Mona Lisa gets a Smile Makeover

Mona Lisa gets a Smile Makeover

please hit the thumbs up button… I’ll be your best friend.

The Not so Secret Life of Dentists

Oh, hello there.  How are you? Whats new?  How’s your mom?  Great, glad to hear it.  So what brings you to my office?  Well we can help you with that.  make yourself comfortable and we will get to it.  First let me tell you about myself.

Everybody needs to know their doctors, so I thought that I would entertain and amaze with some incredibly interesting tidbits so that we can get to know each other better.  Plus my new years resolution is to write more.  Sorry if it is not as composed as I may normally achieve.

I grew up in the dental office where I am now a senior associate dentist.  I worked there in high school as an assistant.  I knew early on that I should be a dentist.  It was a great idea because it married my love of helping others and I get to use my hands everyday.  I get to be my own dentist but if I ever need anything I have access some of the most knowledgeable dentists and managers on the planet. I love my team and it shows in our care and the positive experience of the patients.  Gosh, I know that sounds like a sales pitch but it is really true. 

What shapes my “dental philosophy”

In college I found religion and became a Christian.  That has shaped a lot of my philosophy about how to treat my patients.  Another thing that has shaped my dental philosophy about treatment and patient care is my father, whom I get to work with everyday.  I actually care a great deal about my patients because I feel a great responsibility for my profession.  I treat people as though they members of my own family.  Since I am surrounded with other doctors that feel the same way it is really easy to have a good patient care philosophy.

Little known fact about me: I am a decent ventriloquist

2011 in review

The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 2,400 times in 2011. If it were a cable car, it would take about 40 trips to carry that many people.

Click here to see the complete report.

Tippee the Tooth gets a book!

http://www.blurb.com/books/2254517

Mini Implants and Why They Will Change Everything

Technology is always evolving and changing.  Dentists are often stubborn to change.  For evidence of that, just ask me about angry calls from older periodontists that I am treating periodontitis patients with lasers instead of referring them out.  As the technology to treat dental patients becomes simpler and cheaper, the procedures themselves become simpler and cheaper.  The patients benefit because they can afford procedures they couldn’t before and they are often times quicker and less painful.  One example of this is, of course, my LANAP laser periodontal therapy.  The other which I have become a huge fan of is “mini-dental implants”. 

An implant is an amazing technological marvel.  It was discovered, as most things are, by accident.  I won’t bore with the details of the discovery but suffice it to say that if you place titanium in bone and leave it there long enough it will integrate into the bone.  The bone adheres and bonds to the outer layer of titanium.  Once integrations occurs the implant is not easily removed.  Over the years many different implant designs and techniques were developed.  Some worked while others did not.  After much trial and error, the endosseous implant became the most common form of implant.  It is a “root form” implant meaning that it is a small metal tube that takes the place of a tooth root.  On top of that tube is a hole for a titanium screw that holds in an “abutment” which then will be glued to a fake crown, thereby replacing a lost tooth or teeth. 

It is quite a process to restore a tooth using traditional implant technology.  First you make a hole in the bone using increasingly sized drills.  Most times you need to “flap” the gums and view the bone directly to aid in placing the implant.  This has several drawbacks.  the first is once you see the bone you have lost at least a millimeter of it.  Also the blood and nutrient supply to the bone comes from two places.  The first place is the periosteum, which is the layer of tissue between the gums and bone, but that is disrupted by the flap.  The other source of blood and nutrients needed for proper healing and integration of the implant is found in the bone marrow, which has been reamed out and disrupted by the many drills used to increase the size of the hole for the implant placement. 

When the hole is the right size the implant is placed and then covered without a tooth on top for several months.  This is so integration can happen without disruption.  There is a process called “die-back” where the bone around the implant will shrink and then have to grow back around the implant to integrate.  Most experts agree this is from the trauma of placement.  Then after several months a fake tooth can be placed using a small titanium screw.  The most common problem once the tooth is placed is the screw coming loose and needing to be tightened.  This is relatively simple alth0ugh somewhat inconvenient.  This is the best option we have for implants… or so we used to think.

Change is coming for implants.  Mini-implants have been around sinces the 1960′s but they are only gaining recognition lately.  A mini implant is much like a regular implant except it is longer and skinnier.  It is made out of a strong titanium and extremely resistant to breakage.  Since it is half the width of most regular implants there is no place for a screw hole.  So instead of having an open top it has a ball and square design that when placed will stick out of the gums, eliminating the need for an “abutment” piece that the traditional endosseus implant has.  That also means no small titanium screw that will get loose and have to be re-tightened.  When placed, the replacement teeth or dentures will plug into the top of the mini-implant at the time of implant placement.  So what are some other advantages to using a mini. 

The first advantage is the placement.  The mini can be placed when there is less bone than for larger implants because it is so skinny.  A lot of people wearing dentures have been told they are not good implant candidates.  With mini’s they are good candidates because you need half the bone.  Also they way they are placed is different.  A mini can be placed with one drill, no flap.  The drill goes down only 50-80% of the length of the implant, sparing  the bone, marrow blood supply, and periosteum.  A lot less heat is generated because of the reduced drilling used. 

The next advantage is the immediate tooth replacement.  Teeth and dentures can be replaced at the same time that the implant is placed because of several factors.  The first is the long length of the implant which makes it highly resistant to extraction forces.  The other is since it is “self-tapping” and as it is placed it engages the bone tightly without having “die-back”.  Some mini implants cannot be removed after 3 weeks because they are integrating so fast.  So as soon as the implant is placed they can be loaded and the teeth can be replaced.  Lower and upper dentures can be stabilized very effectively in about an hour of chair time.  You can even use the patients current denture in most cases, eliminating the added expense of having a new denture made.  This saves months of waiting for a regular implant to integrate.

The third advantage is esthetics.  In thin bone, the metal of a larger implant may shine through the gums and you will see a gray line.  This is not always the case but I have seen it enough to know that when it happens there is nothing we can do to hide it’s appearance.  Also because of the size the tooth on top of the implant can look like it has a small neck and have a problem with trapping food.  Anyone with an implant will tell you that they can trap food inbetween those implants very easily.  A mini implant is less likely to show through the bone with placed properly because you are less likely to lose buccal bone when you remove less bone for implant placement.  Also, you can make the tooth on top of the implant drape over the gums to have a very natural appearance.  A simple water pik is all you need to maintain the cleanliness of the mini implants.

The fourth advantage is the cost.  Mini implants are less expensive for the dentist to buy.  They are also quicker to place which means less time in the chair for the patient.  The dentist does not need to buy expensive proprietary implant drills and machines and abutments.  All this translates into a less expensive option for the patient and dentist. 

But is it as effective as a traditional implant?  Yes.  My favorite study is by the guru of mini implants, Dr. Todd Shatkin, who found a 95% success ratio for mini implants which is the same as regular sized implants.  In lower mandibles if the implant was long enough to reach the hard bone at the base of the chin the success ratio was 99%.  Other dentists across the country are finding out the same thing that mini implants are effective and successful.

The ever-evolving world of implants is on the brink of a revolution in thinking.  We have found something as effective, less expensive, quicker, and easier than any previous implant for tooth replacement. 

Ed Helms from the movie "The Hangover"

MY Laser is Better than Yours!

Here is a video I whipped up about the Periolase.  Nevermind the title, just playing with words.

Pearly White Toothpaste Commercial

DOUBLE RAINBOW, Tippee Tooth sings a Hit

Tippee Tooth found the double rainbow song on youtube. Someone help us all.

Perio-Don’t-titis. A Dr. Todd Cartoon

This is my attempt at a viral video.  Hit the like button and share it with others indiscrimitately.  Comments welcome.

Tippee the Tooth gets a Crown