smile technology

Smile technology
Marjorie Wertz
TRIBUNE-REVIEW
January 24, 2005
Madhu Doshi's newfound confidence gives her a smile that brightens a room.
The Murrysville woman credits dental implants she received in 2003.
"I've always had a problem with my upper teeth, especially my front teeth," said Doshi, 58. "A long time ago I had a bridge made for my front teeth but over time I was having trouble with it. I was getting bone loss in my upper jaw."
There are two types of dental implants -- those that sit atop the jaw bone but under the gums, and those that fit into the jawbone similar to the root of a natural tooth.
Subperiosteal or on-the-bone fixtures are placed on top of the jaw with the metal framework's posts protruding through the gum to hold the prosthetic or replacement tooth.
Endosteal, or in the bone, is the most commonly used type of implant. The various types include screws, cylinders or blades surgically placed into the jawbone. Each implant holds one or more prosthetic teeth.
"It is a surgical procedure in which a screw-like titanium fixture is placed in the bone," said Dr. Frank S. DeMarco, of Murrysville, a fellow and diplomat with the American Academy of Implant Dentistry. "Many times we use a local anesthetic, especially if the patient is getting one implant. If the patient has apprehension we can use general anesthesia or nitrous oxide.
"If you want to do the implant in one day, you do the surgical procedure, then in the same day you put in the abutment or fixture which is above the gum and a temporary crown is placed on it. With the other technique, you bury the implant under the gum line and wait for the healing process, about three to six months."
The healing process allows bone to grow around the implant and secure it. Dentists can place a temporary tooth at the site of the implant, but it's not supported by the implant.
Doshi's dentist had advised her to get fitted for dentures, but that didn't appeal to her.
"I went to an implant specialist who told me I didn't have enough bone in my jaw for implants. I was very discouraged," she said.
She decided to consult with another implant specialist and contacted Dr. Roberto Michienzi, of Murrysville. Michienzi performed a bone graft to strengthen Doshi's jawbone. Artificial roots were surgically positioned into her jaw to hold the prosthetic teeth.
Doshi also had to undergo some gum tissue grafting. Michienzi used a material called Alloderm, a material derived from cadavers that acts as a biological scaffold on which normal tissue will eventually grow.
"Normally when you have dental implants done you have to wait six months before you start the second phase of the dental reconstruction, if you have enough jaw bone," said Michienzi, an associate fellow with the American Academy of Implant Dentistry, and a fellow with the International Congress of Oral Implantologists. "If you don't have enough bone and the dentist has to do bone grafts, then it could be a year to 16 months before the reconstruction phase is completed. But the patient gets temporary teeth during this time."
After taking a mold of the patient's real teeth, Michienzi reconstructs the teeth from clay.
"I put the clay teeth in the patient's mouth on the day of surgery and I'll mark them before hand carving them," said Michienzi. "By hand carving the clay I can put a lot of detail into the temporary teeth. We fire the clay in the office and they are placed into the patient's mouth the day of surgery once the implant screws are in place."
Once Doshi's gums and bone healed, a new mold was completed for the permanent teeth that were made of a material called Belleglass.
"A final impression of wax was taken with the implant screws and then the permanent teeth were fixed to the screws," Michienzi said.
The permanent teeth can be made out of all porcelain or a combination of porcelain and metal, either a gold alloy or a base metal with no gold, said DeMarco.
Doshi's husband, P.K. did his homework when it came to his wife's dental implants.
"I did research on the doctor, his experience, and we talked to several of his patients," said P.K. Doshi. "I also researched dental-implant technology and bone grafting to see what was involved. Her treatment lasted a year and was finished in August 2004."
The cost of dental implants can range from $4,000 up to $25,000.
"Insurance is just starting to cover dental implants," said DeMarco. "Over the last year, we've been getting some of the dental insurance that covers implants."
The overall success rate for dental implants is 98.7 percent,according to Michienzi.
Dental implants look and feel like real teeth. Because they are integrated into the bone, implants prevent bone loss and gum recession often associated with bridgework and dentures. Implants won't sacrifice the quality of the adjacent real teeth, and they allow the patient to speak and eat with confidence and comfort. "We spend a lot of time on patient education," said Michienzi. "We teach our patients how to keep their implants clean. Patients with implants should go back to their dentist three times a year so that he can keep an eye on the teeth and implant fixtures to make sure there are no problems."
For Doshi, the yea-long process was worth it.
"I hardly felt any pain and it was not difficult for me to eat during the procedures," said Doshi. "I used to be very self-conscious about my teeth but now I have more confidence. I was able to smile at my daughter's wedding."