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Implant Planning: What to Know About CBCT Scans

Implant Planning: What to Know About CBCT Scans

At Britten Periodontics & Implant Dentistry, we use 3D low radiation Cone Beam CT Scans for diagnosis and treatment planning. While it only take less than a minute, the scan supports a much higher level of patient care compare to conventional 2D X-ray films. 3D low radiation Cone Beam CT Scans allow a detailed look at existing teeth, bone, nerves, and tissue.

The 3D Cone Beam CT Scan provides three-dimensional and cross-sectional views that allow Dr. Britten to:

  • Examine the quality and density of the bone that will anchor the dental implant
  • Determine the proper treatment approach for each individual patient
  • Determine the precise placement of implants
  • Select the correct type and size of the implants
  • Avoid the nerves and sinuses.

Dr. Britten uses the best materials for implants, employing state-of-the art technology and procedures. His commitment to quality implant care has gained the confidence and earned the trust of many of patients just like you.

Proper Home Care for Dental Health!

Proper Home Care

Power toothbrushes, especially Philips Sonicare (Bestsellers | Philips) brushes, are our #1 recommendation for our patients.  They are easy to use and can remove plaque more efficiently than a manual toothbrush.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job holding it for at least 5 seconds on one or two teeth at a time.

Toothbrushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

  1. When using a Sonicare, place the brush at a 45 degree angle, ensuring that you always feel the bristles on the gums.
  2. Brush the outer, inner, and biting surfaces of each tooth.
  3. Use the tip of the brush to clean the inside of the front teeth.
  4. Brush your tongue to remove bacteria and freshen your breath.

Clean Between Your Teeth at least 1-2 x a day With Proxabrushes, Softpicks and/or floss:

Softpicks and interdental brushes (also known as proxabrushes) are available in many sizes and are gaining in popularity because they are easy to use, and for some patients – more effective than flossing alone!

Proxabrushes  – Proxabrushes are available on handles (similar to length of toothbrush handles) or in travel sizes.  A travel proxabrush is covered by a cap that sheaths over the brush. This form of Proxabrush is conveniently kept in ones pocket or purse, and thus is good for those individuals who want to clean between their teeth during the day, or to take to restaurants or trips.

Who Should Use Them?

  • Anyone who finds flossing difficult
  • People who don’t like to floss
  • People with exposed roots
  • Deep dental pockets
  • Areas of bone loss or gum recession
  • Areas where teeth are missing
  • Previous gum surgery which has exposed more tooth and root anatomy
  • Larger spaces between the teeth
  • Grooves and concavities in teeth and roots
  • People with braces – great around brackets and wires

Softpicks – Traditionally, floss has been used to help remove the disease-producing bacteria in between the teeth. This bacteria cannot be reached with a toothbrush alone. Bacteria between the teeth is a primary cause for most gum disease and dental decay. It is so important to clean between your teeth every day!

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

  1. Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
  2. Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
  3. Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

OTHER IMPORTANT ORAL HYGIENE AIDS:

GUM Brand rubbertip stimulator or Plaque Buster travel rubbertip stimulator –  These tools promote healthy and firm gums by massaging the gingival tissues and stimulating the blood flow. It is a traditional method to maintain your gums in good health. It consists of two separate parts: a comfortable ergonomic anodized aluminum handle and a replaceable synthetic rubber tip stimulator. In addition to massaging the tissue it helps to dislodge food particles and dental plaque between the teeth.

  • Point the gum stimulator toward your gums at a 45 ­degree angle.
  • Run the rubber tip of the gum stimulator in a circle for 10 seconds between each tooth. Stimulate the gums by working the rubber tip back and forth along the gum line. Besides removing plaque, it stimulates your gums and helps with blood circulation.
Compared to traditional gum stimulators that use a metal handle with a disposable tip, the Plaque Buster is an innovative, one­piece, injection­molded design with no metal to scratch the user’s teeth. The device was designed for a comfortable overall feel.
TEPE compact end tufted brush – This brush is designed for hard­ to ­reach or simply difficult ­to­ clean areas where the dental plaque buildup will become harmful to teeth or gums, such as:

  • Exposed spaces between the roots of molar teeth due to periodontitis and gum recession, keeping furcations clean
  • Complex fixed dentures, bridges or dental implants that are inherently hard to clean
  • Orthodontic appliances
  • Difficulty in cleaning the back surfaces of the last teeth at the end of the dental arch at the back of the mouth
  • Other hard ­to ­reach areas identified by your dentist or dental hygienist
GUM brand tongue scraper – The front portion of the tongue is pretty self­ cleansing, however, the back portion can often collect more bacteria. You can use a toothbrush or a special tongue scraper. Tongue scrapers come in various designs. Be gentle. Don’t go too far back and stick to the center of the tongue and not the sides which are more delicate and prone to injury. If you have a sensitive gag reflex a tongue scraper will probably work better for you.Do it daily. Just like brushing and flossing, frequency is key. Oral bacteria are constantly reproducing. Once you start doing it daily, you may find that your mouth just doesn’t seem as clean without doing it!

Implant Care – Care for dental implants is just as important as caring for natural teeth. Thorough oral hygiene is necessary to prevent diseases around implants. With proper home care and regular professional maintenance, implants can last a lifetime.

There are many different “tools” to aid in cleaning implants. Our favorite aids include the Tepe compact tuft brush and Proxysoft Bridge and Implant floss.

Oral Hygiene Products We Love

What is Crown Lengthening?

Crown Lengthening

Crown lengthening is generally performed to improve the health of the gum tissue or to prepare the mouth for restorative or cosmetic procedures.  In addition, crown lengthening procedures can also be used to correct a “gummy” smile, where teeth are covered with excess gum tissue.  Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue.  This treatment can be performed on a single tooth, many teeth, or the entire gum line, exposing an aesthetically pleasing smile.

Reasons for crown lengthening

Crown lengthening is a versatile and common procedure that has many effective uses and benefits.  The vast majority of patients who have undergone this type of surgery are highly delighted with the results.

Here are some of the most common reasons for crown lengthening:

  • Restoration of damaged teeth – Periodontal disease can cause severe damage to the teeth, as can trauma and decay.  Where teeth have been broken beneath the gum line, crown lengthening can be used to prepare the area for a new restoration to correct the damaged teeth.
  • Cosmetic uses – Extra gum tissue can make teeth look unnaturally short and can also increase susceptibility to periodontal infections.  Removing excess gum tissue can restore a balanced, healthy look and improve the aesthetic appearance of the smile.
  • Dental crowns – Crown lengthening provides more space between the supporting jawbone and dental crown.  This prevents the new crown from damaging gum tissues and bone once it is in place.

What does crown lengthening involve?

Your dentist will make a series of small incisions around the soft tissue in order to separate the gums away from the teeth.  Even if only one tooth requires the re-contour, neighboring teeth are usually treated to provide a more even reshaping.  Separating the gums provides your dentist with access to the roots of the teeth and the underlying bone.

In some cases, the removal of a small amount of tissue will provide enough tooth exposure to place a crown.  In other cases, your dentist will also need to remove a small amount of bone from around the teeth.  The bone is usually removed using a combination of special hand instruments, and rotary instruments.  The rotary instruments roughly resemble the drill that is used in cavity treatment.

The teeth will look noticeably longer immediately after surgery because the gums will have been repositioned. The teeth will look noticeably longer immediately after surgery because the gums have now been repositioned.

Your dentist may secure the surgical site using an intraoral (periodontal) bandage which serves to prevent infection.  Prescriptions may be provided for pain medication, and a chlorhexidine (antimicrobial) mouth rinse will be given to help reduce any bacteria attempting to recolonize.  The surgical site will be completely healed in approximately two to three months.

Mouth-Body Connection: What You Should Know

Mouth – Body Connection

Research studies have shown that there is a strong association between periodontal disease and other chronic conditions such as diabetes, heart disease, pregnancy complications and respiratory disease.

Periodontal disease is characterized by chronic inflammation of the gum tissue, periodontal infection below the gum line and a presence of disease-causing bacteria in the oral region.  Halting the progression of periodontal disease and maintaining excellent standards of oral hygiene will not only reduce the risk of gum disease and bone loss, but also reduce the chances of developing other serious illnesses.

Common cofactors associated with periodontal disease:

Diabetes

A research study has shown that individuals with pre-existing diabetic conditions are more likely to either have, or be more susceptible to periodontal disease.  Periodontal disease can increase blood sugar levels which makes controlling the amount of glucose in the blood difficult.  This factor alone can increase the risk of serious diabetic complications.  Conversely, diabetes thickens blood vessels and therefore makes it harder for the mouth to rid itself of excess sugar.  Excess sugar in the mouth creates a breeding ground for the types of oral bacteria that cause gum disease.

Heart Disease

There are several theories which explain the link between heart disease and periodontitis.  One such theory is that the oral bacteria strains which exacerbate periodontal disease attach themselves to the coronary arteries when they enter the bloodstream.  This in turn contributes to both blood clot formation and the narrowing of the coronary arteries, possibly leading to a heart attack.

A second possibility is that the inflammation caused by periodontal disease causes a significant plaque build up.  This can swell the arteries and worsen pre-existing heart conditions.  An article published by the American Academy of Periodontology suggests that patients whose bodies react to periodontal bacteria have an increased risk of developing heart disease.

Pregnancy Complications

Women in general are at increased risk of developing periodontal disease because of hormone fluctuations that occur during puberty, pregnancy and menopause.  Research suggests that pregnant women suffering from periodontal disease are more at risk of preeclampsia and delivering underweight, premature babies.

Periodontitis increases levels of prostaglandin, which is one of the labor-inducing chemicals.  Elevated levels prostaglandin may trigger premature labor, and increase the chances of delivering an underweight baby.  Periodontal disease also elevates C-reactive proteins (which have previously been linked to heart disease).  Heightened levels of these proteins can amplify the inflammatory response of the body and increase the chances of preeclampsia and low birth weight babies.

Respiratory Disease

Oral bacterium linked with gum disease has been shown to possibly cause or worsen conditions such as emphysema, pneumonia and Chronic Obstructive Pulmonary Disease (COPD).  Oral bacteria can be drawn into the lower respiratory tract during the course of normal inhalation and colonize; causing bacterial infections.  Studies have shown that the repeated infections which characterize COPD may be linked with periodontitis.

In addition to the bacterial risk, inflammation in gum tissue can lead to severe inflammation in the lining of the lungs, which aggravates pneumonia.  Individuals who suffer from chronic or persistent respiratory issues generally have low immunity.  This means that bacteria can readily colonize beneath the gum line unchallenged by body’s immune system.

What do Bleeding Gums Mean?

What do Bleeding Gums Mean?

Problems such as bleeding gums can be a sign that your gumline is not being properly cared for and may need more attention. While you don’t need to panic if you notice that your gums bleed, you do need to take action to help prevent the progression to a more advanced form of gum disease. Most commonly, gingivitis (inflammation of the gums) is the result of plaque – a sticky film of bacteria forming on the teeth around the gumline or under the gums. Plaque bacteria can lead to gum disease, tooth decay, and even tooth loss.

The Most Common Cause of Bleeding Gums

In most cases, gums bleed because of the harmful plaque – and the millions of bacteria in it – found at or around the gumline being left to develop gingivitis. Gingivitis, the early, yet still reversible form of gum disease, may require treatment and an improved oral hygiene routine to help reverse it.

When gingivitis begins to cause irreversible damage to the gum tissues or bone, the diagnosis would be periodontitis, or periodontal disease.

How to Stop Bleeding Gums

There are many ways to help improve your oral health and keep your gums from bleeding. Since gingival bleeding is mainly due to inadequate plaque removal from the teeth at or around the gumline, starting an effective oral hygiene routine is a great way to help treat and prevent your gums from bleeding.

Brush at least twice a day: Make sure to brush the dentist-recommended two minutes every session to better remove any plaque that can lead to gum disease and tooth decay. Consider switching to an electric toothbrush like the Phiips Sonicare

Clean in between your teeth: Flossing, softpicks or using proxabrushes between your teeth at least once or twice a day is one of the most important ways to help prevent bleeding gums and maintain good oral health. It removes plaque and food particles that may be just under the gumline between the teeth, which is where gum disease often starts.

  • Avoid Tobacco: Tobacco use of all types can damage your gums and can also make you far more likely to develop gum disease.  ***Smoking can mask severe gum disease, as bleeding is minimal or non-existent in smokers, but the damage to the tissues is occurring faster, with the blood supply cut off to help the tissues heal. Also, tar builds up on the teeth and harbors even more harmful plaque bacteria.
  • See a Dental Professional Regularly: Harmful plaque bacteria can even lead to issues beyond gingivitis like weakened tooth enamel. Regular dental hygiene visits at your dentist or periodontist’s office will remove plaque and tartar that can’t be removed at home. This will help prevent gums from bleeding and keep your mouth healthy.
  • Maintain a Healthy Lifestyle: The American Dental Association (ADA) recommends eating a balanced diet and avoiding between-meal snacking. Also, reducing stress from your life can help prevent gum disease to keep your smile healthy.

Why Are My Teeth Sensitive to Cold?

Why Are My Teeth Sensitive to Cold?

One question we get asked often is why teeth might feel sensitive. The answer to this question depends on the ailment, as will the treatment.

To understand the answer to this question, it helps to know a little about the structure of your teeth. Each tooth consists of the crown, which is the visible part of the tooth, and the root, which anchors each tooth into your jaw. Components of the crown include:

  • Tooth enamel– The hard, white-looking layer that protects the sensitive inner parts of each tooth. Tooth enamel is the hardest material in your body – even stronger than bone.
  • Cementum– A thin, protective layer of bone-like tissue under the gum line that protects the tooth root.
  • Dentin– A layer of softer tissue which contains tiny canals or ‘tubules’.
  • Pulp– The soft tissue deep inside each tooth that contains blood vessels, connective tissue and nerves.

If for any reason the enamel starts to wear way or erode, your tooth’s dentin is exposed. When this happens, nerve signals pass to the tooth root and from there to the brain – meaning that things like eating popsicles or drinking hot drinks, which normally don’t cause a reaction, can suddenly trigger pain.

What Causes Sensitive Teeth?

A range of factors can lead to tooth sensitivity, but there are two main underlying reasons: enamel loss and gum recession.

Causes of enamel loss include: 

  • Over-zealous brushing:Brushing too vigorously or too often.
  • Acid erosion:From acidic foods and drinks such as sugary sports drinks and sodas.

Causes of gum recession include:

  • Using a hard bristle toothbrush– This can injure the gum tissue.
  • Gum disease– A common oral health disease that can cause receding gums.
  • Your genes– Regardless of how you care for your teeth, you may be genetically susceptible to gum recession.
  • Smoking– Tobacco products increase plaque build-up on teeth which over time can lead to a greater risk of gum recession.

Professional and at-home teeth whitening (bleaching) treatments may cause temporary sensitivity, although this should disappear within a short time of stopping treatment.

Ways to Keep Your Mouth Healthy

If you’re wondering how to manage tooth sensitivity or how to soothe a sensitive tooth, there are a number of ways:

  • Start using an over the counter toothpaste such as Sensodyne or your dentist may give you a prescription fluoride toothpaste with other minerals that can help.
  • Brush twice a day, every day. Brush gently with a soft-bristled toothbrush for four minutes each time to keep teeth and gums clean and healthy. We often recommend the Philips Sonicare powerbrush to our patients as it is safe and effective in cleaning around both the teeth and gums.
  • Floss daily, or use interdental aides such as softpicks or proxabrushes.Making cleaning between your teeth a part of your daily tooth care routine helps maintain healthy gums.
  • Visit your dentist regularly. Schedule checkups for every six months or more often, as advised by your dentist.

How often should I see my dentist?

Many people are afraid or experience anxiety about going to the dentist, and because of this, some patients will try to go as infrequently as possible. The answer to how often you should see your dentist actually varies, depending on the state of your mouth.

If your teeth and gums are very healthy, you should visit your dentist at least twice a year for dental exams and cleaning. If you have a history of gum disease or other problems, you may need to visit your dental hygienist more often, often anywhere from 3 or 4 up to 6 times a year. Periodontal patients often see their dentist or periodontist every 3 months for hygiene visits, as many studies have shown that more harmful periodontal bacteria repopulate in the mouth in only 11 weeks time.

Frequent dental visits (particularly those for dental cleanings and periodontal maintenance visits) are in your best interest to prevent breakdown of the health of teeth and gums.

What is Peri-Implantitis?

What is Peri-Implantitis?

Peri-implantitis is an infection that hurts gums, bones and other tissues surrounding dental implants. It is very similar to gum disease. Severity can range from minor inflammation of the gums to severe degradation of the teeth and jaw. If left untreated, this often leads to patients losing their dental implants and developing other serious dental problems.

Peri-implantitis is caused by the bacteria and food particles that gradually accumulate around dental implants and gum lines. For this reason, peri-implantitis tends to grow unnoticed in its early stages. However, later symptoms can become severe. Ranging from minor to dangerous, symptoms include:

  • Redness and inflammation of the surrounding gum tissue.
  • Deepening of the gum pockets around the implant.
  • Exposure or visibility of the implant threads.
  • Loosening of the implant.
  • Pus discharging from the tissues around the implant.
  • Loss of supporting bone.
  • Bleeding upon being probed.
  • Swollen lymph nodes around the neck.

Peri-implantitis if left untreated can progress to severe stage and eventually lead to implant loss.  If caught early, and with adequate supervision from a competent dentist, peri-implantitis can be treated before it ever causes undue discomfort or embarrassment.

What is the cause of peri-implantitis?


There are three primary factors that influence your susceptibility to peri-implantitis:

  • Prior disease: patients affected by a disease that affects the whole body (known as systemic disease) can be extra susceptible to peri-implantitis. If you have diabetes or another systemic disease, consult with your dentist about your dental implants. Patients with periodontal disease can be at a higher risk to developing another mouth infection, like peri-implantitis.
  • Oral hygiene: If not cared for, plaque and tartar that are full of harmful bacteria and pathogens can easily build up around teeth and gums. These degrade tissue and cause irritation and infection. Other social factors can cause peri-implantitis, like smoking and drug abuse. What you put in your mouth affects your mouth; we advise extreme caution regarding what you place in your body.
  • Parafunctional habits: an easier term for this is “involuntary habit.” In this case, peri-implantitis is isolated to habits like involuntarily grinding your teeth in your sleep (bruxism), poorly positioning your teeth – either due to misalignment or poor muscle control – when the jaw is fully closed (malocclusion), nail biting and thumb sucking.

How can I avoid peri-implantitis?

Ways to avoid peri-implantitis:

  • Good oral hygiene:
  • Brush your teeth frequently (at least 2 x a day for 2 minutes with a powerbrush – Sonicare is preferred)
  • Use dental floss or other aides recommended by your dentist or dental hygienist, such as Proxysoft Bridge and Implant Floss or TEPE compact tuft brush.
  • If you suffer from any oral parafunctional habits (unconscious or involuntary habits with your mouth), like teeth grinding, poor jaw alignment or nail biting, seek help. Your dentist can provide several suggestions or treatments for these habits before they adversely affect your health.
  • Make sure you have a dental specialist perform dental implant surgery or to treat your peri-implantitis.  Periodontists are also implant specialists, with solid experience and advanced training in proper techniques.  Poor dental work can make your personal oral hygiene difficult and painful, and can expose you to pathogens later.If you are considering dental implants or if you feel you may have peri-implantitis, give us a call! You will receive excellent care. We want you to have a healthy mouth, and we know how to help you get it!

How is peri-implantitis treated?

Sometimes, surgical therapy is necessary to repair the damage from peri-implantitis.  Dr. Britten offers the latest technology in dental implant surgery, using both a “flap” type of procedure, or the use of  Laser Assisted Peri-Implantitis Protocol, or LAPIP. The LAPIP protocol uses a laser to target the bacteria that cause peri-implantitis without disrupting the stability of the implant itself. Using a laser, we can remove necrotic tissue, infection, anaerobes and other undesirables from the implant surface and surrounding periodontal structures.

Why Should Gum Recession be Taken Seriously

Gum recession refers to the loss of gum tissue along the gumline. This can occur as a result of periodontal disease (gingivitis, periodontitis, advanced periodontitis), the natural aging process, or abrasive habits when it comes to brushing the teeth.

Why should gum recession be taken seriously?

When gum recession occurs, the root structure of the tooth becomes exposed. This means that tooth decay and other problems can affect the teeth along the gumline and beneath it. Since healthy gums are essential for a healthy mouth, getting gum recession treated is important for lasting dental wellness. When recession occurs to the point that no firm gum tissue remains, this leaves the roots of the teeth and the underlying bone relatively unprotected, which could result in root sensitivity, bacterial penetration, decay and even loss of teeth.

A gingival graft is designed to address these problems. A thin piece of tissue is taken from the roof of the mouth or gently moved over from adjacent areas to provide a stable band of attached gum tissue around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root, however, the main objective is to re­establish the protective barrier or layer of the gum around the tooth. Occasionally, the patient may need multiple procedures to achieve the ideal amount of root coverage.

Dr. Britten has trained in the latest minimally invasive techniques of gum grafting and can often perform the entire procedure through a pinhole incision.

Laser Assisted Periodontal Therapy

Laser Assisted Periodontal Therapy

Laser therapy uses intense beams of light projected by a dental laser.  Dental lasers can be used to perform a wide variety of treatments.

Minimally Invasive gum disease treatment for moderate to severe cases

Laser Assisted Periodontal Therapy, is an advancement in periodontal infection removal. ™ laser uses a specific wavelength that targets and destroys diseased tissue and bacteria from periodontal pockets.

In Laser Assisted Periodontal Therapy there is no cutting away of the gums or bone as in traditional treatment.  The PerioLase MVP-7 laser is used in our office for periodontal disease treatment. This procedure kills harmful bacteria and removes unhealthy gum tissue without harming bone or healthy tissue.  In ideal candidates, LANAP Periodontal Therapy can be a gentler, more precise treatment that conserves healthy tissue and minimizes pain and discomfort.

Laser Assisted Periodontal Therapy is:

  • More Comfortable 
  • Minimally Invasive
  • Less Damaging
  • Safe
  • Biologically Healthy

The beauty of dental lasers is that they damage far less of the surrounding tissue than traditional techniques – which means less discomfort and pain.

A small laser fiber is inserted into the diseased gum pocket.  This precise laser disintegrates the bacteria and diseased tissue without harming any of your healthy tissues.  The disease is removed and healthy gums and bone are given a good chance to regenerate.

In addition, the laser sterilizes as it removes diseased tissue and provides a sealing clot that inhibits reinfection.

is safe for patients with health concerns.  In addition, patients taking blood thinning medications (e.g. Coumadin, aspirin, Plavix) need not go off of these medications to receive treatment.  It is also more indicated for smokers as gum recession is less prevalent in laser dentistry.

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