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Replacing single teeth with dental implants is very common, and almost easy!
Each case is different, and there are a few common ways that single teeth are replaced, and these depend on if the implant is placed at the same time as the old tooth is removed (this is called immediate placement), or if there is a healing period where the tooth is removed, and nothing is placed for about 2-3 months.
It is normally better to leave the area to heal before placing an implant, but there are some situations where the old tooth can be removed, the implant placed, and the tooth is placed on the implant in a single session. Although this sounds great, always remember that it is a temporary tooth which is placed on the implant at this stage, and the final tooth is normally placed after the implant has joined to the bone.
Implant placement is the bit of this treatment which most people are anxious about. Normally for single teeth, the placement is quick and easy, and healing is without any issues.
If you need additional bone grafting and bone movements, then there may be some swelling and little discomfort after treatment, this normally goes pretty quickly.
The actual surgery part of this treatment takes about 30 minutes, and you should not feel anything because of the anaesthetic used.
After treatment, there may be some metal visible at the gum, or not, depending on the situation. If it is a front tooth, you should always have some kind of temporary tooth while the treatment is completed.
You need to give the new implant a little time to let the bone grow close to it, this can take 3-6 months (or more in very complex cases).
During this time, you shouldn’t feel anything at all.
This is the bit you have been building up to! From this point on, it’s plain sailing, most of the time, no injections, and very short appointments.
Once the tooth is in position, it will feel just like your original tooth, but it will take getting used to because chances are that you have been without a tooth there for 6-9 months, and forgotten what it’s like to have a fixed tooth in that position!
Dental Implants are not cheap, so you want to make sure you care for them well. Although they cannot get tooth decay, they can get gum disease, and this is called peri-implantitis.
This is quite an important subject and I will write about this at a later date.
One person told us the principal dentist explained everything
”so nicely”, ”he made me feel at ease” and said that things were explained each time they
came in. When they first started using the service this person told us they were asked to
provide details of their medical history. They said they were able to ask all the questions
they wanted and were given written aftercare instructions.
For some people the cost of good quality dental care can be enough to keep putting things off, or just keep going to their cheap dentist, who will patch one little thing up every time they go, leading to a false economy.
The problem is that with so many people used to cheap dentistry, their mouths are very likely to be in a unstable condition, by this I mean some teeth may (for example), have very large black fillings, which have been patched up, and are not really strong enough to predictably last more than 5 years. In addition, when doing all this work, the harmony of the bite has not been taken into consideration, and because of this, fillings and teeth keep wearing down and breaking.
When someone with a mouth full of poor quality work seeks the service of a good dentist, the cost of correcting the years of neglect can soon add up. The good news is that there are many ways to spread this.
By prioritizing the treatment to tackle the most pressing things first, and then every month, or few months, you have something else done, then eventually you can reach perfect health, and at a pace that you are comfortable with.
When you have reached this point, chances are you will need little work as time goes on, and your dental bills will become quite low.
Some practices offer the option to finance larger treatment plans, this works very well if a lot of treatment is needed, or a few more expensive treatments are needed, like dental implants or braces.
Most will offer 0% Finance, or even low interest for 24 months.
If you are considering replacing a missing tooth, and straightening your teeth at some point, then it makes sense to speak to your dentist about all these things at the outset. Often, by planning for future treatment, you will get a better outcome, and you can avoid replacing work already done.
Imagine you wanted to re-plaster a wall, and then a year later you wanted to hide some wires behind that wall – you would need to break the wall and redo all that work – wouldn’t it have been cheaper to lay the wires at the outset, to save on the total future cost? The same is often true in looking at long term health of the mouth.
This is especially true for treating gums, as well as that annoying tooth which keeps breaking every 6 months! Its always better to do some temporary treatment to buy some time, and stop the problem getting worse. This can buy you some time, and give you an opportunity to actually find out the true cost of sorting the problem out.
If you lose a tooth, and want to have it replaced with a dental implant, then its never a good idea to wait (if you can help it), the longer you wait, the more bone you lose in the implant site and other teeth start tipping into the space of the missing tooth. This will mean extra treatment to correct all these things. Again, if you tell your dentist that you want something there, then they can put something temporary there to stop other teeth moving into the gap!
Teeth straightening is becoming more and more popular, due to the dramatic improvements possible, short treatment times, and relative low costs (compared to smile design with cosmetic veneers).
If you are trying to move teeth, then is it likely that the lips and face may change, so is it possible to have teeth straightening and also have fuller lips (or thinner lips?)
In short, yes it is, but it is never that easy!
To increase the lip fullness, then your teeth need to be crowded or overlapped at the top, like:
In this case, you can visualise that if the teeth are straightened, then the size of the arch will increase, meaning that the front teeth will move forward, hence increasing the lip fullness.
There are several situations where this may not be a good idea, as you could have some unexpected results.
In this case, if you move your teeth forward, then it will be even more difficult to make your lips close.
In this case, moving your top teeth forward will increase the difference between your top and bottom teeth.
Rounding out your top teeth will only make this tooth tilt problem worse, and quite often the gums will recede if they are pushed too far.
Yes, if moving teeth will not give you the results you are after, then possibly look at using a temporary filler to increase your lip volume.
If you are thinking about straightening your teeth, then you may need to find out prices and the fee for your treatment often depends on the complexity of the treatment, so what do dentists or orthodontists look for when judging the complexity of your treatment?
There is no way I could explain every aspect we look at, as most people (including some dentists) would not understand why it is important!
The end is a good place to start, often people will say they only want one or two overlapping teeth treated, and the overlap is quite slight, then a beginners system like six month smiles, or Inman aligner may be a good treatment.
Often people will prefer a completely invisible treatment like a lingual brace, and for simple treatments, this may be far more affordable than you think.
Something like the treatment above just on a few teeth would probably cost around £2000. If the braces were on the outside, then the fee would be less.
Moderate cases can usually be treated in about 6 months, and often do not require extractions.
In the before and after above, there was enough room to straighten the upper and lower teeth, without any extractions, and because the top and bottom teeth correctly come together, then, no correction of the bite was needed.
Usually if its recommended that some teeth are removed in order to give you a better result, then the case becomes longer to treat, and also more complex.
Dental extractions are often recommended if straightening your teeth will result in the front teeth coming too far forward- Which isn’t really a great look! We do try and minimise the number of teeth that we take out, however in some cases, to get a nice result, extractions are often necessary.
If your teeth are very overlapped, or if your teeth need to move quite far forward or back, then chances are you need significant treatment, however we can only tell once we have a look.
It is a good idea to get different opinions, but expect them to vary quite a lot! There used to be a saying: if you ask two orthodontists, you will get three opinions!
I recently saw someone who had seen one orthodontist, who advised that he would need to have surgery to straighten his teeth, not something he wanted. Then he went to see someone else, who advised he would not need surgery, and treatment would be 24 months. He then saw me, and I cannot see any reason that the treatment should take longer than 9 months! (and I always like to over estimate the treatment times!)
With something like orthodontic treatment, you should get different opinions, and go with who you think is the best. The difficult thing is it is difficult to know who is good. Anyone can fit a brace, and make the teeth look good, however, few people will know what position the teeth so that they are stable in the long term. Closing spaces between teeth for example, can be very difficult to hold closed after treatment, and the last thing you want is for spaces to develop a few years after the treatment finished.
A cross bite is the way a dentist would describe a certain way your teeth bite together.
In the majority of people, the top teeth bite slightly outside of the lower teeth, and in the front, the upper teeth overlap the lower teeth a little, as shown below.
Cross bites can happen at the front or the side, if there is a cross bite on the side, then it can look something like this:
In the photo above, all of the patients right teeth (left of photo) are in cross bite. If the cross bite is at the front, then it looks something like this:
The answer to this really depends on the individual case. When there is a cross bite, there are often jaw joint issues. This is because when your jaw closes in its most comfortable position, the tooth or teeth in cross bite will deflect the jaw, and this pulls it into a less comfortable position.
You can only know if this is happening after a dentist (who understands jaw joints) examines you – It is rare that you feel any pain.
Because of this many people who have cross bites will have some degree of jaw clicking. Clicking in the jaw joint is the most obvious sign that the joint is not functioning correctly, and more often than not, this is due to the bite.
There are many degrees of jaw clicking, and some are easy to fix, and others are more complex, and may require more than just fixing the bite (occlusion).
There are a few ways to fix cross bites, and the most common is to use some type of brace. The best brace type completely depends on the teeth in cross bite, and if there is enough room to correct the bite.
In some cases, braces alone will not fix the cross bite, this could be because the problem is the position of the jaw bones. Here it may be better to have surgery to correct the jaw bones (with braces at the same time), but thankfully it is rare someone will need this much treatment!
In most cases, we just don’t know! two of the most common reasons are:
If you suck your thumb over the age of 6, then there is a tendency for the top back teeth to tilt inwards, and this will cause a cross bite on one side.
In about 10% of people, the lower jaw is slightly down and forward, this will often cause a cross bite at the front. Many of these cross bites can be corrected with braces, however, as suggested above, some may be better treated with surgery.
Many adults think that braces are just for children, but this could not be further from the truth.
In the last few years there has been a massive increase in the number of adults who are looking to have teeth straightening with a cosmetic braces system.
In the past, adults who wanted to have braces would have had to see an orthodontist, who would then offer them fixed braces, and the treatment time would be from 12-24 months! This is now seen as a little unrealistic. The massive increase in the number of adults who are having braces are down to:
Most of the adults I treat either in Kensington or Hertford are people who have had braces in the past. thanks to the NHS, these people are not given good retention, and therefore the teeth move back into their original position.
The old ugly betty type of braces are out of the window for most adults (except for the people who really want them!). These braces are still a fantastic way to move teeth, but they don’t look that great!
These days we use more tooth coloured braces, with nearly all components of the braces being tooth coloured. This means that even the classic train track brace can be discreet.
If this is still too visible, then we can put the brace on the inside of your teeth. This option may be more expensive, but the brace just cannot be seen, and this in my opinion is the ultimate type of brace.
These braces seem a good idea, however in our experience, the patients start getting annoyed with them after 3 years of treatment! It is available, and some people insist on it, however we are doing less and less of it these days.
Braces like Six Month Smiles can give you a quick cosmetic result. The reason most orthodontists would advise your treatment will take up to 24 months is that they are trying to finish everyone in the most idea bite (or what we call occlusion). This means the back teeth need to be moved, then the front teeth. This all takes time.
Most adults only want their teeth straightened, and are usually not concerned about the bite. Luckily, this can be done in about 6 months! So hence Six Month Smiles. Personally I do not use this system as the quality of the brackets is terrible, I do however use their treatment ideas, and what is known as STO (short term orthodontics) – and this can be done with braces on the outside, and braces on the inside.
Clicking in jaws is very common, and most dentist have no idea what it means.
Often the clicking in the jaw joint does not hurt, but the fact it is clicking means that it is not functioning as it should.
The Jaw and the base of the skull are normally separated by a little disc, and when this disc slips away from the joint, you hear a click. You may not get pain in the joint, however you may get headaches, or even other symptoms, which can be very varied, ranging from itchyness to balance disturbances.
Nine times out of ten the problem is the position of the teeth, the bite has often been changed by a dentist (putting a filling in or a high crown), or an orthodontist putting the teeth in an uncomfortable position for the jaw, and stressing the joint – hence starting a click.
Firstly, if you have pain, then there is a problem. If your jaw clicks, then you also have a problem.
In perfect health, you jaw should open in a straight line if you look in the mirror, if your jaw opens to the side, and then clicks into the middle, then you could have a problem in one joint.
You should be able to open your mouth about 50mm when you open and stretch. When you move your jaw to the side, it should move about 15mm. If these measurements are reduced, then you could have a significant problem, even if your jaw does not click!
Depending on the severity of the problem, there could be several solutions. These range from simply straightening a few teeth, to making a hard bite splint to heal the damage to your jaw joint, then reorganise the bite to put the joint in a comfortable position.
If you have a soft bite guard made, and you are told to wear it at night, then you problem is only going to get worse. Most dentists do not understand the jaw joint, and the easy option is to make a soft night guard, and dentists think that if you separate the teeth, the problem will go. Unfortunately this is not only irritating to wear every night, but it just does not work!
Six Month Smiles is (another) branded orthodontic system, like Invisalign, or CFAST, inman aligner – the list goes on! With 6 month smiles, it is basically the first stages of full orthodontic treatment.
Yes, general dentists do need to attend a 2 day course to be allowed to use the Six Month Smiles name, and system. In order to fit a brace, any dentist is allowed to do it, if they feel they have sufficient training. With any kind of treatment, the skill of the dentist is very important, and will affect the quality of the end result.
I feel Six Month Smiles is a good system, personally, I very rarely use it, I prefer to provide a better quality of brace, and use the Six Month Smile theory. This way, there is flexibility to work outside the Six Month Smile system, to provide perfect results.
In most cases, Six Month Smiles will give a dramatic improvement in overlapped teeth. If you think about it, to create space to overlap teeth, like in the following photo, then you need more space… Where will the space come from?
With Six Month Smiles, the space is almost always gained from bringing all the teeth slightly forward: and this is fine in most cases, however there are cases where this is not a good idea, for example if final position of your teeth will be resting on your lower lip, the teeth may move forward over time, due to the force of the lower lip acting on the upper front teeth.
Whoever provides your treatment should always give you a comprehensive options, and this should be in detail. I personally do not believe it is good enough to say:
Six month smiles will fix your teeth in about 6-9 months, the other option is to see an orthodontist, and this treatment will take 2 years
You should get a full orthodontic option in detail, if a specialist would plan your treatment differently, then there must be an advantage of that treatment option, after all, they are specialists in the field, and there is a tried and tested way of moving teeth!
If after understanding both options, you still opt for the Six Month Smiles option, then that is fine, but you should know about all the options in detail. The last thing dentists and patients want is to provide a treatment, and it does’t meet the expectations of the patient.
I think many dentists will have a problem, mainly because Six Month Smiles is sold to dentists as a way to dramatically increase their income, so dentist pay the money, go on the course, and everyone with overlapping teeth suddenly become suitable for Six Month Smiles! The reality is that Six Month Smiles will improve the alignment is nearly all cases, but many dentists will not assess the effect this has on the face as a whole, in addition, they are not suitably trained to give a comprehensive orthodontic treatment plan, so patients will need to see someone else, and have to pay for another consultation to get the comprehensive option! (In reality – who is going to do this?)