Broken crown or temporary? Read before you DIY

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois.  His specialties are cosmetic dentistry, dental implants, and patient education. The focus of this article will be to help patients avoid the problems associated with delay in seeking professional care with or without an attempt to repair or glue teeth themselves at home.

F.Y.I. why D.I.Y. may not always be I.Y.B.I. ( in your best interest)

Life has its surprises. In addition to all the possible mishaps with our homes, cars, plans and the weather to mention a few; our teeth will sometimes add to our daily challenges.

Typical scenarios are a broken or lost filling, loose or lost crown or bridge or perhaps some type of breakage with a full or partial denture. Less common is a sudden problem to natural tooth enamel.

The most common reasons for these problems are:

• An extra hard shock to our tooth or restoration while eating
• Eating something of more than recommended hardness or stickiness
• Using our teeth as tools
• Clenching and tooth grinding due to stress
• Dropping our mouth appliance on the floor or sink
• Traumatic injury – falling down, running into something or somebody

The above factors can cause a good tooth or strong restoration to break or become loose.

When a tooth has already been weakened by decay or has a filling or crown that is not in good condition, even mild forces can cause damage.

Another possibility is when we are undergoing treatment and have a temporary filling or crown or bridge, denture, etc. Brushing too vigorously or chewing even the softest foods can break or dislodge temporaries. Dislodging temporaries while flossing is also a possibility.

(images of broken crowns and temporaries)

 

The problems we see or hear about most commonly are:

1) The crown or bridge does not get reinserted correctly – bite is off; restoration is raised so that repeat loosening is a probability and worse yet, decay or serious staining can get under the crown.

2) The tooth does not get cleaned and dried without having access to dental instruments and equipment and professional experience.

3) The excess glue cannot be adequately cleaned off or the crown is bumped loose in the attempt.

4) The patient secures the crown or bridge but does not follow up with the dentist. In the future significant decay is found.

5) The glue sticks to the patient’s fingers, lips, tongue or opposing teeth.

6) The restoration falls into a sink or is swallowed.

Here are some examples of products used by patients at home (real life stories from my office!) They  are absolutely not recommended to be used in the mouth or to repair any appliance that is placed in the mouth.

Temporary cements available in pharmacies or even at your dental office may be free of toxic substances in household or commercial adhesives, but still need to be used with caution as I will explain in a minute.

Below are the various cements and tools used by dentists for temporary and final cementation. In an office such as ours, we typically have 6 – 10 types over a wide range of strength. The photo in the middle shows a typical set up in a dental office for cementing or recementing. Dentists have cleansers for both the tooth and the crown. They also have water spray, suction and cotton rolls at their disposal. Their instruments include spatulas for proper mixing and loading, mirrors for looking into as well as guarding the tongue or cheek once the tooth is cleaned and dried.

Various dental products are used to decontaminate the crown and the tooth. Chemical agents are also used for preventing bleeding from the gums.
 
Also, before mixing the new cement, the old cement must be cleaned out.

The direction that the crown faces must be known.
When in doubt try laying the tooth down in various directions to determine the correct orientation.

Thank you for reading,
Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

Dentures in full detail

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This arcile outlines various types and sizes of dentures and which one may be right for you.

This article will describe different types of dentures; i.e. treatment options when all teeth within an arch (upper or lower) are missing already or need to be extracted. 

1. Full denture
2. Full denture retained by 2 or more remaining teeth over denture
3. Full denture retained by 2 or more mini implants
4. Full denture retained by 2 or more standard implants with bars attached
5. Full denture screwed down to multiple implants
6. Long-span fixed bridge cemented or screwed onto multiple implants

1. Full Denture

• Supported entirely by resting upon the ridge bone and palate in the case of uppers.
• Retained by fitting into undercut areas.
• -Least costly investment initially; does require relines recommended about every year at the start then about every three years on the average
• teeth wear, bone resorbs so that a new denture is typically needed after every 5 years
• May require adhesive paste to provide additional retention initially for major chewing and later for all eating and speaking

Ridge bone continues to be lost due to two reasons:

• Atrophy - lack of use since no more tooth roots embedded in bone
• Resorption - forces upon bone as denture shifts during chewing causes stress

Resorption is magnified and accelerated the longer the denture is worn without relining and the more unbalanced the bite is from the start (over bite, irregularities) or has become due to uneven wear of the teeth (especially a problem when various teeth oppose the denture - some natural enamel, some porcelain, various types of filling materials).  Dentures must be made and maintained in harmony with the surrounding muscles.The tongue is an especially important factor in having success with lower dentures.

More to consider with full dentures:

• Denture can be made to be attractive and natural looking
• When initially fitted dentures allow about 25% of the chewing force possible with strong full set of natural teeth
• Undercuts give dentures retention but also can be a source of sore spots

2. Full denture retained by 2 or more remaining teeth over denture

• Two or more teeth with reasonably healthy bone and gum tissue can be saved so that a denture can be retained over them - The denture is still completely supported by resting on the gums and underlying bone The remaining teeth provide retention only.
• Saving teeth also saves bone thus avoiding even more atrophy - the bone stays around the roots as long as forces are normal
• The denture can be retained by a variety of options: silicone rubber, O- Rings or "snap "attachments, clips on a bar.
• Teeth saved must be in good condition and must be maintained by good home care and professional cleanings in order to make this feasible.
• Attachments work well when there are poor existing undercut areas and / or very strong muscles wanting to dislodge the denture.
• The forces used when chewing should still be within the 25 - 35% range. Care should be used in type of food and force used so that the attachments and remaining tooth roots are not overloaded. A night time retainer or second denture is often made to prevent clenching upon the attachments while sleeping.

3. Full denture retained by 2 or more mini implants

• Denture is supported by the gums and bone Implants provide retention typically by silicone rubber or attachments like a snap.
• The mini implants help prevent further atrophy of the ridge bone sine the implant acts similar to a tooth root.
• Mini implants are great when teeth are not available, are in poor condition, or are poorly spaced for proper balance and stability.
• Mini implants are usually one piece - that is implant and abutment all in one.
• Mini implants are indicated in the lower front area due to their size and the type of bone density found in this area - which is typically the densest bone in the mouth.
• In some cases the denture can be fit to be retained by the implants in the same appointment due to the dense bone allowing for immediate stability.

4. Full denture retained by 2 or more standard implants with bars attached

• Four or more standard size implants are strategically placed and joined by bars that are screwed down to the implants forming a frame. The denture has retention clips that fit over the bar usually in 2 - 4 places. In this case the denture rests upon the bar and is passive to the gum and bone tissues.
• Dentures supported by bars can typically allow 50 - 60 % of maximum chewing force (based on natural teeth)
• Dentures are removed for cleaning. Implants and bars require cleaning with brush and floss with moderate effort needed. As with any implant, professional exam and cleaning are recommended every 6 months and, in some cases, every 3-4.

5. Full denture screwed down to multiple implants

• Four or more standard size implants are placed and joined by bars similar to the above clip on but removable denture over bars. In this case, however, the denture is screwed onto the bar and not removable by the patient. These appliances allow 60 - 80% of maximum chewing ability. Since they can not be removed for cleaning after each meal, the denture borders are raised off the gum tissue enough to allow floss to pass under the base. Also frequent brisk rinsing and use of an irrigator such as a "Water-Pik" are highly recommended for cleaning several times each day.
• The bar under-structure is similar to the previous over denture however the denture is not removable by the patient since it is screwed down to the bars.

6. Long-span fixed bridge cemented or screwed onto multiple implants

• Multiple single crowns allow best appearance and easiest flossing.
• Implants can also be abutments for several bridge sections or one long span bridge for the entire arch.
• These restorations allow maximum cosmetic appearance since the crowns are made from porcelain which has natural translucency, many shades are available and shades can be custom blended.
• These restorations are the strongest and can deliver 80 - 90% chewing force.

Excellent daily home care is needed just like when a patient has many remaining natural teeth heavily restored by crowns or bridges. That means flossing between the implants.

Implants help maintain jaw bone since they give the bone a purpose - the bone in use with normal amount of force stays healthy - similar to exercising for muscles and joints.

In many cases a patient wears a partial or full denture as a temporary when they ultimately plan to have implants as their long term tooth replacement. Having good fitting and nice appearing partial or full dentures prevents further damage to remaining teeth and also protects implants as they heal within the bone. Having a good partial or full denture and also a dentist who knows how to customize and modify them, can be a great advantage when a patient desires implants but will need a year or even much longer before completion.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

the ultimate in cosmetic dentistry

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article acknowledges the cosmetic aspect of restorations, i.e. matching crowns and veneers with your natural teeth.

Matching one restoration (crown or veneer) to natural enamel when the tooth being restored or replaced is right at the front of the mouth: You will need to look very closely to tell the tooth with porcelain from the others. From a distance of 12 inches or more, the restored tooth and other natural teeth are indistinguishable.

When there is decay or traumatic damage to only one tooth, we will always try to be as conservative as possible.

When this is not entirely feasible, one or more of the adjacent teeth may have to be restored as well in order to obtain the finest shade and shape match.

When patients have several teeth with decay, fractures, color or alignment problems, then of course we will will have to restore the entire group.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

New trends in dentistry

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. The focus of this article will be Dr. LaVigne's office approach to the latest dental technology and how his office stays current.

New technology impresses people in different ways. Some people have to have all the latest gadgets in their life and expect that from those who they make any major purchases for products or service. On the opposite extreme are those who are highly skeptical of "new fangled ideas" or do not see the benefit for themselves.

In between are those of us who carefully learn and try out new ideas. We do test trials and compare the results obtained with the new versus the old way. We also cautiously weigh the cost versus the benefits. When we do decide to make any change or transition we are confident that we can justify our investment as well as our effort and time. Taking the "sensible approach" one step further is reflected in our decision to maintain those older products and techniques that still have validity. Rather than an abrupt revolution, we evolve by offering and utilizing both some new and some of the old materials and methods.

We get a fair amount of new patients in our office that have not been regular dental patients. Those who have not been in our office before are often impressed by several of the steps that we take and the equipment we use. The number one thing that they comment about is how we use the intraoral camera. We use it frequently for exams and also for procedures allowing before / during/ after treatment to be seen by the patient. In addition to the visual image, they are always impressed with our style of presentation. We aim to be informative and clear to understand. We will only share "the gory details" on request! By the way, our television monitors are not large flat screens. The classic ones are still working fine.

There are many other examples of new equipment, instrumentation and materials in use in our office. I do a tremendous amount of continuing education. I attend classes, reads journals and current textbooks. I see many classes on videos. In addition to researching and learning new techniques and skills, I have also tested quite a few ideas in his own mouth. With the help from other dentists and also from my team, I have tested many types of dental materials including tooth shade restorations and various adhesive cements. I also personally try numerous home care products at-home tooth whitening methods.
Another group of new patients that we impress are those that see the value of our sensible approach.
We do not hype nor do we over-sell. We always try to be helpful and fair in explaining both advantages and disadvantages. Whether we are purchasing some major new equipment or redecorating our office, we consider carefully every aspect of the decision.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

tooth repair in one day

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article focuses on the concept of repairing a tooth and/or dental implant in one day's worth of procedures. There are many pros and cons to this practice. 

While it may seem tempting to have all of your teeth problems fixed in one day, this may not be the healthiest reality.

For example, the procedure of placing 6 implants, allowing 4-6 months for healing and later delivering a full denture that is screwed down over the implants has been a successful treatment option for over 10 years.

Recently, the concept has been advanced to placement of the implants immediately after extracting remaining teeth and also placement of the denture attached to those implants in the same visit. In addition, reducing the number of implants to 4 has been used.

This works wonders for some patients who qualify for this major treatment. However. there are many who cannot have this same treatment regimen. In order for the "all on four, teeth in one day" to be realized, there are indications and prohibited conditions. In order for implants to be placed immediately following extractions in general:

The teeth being extracted must either be distant enough from the implant sites or the bone must be adequate to allow an implant wider and f or longer than the extraction site. There should be no active infection.

Although prosthetic teeth are placed immediately, there must be absolute compliance by the patient with regard to eating extremely softly for the recommended time frame. There must also be provision made to prevent the effect of bruxism (teeth grinding during sleep) from damage to and failure of the implants healing within the bone.

The total surgical and restorative procedure is at a fairly high cost in a short period of time. Even with zero percent financing, some patients find this difficult to fit into their overall budget.

The good news is that there are other options for patients to consider. Rather than make a quantum leap to a denture loaded upon 4 implants in one appointment, patients can elect to go much more gradually. As an example, teeth can be extracted one or a few at a time. Implants can be placed one or two at a time. Extraction sites can be allowed to heal and Implants can be left unloaded in the traditional fashion for at least 3 months. The patient is fitted with a temporary partial denture or temporary plastic fixed bridges. These can be modified as the treatment progresses. Implants that have been confirmed as integrated into bone can then be used as' anchors while additional teeth are extracted and more implants placed.

The above approach allows for treatment to be phased in over a much longer time frame. While the concept of everything done quickly is appealing to some, it is not for everyone.

The advantages of the gradual phase in method are as follows:

1) Conservatively allowing time for healing of extraction wounds, bone grafts, implants
and confirming this stability before relying on their support for chewing.

2) Extend financing even further by doing the treatment in smaller phases still possibly using zero percent financing.

3) Avoiding complications from infection, night clenching.
4) Give patient opportunity to gradually become acclimated to having implants and doing the necessary daily care before they invest in everything on 4 - 6 implants.

5) Allow more opportunity to make adjustments to the appearance and occlusion (bite) by a more gradual transition and ability to do more try in visits before the prosthesis is completed.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.

Please call our Palatine, IL dental office for an appointment: 847-359-1292.

should I get a root canal or implant?

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article will highlight root canal treatments, causes of needing a root canal, and possible benefits, risks, and complications of having a root canal procedure.

 

Root canal treatment involves the removal of the pulp (soft tissue from the channel within the root of a tooth). The pulp is comprised of blood vessels, connective tissue and nerve. The pulp is needed when a tooth is in active growth stages. The blood vessels provide calcium as the tooth matures from the inside. The walls of the root (as well as the visible coronal part of the tooth) grow thicker as the calcium is transformed into dentin.

Roots typically reach maturity in length and thickness of the walls within about 2 – 3 years after the tooth erupts into the mouth.

After that time, additional calcification may continue. Additional calcification comes as a response to such stimuli as:

• Hot or cold temperatures – the tooth attempts to further “insulate” itself

• Decay – the tooth attempts to repair itself as decay advances from the outside

• Unusual biting or clenching forces – the tooth calcifies inside the pulp canal as a response to the on and off pressures felt at the apex of the root where the blood vessels enter and exit the end of the root.

Common reasons for needing a root canal include:

1) Decay has accelerated beyond the ability of the repair process so that bacteria enter the pulp from the outside. In some cases there is direct entry of bacteria. In other cases, the acidic excretions of bacteria cause the irritation and pain, but there is no actual infection.

2) Tooth fractures allow bacteria or their acidic excretions to come in contact with the pulp.

3) Tooth trauma. Sudden force can cause the tooth to be intruded into the bony socket. This can sever the blood vessels so that the tooth no longer has live blood flow within. This causes the remaining soft tissue of the pulp to break down ("dead nerve"). Having a dead nerve or necrotic pulp can temporarily mean no pain but later can lead to infection from the toxic debris.

4) Teeth clenching. Constant, repetitive forces can cause the same cutting off of the blood flow. Clenching can slowly cause the pulp to calcify along the canal walls. As the channel becomes smaller in diameter, blood flow gradually decreases. Another response to abnormal forces is a pulp stone. Instead of or in addition to narrowing of the canal walls, a pulp stone accumulates in the pulp chamber. At some point it can also cut off the flow of blood.

5) Restoration needs.  Sometimes a root canal is recommended or necessary in order to provide proper strength or adherence of a filling or crown. Sometimes there is no direct exposure of the pulp however, the preparation for the filling or crown will either expose the pulp or come so close that the tooth will be extremely sensitive and have a high

Some teeth having previously large fillings or crowns or having major fractures will need a post in order to retain a new crown. A post can only be placed if a root canal is performed first.

 

Factors that make root canals highly successful:

• Vital: fresh pulp – little or no bacterial contamination
 
• Normal to fairly large canals
 
• Straight to slightly curved root forms
 
• Technique, details followed during treatment
 
• Good to excellent placement of temporary filling

• Good and timely placement of permanent restoration following root canal

Factors that complicate root canal treatment:

• Some bacterial contamination of the pulp
 
• Significantly small diameter canals 
 
• Highly curved or irregular root forms
 
• Intersecting or lateral accessory canals – tiny side branches from the main canal
 
• Significant wall calcification or pulp stone making entry and negotiation difficult
 
• Delay is seeking initial treatment or completing permanent restoration
 
• Challenging situations such as location of tooth, ability to open wide, ability to effectively isolate the tooth with a rubber dam, alignment issues that make taking accurate x-ray difficult

• Re-treatment of root canals with no structural challenges but with return of bacteria from a recurrent cavity allowing bacteria to reach the previously sealed canal

Factors that make root canal treatment highly risky:

• Gross bacterial contamination, long-term and beyond the canal into surrounding bone, possibly sinus involvement
 
• Extremely curved and also very small diameter combinations
 
• Complete calcification so that a canal cannot be entered even with the finest file size
 
• Extremely large pulps such that walls are thin and vulnerable to fracture
 
• Failure by patients to follow through with permanent restoration
 
• Re-treatment of root canals with major complications such as blocked passages and other obstacles

• Teeth that have been grossly exposed to bacteria for an extended time so that the tooth structure is highly compromised – Softened or thin and brittle will not allow long term success with restorations – fillings will not hold, cemented crowns will not adhere long term or there is a high chance of fracture simply from normal chewing.

Implants may be a better option rather than perform extensive procedures (i.e. getting a root canal) with great risk.

With all the advancements, implant placement and restoration has become much more reliable and predictable.

Thank you for reading,
Dr. Ray

 

 

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

Stem cells in teeth

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article provides an overview of a growing trend and ethical issue in today's healthcare industry: stem cells. You may not realize that stem cells are also in teeth!

What are the benefits of stem cell use?

Stem cells are used to create many other types of live cells which are grown into various body tissues. The live tissue is then used to repair or possibly even make an entire new organ.
Stem cells are the seeds of life having the ability to transform into all other types of cells that make up skin, bone, nerves, muscles, blood vessels and blood cells and also the variety of specialized organs, even heart and brain. This is how nature creates entire individuals. This is how our bodies repair themselves and replenish older cells.

On the contrary, currently used surgery and drug therapy are either only partially helpful or totally mask symptoms but do absolutely nothing to really repair an injury or cure a condition.

There are already known and also potential yet unproven reasons to believe that stem cell treatment will be far superior compared with currently used medical treatment.

Imagine being able to repair damaged bone, muscle, tendons and joints with perfectly healthy new tissue that is made from your own cells (or possibly a closely matched family member).
Some of these techniques are already being done. Use of stem cells can already replenish immune blood cells and produce bone.

Now imagine being able to create a new kidney rather than live on dialysis or have the risks associated with donation. Perhaps at some point in the future it may be possible to create a new heart or even a brain rather than live with one that has been patched or compromised by removing some parts.

What is the history?

Stem cell harvesting is a spin off from blood donation. Donation of whole blood came first followed by filtration of platelets (the cells that form blood clots). Later it was discovered that a similar filtration process could be used to harvest blood stem cells that can be transformed into other blood cells especially those needed for the immune system. Cells obtained by either blood filtration or bone marrow donation have replaced or supplemented immune systems of patients destroyed by cancer such as leukemia.

The ability to create new bone and blood cells is already in use.

The use of stem cells to transform into nerve, muscle and to form organs is still under research.


How can stem cells be obtained?

Stem cells are currently found available in the following:
-Bone marrow
-Blood donation / filtration
-Umbilical cord of newborns
-Teeth

What are the moral and ethical issues?

This is a complex topic. Some people believe that any use of stem cell engineering is beyond what should be done by humans – “Playing God”. Some are more specific about the unlimited possibilities with main concerns about:

1) Eventually allowing genetic engineering – ultimate “test tube babies”
2) Abuse and spread of abortion (for umbilical tissue if not worse)
3) Black market and other cost / profit-related issues.

Stem cells harvested from blood, bone marrow, teeth and umbilical cords, placentas are called adult stem cells. While these can be transformed into various types of cells, tissues and probably organs in the future; they cannot create new humans or any other animal.

Only embryonic stem cells can create a new individual. This is not the intent of current research and use of adult stem cells.

More about tooth stem cells

Stem cells found in teeth can be both hemopoetic and mesenchymal.

Therefore there is a potential to direct transformation into any other type of tissue cell needed not only for blood or bone but also for muscle, tendon, nerves, skin, and specialized types found in various organs.

Stem cells are found in many teeth but are most feasible to obtain in the following teeth at the following stages:

1) Primary (baby teeth) that are at the front of the mouth and are just getting ready to be lost naturally.
2) 3rd molars (wisdom teeth) that are still actively growing and do not yet have complete root formation.
3) Bicuspid teeth that are planned for removal for orthodontic crowding and also have roots that are not fully developed.

There are other situations that can provide stem cells, however the above are the the best due to:
1) Greatest number of healthy stem cells.
2) Greatest opportunity and least risk in removal and successful harvesting.
3) Stem cells are a bonus added to an already needed tooth removal or natural loss.

How do I learn more and actually apply?

More information and application to participate can be found online at www.StemSave.com or by calling 877-StemSave (877-783-6728).

A word about cost: When you first see the fees for long-term storage of your tooth stem cells, you will probably think, “that is a lot!”. When you make a comparison with the cost of having currently available surgeries and other medical treatments, you may see the potential for your investment now to be completely justified.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

Sedation dentistry

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article highlights pros and cons of sedation dentistry as well as tips for easing dental-related anxiety.

Some patients have extreme anxiety about any type of medical / dental care.

They avoid treatment for so long that ultimately they need major procedures on one or more teeth or even extensive full mouth treatment.

They may build up their fear level so high that they feel the only way to get needed treatment is with general anesthesia - sleeping through it all.

We hear radio ads and see printed ads on every media including the internet that offer patients the alternative of sleep dentistry. Some make it sound easy to have everything done in one session including cosmetic treatment. While this sounds wonderful at first glance, there are significant reasons not to undergo general anesthesia for complete dental care:

1) Local Anesthetics are much safer.
2) Some procedures, especially cosmetic procedures and very large restorative cases require interaction with the patient. Patients need to open and close, smile, offer their opinions and approval.

3) Many restorative procedures - from simple fillings through complete bridges or dentures require that the bite be checked. This can only feasibly be done with an alert and co-operative patient.

4) Many dental procedures require water cooling, irrigation and rinsing. When patients are completely sleeping, this is difficult and very compromised.

5) Complex dental work requires much time making and fitting temporary restorations. This will greatly extend the amount of time a patient remains under general anesthesia.
While there are certainly indications for complete general anesthetics, I believe that its use should be limited. Perhaps a few procedures that are the most fearful should be performed under general anesthetic. Some patients may have a medical condition or handicap that necessitates having dental treatment done while completely sleeping.

Other patients may just not be aware of other alternatives and some may simply not be trying to deal with their anxiety. Perhaps they would benefit from some of the techniques that we use:

1) Gradually overcome anxiety by having a small procedure done comfortably in order to gain their trust and ease their fears.

2) Witness that gentle technique, generous use of topical and local anesthetics, testing the effectiveness of the local anesthetic and a gentle approach to the treatment itself will improve their outlook and ability to deal with treatment.

3) Rather than be completely asleep, undergo sedation. By having nitrous oxide (laughing gas) just prior to treatment and throughout the "scary" parts a patient can be relaxed. They will still be able to participate in checking the bite, having discussions, etc. when needed. An even greater level of sedation can be reached if Valium, Xanax or similar drug is taken roughly 30 - 60 minutes before treatment. Some patients may also benefit from having a sedative to get a good night's rest before. The best dental care is done carefully and with proper water cooling for instruments and rinsing for removal of bacteria, debris and having a clear area for use of impressions, adhesives and other materials. Most extensive dental treatment is not due to sudden trauma but rather the result of many months or years of not receiving care.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.

Premium partial and full dentures

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article, with detailed images of dentures, provides an in-depth explanation of dental temporaries, premium, partial and full dentures.

Not all removable appliances are created equal nor should they all be called "plates".

On the contrary, removable partial or full dentures can be part of a complete "makeover". Any denture, even the most economical and temporary variety, will provide a better look than multiple missing teeth or rampant decay and infected gums.

While temporary, first dentures placed immediately after extractions are certainly an improvement over the previously poor teeth and gum conditions, they are only average compared to what can be created when a second, customized appliance is made. Once the gum and bone tissues have adequately healed, new impressions are made which assure a better fit to the current conditions. When the second denture is made there are several benefits that were not feasible when the initial denture was made:

1. Impressions made with the "guess work" removed on how the fit will be after tooth extractions.
2. Second denture can be made without rush and tried in before completion.

3. Time is allowed for treatment of other remaining teeth and problems within the same arch as well as the opposing arch.

4. Some changes in the bite (occlusion) are possible (and highly desired for optimum stability) when the mouth is now considered as a whole and modifications are planned.

5. Some changes in shade and size and arrangement of the teeth are possible.

All of the above can be possible with standard dentures.

When even more customization and best possible fit and durability are desired, a premium full or partial denture is the right choice.


Premium dentures include higher quality tooth material and details in the pink gum area to look most natural.

Standard dentures are nice but ordinary when compared with the premium option.


(Above) Another view of a premium full upper denture showing the nicely finished and detailed work in the base as well as the setting of teeth. Attention is paid to adequate thickness for strength while making optimum room for the tongue to feel comfortably at home. Speech as well as chewing and smiling are all considered.

The tooth size, shape, color and arrangement can be varied within a range. Custom made removables can create a nice natural look with a personal touch. This means that teeth match other existing teeth and the arrangement of the teeth is fairly straight and definitely assuring a balanced bite. However, there are minor imperfections making a realistic result. When there are no other teeth that need to be matched, then a nice clean but neutral shade is chosen. On the other hand, if desired by the patient they can be made very white and very straight (supernatural).

Here are the main features of premium denture appliances:

1. Quality teeth with greater durability and natural variations in opacity and translucency Varied shade and contour of the artificial gums ( rather than very smooth and very pink)

2. High quality lab work

3. Minimum two step custom impression technique for optimum fit

4. Additional time and attention by your dentist in planning and tooth set-up

5. Even greater ability to correct cosmetic problems, stabilize bite and correct alignment when entire mouth (both upper and lower arches) are being considered.

Additional time and steps are taken during the transition period from initial dental problems through final restoration. Temporaries are made and modified as needed in order to accommodate additional extractions, fillings, healing and cosmetic changes.

When there are cavities, gum problems, etc. with the anchor teeth or the opposing teeth then these problems are addressed prior to making the final restoration.

In order to create the best possible esthetic results and create long term stability, the bite is refined in all dimensions in order to obtain greatest chewing ability while assuring the least amount atrophy of ridge bone.
Teeth are best able to withstand normal chewing forces (and abnormal clenching forces) when there are many teeth with long roots firmly embedded in bone and with no spaces between them. Having roots in vertical alignment is also a key factor.

Bone can be lost from too much force as well as from lack of use. Ridge bone also lost due to the same two reasons. Atrophy is loss of bone due to lack of use - since there are no longer teeth with roots supported within bone, the bone weakens and "melts away" from disuse. Resorption of jaw bone happens due to too much force such as when dentures are rocking and rubbing causing irritation. In order to maintain healthy bone for as long as possible the following are needed:

1. Optimum fit from the start

2. Refitting via relining as needed and as early as needed

3. Establishing an optimum occlusion (bite) Dentures must have balanced forces to prevent tipping. Denture teeth must be aligned over the bony ridge to reduce adverse leverage:




4. The bite must be maintained and checked for uneven wear periodically. This is extremely important when there are a variety of tooth materials - natural enamel, porcelain, metal or plastic.

Dentures work best when the bite is well balanced. Missing teeth in one area causes overload and tipping forces. Teeth that are irregular like "mountains and valleys" will also cause very unstable conditions.

Bone is lost around teeth due to periodontal infection. Habitual clenching due to stress especially happening during sleep also contributes to recession of gum and bone. When some teeth are already missing the amount of force upon the remaining teeth is increased.

Sometimes it is recommended to have a night guard retainer when a patient has a full or partial denture. The Denture is worn during the day for normal eating and speaking. The retainer worn while sleeping protects from damage due to night clenching. This is especially beneficial when a patient has only a few remaining teeth. Without a night retainer, they are highly likely to grind the remaining teeth loosening more bone and also frequently bite their tongues and cheeks while asleep.

More time and quality materials are used in every step.
See the image below: the denture on the left is average while the right one shows excellent
fit that can only be possible with custom impressions.


Lower dentures are notorious for being loose and easily dislodged by the tongue. Note how the borders are established to avoid interference with muscles.  Also note how the denture is fashioned with a "cavern" to accommodate the tongue. The tongue actually helps weigh down the denture instead of constantly lifting the denture upward.


Examples of customized partial dentures

Use of flexible nylon denture bases and silicone retention surrounding natural teeth have many benefits including: Easy to place by first time denture patients and patients who have limited strength and dexterity in their hands. Effective but gentle retention on the anchor teeth. Little or no preparation of anchor teeth required compared to traditional metal frames and clasps. They are light weight and easily modified. The disadvantage is being less strong than a partial with a metal framework.

See these images of customized partial dentures:
CuSil Silicone retention (left)
Flexi Nylon base and clasps (right)



Nylon tooth shade clasps on standard frame partial denture:



When there are only a limited number of remaining teeth that are strong enough to serve as anchor teeth, traditionally a partial denture is made that has visible metal clasps. As an alternative, tooth shade nylon clasps can be placed in areas that would otherwise show metal. Nylon clasps have the additional benefit of being gentle to the anchor tooth. Flexible partial dentures can be made that are held in place by the necks of the teeth so that there is virtually no artificial material above the gum line. Another method of saving worthwhile teeth, few in number and giving more support to a denture than resting solely upon the gum tissue is to make an over denture. In this case the anchor teeth and anchors are completely invisible under the denture base.

In many cases, a patient wears a partial or full denture as a temporary when they ultimately plan to have implants as their long term tooth replacement. Having good fitting and nice appearing partial or full dentures prevents further damage to remaining teeth and also protects implants as they heal within the bone. Having a good partial or full denture and also a dentist who knows how to customize and modify them, can be a great advantage when a patient desires implants but will need a year or even much longer before completion.

We will be happy to show further examples and give you further information.

We can provide you with an estimate for comparison when you have the ability to choose between Economy, Standard and Premium restorations for your individual situation.

Thank you for reading,

Dr. Ray

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.