dental implant (6)

When you think of COVID-19 symptoms, what comes to mind? Probably a fever, dry cough and shortness of breath — perhaps loss of taste and smell. Yet an inability to enjoy the flavors of a savory bowl of pasta or your favorite dessert is not the only oral health problem people can experience with this virus. Below are other conditions that doctors and researchers have noticed are appearing with COVID-19.

Geographic tongue occurs when there’s a loss of papillae — tiny projections that are shaped like hairs — from the tongue’s surface. Those experiencing it develop red, smooth patches, as though a map has been spread out on their tongues. Some patients develop pain or burning, as well as sensitivity to certain foods.

Xerostomia, or dry mouth, is caused by insufficient production of saliva. Dry mouth can create a cascade of problems, from difficulty chewing and swallowing to hoarseness, sore throat, gum problems and more.

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Dental fractures are more common than you might imagine. Your teeth may break, chip, or crack due to a wide range of reasons, leading to severely painful symptoms and dangerous consequences. Luckily, identifying the problem and discussing methods of treatment with your dental specialist can help you avoid unnecessary discomfort and irreversible damage.

Keep on reading to discover the five key facts about dental fractures, their symptoms, culprits, and treatment options.  

1. What dental fractures look and feel like
Dental fractures usually occur without any obvious symptoms. Most of them start as microscopic cracks along the typically smooth tooth surface and are undetectable to the naked eye. Your dental specialist can diagnose these cracks by applying detection dyes to the teeth. 

Some fractures can be quite visible, taking the form of hideous chips and splits in the teeth. In severe cases, one or more of your teeth can shatter into pieces, leaving only the pulp and the portion of dentin still attached to your jawbone. 

Minor cracks in the outer surface of your teeth (also called hairline cracks) may be completely painless. However, a severe crack that causes tooth parts to shift can irritate the fragile nerves in the pulp, resulting in extreme pain whenever you eat or even move your jaws. Besides, the unprotected pulp can respond painfully to the temperature changes. 

2. Why dental fractures occur
Even the enamel, the strongest material in your body, can only take so much. If you bite down on a solid item with complete force, your enamel can easily break or crack. A blow to the face or jaw can result in tooth breaking and chipping as well. Even daily wear and tear can lead to damaged teeth, particularly on those older than 50 or diagnosed with bruxism

3. How dental fractures trigger other problems
Apart from causing severe toothache, dental fractures can put you at risk of experiencing pain from oral infections. Even the smallest pits and fissures in your enamel can allow bacteria to enter the insides of your tooth. This can result in infection accompanied by extreme pain in your tooth and jaw. 

Don’t take such a problem lightly, as oral infection can lead to further complications if left untreated. Bacteria can affect the roots of adjacent teeth or even travel via blood vessels in your jaw to different organs in your body, putting you at risk of potentially life-threatening conditions. Timely treatment is the best way to prevent such risk. 

4. Which restorative option to consider
Dental fracture treatment depends on its severity and the area of your mouth that’s affected. If there are only one or a few minor cracks, nothing except routine monitoring for changes may be needed. If the affected tooth is highly sensitive or exposed to bacteria and additional damage, you may require some restorative treatment. 

Consider installing dental veneers to safeguard and cover chips and cracks in your front teeth. This restorative method is minimally invasive and quite affordable. However, if the affected tooth is weak or has undergone a root canal, it may benefit more from a dental crown. 

5. When extracting and replacing the tooth is needed
Fractured teeth cannot always be saved with restorative treatment. For example, crowning the affected tooth doesn’t necessarily repair the split or crack that extends down into the tooth. Sometimes your tooth can endure irreversible damage that disables it from supporting the crown. 

In such a case, your dental specialist may recommend pulling it out. Extraction not only helps to stop the pain but also eliminates the odds of additional infections. Once the extraction site heals, your missing tooth can be replaced with a dental implant. 

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If you have a missing tooth or need to have a tooth removed, a dental implant is one replacement option. A dental implant can replace one tooth, two or more teeth, or serve as an anchor for a bridge or dentures. Dental implants are the best quality tooth replacement option, but they come at a price.

How much do dental implants cost in Middlesex County, MA and the surrounding area? It depends on a number of factors. Here’s an overview of what you can expect for a dental implant quote and what contributes to the cost.

What is a Dental Implant?
A dental implant is an artificial tooth and root system. A titanium post is placed in the jaw bone to serve as the anchor for a porcelain crown. It looks and functions as closely as possible to a natural tooth and can last for a lifetime.

Average Cost of a Dental Implant
One dental implant to replace one tooth can cost between $3,000 and $4,500. Depending on where you go, you could get a slightly higher or slightly lower quote. Many different factors affect the cost of a dental implant, and the price may not be the same for every patient.

Factors that Contribute to the Cost of Dental Implants
The price of a dental implant may vary depending on the following factors:

  • Location of the missing tooth. Where the dental implant will be placed in your mouth is a factor in the cost. The easier it is to access, the lower the price may be. On the other hand, if the tooth is a highly visible front tooth, it may cost more to ensure it looks natural.
  • Preparatory procedures. Before a dental implant can be placed, there must be sufficient bone density in the jaw to support it. If there isn’t, which is likely if the tooth has been missing for a while, a bone graft procedure may need to be performed first. A bone graft involves surgically placing a bone graft on top of the existing jaw bone under the gums to fortify it and encourage regeneration. This adds to the total cost of a dental implant.
  • The quality of the materials. Most dental implants and the abutment / connection post are made of titanium, with a porcelain crown. These are considered to be the best quality materials for dental implants. Anything less may come at a lower cost, but may not last as long or look as natural.
  • The location of your dentist’s office. The geographic location of your dental office plays a part in the cost of a dental implant. The cost of living in an area affects all kinds of services, and dental care is included.
  • Your dentist’s level of experience. The more experienced your dentist is at placing dental implants, the higher the cost may be. With experience comes a better reputation, a wider base of patients, and the ability to charge more for their expertise.

Does Insurance Cover Dental Implants?
In most cases dental insurance will not cover dental implants. Insurance providers consider dental implants to be a cosmetic procedure, even though they serve a dental health purpose. In some cases medical insurance will cover just the implant root when there is a medical need for it. Insurance providers also tend to cover the least expensive option rather than what is best for the patient.

How to Make Dental Implants More Affordable
If a dental implant is in your best interest, it is worth the cost. Financing is one way to make the cost of dental implants more affordable, allowing you to make affordable monthly payments. CareCredit and other credit options are available to help you pay for medical costs not covered by your insurance.

Periodontal Associates Specializes in Dental Implant Placement
If you’re looking for an experienced periodontist to place your dental implant, contact Periodontal Associates. Our skilled surgical specialists have over 30 years of experience placing Dental implants and performing other dental procedures. You can rest assured that we have your best interest in mind when it comes to your dental health.

Call 508-875-6185 today to schedule a consultation at our Framingham office or 617-964-6185 for our Newton Centre office. You can also request an appointment at your convenience. We look forward to providing you with top quality periodontal services.

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Every surgery involves a wide range of external and internal factors that may result in complications or even complete treatment failure. Teeth implants aren’t the exception. They are used to permanently replace missing teeth and are a common alternative to dental bridges and dentures. Teeth implants are anchored directly into the bone of your jaw, which helps restore your mouth’s function and improve the appearance of your smile. While teeth implant procedures have a high success rate, some patients can experience various complications. 

Below are the most common implant problems and their potential causes that you should be aware of before choosing dental implants to replace your missing teeth. 

1. Failed osseointegration 

Osseointegration means a direct structural and functional connection between your jawbone and a tooth implant. It happens within several months after the implant’s installation. Dental implant failure typically occurs when your jawbone fails to bond correctly with the implant. An implant fails when it falls out or shows symptoms of bone deterioration. The common risk factors for failed osseointegration include improper positioning, poor bone mass or volume, excessive bite force, damaged oral tissues, mouth injury, or even anesthesia side effects.  

Your jawbone should have enough volume and density for a tooth implant to be installed into it. If it lacks proper height, length, or width, treatments like bone grafting and the augmentation of the maxillary sinus are essential to achieve adequate jawbone space and mass. However, both of these procedures add to the overall treatment cost and postoperative recovery time. 

Keep in mind that if you’re missing any teeth, the underlying jawbone can start to slowly deteriorate due to lack of stimulation from chewing. If you’ve avoided replacing your missing teeth for months or more, undergoing bone grafting may be necessary before getting any artificial ones. 

2. Peri-implantitis

Peri-implantitis is a disease that occurs when bacteria infects your jawbone during surgical treatment or at the time of postoperative recovery due to a lack of good dental hygiene. It can also develop due to dental cement leaking from under the crown and getting caught in your gum line. 
Common dental implant infection symptoms include swollen gums and inflamed bone tissue surrounding your implant. Persisting peri-implantitis can result in jawbone deterioration and failure of an implant. There’s often a chance to treat this infectious disease, but the affected tooth implant must be removed in most cases. Sometimes, peri-implantitis develops a few months or years after the surgery. Diabetes, smoking, receding gums, and bad dental hygiene can increase your odds of experiencing this infection.

 3. Nerve and tissue damage

In rare cases, dental implant failure can result from damage to the tissue surrounding an implant, particularly the nerves. If your implant is installed near a nerve, you may end up experiencing continuous pain, loss of sensation, and tingling in your gum line, tongue, cheeks, chin, or lips. Depending on the severity of the nerve damage, removing your tooth implant may be necessary. This problem typically occurs due to a mistake made by an unskilled dental specialist. If your postoperative pain and/or the bleeding gets stronger or lasts longer than three days, consult your surgeon ASAP. 

4. Allergic reaction

Modern dental implants are usually manufactured from a nickel-titanium alloy. Some people may experience an inflammatory or allergic reaction to titanium. Your symptoms may extend from itching to myalgic encephalomyelitis. The only scientifically proven way of determining whether or not you experience a titanium allergy is undergoing a memory lymphocyte immunostimulation assay. 

5. Foreign body rejection

Just like organ transplants, tooth implants can also be rejected by your body. In such a case, your body treats an implant like a foreign object that needs to be pushed out or eliminated. 

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The SARS-COV-2 viral pandemic has changed most aspects of our work and home lives. Dentists are on the frontlines of possible exposure to the SARS-COV-2 virus that causes COVID-19 disease. Recent case studies have identified the likelihood that the virus is most commonly being transmitted via aerosols. Dentists have the highest risk of exposure to asymptomatic carriers of the virus due to working in the mouth. Not only that, common dental procedures produce aerosols suspended in the air that could contain the virus from asymptomatic carriers.

High cost advanced PPE (personal protective equipment) like n95 masks and face shields are used to protect the dental team. However, once aerosols are generated, they can circulate thru space and pose a risk to unprotected individuals. Containing and controlling aerosols is a major focus in dentistry. Many dentists are using enhancements to their HVAC (heating, ventilation, air conditioning) systems to help filter out potentially disease-causing aerosols. Stand-alone HEPA filtration units incorporating UV light disinfection (air purifiers) are the easiest way of improving air quality. Most of these units however do not have uniform regulatory certification of efficacy. They may have undergone consumer product testing, but none have certified the ability to fully capture and kill SARS-COV-2 virus.

One can assume that a HEPA filter would trap the most likely sized aerosol particle that could carry the SARS-COV-2 virus 99.9% of the time. Like n95 masks however, the HEPA filter does lose efficiency over time. The UV light will deactivate virus but this depends on the speed of airflow and how much UV contact time is necessary for kill. The analogy is driving your car thru the carwash at 30 miles an hour. How clean will it really get?

In addition to stand-alone air purifier units, there are other options that could be used to improve air quality. HVAC contractors can install powered HEPA filters to existing systems. These improvements can run from $3000-$8000 per unit. However, improving filtration can be as simple as changing to higher quality filters on the HVAC unit.  The American Society of Heating and Air-Conditioning Engineers (ASHRAE) created Standard 52.2-2017 to describe Minimum Efficiency Reporting Value (MERV). It is possible to purchase MERV 12-16 filters that can be a significant improvement over most common furnace filters.

Added filtration will require more frequent filter changes and some filters (especially dirty filters) will reduce the efficiency of heating and cooling because of lowering airflow. A common problem with insufficient airflow is a frozen AC coil within the HVAC unit. This will cause lack of cooling and water pooling around the HVAC unit. An inconvenience, but easily remedied.  More dangerous is low flow during the heating season which can cause a crack in the furnace leading to Carbon Monoxide poisoning.

Before doing any modifications, contact your local HVAC service provider. For more information on air quality, go to ASHRAE:

The links below contain more technical information regarding advanced filtration: Dr. Panek is a private practice Oral & Maxillofacial Surgeon practicing in Grand Rapids, MI.

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An Overview of the Dental Implant Procedure


A dental implant is a process which involves replacing an extracted tooth with a metal stud or post screwed directly into the bone that remains as an anchor to the crown or false dental replacement that would somehow or another not have anything to keep it arranged directly into the tooth attachment of your missing tooth. That is the primary purpose of a dental implant procedure. The false teeth, dental replacement, or crown, is placed right on the stud. Then, the post itself makes your new teeth work like genuine teeth. It is the best alternative used for dentures with loose attachment or those who have a high tendency to fall out (because they are not attached to the gums. Implants look more like real teeth as compared to the detachable dentures or crown attached atop dental bridges which can damage the adjacent teeth of both sides. This helps to place the artificial tooth in between the teeth or hanging the tooth like a bridge in the gap present between the teeth.

The procedure of a tooth implant can be broken into seven steps

1- Remove the Tooth- The tooth should be removed as soon as possible just for the care of the buccal plate or to protect the bone surrounding the tooth. A fine diamond bur is used during removal to trace the root. Periotomes may be located between the bone and root helping in tooth removal. After the removal of the tooth, it is necessary to examine the exact site of the bone and try to find out any bony defects.

2- Attach the Socket- It is necessary to graft the socket in the bone just to preserve and protect the bone for the implant. A surgical curette should be used to clear the socket from granulation material. Then irrigate the site using a scaler to scrape the wall to start bleeding. Grafting material (either synthetic or allograft) is used to fill up the socket to the crest of the bone.7430447482?profile=RESIZE_710x


3- Allow the Attached Extraction Site to Heal- Next, the crest preservation process, the grafting material assists to keep the bone volume that is necessary to an easy, expected implant placement process and anesthetic, practical result. The extraction site takes four months to heal and the graft to establish. At this time local bone cells develop and replace the grafting material and function as a perfect place for implant placement.

4- Flapless Surgery- The implant is placed after the healing of the socket site. The site should have adequate ridge width and height. The site should be examined properly intraorally and radiography is used to confirm the bone volume for implantation. After the administration of anesthesia before surgery, a periodontal probe is used to further confirm the occlusal and lingual bone, this must be confirmed before implant placement. The best option for implant placement is the flapless implant process due to its benefits like it is less insidious, decreases disturbance of the blood supply, and assists a smooth healing procedure. During the flapless surgical method, an opening is created for osteotomy with the help of a tissue punch at the exact location and to make sure the implant is located 1.5mm from the adjacent teeth. Radiographs are used to validate the precise positioning and angulations. Multiple surgical drills are used to adjust the diameter and length of the implant. Once the surgery has been completed the implant is placed. A torque wrench is used to achieve the final implant placement, and stability can be confirmed.


5- Placing Healing Abutment- After the confirmation of primary stability, a healing abutment is placed at the site of the implant placement. It is essential to make sure that the healing abutment is out of occlusion in centric. This will protect the implant against applied forces during the healing time.

6- Get a Final Impression- Three months after the implant placement, a healing abutment is detached. This will expose a healthy soft-tissue collar around the insert site, which has been guided by the healing abutment. Vinyl polysiloxane material is used to take a closed impression and a final fabrication sent to the lab.

7- Deliver a Screw-Retained Crown- The dental laboratory constructs the perfect restoration based on the final impression. In the case of a single tooth implant, screw-retained crowns are the best option because these are esthetic, predictable, and easy to place. The crown directly attached to the implant is better than fixing the abutment with cement. The shape, fit and contour are designed digitally for a screw-retained crown which is perfectly aligned to soft tissue.


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