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Dental Implants & Medications – Newton, Wellesley, MA

Each year, about 500,000 North Americans get dental implants. Dr. Ryne Johnson, ryneprosthodontist and managing partner of Newton Wellesley Dental Partners, considered by many as a pioneer in the synergistic use of computers in implant dentistry says, “If you are one of them, and are preparing to have a dental implant, it might be a good idea to start taking beta blockers, medication that controls high blood pressure, for a while. And to stop taking heartburn pills”.

A body of research indicates that in order to raise the odds that dental implants will attach properly, there are clear benefits to taking certain common medications and avoiding others.

Bone cell growth, healing and death

"The success of procedures like dental implants depends mainly on how the existing bone accepts the implants to create a connection between the living bone and the surface of the implant," says Dr. Johnson, who has been involved in implant dentistry since 1988. "Because some medications affect bone metabolism and the way that bone cells heal and multiply or die, they can have an important effect on the success of implants."project3

A McGill research team reviewed data about the integration of dental implants gathered from over 700 patients. They then confirmed the results they saw in human patients through studies in rats.

Implications for hip and knee replacements

"We believe that this research may have implications for orthopedic interventions such as hip and knee replacements, because the same mechanisms of bone cell growth break down, and healing take place in all the bones in the body," says one of the researchers. "Our work with implants in rats suggest that this is indeed the case, but further research will be needed to confirm it."

Drugs that aid integration of implants - Beta blockers

  • Conclusions are based on 1499 dental implants in 728 patients between Jan. 2007 -- Sept. 2013 at the East Coast Oral Surgery in Moncton, New Brunswick
  • 327 implants were in 142 people who took beta blockers for hypertension
  • 1172 implants were in 586 people who didn't take beta blockers
  • Failure rates of implants for people using beta blockers was 0.6%
  • Failure rates of implants in people who don't take beta blockers was 4.1%
  • More than 640 million patients around the world take beta blockers to control hypertension.

"We carried out this study because we knew that beta blockers have been reported to increase bone formation," says Prof. Tamimi from McGill's Faculty of Dentistry. "So we thought it was possible that they would also decrease the risk of failure of dental implants. However we didn't expect that there would be such a clear difference in the failure rates for implants between users and non-users of beta blockers. Randomized clinical trials will need to be carried out as well as other studies of large numbers of patients to investigate this phenomenon in more depth."

Drugs that impede integration of dental implants - Heartburn treatment

  • Conclusions are based on 1773 dental implants in 799 patients between Jan. 2007 -- Sept. 2015 at the East Coast Oral Surgery in Moncton, New Brunswick
  • 133 implants were in 58 people who took heartburn medication
  • 1640 implants were in 741 people who don't take heartburn medication
  • Failure rates of implants for people using heartburn medication were 6.8%
  • Failure rates of implants for people not taking heartburn medication were 3.2%
  • More than 20 million Americans, about one in 14 people, take heartburn medication.
  • Heartburn medication is rapidly becoming the third most prescribed pharmaceutical product worldwide, especially for elderly people, who take it either on an occasional or long-term basis.

"Scientists already knew that drugs for heartburn reduce calcium absorption in bones and generally increase the risk of bone fractures," says Dr. Tamimi, of McGill's Faculty of Dentistry. "That is why we wanted to look at how it affects the integration of implants and bone healing after this type of surgery. But we didn't expect to find that the negative effects of these type of drugs would be as great as they are. Further work will need to be done to find the appropriate dosages and time periods that people should take or avoid these medications."

For additional blogs by Dr. Johnson, click here

To learn more about Dental Implants, contact Newton Wellesley Dental Partners.

Original article:  www.eurekalert.org

Artwork: www.medicalxpress.com

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Dental Implants Failures – Newton, Wellesley, MA

Dental implants are now used widely around the globe.  However, questions about patient risk assessment prior to placing the implants still abound. Dr. Ryne Johnson, prosthodontist and managing partner at Newton Wellesley Dental Partners asks, “What causes implants to fail in some patients but not others?

There are several factors which negatively influence implant predictability:

1. Gum and Bone Disease:  The placement of implants in a patient with periodontal disease would be one relevant concern. Resproject1earchers from Sweden performed a systematic review to determine if persons with periodontitis are more susceptible to peri-implantitis. The conclusion was that an increased susceptibility for periodontitis may also confer an increased risk for implant loss, loss of supporting bone, and postoperative infection.

2. Smoking: A recently published study discussedproject2 the effectiveness of implant treatment in a large patient population nine years after treatment. They used a large and randomly selected patient sample, and concluded that patient characteristics and implant features affect results. They discovered that smokers and patients with an initial diagnosis of periodontitis were at higher risk of implant loss. A 2014 study confirmed that placement of implants in smokers pointedly affected implant failure rates, the risk of postoperative infections, and marginal bone loss.

3. Shoproject3rt Implants: Those with implants shorter than 6 mm and implants using particular brands of products also showed increased risk.

project4

4. Teeth Grinding:  Several studies have clearly demonstrated an increased failure rate on patient with nocturnal bruxism.  The off-axis forces delivered to implants in people who grind their teeth can be significant and will over-stress the bone.

Dr. Johnson is considered a pioneer in the synergistic use of computers in dental implant dentistry and performed his first implant reconstruction in 1988.

For additional blogs by Dr. Johnson, click here For more information on dental implants, Contact Newton Wellesley Dental Partners.

Original article in www.dentistryiq.com, Artwork: www.pintrest.com, www.implantninja.com, www.slideshare.com, www.ceraroot.com

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Dental Implants, A Patient’s Primer – Newton, Wellesley, MA

Dental implants have become ‘mainstream’ as a treatment option for many patients.  Dr. Ryne Johnson, prosthodontist rsj-10-10-16and managing partner of Newton Wellesley Dental Partners has been doing implant supported reconstructions since 1988 and has been regarded as a pioneer in the synergistic use of CT Scans, CAD/CAMs and state of the art dental material science to deliver outstanding results.  He wants people to have some perspective on the process:

Before the procedure

Dental implants require a strong jaw bone. Patients who have lost a lot of jawbone may need to have a bone graft procedure performed before this procedure. Dr. Johnson will identify the available bone…sometimes with a CT Scan if necessary.  In some instances, this can be done BEFORE any teeth are removed (implants may be placed the same day) or AFTER the area has healed from tooth removal (with adequate bone preservation techniques employed at the time of extraction).

You will receive instructions about how to prepare for the day of the procedure. It is highly recommended you quit smoking several months before the procedure as smoking can cause poor osseointegration (poor bone and implant integration), which is the leading cause of implant failure.

Anesthetic

The procedure starts with a local anesthetic. This will make the implant site and the area around it completely numb. project1You will be awake, but you won't be able to feel any pain in that area. You might still feel pressure, vibrations, or some other sensations that might be uncomfortable, but no pain. Some offices offer conscious sedation or partial sedation where you are awake and numb, but "out of it" and mostly unaware of what is going on. Some people describe the feeling as similar to being drunk. Partial sedation is usually more expensive than local anesthetic and is not available at every office.

A dentist applies local anesthetic to a patient's lower jaw. A numbing gel is usually applied so that the patient will not feel the injection.

Preparing the implant site

After the anesthetic has taken effect, the implant site will be prepared and the gums will be retracted so the dentist can access the jawbone and evaluate the implant site. The bone needs to be relatively flat and smooth, and the dentist might use a drill to reshape it.

Drilling the pilot hole

The dentist will then use a series of drills to make a hole in the jawbone for the implant (s)…sometimes a “placement jig” will be fabricated from the CT Scan work up. They will first create a divot using a small round bur, and then a pilot drill to create a pilot hole. They may use a plastic jig prepared from plaster casts to help guide the pilot drill, but this is mostly up to the dentist if they need one. They may also use an alignment pin to make sure the pilot hole is on target. project4If no adjustments are needed, the pilot hole will be drilled deeper. As the hole is being created, the dentist may flush the area with water or saline to keep the bone cool and prevent overheating caused by drilling. Once the pilot hole is finished they will check its alignment again using the alignment pin. If the positioning of the implant is close to other anatomical structures, such as nerves or blood vessels, they may take an x-ray with the alignment pin in place to check its position.

Finishing the hole

When the pilot hole is finished, the dentist will use a series of increasingly larger drill bits until it's the correct diameter for the implant. The size of the implant will have been chosen ahead of time based on the condition of the bone.Usually, your dentist will want to select the largest implant that your bone can sustain because larger implants distribute their load to the bone better than smaller implants do. Most are about 4 mm in diameter.

After the hole for the implant is finished, the alignment will be checked again using the pin. Then the whole will be threaded using a screw tap to match the threads on the implant. Some implants are self-tapping and don't require this step. Dental implants are roughly the size of the root of a normal tooth.

Placing the implant

Finally, the implant will be placed. This can be done using a special head for the dental drill or using a small hand wrench. Sometimes it is actually done using a small torque wrench. This can cause some unpleasant sensations but skilled surgeons are able to minimize the discomfort. The surgical site will be closed using an implant cap and stitches.

Healing and osseointegration

The stitches will be left in place for 7 to 10 days, after which they will be removed. In some cases, the gum flaps may be stitched so that they cover the implant cap as the site heals and the gum tissue will later be trimmed back when the abutment is placed. The implant will be given 3 to 6 months to osseointegrate (fuse with the bone) before the restoration (consisting of the abutment and crown) is placed.

Note: It is extremely important that you keep the implant area and surrounding teeth clean. Peri-implantitis isproject3 a condition that is caused by bacteria infecting the area surrounding an implant and can cause bone loss and implant failure due to poor osseointegration. Some clinics offer "immediate load" implants where a temporary restoration is placed the same day as the implant. This restoration will be removed in the future and a permanent one placed. Not every patient is a candidate for immediate load implants; this is an option you should discuss with your dentist. The treatment will be completed on a second trip, after osseointegration is complete and the abutment and prosthesis is custom-made. Dental implants are made up of three parts; the implant (screw), the abutment (stump), and the crown (tooth).

Final/Definitive restoration

After the implant has healed and is stable, the definitive restoration can be placed. This can consist of a crown, bridge, or denture. The implant cap (think ‘manhoproject2le cover’) is removed and replaced with an abutment and the dental prosthesis is placed on top of it. For most conventional implants, this is a crown that either screws on to the abutment or is cemented in place. Removable restorations like dentures may have clips or snaps of some kind.

After the procedure

Most patients are extremely satisfied after dental implants. After the implant is placed, your dentist will advise you to stick to chewing soft foods while the implant osseointegrates. Immediate load implants will also need time to osseointegrate, and your dentist will tell you when the temporary parts of the implant need to be replaced with a permanent restoration. Patients who have had dental implant surgery say that the pain is mostly a dull ache in their jaw after the anesthetic wears off and it is gone completely within a week. After the final restoration is complete, though, patients are able to treat the prosthetic like a normal tooth and can hardly tell the difference. They look, feel, and can be used just like normal teeth.

For more blogs by Dr. Johnson, click here For more information on dental implants or to arrange a consultation, contact Newton Wellesely Dental Partners.

Original article:  www.medigo.com

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Dental Implants: You Have Options – Newton, Wellesley, MA

If you’re missing a tooth, Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners rsj-10-10-16wants you to know, “you’ve got several options. The least advisable is to do nothing! It’s not just about aesthetics…Replacing a lost tooth is important to restoring maximum function, maintaining the alignment of surrounding teeth, and preserving facial contours”.  Dr. Johnson has been involved in implant dentistry since 1988 and is regarded as a pioneer in the synergistic use of CT Scans, CAD/CAM and placement ‘jigs’ to create implant supported reconstructions with stunning results.

Your pearly whites don’t just look pretty, they are important place holders for each other. Over time, those adjacent to a toothless gap can drift to fill the space and move out of alignment.  Additionally, tooth roots below the gums provide stimulation that the underlying jawbone needs to maintain its form and density.

Following are common approaches to replacing a lost tooth. The most appropriate for you will depend on a variety of factors that you should discuss with your dentist.

Dental Implantsproject1

Today’s gold standard for tooth replacement is the dental implant. This is actually a tooth root replacement to which a separately fashioned crown is attached. For successful implantation, there must be a sufficient amount of healthy jawbone to anchor the implant and the adjacent gums and teeth must be healthy. Certain systemic health conditions may preclude implantation as well.

PROS: Aesthetic, functional, reliable Stimulates the jaw bone to remodel and rebuild Does not compromise the integrity of adjacent teeth Decreased risk of periodontal (gum) disease compared with a bridge

CONS More expensive than a bridge (but more durable so it could be more cost effective long term) Requires minor surgery and healing time before placement of  a permanent crown

Bridges project2

Prior to implants, the three-unit fixed partial denture (FPD), or fixed bridge, was the standard approach for tooth replacement. In this scenario, the two teeth on either side of the gap (the “abutment” teeth) are crowned and the crowns support a “pontic” — a false tooth — between them like pickets in a fence.

PROS: Provides normal  function and aesthetics Less wait time than with implants Less expensive than implants

CONS: Damage to abutting teeth (must be shaped to accommodate the crown) Greater susceptibility to tooth decay Jawbone beneath the ‘fake tooth’ may deteriorate over time

Removable Partial Denture (RPD)project3

A removable denture is made of an artificial tooth anchored in plastic that mimics gum tissue. It is attached to metal clasps that hook onto adjacent natural teeth. It can be removed for cleaning.

PROS: Aesthetic, functional Least expensive option

CONS: Greater susceptibility for periodontal (gum) disease and tooth decay Usually results in teeth becoming loose May have stability and comfort issues May not fit right over time Jawbone underneath may deteriorate over time

For more information on your options for replacing missing teeth, contact Newton Wellesely Dental Partners.

For more information and access to additional blogs by Dr. Johnson, click here

original article:  www.deardoctor.com artwork: www.samdental.com, www.dentalcrest.com

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Dental Implants – All on Four – Wellesley, Newton, MA

Those who have missing teeth — or are soon to have their last, failing teeth removed — have several options for tooth replacement. One of the most advanced and reliable techniques is to permanently attach lifelike prosthetic (new replacement) teeth to dental implants that are anchored in the jawbone. x1

Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners, is recognized as a pioneer in dental implants and placed his first implant prosthesis in 1989.  Since that time, he has honed his approach to develop a computerized technique, incorporating CT scan coupled with CAD/CAM technology.  This synergistic effort offers immediate results with incredible precision.

Implant-supported teeth look and function just like real teeth, and are maintained with the same oral hygiene practices, such as brushing and flossing. They provide important health benefits (described is this article). And while dental implants are relatively expensive, a newer procedure that also provides functional teeth on the same day implant surgery is performed has brought the cost down and put this beneficial technology within the reach of many.

Implant-supported teeth allow normal function of the whole stomatognathic system (“stomato” – mouth; “gnathic” – jaws) including the nerves, muscles and jaw joints. By permanently replacing missing teeth — and lost gum tissues — dental implants restore the support of the facial structures (cheeks and lips), thereby creating a more youthful appearance as well as the ability to function normally. This includes chewing tough foods, eating fresh fruits and vegetables, laughing, kissing, speaking confidently, and smiling with joy.

Dental Implants: State-of-the-art Tooth Replacement Systems

It is not an overstatement to say that permanent tooth replacement with implants has revolutionized dentistry. Implants have particularly transformed the lives of people who are edentulous (completely toothless) by giving them a solution that is a lot more comfortable, secure, and reliable than removable dentures. They also prevent the loss of jawbone density and volume that is inevitable when teeth are lost. Dental implants stabilize and stimulate the bone around them, maintaining bone dimension and strength. This is something removable dentures can't do. In fact, wearing dentures actually accelerates bone loss.

A dental implant is a small, screw-shaped post that replaces the root of a missing tooth — the part that is housed in the bone beneath the gum. Implants are made of titanium, which has a unique ability to fuse to bone in a process called osseo-integration (“osseo” – bone; “integration” – to join with or fuse to). That's what makes them so sturdy and reliable.

After implants are inserted into the jawbone during a well-tolerated surgical procedure, fixed bridges can be attached to them immediately that look and function like real teeth. This can be accomplished in one or both jaws in the same day.

 All For One — And One “Four” All

Today's state-of-the-art implant systems enable a minimum number of implants to support a maximum number of teeth. That means as few as four implants can be used to support a full arch (upper or lower jaw) of fixed, non-removable replacement teeth. And this remarkable life-changing event can be accomplished in a single day!

Success will depend on some crucial steps:

This person had no upper teeth and wore an old denture that fit poorly.x2
x3An implant-supported fixed denture replaced the upper teeth, re-establishing the smile as well as the ability to eat.
  • When the implants are placed in the jawbone, they must remain completely immobile to allow the process of osseo-integration to occur. Any force that causes even minute movement of the implants in the early healing phase can ruin the integration process, resulting in implant failure. That's why a soft diet (no hard, crunchy or tough foods) during the first 6-8 weeks is essential.
  • The implants themselves must be strategically placed to offer the most effective support. By rigidly connecting the new teeth to the implants, they stabilize each other. Think of this arrangement like a tabletop or chair supported by four legs — which are sometimes angled outward for maximum support.
This process is not only the most efficient way to replace all the teeth, but also the most cost-effective strategy for implant-supported tooth replacement. Individual implants to replace each tooth are impractical and not recommended. Given that there are usually 28 functional teeth (excluding wisdom teeth), replacing teeth individually can be vastly more expensive and may not offer any better results.

For more information on dental implants in Newton and Wellesely, MA, contact Newton Wellesley Dental Partners.

For additional blogs by Dr. Johnson, click here

Original article:  http://www.deardoctor.com/

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