Common Procedures

 

Topics on this page

Regular Exams and Cleanings | Bonding | Bridges | Crowns | Extractions | Implants | Fillings | Root Canals
Sealants | Veneers | Mercury-Free Dentistry | Holistic Dentistry | Non-Surgical Gum Treatments
Digital X-Rays | Sleep Apnea Prosthetics


exams and cleanings

Regular exams and cleanings

Regular exams are an important part of maintaining your oral health. During your regular exam, we will:

  • Check for any problems you may not see or feel
  • Look for cavities or other signs of tooth decay
  • Inspect your teeth and gums for gingivitis and signs of periodontal disease
  • Perform a thorough teeth cleaning

Your regular exam can take anywhere from 20 minutes to 40 minutes. Each regular exam includes a detailed teeth cleaning, during which our hygienist will clean, polish, and rinse your teeth to remove any tartar and plaque that have built up on the tooth's surface.

Visiting our office every six months gives you the chance to talk with Dr. Bonn and receive answers to any questions you may have about your oral health. Regular exams are offered by appointment only, so please contact our practice today to schedule your next dental exam and teeth cleaning.

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bonding

Bonding

Bonding is a conservative way to repair slightly chipped, discolored, or crooked teeth. During dental bonding, a white filling is placed onto your tooth to improve its appearance. The filling "bonds" with your teeth. Because it comes in a variety of tooth-colored shades, it closely matches the appearance of your natural teeth.

Tooth bonding can also be used for teeth fillings instead of amalgam fillings. Many patients prefer bonding fillings because the white color is much less noticeable than silver amalgam. Bonding fillings can be used on front and back teeth, depending on the location and extent of tooth decay.

Bonding is less expensive than other cosmetic treatments and usually can be completed in one visit to our office. However, bonding can stain and is easier to break than other cosmetic treatments such as porcelain veneers. If it does break or chip, tell Dr. Bonn. The bonding can generally be easily patched or repaired in one visit.

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bridges

Bridges

A bridge may be used to replace missing teeth, help maintain the shape of your face, or alleviate stress in your bite.

A bridge replaces missing teeth with artificial teeth, looks great, and literally bridges the gap where one or more teeth may have been. Your bridge can be made from gold, alloys, porcelain, or a combination of these materials and is bonded onto surrounding teeth for support.

The success of any bridge depends on its foundation — the other teeth, gums, or bone to which it is attached. Therefore, it's very important to keep your existing teeth, gums, and jaw healthy and strong.

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crowns

Crowns

Crowns are a cosmetic restoration used to improve your tooth's shape or to strengthen a tooth. Crowns are most often used for teeth that are broken, worn, or have portions destroyed by tooth decay.

Crowns are "caps" cemented onto an existing tooth which fully cover the portion of your tooth above the gum line. In effect, the crown becomes your tooth's new outer surface. Crowns can be made of porcelain, metal, or both. Porcelain crowns are most often preferred because they mimic the translucency of natural teeth and are very strong.

Crowns are often preferable to silver amalgam fillings. Unlike fillings that apply metal directly into your mouth, a crown is fabricated away from your mouth. Your crown is created in a lab from your unique tooth impression, which allows a dental laboratory technician to examine all aspects of your bite and jaw movements. Your crown is then sculpted just for you so your bite and jaw movements function normally once the crown is placed.

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extractions

Extractions

There are times when it is necessary to remove a tooth. Sometimes a baby tooth has misshapen or long roots that prevent it from falling out as it should, and the tooth must be removed to make way for the permanent tooth to erupt. At other times, a tooth may have so much decay that it puts the surrounding teeth and jaw at risk, so Dr. Bonn may recommend removal and replacement with a bridge or implant. Infection, orthodontic correction, or problems with a wisdom tooth can also require removal of a tooth.

When it is determined that a tooth needs to be removed, Dr. Bonn may extract it during a regular checkup or request another visit for this procedure. The root of each tooth is encased within your jawbone in a "tooth socket," and your tooth is held in that socket by a ligament. In order to extract a tooth, Dr. Bonn must expand the socket and separate the tooth from the ligament holding it in place. While this procedure is typically very quick, it is important to share any concerns or preferences for sedation with us.

Once a tooth has been removed, neighboring teeth may shift and cause problems with chewing or your jaw joint function. To avoid these complications, Dr. Bonn may recommend that you replace the extracted tooth.

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implantsImplants

If you are missing teeth, it is crucial to replace them. Without all your teeth, chewing and eating can destabilize your bite and cause you discomfort. When teeth are missing, your mouth can shift and even cause your face to look older. Implants are a great way to replace your missing teeth.

implants processAn implant is a new tooth made of materials that looks just like your natural tooth. Your implant is composed of two parts that mimic a tooth's root and crown. The implant's "root" is a titanium rod placed into the jaw bone to act as a root. Once the rod is in place, a porcelain crown is attached to replace the top part of your tooth.

Implants may also be used to anchor dentures, especially lower dentures that tend to shift when you talk or chew. For patients with removable partial dentures, implants can replace missing teeth so you have a more natural-looking smile.

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fillings

Fillings

Traditional dental restoratives (fillings) include gold, porcelain, and composite/amalgam. The strength and durability of traditional dental materials continue to make them useful for situations where restored teeth must withstand extreme forces that result from chewing, such as in the back of the mouth.

Newer dental fillings include ceramic and plastic compounds that mimic the appearance of natural teeth. These compounds, often called composite resins, are usually used on the front teeth where a natural appearance is important. They can be used on the back teeth as well, depending on the location and extent of the tooth decay. Composite resins are usually more costly than the older silver amalgam fillings.

What's Right for Me?

Several factors influence the performance, durability, longevity, and expense of dental restorations:

  • The components used in the filling material
  • The amount of remaining tooth structure
  • Where and how the filling is placed
  • The chewing load the tooth will have to bear
  • The length and number of visits needed to prepare and adjust the restored tooth

The ultimate decision about what to use is best determined in consultation with Dr. Bonn. Before your treatment begins, you can discuss the options with him. To help you prepare for this discussion, it is helpful to understand the two basic types of dental fillings: direct and indirect.

  • Direct fillings are placed immediately into a prepared cavity in a single visit. They include dental amalgam, glass ionomers, resin ionomers, and composite (resin) fillings. Dr. Bonn prepares the tooth, places the filling, and adjusts it during one appointment.
  • Indirect fillings generally require two or more visits. They include inlays, onlays, veneers, crowns, and bridges fabricated with gold, base metal alloys, ceramics, or composites. During the first visit, Dr. Bonn prepares the tooth and makes an impression of the area to be restored. Then he places a temporary covering over the prepared tooth. The impression is sent to a dental laboratory which creates the dental restoration. At the next appointment, Dr. Bonn cements the restoration into the prepared cavity and adjusts it as needed.

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root canals

Root canal (endodontic) treatment

In the past, if you had a tooth with a diseased nerve, you'd probably lose that tooth. Today, with a special dental procedure called root canal treatment, you may save the tooth.

Inside each tooth is both the pulp and the nerve. The nerve is the vestige of the tissue that originally formed the tooth. Once the tooth has been in the mouth for a time, the functioning of the nerve is no longer necessary.

When a tooth is cracked or has a deep cavity, bacteria can enter the pulp. Germs can cause an infection inside the tooth. Left without treatment, pus builds up at the tip of the root, in the jawbone, forming a "pus-pocket" called an abscess. An abscess can cause the pulp tissue to die. If the infected pulp is not removed, pain and swelling can result. Certain by-products of the infection can damage your jawbones and your overall health. Without treatment, your tooth may have to be removed.

Treatment often involves from one to three visits. During treatment, your general dentist or endodontist (a dentist who specializes in problems of the pulp) removes the diseased pulp. Next, the pulp chamber and root canal(s) of the tooth are cleaned and sealed.

Often, posterior teeth that have endodontic treatment should have a cast crown placed in order to strengthen the remaining structure. Then, as long as you continue to care for your teeth and gums with regular brushing, flossing, and checkups so that the root(s) of the restored tooth are nourished by the surrounding tissues, your restored tooth can last a lifetime.

Most of the time a root canal is a relatively simple procedure with little or no discomfort, involving one to three visits. Best of all, it can save your tooth and your smile!

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sealants

Sealants

Sometimes brushing is not enough. Everyone has hard-to-reach spots in their mouth, and brushing doesn't always fully clean those difficult places. When that happens, you are at risk of tooth decay. Using sealants on your teeth gives you an extra line of defense against tooth decay.

Dental sealant is a plastic resin that bonds to the deep grooves in your tooth's chewing surface. When sealing a tooth, the grooves of your teeth are filled and the tooth surface becomes smoother — and less likely to harbor plaque. With sealants, tooth brushing becomes easier and more effective against tooth decay.

Sealants are usually applied to children's teeth as a preventive measure during the years of most likely tooth decay. However, an adult's teeth can also be sealed. It is more common to seal "permanent" teeth rather than "baby" teeth, but every person has unique needs. Dr. Bonn will recommend sealants on a case-by-case basis.

Sealants generally last from three to five years. However, it is fairly common to see adults with sealants still intact from their childhood. A dental sealant only provides protection when it is fully intact, so if your sealant comes off you must let your dentist know.

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veneers

Veneers

There's no reason to put up with gaps in your teeth or teeth that are stained, discolored, badly shaped, chipped, or crooked. Today, a veneer placed on top of your teeth can correct nature's mistake or the results of an injury and help you have a beautiful smile. Veneers are a highly popular solution among dental patients because of their lifelike tooth appearance.

Veneers are thin, custom-made shells crafted of tooth-colored materials (such as porcelain) and designed to cover the front side of your teeth. To prepare for veneers, Dr. Bonn will create a unique model of your teeth. This model is sent to the lab technition to create a mock up of your new smile.

With the mock-up as a guide, Dr. Bonn will then prepare the teeth either by reshaping the teeth, minimal reduction, or no tooth reduction at all. Temporaries will be fabricated so you can see a preliminary view of the newly created smile and agree that this is the appearance that you like. A copy of the temporaries is sent to the lab to recreate this smile in porcelain.

During the cementation appointment, you once again have a chance to view the veneers in your mouth prior to permanent placement. Every step is performed to ensure predictability and satisfaction.

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Mercury-free dentistry

All restorative materials in this office are mercury-free. The advent of tooth-colored composites and porcelains have made the use of mercury amalgams obsolete.

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Holistic dentistry

The placement of amalgam (mercury containing) fillings has been under debate for some time now. Although the Food and Drug Administration and the American Dental Association have expressed the opinion that there's a lack of evidence to indicate health risks to the patient from mercury containing fillings, anecdotal evidence supports health improvements after removal of amalgams.

This commentary is not intended to debate the issue of amalgams, which this author stopped placing in 1996, but rather the steps we implement to protect the patient from mercury aerosols created during the removal of amalgams.

Amalgam fillings have been utilized as a restorative material for dentistry since the 1920s. As with the majority of restorative materials, amalgams have a limited life expectancy. Clinical research has shown they last between 12 to 15 years on average. The size of the restoration, as well as the oral hygiene of the patient, plays a primary role in their longevity.

Removal of these fillings, whether the result of need or request, is done through the use of a high-speed rotary hand piece which emaciates the amalgam. During the physical removal of the amalgam, mercury aerosols may be released.

There are a number of procedures that should be implemented for the safety of the patient. Removal of the amalgam should be done under copious amounts of cold water. To avoid any ingestion or breathing in of the amalgam, the use of a rubber dam is critical. A rubber dam will isolate the teeth where the amalgams are to be removed, and a high volume suction is utilized to capture all debris.

A nose cap inhalation device, such as those used to deliver nitrous oxide, can be used to prevent any inhalation of the loose mercury aerosols. The patient can breathe either clean air or oxygen through the nose hood.

By following these protective protocols, the removal of mercury containing amalgams can be accomplished comfortably and safely.

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Non-surgical gum treatments

Early detection and treatment is the key to preserving teeth for a lifetime. If gingivitis or periodontal disease is detected, more than 90% of the cases can be treated successfully by non-surgical means.

This will involve visits with a hygienist who performs comfortable and thorough cleanings using hand instrumentation and ultrasonic instrumentation. Antibiotic mouth rinses will be used along with Oraquix, a numbing gel placed in the gum cuffs to be cleaned.

Further adjunctive treatment may involve using Arestin, an antibiotic powder that can be placed in deeper pockets to aid healing.

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Digital X-rays

We offer digital X-rays, which represent the latest technology in oral prevention and detection. With the digital systems we can reduce the amount of radiation exposure by more than 75%.

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Sleep apnea prosthetics

There are three types of sleep apnea: obstructive, central, and mixed. Of the three, obstructive is the most common. Despite the difference in the root cause of each type, in all three people with untreated sleep apnea stop breathing repeatedly during their attempts to rest, sometimes hundreds of times during the night and often for a minute or longer each time.

Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked, but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing. Consequently, sleep is extremely fragmented and of poor quality.

Sleep apnea is very common — as common as adult diabetes — and affects more than twelve million Americans, according to the National Institutes of Health. Risk factors include being male, overweight, and over the age of forty, but sleep apnea can strike anyone, at any age, even children. Because of the lack of awareness on the part of the public and health care professionals, the vast majority of sleep apnea sufferers remain undiagnosed and therefore untreated, though this serious disorder can have significant consequences.

Untreated, sleep apnea can lead to high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for impaired performance on the job and motor vehicle crashes. For many with sleep apnea, there is the distressful side effect of snoring. This can become a source of contempt or irritation from one's spouse, who often instigates treatment for the affected person.

Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues. A night of slumber in a sleep lab, hooked to monitors that measure both breathing and brain waves while health workers watch, has long been the standard for diagnosing sleep apnea or another disorder. While not a hundred percent effective, these tests can ascertain the severity of the condition and prescribe the recommended course of action.

But this lab-based polysomnography, or PSG, can cost $1,500. And while access has improved, there are large parts of the country where reaching a sleep lab can mean a few hundred miles of driving.

The most recommended treatment today is a CPAC machine. This delivers positive pressure oxygen through the nose via a mask. While very useful, there have been complaints of discomfort, dryness, and noise.

Other options are available in the dental community. Efforts to remove or recontour the uvula (the soft tissue that hangs at the back of the soft palate) have been attempted. This procedure has not been widely accepted due to post-operative discomfort and lack of successful outcomes.

A prosthetic mouthpiece has been developed and used with a higher success rate. This laboratory-constructed mouthpiece is fitted after molds of the patient's teeth have been taken. The mouthpiece fits over both the upper and lower teeth simultaneously. The purpose is to hold the lower jaw forward and keep the patient's airway open during sleep.

The mouthpiece can be adjusted to three settings, each one holding the jaw a little farther forward. A patient typically begins with the lowest setting and adjusts forward if the apnea is not reduced. So a period of trial and adjustments may be required. While cumbersome at the onset, feedback from wearers have been positive over time. The costs for a sleep apnea appliance ranges from $350 to $500.

The benefits of seeking and receiving treatment for sleep apnea can be life-altering. In this practictioners view, they warrant continued research.

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