My Blog

Posts for: April, 2020

By Scott A. Allegretti, DDS Provincetown Dental Arts
April 28, 2020
Category: Dental Procedures
Tags: bone grafting  
WecanBuildupLostBoneBeforeYourImplant

The “magic” behind a dental implant’s durability is the special affinity its imbedded titanium post has with bone. Over time bone grows and attaches to the titanium surface to produce a strong and secure hold.

But there’s one important prerequisite for ultimate implant success—there must be an adequate amount of bone available initially to properly position the post during implantation. Otherwise, the implant may not have enough support to position it properly or cover the implant surface completely with bone.

Inadequate bone can be a problem for patients who lost teeth some time before and now desire to an implant restoration. This happens because when teeth are missing, so are the forces they generate during chewing. These forces stimulate new bone growth around the tooth root to replace older, dissolved bone at a healthy rate. If that replacement rate is too slow, the volume and density of bone may gradually diminish.

There is a way, though, to build up the bone for future implantation. Known as bone preservation procedure or a ridge augmentation, it’s a surgical procedure in which the dentist adds bone grafting material to the extraction socket or the bony ridge. The graft serves as a scaffold for new bone cells to grow and multiply. If successful, there will be enough new bone volume after several months of healing to support proper implant placement.

Bone grafting can add more time to the implant process. It may also mean you will not be able to undergo immediate crown placement after implantation (a “tooth in one day” procedure). Instead we would probably suture gum tissue over the implant to protect it and allow for full integration with the bone over a few more months. In the meantime, though, we could fit you with a temporary restoration like a removable partial denture (RPD) or a bonded bridge to improve the appearance of the space while the bone continues to heal.

After several months, your implant will have a better chance of a secure hold and we can then attach a life-like crown. Even if you’ve suffered bone loss, you’ll then have the benefit of not only a durable implant but also a new smile.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation.


By Scott A. Allegretti, DDS Provincetown Dental Arts
April 18, 2020
Category: Dental Procedures
Tags: dental implants  
AlthoughRareAllergicReactionstotheMetalinImplantsCouldbeaConcern

You’re considering dental implants and you’ve done your homework: you know they’re considered the best tooth replacements available prized for durability and life-likeness. But you do have one concern — you have a metal allergy and you’re not sure how your body will react to the implant’s titanium and other trace metals.

An allergy is the body’s defensive response against any substance (living or non-living) perceived as a threat. Allergic reactions can range from a mild rash to rare instances of death due to multiple organ system shutdowns.

A person can become allergic to anything, including metals. An estimated 17% of women and 3% of men are allergic to nickel, while 1-3% of the general population to cobalt and chromium. While most allergic reactions occur in contact with consumer products (like jewelry) or metal-based manufacturing, some occur with metal medical devices or prosthetics, including certain cardiac stents and hip or knee replacements.

There are also rare cases of swelling or rashes in reaction to metal fillings, commonly known as dental amalgam. A mix of metals — mainly mercury with traces of silver, copper and tin — dental amalgam has been used for decades with the vast majority of patients experiencing no reactions. Further, amalgam has steadily declined in use in recent years as tooth-colored composite resins have become more popular.

Which brings us to dental implants: the vast majority are made of titanium alloy. Titanium is preferred in implants not only because it’s biocompatible (it “gets along” well with the body’s immune system), but also because it’s osteophilic, having an affinity with living bone tissue that encourages bone growth around and attached to the titanium. Both of these qualities make titanium a rare trigger for allergies even for people with a known metal allergy.

Still, implant allergic reactions do occur, although in only 0.6% of all cases, or six out of a thousand patients. The best course, then, is to let us know about any metal allergies you may have (or other systemic conditions, for that matter) during our initial consultation for implants. Along with that and other information, we'll be better able to advise you on whether implants are right for you.

If you would like more information on the effects of metal allergies on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Metal Allergies to Dental Implants.”


By Scott A. Allegretti, DDS Provincetown Dental Arts
April 08, 2020
Category: Dental Procedures
WisdomTeethCanStillbeaProblemfortheWorldsYoungestBillionaire

According to Forbes Magazine, Kylie Jenner is the world's youngest billionaire at age 22. Daughter of Caitlyn (Bruce) Jenner and Kris Jenner, Kylie is the founder and owner of the highly successful Kylie Cosmetics, and a rising celebrity in her own right. But even this busy CEO couldn't avoid an experience many young people her age go through each year: having her wisdom teeth removed.

At around 10 million removals each year, wisdom teeth extraction is the most common surgical procedure performed by oral surgeons. Also called the third molars, the wisdom teeth are in the back corners of the jaws, top and bottom. Most people have four of them, but some have more, some have fewer, and some never have any. They're typically the last permanent teeth to come in, usually between ages 17 and 25.

And therein lies the problem with wisdom teeth: Many times, they're coming in late on a jaw already crowded with teeth. Their eruption can cause these other teeth to move out of normal alignment, or the wisdom teeth themselves may not fully erupt and remain fully or partially within the gums (a condition called impaction). All of this can have a ripple effect, decreasing dental function and increasing disease risk.

As Kylie Jenner has just experienced, they're often removed when problems with bite or instances of diseases like tooth decay or gum disease begin to show. But not just when problems show: It's also been a common practice to remove them earlier in a kind of “preemptive strike” against dental dysfunction. But this practice of early wisdom teeth extraction has its critics. The main contention is that early extractions aren't really necessary from a medical or dental standpoint, and so patients are unduly exposed to surgical risks. Although negative outcomes are very rare, any surgical procedure carries some risk.

Over the last few years, a kind of middle ground consensus has developed among dentists on how to deal with wisdom teeth in younger patients. What has emerged is a “watch and wait” approach: Don't advise extraction unless there is clear evidence of developing problems. Instead, continue to monitor a young patient's dental development to see that it's progressing normally.

Taking this approach can lead to fewer early wisdom teeth extractions, which are postponed to a later time or even indefinitely. The key is to always do what's best for a patient's current development and future dental health.

Still, removing wisdom teeth remains a sound practice when necessary. Whether for a high school or college student or the CEO of a large company, wisdom teeth extraction can boost overall dental health and development.

If you would like more information about wisdom teeth and their impact on dental health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Wisdom Teeth: To Be or Not to Be?