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Illustrations: How A Tooth Decays

Illustrations: How A Tooth Decays

Healthy Tooth
Healthy Tooth
Enamel is the hard outer crystal-like layer. Dentin is the softer layer beneath the enamel. The pulp chamber contains nerves and blood vessels and is considered the living part of the tooth.

White Spots
White Spots
Bacteria that are exposed to sugars or carbohydrates can make acid, which attacks the crystal-like substance in the tooth’s outer surface. This process is known as demineralization. The first sign of this is a chalky white spot. At this stage, the decay process can be reversed. Using fluorides at home and in the dental office can help the tooth repair itself.

Enamel Decay
Enamel Decay
Demineralization continues. Enamel starts to break down. Once the enamel surface is broken, the tooth can no longer repair itself. The cavity has to be cleaned and restored by a dentist.

Dentin Decay
Dentin Decay
The decay reaches into the dentin where it can spread and undermine the enamel.

Pulp Involvement
Pulp Involvement
If decay is left untreated, it will reach the tooth’s pulp, which contains nerves and blood vessels. The pulp becomes infected. An abscess (swelling) or a fistula (opening to the surface of the gum) can form in the soft tissues.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Apicoectomy

What Is It?

Your teeth are held in place by roots that extend into your jawbone. Front teeth usually have one root. Other teeth, such as your premolars and molars, have two or more roots. The tip of each root is called the apex. Nerves and blood vessels enter the tooth through the apex, travel through a canal inside the root, and into the pulp chamber, which is inside the crown (the part of the tooth visible in the mouth).

An apicoectomy may be needed when an infection develops or persists after root canal treatment,or retreatment. During root canal treatment, the canals are cleaned, and inflamed or infected tissue is removed. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.

An apicoectomy is sometimes called endodontic microsurgery because the procedure is done under an operating microscope.

What It’s Used For

If a root canal becomes infected again after a root canal has been done, it’s often because of a problem near the apex of the root. Your dentist can do an apicoectomy to fix the problem so the tooth doesn’t need to be extracted. An apicoectomy is done only after a tooth has had at least one root canal procedure.

In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect additional canals that were not adequately treated and can clear up the infection by doing a second root canal procedure, thus avoiding the need for an apicoectomy.

An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.

Preparation

Before the procedure, you will have a consultation with your dentist. Your general dentist can do the apicoectomy, but, with the advances in endodontic microsurgery, it is best to be referred to an endodontist.

Your dentist may take X-raysand you may be given an antimicrobial mouth rinse, anti-inflammatory medication and/or antibiotics before the surgery.

If you have high blood pressure or know that you have problems with the epinephrine in local anesthetics, let your dentist know at the consultation. The local anesthetic used for an apicoectomy has about twice as much epinephrine (similar to adrenaline) as the anesthetics used when you get a filling. The extra epinephrine constricts your blood vessels to reduce bleeding near the surgical site so the endodontist can see the root. You may feel your heart rate speed up after you receive the local anesthetic, but this will subside after a few minutes.

How It’s Done

The endodontist will cut and lift the gum away from the tooth so the root is easily accessible. The infected tissue will be removed along with the last few millimeters of the root tip. He or she will use a dye that highlights cracks and fractures in the tooth. If the tooth is cracked or fractured, it may have to be extracted, and the apicoectomy will not continue.

To complete the apicoectomy, 3 to 4 millimeters of the tooth’s canal are cleaned and sealed. The cleaning usually is done under a microscope using ultrasonic instruments. Use of a surgical microscope increases the chances for success because the light and magnification allow the endodontist to see the area better. Your endodontist then will take an X-ray of the area before suturing the tissue back in place.

Most apicoectomies take between 30 to 90 minutes, depending on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.

Follow-Up

You will receive instructions from your endodontist about which medications to take and what you can eat or drink. You should ice the area for 10 to 12 hours after the surgery, and rest during that time.

The area may bruise and swell. It may be more swollen the second day after the procedure than the first day. Any pain usually can be controlled with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofem (Advil, Motrin and others) or prescription medication.

To allow for healing, you should avoid brushing the area, rinsing vigorously, smoking or eating crunchy or hard foods. Do not lift your lip to examine the area, because this can disrupt blood-clot formation and loosen the sutures.

You may have some numbness in the area for days or weeks from the trauma of the surgery. This does not mean that nerves have been damaged. Tell your dentist about any numbness you experience.

Your stitches will be removed 2 to 7 days after the procedure, and all soreness and swelling are usually gone by 14 days after the procedure.

Even though an apicoectomy is considered surgery, many people say that recovering from an apicoectomy is easier than recovering from the original root-canal treatment.

Risks

The endodontist will review the risks of the procedure at the consultation appointment. The main risk is that the surgery may not work and the tooth may need to be extracted.

Depending on where the tooth is located, there may be other risks. If the tooth is in the back of your upper jaw, the infection can involve your sinuses, and your dentist may suggest antibiotics and decongestants. The roots of the back teeth in the lower jaw are close to some major nerves, so surgery on one of these teeth carries a slight risk of nerve damage. However, your endodontist will use your X-rays to see how close the roots are to the nerves, and the chances of anything happening are extremely small.

An apicoectomy is usually a permanent solution, and should last for the life of the tooth.

When To Call a Professional

If you’re having any pain or swelling from a tooth that has had root-canal treatment, contact your dentist, who will take X-rays and do an exam. If your dentist feels you need an apicoectomy, you will need to set up an appointment for a consultation.

Please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Cracked Tooth Syndrome

What Is It?

Unlike teeth with obvious fractures, teeth with cracked tooth syndrome usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify.

Cracked tooth syndrome more often occurs in molars, usually lower molars, which absorb most of the forces of chewing.

People who grind or clench their teeth may be more susceptible to cracked tooth syndrome because of the constant forces put on their teeth. Sometimes a person’s normal bite causes certain molar cusps (the highest points of the tooth) to exert so much pressure on the opposing tooth that it cracks.

Teeth with large fillings or teeth that have undergone root canal treatment are weaker than other teeth and may be more likely to crack. People with one cracked tooth are more likely to have others, either at the same time or in the future.

Symptoms

You may experience pain in the tooth when you bite or chew. However, it probably will not happen all the time. The tooth may be painful only when you eat certain foods or when you bite in a specific way. You will not feel a constant ache, as you would if you had a cavity or abscess, but the tooth may be more sensitive to cold temperatures. If the crack worsens, the tooth may become loose.

Many people with cracked tooth syndrome have symptoms for months, but it’s often difficult to diagnose because the symptoms are not consistent.

Diagnosis

Diagnosis of cracked tooth syndrome is often difficult. Your dentist will do a thorough examination of your mouth and teeth, focusing on the tooth in question. He or she may use a sharp instrument called an explorer to feel for cracks in the tooth and will inspect the gums around the tooth for irregularities. Your dentist also may take X-rays, although X-rays often do not show the crack.

Your dentist may use a special instrument to test the tooth for fractures. One instrument looks like a toothbrush without bristles that fits over one part of the tooth at a time as you bite down. If you feel pain, the cusp being tested most likely has a crack affecting it.

Your dentist may shine a fiber-optic light on the tooth or stain it with a special dye to search for a crack. If the tooth already has a filling or crown, your dentist may remove it so he or she can better inspect the tooth.

Expected Duration

How long symptoms last depends somewhat on how quickly a cracked tooth can be diagnosed. Even then, treatment may not always completely relieve the symptoms.

Prevention

If you grind or clench your teeth, talk to your dentist about treatment. Grinding can increase your risk of cracked tooth syndrome.

Treatment

Treatments for cracked tooth syndrome do not always completely relieve the symptoms.

Treatment depends on the location, direction and extent of the crack. Cracks vary from superficial ones in the outer layers of the tooth to deep splits in the root affecting the pulp (the center of the tooth, which contains the tooth’s nerves).

If the crack affects one or more cusps of a tooth, the tooth may be restored with a crown. If a crack affects the pulp, you probably will need root canal treatment. About 20% of teeth with cracked tooth syndrome require root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it still will respond to pressure. This means that if you felt pain when you bit down before the root canal, you probably will not feel it as intensely as before, but you may feel it from time to time.

In some severe cases, the tooth may need to be extracted. Some cracks extend into the root of the tooth under the bone and there’s no way to fix the tooth. If your dentist decides the tooth needs to be extracted, you can have it replaced with an implant or a bridge.

When To Call a Professional

If you experience pain upon biting or chewing, contact your dental office.

Prognosis

Treatment of cracked tooth syndrome is not always successful. Your dentist should inform you about the prognosis. In some people, a restoration with a crown will relieve all symptoms. In others, root canal treatment solves the problem. Some people continue to have occasional symptoms after treatment, and may need to have the tooth extracted.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Cheilosis/Cheilitis

What Is It?

Cheilosis (also called cheilitis) is a painful inflammation and cracking of the corners of the mouth. It sometimes occurs on only one side of the mouth, but usually involves both sides. This disorder occurs most frequently in people with ill-fitting dentures that fail to adequately separate the upper and lower jaws. People with habits that irritate the corners of the mouth, like licking or rubbing those areas, also are more likely to develop cheilosis. Moisture gathers in skin folds at the corner of the mouth and provides a fertile environment for the formation of yeast (Candida) infections.

People with health disorders such as anemia, diabetes and immune deficiencies are particularly vulnerable.

Symptoms

Cracking, painful inflammation and sometimes weeping at the corners of the mouth.

Diagnosis

Your dentist or physician first will look to see if your dentures are fitting properly. He or she also will ask about your oral habits, such as licking the corners of your mouth. Blood tests may be done to test for anemias or immune deficiencies, and a smear or culture from the area may be tested to detect bacterial or yeast infections.

Expected Duration

Once the underlying cause is corrected, healing usually is quick.

Prevention

If you wear dentures, visit your dentist to be sure they fit properly and adequately support the face. Avoid licking or rubbing the corners of your mouth.

Treatment

Treatment focuses on eliminating causes such as oral habits or poorly fitting dentures. Infections may be treated with steroids or antifungal or antibacterial medications applied directly to the affected area. Severe infections, particularly in people with underlying medical problems, may require antifungal drugs that are taken orally.

When To Call A Professional

If you experience constant or repeat inflammation in the corners of your mouth, you should contact your dentist or doctor.

Prognosis

Good, once the cause has been eliminated.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Canker Sores

What Is It?

This disease causes painful, round ulcers to develop on the linings of the cheeks and lips, the tongue or the base of the gums. The tendency to develop these ulcers is inherited. Ulcers also can be associated with other diseases, particularly connective tissue diseases such as lupus or Behçet’s syndrome, which cause symptoms on the eyes and genitals as well as the mouth. There can be one or many ulcers at the same time, and they are recurrent, which means they keep returning. Multiple ulcers are scattered across the lining of the mouth, not clustered. Most people get one to three of these lesions at each episode, but a small number of people get more than a dozen ulcers at a time.

The cause of canker sores is not known, but most theories involve an immune abnormality. Certain blood diseases, vitamin and mineral deficiencies, allergies, trauma and Crohn’s disease cause similar ulcers. Canker sores are often confused with cold sores, which are caused by a herpes virus.

Approximately 17% of the population has recurrent aphthous stomatitis, which is classified into three categories:

  • Minor ulcers are less than 1 centimeter (slightly less then ½inch) in diameter and do not leave scars. The sores usually heal within two weeks.
  • Major ulcers (also called Sutton’s disease) are almost ½ inch or more in diameter, take longer than minor ulcers to heal and may leave scars.
  • Herpetiform ulcers are clusters of dozens of smaller ulcers. This form is rare.

People tend to have two to six ulcers per episode and have several episodes each year. For most people, canker sores are merely an annoyance, but some people experience large, painful, frequent sores that can reach 2 to 4 centimeters in diameter. The ulcers can interfere with speech and eating and can last for weeks to months, causing significant pain and disability. When they do heal, they may leave scars that can make it more difficult to move the tongue and can destroy oral tissue.

Symptoms

You may feel a burning or tingling sensation in an area of inflammation before an ulcer appears. An ulcer takes two to three days to form completely. The sores are round, shallow and symmetric, which means they are the same on all sides. The are painful. They usually are found on the inner part of the lips and cheeks and the tongue.

Diagnosis

Canker sores are the most common recurring oral ulcers and are diagnosed mostly by process of elimination. If the ulcers become more frequent or severe, are accompanied by other symptoms (such as rashes, joint pain, fevers or diarrhea) or are larger than about ½inch in diameter, you should visit your dentist or physician. He or she will try to rule out blood diseases, connective tissue diseases, drug reactions and skin disorders. A biopsy and blood tests may be required to rule out other conditions or diseases.

Expected Duration

The painful stage lasts 3 to 10 days, and most canker sores disappear within 2 weeks.

Prevention

There is no way to prevent canker sores.

Treatment

Treatment focuses on relieving symptoms. Rinsing with a warm-water solution and eating bland foods can minimize discomfort. Anesthetic medications or over-the-counter agents that are placed directly on the sores to coat them also may help.

People with more severe disease may need steroid medications placed on the lesions. These medications significantly shorten the healing time of the ulcers and prevent them from becoming larger. Other possible treatments include placing a medication called chlortetracycline (Aureomycin) on the sores or injecting steroids into the sores. In very severe, disabling cases, your dentist may prescribe oral medication.

When To Call a Professional

Canker sores usually are painful but are not a significant risk to your health. However, if you have severe, recurring canker sores, or if they are becoming worse, consult your dentist or physician. He or she may do tests to look for blood problems such as anemias or deficiencies of iron, folate or vitamin B12. Some research has shown that canker sores improve when these deficiencies are treated. Persistent or large ulcers can also occur as a part of other, more significant, disorders, including inflammatory bowel disease, connective tissue diseases, drug allergies, arthritic disorders, inflammatory skin disorders and cancer.

Prognosis

Most canker sores clear up without treatment and do not leave scars, although they usually return.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Bruxism – Teeth Grinding

What Is It?

bruxismBruxism is clenching or grinding your teeth, often without being aware that your are doing it. In the United States, bruxism affects an estimated 30 to 40 million children and adults.

Some people grind their teeth only during sleep; this condition is called “nocturnal bruxism” or “sleep-related bruxism.” Others grind their teeth during the daytime as well, most often during situations that make them feel tense or anxious. People with severe bruxism can fracture dental fillings or cause other types of tooth damage. Severe bruxism has also been blamed for some cases of temporomandibular joint dysfunction (TMD), mysterious morning headaches and unexplained facial pain.

Bruxism can have a variety of psychological and physical causes. In many cases, it has been linked to stress, but it can also simply be the body’s reaction to the teeth being aligned wrong or a poor bite (the way the teeth come together). Bruxism can sometimes occur as a complication of severe brain injury, or a symptom of certain rare neuromuscular diseases involving the face. Bruxism also can be an uncommon side effect of some psychiatric medications, including antidepressant medications, including fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil).

Symptoms

Symptoms of bruxism include:

  • Rhythmic contractions of the jaw muscles
  • A grinding sound at night, which may disturb the sleep of someone who shares a bedroom with a “bruxer”
  • A dull morning headache
  • Jaw muscles that are tight or painful, especially in the morning
  • Chronic facial pain
  • Damaged teeth, fractured dental fillings and injured gums

Diagnosis

Your dentist will ask about your current life stresses, your general dental health and your daily medications. He or she also will want to know whether you routinely drink beverages containing alcohol or caffeine, because both of these chemicals seem to increase the tendency to grind your teeth.

If you share your bedroom, the dentist also may want to ask that person about your sleep habits, especially about any unusual grinding sounds heard during the night.

Your dentist will examine you, paying special attention to your mouth and jaw. During this exam, your dentist will check for tenderness in your jaw muscles, as well as for any obvious dental abnormalities, such as broken teeth, missing teeth or poor tooth alignment. If your dentist suspects that you have bruxism that is related to dental problems, he or she may conduct a more detailed assessment. In addition to checking your “bite,” the dentist will examine your teeth and gums for damage caused by bruxism. The dentist will also take a series of mouth X-rays.

If your child grinds or clenches his or her teeth, discuss the problem with your family dentist. Although many children eventually outgrow bruxism, even short-term tooth grinding can cause damage to your child’s permanent teeth.

Expected Duration

Of all children who brux between the ages of 3 and 10, more than half will stop spontaneously by age 13.

In teenagers and adults, how long bruxism lasts depends on its cause. For example, bruxism can last for many years if it is related to a stressful life situation that doesn’t go away. However, if bruxism is being caused by a dental problem, it should stop when the teeth are repaired and realigned — often within a few dental visits.

Prevention

If your bruxism is related to stress, you may be able to prevent the problem by seeking professional counseling or by using strategies to help you learn to relax. Also, try cutting down on stimulants such as tobacco and caffeine.

In both children and adults, tooth damage related to bruxism can be prevented by wearing a night bite plate or a bite splint (a dental appliance worn at night to stop teeth grinding).

Treatment

The treatment of bruxism varies depending on its cause:

  • Stress — If you have bruxism that is stress-related, your dentist or physician may recommend professional counseling, psychotherapy, biofeedback exercises or other strategies to help you relax. Your dentist or physician also may prescribe muscle relaxant medications to temporarily ease the spasm in your clenched and overworked jaw. If conventional therapy does not help, your dentist may refer you to an oral surgeon who may inject botulinum toxin directly into your jaw muscles (to temporarily interfere with muscle contractions).
  • Dental problems — If your bruxism is related to tooth problems, your dentist will probably treat it with occlusal therapy (to correct tooth alignment). In severe cases, your dentist may need to use onlays orcrowns to entirely reshape the biting surfaces of your teeth.
  • Brain injury or neuromuscular illness — Your bruxism may be especially hard to treat if you have these medical problems. Your oral surgeon may give you injections of botulinum toxin if more conservative treatments fail.
  • Medication — If you develop bruxism as a side effect of antidepressant medications, your doctor either can switch you to a different drug or give you another medication to counteract your bruxism.

When To Call A Professional

Call your physician or dentist if you have symptoms of bruxism, or if you are told that you grind your teeth while you sleep.

Also, make a dental appointment immediately if you fracture a tooth, lose a filling, or notice that your teeth are becoming abnormally loose in their sockets.

Prognosis

Even without special treatment, more than half of young children with bruxism stop grinding their teeth by age 13. Until your child stops bruxing on his or her own, your dentist can fit your child with a night bite plate to prevent excessive tooth wear. This device is effective in almost all children who use it as directed.

In teenagers and adults, the outlook is excellent if bruxism is treated properly. Even if all other therapies fail, injections of botulinum toxin can temporarily stop bruxism in most patients.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

Can Medication Have an Effect on My Oral Health?

Can Medication Have an Effect on My Oral Health?
oral health medication

Yes, medications can have oral side effects — dry mouth being the most common. Be sure to tell your dentist about any medications that you’re taking, even medicines that you purchase without a prescription.

These are the types of medications that will often produce dry mouth:

  • Antihistamines
  • Decongestants
  • Pain Killers
  • Diuretics
  • High Blood Pressure Medications
  • Antidepressants

Other medications may cause abnormal bleeding when brushing or flossing, inflamed or ulcerated tissues, mouth burning, numbness or tingling, movement disorders and taste alteration. If you experience any of these symptoms,  please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

A Closer Look at Cavities


Follow the development of a cavity and learn how minor changes to your daily routine can help protect your smile.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

How to Care for Children’s Teeth

How to Care for Children’s Teeth

This short video teaches you the correct way to brush children’s teeth giving them a healthy start toward a lifetime of good oral health.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.

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Implants: The Modern Solution for Missing Teeth

Tooth human implant (done in 3d graphics)

Dental implants are increasingly valuable tools in modern dentistry. Although they have been available for more than a quarter of a century, only in the last decade has technology advanced so that implants can be considered the optimal solution for missing teeth. Instead of endless rounds of heroic attempts to save a failing tooth, it is increasingly simpler, less invasive, and more cost-effective to replace the failing tooth with a dental implant.

If relatively little tooth structure remains supragingivally or furcation involvement is incipient, then conventional therapy could be tedious, time-consuming, and short-lived. If root caries are rampant, periodontal disease is aggressive, or systemic health is in decline, then aggressive therapy to save a failing dentition could be as counterproductive as it is contraindicated. Interceptive implant therapy should be considered under these circumstances.

Today, most dental implants can be placed in simple 1-stage surgical procedures. Long-term survival rates have been steadily improving, even in smokers. Restorative processes are simpler and more reliable.

Modern dental implants are generally made from titanium, with a threaded and rough microsurface on the outside. They come in lengths ranging from 7 to 16 mm and diameters from 3.5 to 6.0 mm. Increasingly, implants tend to be manufactured so that tapering aids initial stability. A special subclass of 1-piece small-diameter implants is also available.

Dental Implants

The 4 portionsof implants (Figure 4) are:

  • Implant body;
  • Collar;
  • Connection; and
  • Abutment.[1]

Figure 4. Schematic of a dental implant.

Implant body. The implant body is the portion inserted in the bone, with an exterior surface designed to osseointegrate (fuse) to the bony surface with which it comes into contact.

The rough surface interfacing with bone is generally achieved by abrasively blasting the exterior surface before it is treated with special acids. This creates an extremely porous microsurface, which facilitates osseointegration.[2]The improved osseointegration of modern implants has resulted in higher survival rates over earlier-generation systems.[3]

Collar. The collar is the upper part of the implant body that traditionally starts the passage through the gingival complex into the mouth.

With early implants, bone and gingiva levels used to “die-back,” “lose bone,” or “develop biologic height” when exposed to the oral environment. A variety of collar designs were developed to try and minimize this bone loss. The implants have now improved so that bone loss with modern systems is greatly reduced, with the result that implants are now electively placed deeper into the bone.

Connection. This is a 2-part device. The first part lies generally inside the implant body. The other component of the abutment or restorative device fits inside and is secured with a screw.

This portion can make a restoration either extremely difficult or quite simple. Problems can result if the connection is weak, fragile, easily worn, or has high rotational instability. Clinical procedures can become complex, tedious, and liable to fail. If not stable, screws can loosen and restorations can fall off. In contrast, deep, strong connections with good rotational stability make life simple for the restorative dentist and allow for fabrication of more durable restorations.[4]

Abutment. This device fits into the connection and emerges to pass through the gingival complex with an “emergence profile” (the form passing through the gingival complex) and a final portion, which retains the final crown.

As the trend to place implants deeper continues, development of the “emergence profile” in the abutment becomes more important. When placed properly, the portion of the implant emerging from the gingiva allows the implant to reproduce the shape, appearance, and color of a tooth. Traditionally made of titanium, abutments have also been made with a cast gold process and increasingly with zirconia, at least in the emergence and restorative portion of the implant. This material allows for a custom form, provides the optimal gingival reaction, and has a natural color. A conventional crown provides the final restoration.

A Natural Result

Implant-based restorations can only appear natural when the surrounding soft and hard tissues in the region appear “normal.” As in this case, soft and hard tissue augmentation is often required at the time of implant placement to generate the desired aesthetic and functional result.

For more information, please call Dr. Jeffrey Fester in Roswell, GA, 770.587.4202 to schedule a free consultation.