Gregory Tarantola, DDS. 559 West Twincourt Trail Suite 606 St. Augustine, Fl

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2 Gregory Tarantola, DDS 559 West Twincourt Trail Suite 606 St. Augustine, Fl

3 Disclaimer The information in this book is not a replacement for the services of a dentist or health care professional. Please do not use this e-book to diagnose or treat a medical or health condition. Please consult a dentist in all matters relating to your dental care, and use discretion when using any of the strategies mentioned here. 3 P a g e

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5 Table of Contents What are Dental Implants What Dental Implants Can Do Can They Improve Your Life? Types of Implants in Use Today Single Tooth Implant Procedure Anterior (Front Teeth) Implant Procedure Posterior (Lower Back Teeth) Replacement Implant Procedure Full Lower Replacement Implant Procedure Full Upper Replacement Implant Procedure Who Should Place Implants? How Long Will Implants Last? Advantages of Dental Implants Over Dentures or a Bridge What Is Treatment Like? What Can I Expect After Treatment? Who Should Not Have Dental Implants? Crippling or Uncontrolled Disease Pregnancy Psychiatric or Emotional Treatment Poor Motivation to Accept and Follow Needed Treatment Lack of Muscular Coordination to Manage Oral Hygiene Procedures Are There Any Risks to My Health with Implant Treatment? Surgery or Anesthetic Psychological... 26

6 Medical Cost Dental Implant Placement Options Replacing a Single Tooth What are the advantages of a single-tooth implant over a bridge?. 29 How will the implant be placed? Replacing Several Teeth Advantages of implant-supported bridges over fixed bridges or removable partial dentures Dental Implants: Consultation, Procedure, Recovery and Aftercare Tooth Loss Dental Implants: Consultation, Placement, and Recovery The Dental Implant Placement Procedure Dental Implants Recovery Implant Surgery Follow-up and Aftercare How to Find a Local Specialty Dentist and Choose the Right One for You Family Dentistry: Dental Care for the Whole Family Family Dentistry Services Training and Practice Senior Dental Care Tooth Loss, Periodontal Disease, and Other Dental Concerns for Senior Patients Dental Hygiene for Seniors Full Mouth Reconstruction... 46

7 Tooth Restoration Bridging the Gap with a Dental Bridge Dental Bridges Consultation and Treatment Planning Dental Crowns: Preserve Damaged Teeth with a Crown Dental Crowns Consultation and Treatment Planning The Dental Crown Clinical Procedure Dental Fillings Dental Fillings Consultation and Treatment Planning Ensuring Fit and Comfort Preventive Dentistry: Care Today, Savings Tomorrow Early Prevention Preventive Dentistry Strategies What Mouth Conditions Might Require a Dental Implant? Timetable of a Typical Course of Implant Treatment Summary of Dental Implants... 69

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9 Dear Patient, Thank you for downloading this e-book. I have compiled this as a quick resource to enable you to learn more about dental implants, how they work, and how to care for them. These are often an excellent solution to replacing teeth in a manner that looks and feels more like your actual teeth. In addition to finding useful information on dental implants in this e-book, you will be pleased to learn that you are now on our exclusive newsletter subscriber list. This entitles you to some cutting edge information on dental health and wellness, all delivered to you in your at regular intervals each month. Each edition will feature valuable tips, dental health maintenance ideas, expert advice, and informative articles to keep your mouth healthy and pain-free. You can share this excellent resource of healthy living with your acquaintances, by forwarding it to their address or asking them to sign up for FREE from the link you accessed. This newsletter is our commitment to improving your dental health as your preferred dental professional. Thank you! 9 P a g e

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11 What are Dental Implants Dental Implants 101 A dental implant is an artificial tooth root that a periodontist places into your jaw to hold a replacement tooth or bridge. Dental implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason. While high-tech in nature, dental implants are actually more toothsaving than traditional bridgework, since implants do not rely on neighboring teeth for support. Dental implants are so natural-looking and feeling that you may forget you ever even lost a tooth. You know that your teeth can affect your confidence level and how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of open spaces from missing teeth. Maybe your dentures don't feel secure in your mouth. Perhaps you have difficulty chewing with dentures or partial dentures. If you are missing one or more teeth and would like to 11 P a g e

12 smile, speak, and eat again with comfort and confidence then there is good news in this book for you! Dental implants are teeth that can look and feel just like your very own natural teeth! Under proper conditions, such as placement by a periodontist and diligent patient maintenance, implants can last a lifetime. Long-term studies also continue to show improving success rates for implants. What Dental Implants Can Do Replace one or more teeth without affecting bordering teeth. Support a bridge and eliminate the need for a removable partial denture. Provide support for a denture, making it more secure and comfortable. Can They Improve Your Life? There have been very few advances in Cosmetic Dentistry that have had as great an impact as dental implants. So, what exactly are dental implants? Quite simply, an implant is a titanium screw used to replace the missing or damaged root. Dental implants can be used to replace a single missing tooth or to anchor multiple teeth together, as with a bridge or a denture. Dentures will be necessary whenever all of the teeth are missing in either the upper or lower jaw. Following a general period of healing, where the implant fuses with the bone tissue, a single crown, a bridge or denture is placed over the implant(s). The benefits of dental implants can be quite dramatic in patients of all ages with loose, missing, or decayed teeth that have occurred either naturally or through an accident. Whether the choice for this type of treatment is made for oral health or simply cosmetic reasons, there is 12 P a g e

13 absolutely no substitute for the gift of a healthy, attractive smile. Without question, your healthy smile affects your self-esteem, job performance, energy levels, and social interaction. Simply stated, dental implants will surely improve the quality of life through the following important benefits: Prevent bone loss, by halting and even reversing the bone loss that typically results from losing teeth. Eliminate gum irritation and the pain of exposed nerves associated with conventional full or partial dentures. Allow you to speak with confidence in a relaxed and natural tone; without worry of moving or slipping dentures or partial dentures. Eliminate the inconvenience of messy denture adhesives that often must be re-applied throughout the day. Eliminate the need to cover your mouth when you laugh or smile, worried that your denture will pop out or fall down. Restore chewing efficiency comparable to that of natural teeth, as well as the natural ability to taste and enjoy your food. This also promotes better nutrition. 13 P a g e

14 Improve your appearance, since dental implants look, feel, and function like natural teeth. Improve your self-esteem and confidence with a healthy smile. The complete procedure generally takes about 4-6 months for the upper jaw and 3 months for the lower jaw. Success rates will range between %, depending first of all upon where the implants are placed and secondly, whether they're placed into natural bone or grafted bone tissue. A significant consideration affecting failure rates is whether or not the patient is a smoker. When a patient smokes, it's been shown that they are statistically two and a half times more likely to have an implant fail than a non-smoker. Daily brushing and flossing are absolutely necessary for long-term success. The good news here is that there are lots of supplemental products that will allow you to clean and maintain the implants properly. With that being said, undoubtedly, the best steps to take in avoiding ailing or failing dental implants are to implement a program of recommended oral hygiene and regularly scheduled diagnostic visits with your dentist. As to how to answer the questions relating to exactly how long dental implants will last, it's important to note that the first implant recipient, dating back to 1965 still has his original implants, which are healthy and function to this day. So, with proper care there's every reason to believe that your implants can be in good health and with you for the rest of your life. Types of Implants in Use Today ENDOSSEOUS (en-doss-ee-us)- within the bone This 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. This 14 P a g e

15 type of implant is generally used as an alternative for patients with bridges or removable dentures. SUBPERIOSTEAL (sub-pear-ee-oss-tee-al)- on top of the bone These are placed on top of the jaw with the metal framework's posts protruding through the gum to hold the prosthesis. These types of implants are used for patients who are unable to wear conventional dentures and who have minimal bone height. TRANSOSTEAL (trans-oss-tee-al)- through the bone These implants are either a metal pin or a U-shaped frame that passes through the jawbone and the gum tissue and into the mouth. Single Tooth Implant Procedure This is done by surgical placement of the implant(s) into the bone. This can usually be done right in the dentist s office, with a local anesthetic. After surgery, there is a healing period of approximately four months. During this time, the implants fuse to the bone by a process known as osseointegration. 15 P a g e

16 Next, there is a minor surgical exposure of the top of the implant, whereby the dentist will attach the post to the implant. The function of the post is to become the support for either one tooth or a set of teeth. This is a short procedure that usually requires only local anesthesia. The last phase is the restorative phase. The dentist will take impressions and then make a prosthesis that will attach to the implants. This will require several visits. Once completed, your mouth will be restored to looking normal, with natural looking and strong teeth. Anterior (Front Teeth) Implant Procedure Missing front teeth have unique demands. The challenge is to replace your now missing teeth for both appearance and function without harming your remaining teeth or gum tissue. The first step is to replace missing tooth roots by placing titanium implants. The implants will remain covered underneath the gum for approximately three to six months. During that time, osseointegration (fusion of bone to titanium) takes place. The second step of the procedure involves uncovering the implants and attaching extensions. This completes the foundation on which your new teeth will be placed. 16 P a g e

17 The final step is the placement of your new teeth. With techniques that ensure optimal size, shape, color and fit, these replacement teeth will blend with your facial characteristics and remaining natural teeth. Posterior (Lower Back Teeth) Replacement Implant Procedure Missing back teeth have unique demands. The challenge is to replace your now missing teeth for both appearance and function, without harming your remaining teeth or gum tissue. The first step is the placement of the titanium implants. The implants will remain covered underneath the gum for approximately three to six months. During that time, osseointegration takes place. The second step of the procedure involves uncovering the implants and attaching extensions. This completes the foundation on which your new teeth will be placed, followed by the placement of the new teeth. Full Lower Replacement Implant Procedure The first step is to replace missing roots by placing the titanium implants. The implants will remain covered underneath the gum for approximately three to six months. During that time, osseointegration takes place. The second step of the procedure involves uncovering the implants and attaching extensions. This completes the foundation on which your new teeth will be placed. 17 P a g e

18 The final step is the placement of your restoration. With techniques that ensure optimal size, shape, color and fit, this removable restoration will blend with your facial characteristics, while providing support needed for a natural appearance. Full Upper Replacement Implant Procedure As with all of the other types of replacements; the first step is to replace missing tooth roots by placing titanium implants. The implants will remain covered underneath the gum for approximately six months. During that time, osseointegration should take place. The second step of the procedure involves uncovering the implants and attaching extensions. This completes the foundation on which your new teeth will be placed. The final step is the placement of your restoration. With techniques that ensure optimal size, shape, color, and fit this removable restoration will blend with your facial characteristics, while providing support needed for a natural appearance. Who Should Place Implants? Implant treatment is a highly technical, complex form of dentistry. It is not a type of treatment that all dentists can or want to provide. Dr. Tarantola has had training and experience with dental implants. Sometimes, due to the complexity of your situation, Dr. Tarantola may work in conjunction with a surgical specialist. Treatment may be provided in several ways: Implants can be placed in your jaw by a team of dental specialists. This might include an oral surgeon or a periodontist who performs the surgical procedures and then Dr. Tarantola designs and makes the teeth. 18 P a g e

19 Many situations are such that Dr. Tarantola may both perform the surgery and make the teeth. We use Bicon implants which offer the advantage of not needing extensive bone grafting. Dr. Tarantola s knowledge, skills, and training include implant procedures in his practice and he can perform all of the procedures. In very complex cases, a team approach (several doctors) to treatment is generally preferred, because all members of the team see the patient for consultation, examination, and planning before any treatment is started. Dr. Tarantola leads the team with the restorative treatment plan. How Long Will Implants Last? With advances in the science of implant dentistry, you can now expect that most dental implants will function indefinitely. However, like any dental restoration, the teeth may wear or break and need to be repaired or replaced. Advantages of Dental Implants Over Dentures or a Bridge 19 P a g e

20 Every way you look at it, dental implants are usually a better solution to the problem of missing teeth than most other solutions. Esthetic Dental implants look and feel like your own teeth! Since dental implants integrate into the structure of your bone, they prevent the bone loss and gum recession that often accompany bridgework and dentures. No one will ever know that you have a replacement tooth. Tooth-saving Dental implants don't sacrifice the quality of your adjacent teeth like a bridge does because neighboring teeth are not altered to support the implant. More of your own teeth are left untouched, a significant long-term benefit to your oral health! Confidence Dental implants will allow you to once again speak and eat with comfort and confidence! They are secure and offer freedom from the irksome clicks and wobbles of dentures. They'll allow you to say goodbye to worries about misplaced dentures and messy pastes and glues. Reliable The success rate of dental implants is highly predictable. They are considered an excellent option for tooth replacement. What Is Treatment Like? In complex cases, this procedure is a team effort between you, your dentist, and your surgeon. Your surgeon and Dr. Tarantola will consult with you to determine where and how your implant should be placed. Depending on your specific condition and the type of implant chosen, Dr. Tarantola will create a treatment plan tailored to meet your needs. More information about different treatment options is described below. 20 P a g e

21 Replacing a Single Tooth If you are missing a single tooth, one implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root. Replacing Several Teeth If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots. Replacing All of Your Teeth If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them. Dental implants will replace both your lost natural teeth and some of the roots. Sinus Augmentation A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and due to the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants. The Bicon system oftens eliminates this need. 21 P a g e

22 Ridge Modification Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. 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. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come. What Can I Expect After Treatment? As you know, your own teeth require conscientious at-home oral care and regular dental visits. Dental implants are like your own teeth and will require the same amount of care. In order to keep your implant clean and plaque-free, brushing and flossing still apply! After treatment, Dr. Tarantola will develop the best care plan for you. Periodic follow-up visits will be scheduled to monitor your implant, teeth. and gums to make sure they are all healthy. 22 P a g e

23 Who Should Not Have Dental Implants? If you have any of the following conditions, dental implant therapy may not be for you. Crippling or Uncontrolled Disease Conditions that affect the body's ability to heal and repair itself may have a negative effect on the placement and health of an implant. Persons with diseases (such as diabetes) that are not under control are not good candidates for dental implants because the uncontrolled disease keeps the body from healing itself normally. However, a diabetic person who has their diabetes under proper control by a doctor could be treated successfully with implants. Other diseases such as leukemia or hyperparathyroidism (abnormal activity of the parathyroid glands) also may affect the outcome of implant treatment. Persons who are undergoing chemotherapy or radiation therapy for cancer should not have treatment procedures that 23 P a g e

24 are advantageous but not urgent (such as dental implants) until cancer treatment is completed and the doctor says it is safe to proceed. If you have any questions about how your general health might affect dental implants in your mouth, you and your dentist should discuss this with your doctor. Pregnancy Women who are pregnant should not undergo any treatment such as dental implants until after the first three months of their pregnancy. It is best to wait until after delivery to start dental implant treatment. Psychiatric or Emotional Treatment People with psychiatric disorders such as chronic depression or personality changes requiring treatment, or people undergoing severe emotional stress, should avoid situations that may complicate or disturb their lives. Dental implant therapy may place additional stress on persons who are unable to tolerate it. As with other diseases, open discussion of the problem should involve the patient, dentist, and doctor before implant treatment is considered. Poor Motivation to Accept and Follow Needed Treatment 24 P a g e

25 For dental implants to be successful, you must be committed to following all of the necessary steps before, during, and long after treatment. People who are not able or willing to undergo the necessary treatment, or to take care of their new teeth on a regular basis, should not consider implant therapy. Lack of Muscular Coordination to Manage Oral Hygiene Procedures To keep the bone and gums around dental implants healthy, you must carefully clean the implants. This means that you must be able to handle a toothbrush, dental floss, or other cleaning tools to remove food and plaque. Persons with severe arthritis or other handicaps that affect the hands and arms may not be good candidates for implant treatment. Are There Any Risks to My Health with Implant Treatment? Some health factors are important when considering dental implants: Surgery or Anesthetic Usual precautions associated with a local or general anaesthetic must be taken. Sometimes an opening into the sinus cavity above the upper teeth or a nerve injury can occur. These incidents seldom result in permanent damage. 25 P a g e

26 Psychological People who experience abnormal psychological stresses or are not motivated may have problems with surgery and may not be able or willing to follow oral hygiene instructions. However, persons who avoid contact with other people because they are concerned about their missing or unattractive teeth may be helped. Medical There are some temporary conditions that can result from implant placement: pain and swelling of gums, lip, or tongue; speech problems; and inflammation (heat, redness, swelling, and pain) of the gums. Possible long-term difficulties may include nerve injury, bone loss if the implants fail, overgrowth of gums, and mouth or general bacterial infection. For those people who have other body part replacements or heart valve problems, endocarditis (inflammation of the inside lining of the heart) or infection may be a risk. Cost After you have been examined by Dr. Tarantola and before you make any decision on implant treatment, you must consider cost. Just like any complicated and time-consuming medical or dental procedure, 26 P a g e

27 implant treatment is moderately expensive. You should be aware of all of the costs involved. If you will be treated by a team of dentists, make sure that you receive cost estimates from each one involved. For example, if an oral surgeon will be placing the implants into your jaw Dr. Tarantola is going to make the restoration (prosthesis) to replace the teeth, you will get cost estimates from both. If you have dental insurance, you should contact the insurance company before you start treatment to find out whether or how much of the treatment might be covered. Insurance policies vary in their coverage of elective procedures such as implants. It is important that you fully understand how much your insurance company will pay and how much you yourself will be responsible for paying before you agree to proceed. 27 P a g e

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29 Dental Implant Placement Options Dental Implants 101 Under proper conditions and diligent patient maintenance, implants can last a lifetime. Dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Dr. Tarantola does a thorough, complete exam, studies all the data and consults with specialists if needed, all on your behalf. In this way, the best plan can be developed. Then Dr. Tarantola will consult with you to determine where and how your implant should be placed. Depending on your specific condition and the type of implant chosen, Dr. Tarantola will create a treatment plan tailored to meet your needs. Replacing a Single Tooth If you are missing a single tooth, one implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root. What are the advantages of a single-tooth implant over a bridge? A dental implant provides several advantages over other tooth replacement options. In addition to looking and functioning like a natural tooth, a dental implant replaces a single tooth without sacrificing the health of neighboring teeth. The other common treatment for the loss of a single tooth, a tooth-supported fixed bridge, requires that adjacent teeth be ground down to support the cemented bridge. 29 P a g e

30 Because a dental implant will replace your tooth root, the bone is better preserved. With a bridge, some of the bone that previously surrounded the tooth begins to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy and intact. In the long term, a single implant can be more esthetic and easier to keep clean than a bridge. Gums can recede around a bridge, leaving a visible defect when the metal base or collar of the bridge becomes exposed. Resorbed bone beneath the bridge can lead to an unattractive smile. The cement holding the bridge in place can wash out, allowing bacteria to decay the teeth that anchor the bridge also. How will the implant be placed? First, the implant, which looks like a screw or cylinder, is placed into your jaw. Over the next two to six months, the implant and the bone are allowed to bond together to form an anchor for your artificial tooth. During this time, a temporary tooth replacement option can be worn over the implant site. 30 P a g e

31 Often, a second step of the procedure is necessary to uncover the implant and attach an extension. This small metal post, called an abutment, completes the foundation on which your new tooth will be placed. Your gums will be allowed to heal for a couple of weeks following this procedure. There are some implant systems (one-stage) that do not require this second step. These systems use an implant which already has the extension piece attached. Dr. Tarantola will advise you as to which system is best for you. Finally, a replacement tooth called a crown will be created for you by Dr. Tarantola and attached to the abutment. After a short time, you will experience restored confidence in your smile and your ability to chew and speak. Dental implants are so natural-looking and feeling that you often forget you ever lost a tooth. This is one of the biggest benefits of implants is their realistic look and feel; along with a more realistic usage of the tooth when chewing and speaking. For many, the higher cost is well worth a more realistic replacement. Replacing Several Teeth If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots. 31 P a g e

32 Advantages of implant-supported bridges over fixed bridges or removable partial dentures Dental implants provide several advantages over other teeth replacement options. In addition to looking and functioning like natural teeth, implant-supported bridges replace teeth without support from adjacent natural teeth. Other common treatments for the loss of several teeth, such as fixed bridges or removable partial dentures, are dependent on support from adjacent teeth. 32 P a g e

33 Dental Implants: Consultation, Procedure, Recovery and Aftercare Dental implants are artificial tooth roots used to support a restoration for a missing tooth or teeth, helping to stop or prevent jaw bone loss. The dental implant procedure is categorized as a form of prosthetic (artificial replacement) dentistry, but is also considered a form of cosmetic dentistry; for this reason many dental insurance plans will not always pay for implants or will only pay partial amounts. People who have lost teeth might feel too self-conscious to smile or talk. Additionally, biting irregularities caused by tooth loss can have a negative effect on eating habits, leading to secondary health problems like malnutrition, jaw alignment issues and more. By replacing missing tooth roots, dental implants provide people with the strength and stability required to eat all the foods they love, without struggling to chew. Additionally, dental implants stimulate and maintain jaw bone, preventing bone loss and helping to maintain facial features. Tooth Loss Teeth are lost because of: 33 P a g e

34 Tooth decay Root canal failure Gum disease (Periodontitis) Trauma to the mouth (tooth injury) Excessive wear and tear Congenital defects Dental Implants: Consultation, Placement, and Recovery To determine if implants are right for you, a consultation with Dr. Tarantola is needed. During this appointment, he will thoroughly examine your teeth and gums and evaluate bone density and quantity. This may involve X-rays and computer tomography scans (CT scans) to ensure there is sufficient bone structure for placing the implant(s), and to determine exactly where the implant should be placed. Based on the condition of your oral tissues, oral hygiene and personal habits, and commitment to follow aftercare instructions, your dentist will advise you of the most appropriate dental implant treatment plan. Some patients with insufficient bone or gum tissue 34 P a g e

35 require bone or soft tissue grafts and/or the use of small diameter implants (also called mini implants). The Dental Implant Placement Procedure Today's dental implant restorations are virtually indistinguishable from other teeth. This appearance is aided in part by the structural and functional connection between the dental implant and the living bone. Implants are typically placed in a single sitting but require a period of osseointegration. Osseointegration is the process by which the dental implant anchors to the jaw bone. Osseointegrated implants are the most commonly used and successful type of dental implant. An osseointegrated implant takes anywhere from three to six months to anchor and heal, at which point your dentist can complete the procedure by placing a crown restoration. If osseointegration does not occur, the implant will fail. Dental Implants Recovery Dental implant recovery depends on a number of factors, one of which includes the various procedures required to complete your treatment. However, it is generally recognized that once an implant has been placed, maintaining diligent oral hygiene habits is required to ensure proper fusing of the implant and bone structure. If cared for 35 P a g e

36 properly, an implant restoration can remain in place for more than 40 years. After the initial surgical procedure, discomfort should be minimal. Swelling of your gums and face may occur, as well as minor bleeding and bruising of the implant site. Prescription pain medications may be prescribed by your dentist to relieve any pain or discomfort you feel after the procedure. Complete osseo-integration from the surgical procedure to place the dental implant(s) takes up to six months, while the fitting and seating of the crown(s) can take up to two months. Again, this timeframe depends on individual cases and treatments; as everyone heals differently. Follow-up appointments with your treatment coordinators are essential for monitoring your progress. Implant Surgery Follow-up and Aftercare For five to seven days after surgery, your diet should be restricted to soft foods. If stitches are present, they may need to be removed by your dentist; however, self-dissolving stitches that do not require removal are typically used. 36 P a g e

37 If provisional restorations were placed along with the dental implant, it will be important to clean them as you would your natural teeth to ensure the best possible healing and fusing of the implant. Failure to floss and brush is a leading cause of implant failure, and infection can occur if the implant and surrounding areas are not cleaned properly. Smoking also is attributed to high failure rates with dental implants and should be avoided following implant procedures. 37 P a g e

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39 Dr. Tarantola has the training and experience for your implant reconstruction. Dr. Tarantola has worked closely with specialists in complex cases and has placed implants in the more routine cases for over 25 years. He lectures to dentists worldwide and has published a dental textbook entitled Clinical Cases In Restorative and Reconstructive Dentistry. It is not only a didactic book but has over 50 fully documented cases he has completed which are used to teach the principles in the didactic section. If you are considering dental implants and already have a dentist, be sure to ask lots of questions; what kind of experience does he/she have placing dental implants as well as restoring them. Ask to see photographs of actual treatment he/she has performed. The practice of Dr. Tarantola offers a totally free, no-obligation MEET AND GREET consultation. Dr. Tarantola provides treatment with help from dental hygienists and dental assistants. A dental hygienist performs professional dental cleanings. The hygienist's designation may be RDH (Registered Dental 39 P a g e

40 Hygienist), or RDHEF (Registered Dental Hygienist with Extended Functions). 40 P a g e

41 Family Dentistry: Dental Care for the Whole Family Dental Implants 101 Family dentistry, like general dentistry, provides services related to the general maintenance of oral hygiene and tooth health. The terms family dentistry and general dentistry are often used interchangeably, though there is a slight difference between the two. Some dentists restrict their practice to certain age groups. For example, pedodontists restrict their practice to providing dental care and treatment specifically to children or pediatrics. Family dentists typically care for a wide variety of patients, from young children to older adults. Family dentists are responsible for ensuring that plaque build up around the teeth is kept to a minimum, that tooth decay is eliminated, cavities are filled, and that gums remain healthy. Family Dentistry Services Because they are considered to be the first level of defense against dental abnormalities, family dentistry and general dentistry are viewed primarily as preventative fields. The American Dental Association (ADA) recommends that you visit your family dentist for a check-up a minimum of two times each year. Such checkups provide routine or 41 P a g e

42 deep cleanings to eliminate plaque build up and prevent tooth decay. If necessary, we also provide natural treatments to help strengthen the teeth; a procedure also important in the prevention of tooth decay. Preventative dental check-ups can help with the detection of oral health problems long before the onset of symptoms. Your family dentist will work closely with a specialist; especially when you are getting dental implants or other procedures that require a lot of work and knowledge. You should have a close relationship with your dentist; so much so that even during your time working with a specialist you should be able to contact your family dental office and ask questions if you feel uncomfortable about anything. It s very important that your dentist and specialist work closely together. Training and Practice After earning an undergraduate degree and passing the Dental Admission Test (DAT), prospective family dentists must complete a three- to five-year dental school program that equips them with a general dentistry education. Dental school is intensive, incorporating much of the same curriculum as a typical medical school. Before graduating, students must pass the National Board Dental Examinations (NBDE) in order to become licensed dentists. After passing the NBDE, the dentist is awarded the degree of Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD). DDS and DMD are different titles for the same education and degree. 42 P a g e

43 Following dental school, the majority of dentists choose to move immediately into practice as a general or family dentist. Others, however, opt to pursue postgraduate training to become a specialty dentist. Nine specialty fields of dentistry are recognized by the American Dental Association: Dental Public Health Endodontics Oral & Maxillofacial Pathology Oral & Maxillofacial Radiology Oral & Maxillofacial Surgery Orthodontics Pedodontics (Pediatric Dentistry) Periodontics Prosthodontics Many of these specialists will be imperative to your having a successful and positive experience with dental implants. Senior Dental Care 43 P a g e

44 Dental care for seniors involves unique considerations. Seniors are more likely to suffer from a host of oral health issues resulting from the natural aging process, their inability to receive proper oral health care due to financial constraints (no dental insurance) or their inability to provide adequate dental hygiene care for themselves. These factors, combined with the limited dental benefits provided by state aid programs for the aged, blind or disabled, leave many seniors at risk of ignoring tooth decay and tooth infection until there is no alternative but tooth extraction which is the only dental procedure covered by many state aid programs such as Medicaid or Medicare. Tooth Loss, Periodontal Disease, and Other Dental Concerns for Senior Patients Prior to tooth loss, seniors may experience tooth sensitivity or discoloration due to the loss of enamel and dentin (hard, calcareous tissue beneath the enamel), or root deterioration caused by gum recession. Seniors are more prone to periodontal disease (gum disease) resulting from improper dental hygiene practices, poor diet, ill-fitting 44 P a g e

45 dental appliances and/or diseases such as cancer or diabetes. In fact, the supporting bone structure for the teeth, including the jaw, may shift, which can play havoc on a senior's bite and may contribute to tooth decay. Seniors are also more likely to suffer from inflammation of gum tissue, dry mouth syndrome (often caused by medications), root surface decay or oral thrush (a fungal disease causing ulcers and whitish spots on membranes of the mouth due to its effect on the immune system). Dental Hygiene for Seniors Brush, floss and rinse with mouthwash properly to maintain dental hygiene, as instructed by your dentist. Look into special toothbrushes to clean hard-to-reach areas of the mouth. Know the warning signs that indicate your mouth, teeth or gums may be in jeopardy, including tooth sensitivity, teeth grinding, pain, mouth sores, bumps (see oral cancer), swelling, loose teeth, jaw popping or clicking, difficulty quenching thirst, swallowing or chewing (dry mouth syndrome). Visit your dentist as often as he or she recommends for regular dental hygiene checkups. Maintain dental appliances such as dentures and dental bridges properly. Dr. Tarantola recommends natural products such as xylitol and licorice root to prevent decay and MI paste (calcium and phosphate) to strengthen the root surface. 45 P a g e

46 Consider seeing your dentist before and after surgery. Tell your dentist about any medications that you are taking or changes to medication. If brushing and flossing are difficult for you, try to elongate the toothbrush with tongue depressors or something similar, or ask for assistance. You may also try using a soft washcloth or gauze to remove debris from the teeth, rinsing frequently. Use this method until you are able to brush your teeth again. People suffering from arthritis or a similar medical condition that limits manual dexterity can try inserting the back end of a toothbrush into a standard tennis ball for better maneuverability. Dr. Tarantola may recommend other such innovations designed to make the practice of oral hygiene simple and effective Full Mouth Reconstruction Full mouth reconstruction, full mouth rehabilitation, and full mouth restoration are terms often used interchangeably to describe the process of rebuilding or simultaneously restoring all of the teeth in both the upper and lower jaws. 46 P a g e

47 Full mouth reconstruction typically involves Dr. Tarantola s restorative expertise (performing procedures like crowns, bridges and veneers), and can incorporate dental specialists like periodontists (specializing in the gums), oral surgeons, orthodontists (specializing in tooth movements and positions) and endodontists (specializing in the tooth pulp). The need for full mouth reconstruction may result from: Teeth that have been lost due to decay or trauma. Teeth that have been injured or fractured. Teeth that have become severely worn as a result of long-term acid erosion (foods, beverages, acid reflux) or tooth grinding. Ongoing complaints of jaw, muscle, and headache pain requiring adjustments to the bite (occlusion). Tooth Restoration Bonding: The bonding process is applicable in almost every dental procedure performed today. It is accomplished in one visit to the dentist. No mold-taking, no "temporary," no lab-fabrication. It may take care of chips, gaps between the teeth, staining, splotches from wearing braces, crookedness or even teeth whose shapes are 47 P a g e

48 displeasing. Plus, it's less expensive than procedures needing the lab technician. Dental Bridges: Dental bridges, dental implants, and partial dentures are used to replace missing teeth that would otherwise adversely affect your mouth. The negative effects of one or more missing teeth can include the shifting of other teeth to accommodate for the open space, a change in the bite that may affect your ability to eat, a speech impediment, and an increased risk for periodontal disease and tooth decay. Dental Crowns: Whether a crown is needed for tooth cracks, excessive tooth decay, damaged tooth protection, teeth grinding, missing teeth, need for beautification or an improper bite resulting from the natural wear and tear produced by aging, dental crowns of today can satisfy your functional and esthetic needs. The purpose of a dental crown is to encompass and protect a needy tooth with a customdesigned tooth material, much like a fitted cap. Dental Crown Dentists: Both the dentist and the laboratory technologist play a role in the design and treatment outcome of a crown. Art and science are important factors in designing the proper anatomical features of the crown to provide the best possible fit in the mouth. Dr. Tarantola performs these treatment options; be aware the level of expertise varies among dentists. Dental Fillings: Dental fillings are used to repair minimal tooth fractures, tooth decay, or otherwise damaged surfaces of the teeth. Dental filling materials may be used to even out tooth surfaces for better biting or chewing. In many cases, individuals with enamel loss resulting in tooth sensitivity will notice a significant improvement or complete elimination of sensitivity once the appropriate dental filling material is placed. 48 P a g e

49 Dental Filling Materials: You have many choices when it comes to restoring damaged or decayed teeth, even down to the type of dental filling material to use. Dr. Tarantola uses no metals, only biocompatible composites and porcelains. Dental Implants: In many cases, dental implants may be the only choice to restore all necessary functions of the teeth and supporting structures. An implant can replace a single missing tooth and multiple implants can be used to support a dental bridge for the replacement of multiple missing teeth. Implants can also be used to increase the retention of dentures, helping to minimize gum irritation. Another implant advantage is that they do not require the preparation of adjacent teeth that would be necessary for bridgework. How much do dental implants cost? Dental Implant Cost and Candidacy: The cost of dental implants depends on many factors, including the type of implantation, the dentist performing the procedure, the location where it is performed, the material used and the amount of dental insurance you have or don t 49 P a g e

50 have. Determining your candidacy is a process that starts with a comprehensive oral health evaluation and sitting down with each and every person involved throughout the entire process to determine the final cost factor. When you are being given estimates make sure you are told the total cost of every procedure you will need to make your dental implant(s) complete. Bridging the Gap with a Dental Bridge One or more missing teeth can adversely affect the appearance and functionality of your smile. Missing teeth can cause a change in occlusion (bite), shifting of the teeth, temporomandibular joint disorder (TMJ), speech impediments, an increased risk for periodontal disease and a greater chance of tooth decay. Dental bridges, like implants and partial dentures, are used to replace missing teeth. There are several types of fixed dental bridges (cannot be removed), including conventional fixed bridges, cantilever bridges and resin-bonded bridges. Typically, conventional and cantilever bridges require shaping of the teeth surrounding a missing tooth. Crowns are then placed on the shaped teeth and attached to an artificial tooth (called a pontic). A resin-bonded bridge requires less preparation of adjacent teeth. It is often used to replace front teeth, provided that the gums are healthy and the surrounding teeth do not have extensive dental fillings. Dental Bridges Consultation and Treatment Planning Once Dr. Tarantola has determined that a dental bridge is the best replacement for your missing tooth or teeth, you will be advised of different materials that the dental laboratory can use to make your restoration. Material availability will depend upon where in the mouth the bridge will be placed, whether or not you grind or clench your 50 P a g e

51 teeth (bruxism), your dental insurance coverage, and other factors outlined by your dentist. Dental bridges today can be fabricated from high-strength metal-free materials such as zirconia. Dr. Tarantola will take X-rays and impressions of the area requiring a bridge, as well as preoperative photographs, for use in planning the ideal bridge restoration for you. Depending upon the number of consecutive teeth you are missing, your bridge could be three or more units; two crowns that are cemented to the teeth on either side of the space (called abutments), plus one or more false teeth (called pontics) to fill the space. Additional impressions will be taken after your dentist prepares the abutment teeth for the bridge. Dental Crowns: Preserve Damaged Teeth with a Crown Dental crowns, also known as "caps," preserve the functionality of damaged teeth. A dental crown may be used to protect a cracked tooth, restore functionality of a tooth with excessive decay or replace a preexisting crown. The purpose of a dental crown is to encase a needy tooth with a custom-designed material. Dr. Tarantola today has a variety of conservative treatment options through which to restore teeth. If possible, these options should be explored and discussed before selecting the full coverage crown. 51 P a g e

52 Dental Crowns Consultation and Treatment Planning If tooth decay or damage is so extensive that veneers, direct composite bonding or other conservative treatments aren't viable treatment options or if you have undergone root canal therapy Dr. Tarantola will consult with you about dental crowns. Whether used to restore a damaged tooth or to create a lifelike tooth replacement for an implant, crowns can be fabricated in dental laboratories or in your dentist's office, depending upon the crown material. Part of your dental crown consultation may involve taking impressions of your existing tooth (or teeth) as a basis for creating the shape and size of your crown restoration(s). If dental crowns will be used as part of a smile makeover, these impressions are used to make models for designing the new length, shape and alignment of your teeth, so that you can preview your new smile before committing to treatment. Dr. Tarantola also will describe the tooth preparation process, as well as your options with regard to local anaesthesia (to numb your teeth and surrounding areas) and sedation dentistry, if necessary. If your dental crown treatment involves placement of a temporary crown, your dentist will advise you of how long you will need to have the temporary in place and what hygiene steps to take to ensure functionality. The Dental Crown Clinical Procedure During the dental crown procedure, Dr. Tarantola prepares the tooth and makes a molded impression of the teeth to send to a dental laboratory. A fitted, temporary crown is created during this visit to temporarily protect the tooth while the final restoration is being made in the dental laboratory. Once completed, the tooth crown is cemented or adhesively bonded at a later visit. 52 P a g e

53 A recent technology, CAD/CAM technology (computer-aided design/manufacturing technology) has evolved to display a 3-D picture of the teeth. A restoration is then created through milling of a ceramic block. If this technology is located in the dental office (chair-side CAD/CAM), there will be no need for a temporary crown or return visit for the final cementation. Dental Fillings A dental filling is a type of restorative dentistry treatment used to repair minimal tooth fractures, tooth decay or otherwise damaged surfaces of the teeth. Dental filling materials, which include composite, porcelain, but never silver/mercury in Dr. Tarantola s practice, may be used to even out tooth surfaces for better biting or chewing. Enamel loss is a common component of tooth decay and may result in tooth sensitivity. In many cases, tooth sensitivity caused by enamel loss will be significantly improved or completely eliminated once an appropriate dental filling material is placed. However in some cases, depending on the extent of tooth decay or damage, the affected tooth may require additional or alternative procedures, including: Dental Fillings Consultation and Treatment Planning 53 P a g e

54 One of the more common oral health issues discovered during scheduled cleanings is decay. Dr. Tarantola will examine suspect teeth using a dental probe and sometimes the Diagnodent, as well as take an X-ray and digital photos to determine the extent and exact location of the cavity and decay. Once it is determined that a filling is needed, Dr. Tarantola will advise you of your options for filling and sealing the cavity to prevent further decay and damage to the tooth. Based on your medical history, location of the cavity, esthetic needs, biting force, durability, cost, number of visits necessary and your preference, your dentist will decide which filling option is best for you. These options include direct composite bonding, or porcelain inlays/onlays created in a dental laboratory, or using in-office CAD/CAM equipment. Depending on what your best option is, your dentist may be able to complete your filling immediately. In preparation for treatment, the area surrounding the affected tooth will be anesthetized (numbed) using a local anaesthetic. Ensuring Fit and Comfort Tooth restorations must feel comfortable. An ill-fitting tooth restoration may affect the outcome and longevity of the procedure. Illfitting restorations can house bacteria that may cause tooth decay. Dental technicians use sophisticated equipment like articulators and high-powered microscopes to ensure the dimensional accuracy of each restoration and corresponding occlusion. Such assurances help determine the look, feel and fit of your restoration(s), yielding optimal fabrication. 54 P a g e

55 The lab technician's familiarity with and comfort in using the materials impact the fit and comfort of the restoration. Because of this, you may wish to discuss certain dental lab issues with Dr. Tarantola, such as: Are the materials used in each dental procedure of the highest quality? What are the experiences and education of the dental technician? Does the dentist work and communicate with a specific dental lab technician, or does the dentist use a large commercial dental laboratory? Does the laboratory outsource the work overseas? In such cases, dentists have no control over the quality of the materials used in fabrications. 55 P a g e

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57 Preventive Dentistry: Care Today, Savings Tomorrow Dental Implants 101 If you don't take care of your teeth and properly manage your oral health, you may find yourself forking over thousands of dollars in restorative dental care. Did you know that a full mouth reconstruction can cost between $45,000 and $80,000? By practicing preventive dentistry, you can safeguard yourself from these dental costs. Preventive dentistry emphasizes the importance of ongoing hygiene procedures and daily practices to prevent tooth decay and other dental diseases and conditions. Effective preventive dentistry combines at-home oral care by patients with chair-side treatments and counselling by dental professionals. For example, the American Dental Association (ADA) recommends a minimum of two dental checkups each year for professional cleaning and management of any developing conditions. Adhering to this recommendation can help your dentist stop dental disease in its earliest stages, protecting your smile and limiting your expenses. Early Prevention 57 P a g e