Complex Restorations

What is a Prosthodontist?

            A prosthodontist specialist is a Dentist that has 3 or more years training beyond that of a regular General Dentist. It is one of the 7 recognized specialties by the American Dental Association. Prosthodontists are involved with fabricating Dentures, Crowns, Bridges, and other aspects of restorative dentistry.

Not only does a prosthodontist deal with simple cases, but are specially trained for the more complex cases.  Some examples are patients who need full mouth reconstruction, with real teeth or in combination with dental implants, cancer patients who have lost their jaws, nose, ears, etc. and is not limited to the mouth.

Teeth in a day

            There has been much talk of “teeth in a day” “teeth in an hour” “teeth in 10 minutes” etc. but what most people don’t realize is that these are temporaries that are used until the implant “heals”, and this cannot be done with everyone. It depends upon that particular person, and that particular situation, and there may be compromises involved. A more conventional approach may be temporary “bonded bridges”, temporary “retainers”, temporary dentures or partial dentures, etc. and when the implant “heals” then the final “permanent” restoration can be completed.Incomplete. I will send you the completed article later.

Have you been considering dental implants, but were afraid to really consider them because of the PAIN?

Dental implants have been a revolution in dentistry. They have many advantages as compared to previous technologies. They look, feel and function more like your natural teeth. Your speech, taste, looks, and chewing ability are more natural. The success rate for dental implants are very high. They are conservative; no need to grind down your adjacent teeth for a bridge. They don’t get recurrent decay; this is the leading cause of failing conventional dental work. Until dental implants were invented, we did not have the technology to maintain the jawbone levels once teeth were extracted.

With all these advantages (and many more, see our webpage: TriValleyImplants.com), you would think that more people would prefer this treatment option. However, the fear of PAIN is a major concern of many people. What sane person would like to have their jawbone drilled? Actually, there are very few pain nerves in the jawbone. Most are in the gum soft tissue area. With older surgical techniques, the gum needed to be cut and pealed. This meant longer procedure times, more pain and delayed healing.

We use the latest minimally invasive surgical placement techniques to not only significantly reduce the discomfort of dental implant placement, but reduce healing time as well. Many patients may not need any pain medication at all. In many situations the procedure may even be 10 minutes or less! Of course, this will vary between patients, but our philosophy is to reduce trauma as much as possible without compromising the outcome. Our technology is good, but not as good as nature. Implants are the closest technology we have to nature.

Implant consultations are free. We have reasonable fees and 100% financing. Let’s see what we can do for you. The University of Illinois at Chicago, NY Brookdale Hospital, and The University of the Pacific graduate

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Gregory K. Louie DDS, DICIO, AFAAID, Prosthodontics Specialist
520 La Gonda Way, Suite 101
Danville, CA  94526
925-785-9089 Member: ADA,CDA,ACP,AAID,AACD,ICOI,AGD

New Technology and Dental Implants

Imaging technology:

There are two types of x-ray imagery commonly used in dentistry.  Conventional 2 dimension (2D) and Computerized tomography (3D).  Each has their advantages and disadvantages, but with the availability of 3D, and being able to see in 3 dimensions, not only it is much easier to work around dangerous anatomical areas, but surgical guides can be fabricated with high accuracy from this data. The type of 3D machines used in dental offices is of the Cone Beam type (CBCT). These machines have about 30 times less radiation as conventional helical scan 3D (CAT) machines found in hospitals, and are thus much safer. Dimensional distortion is very small as compared to 2D images. 20% or more uneven distortion can occur with 2D, and the distortion varies with film and patient position, as well as the manufacturer brand of machine involved. 3D imagery does not have this limitation. We provide complimentary implant consultations with free CBCT scans.

Bioactive technology:

There have been many advances in improving wound healing (implant integration). Natural products from the body include extracting growth factors (healing proteins) from the blood or tissues. In implant dentistry, 3 types of growth factor techniques are used to extract growth factors: Platet Rich Plasma (PRP), Platelet Rich Growth Factors (PRGF), and Platelet Rich Fibrin (PRF). Each of these too, has their advantages and disadvantages. For those who do not like the idea of having blood drawn, there are 2 synthetic growth factor products available in the US that can also improve wound healing, Gem-21 and Infuse. We use all of these techniques, and more.

The latest technology we use involves using a special type of Laser to biostimulate healing.

Surgical techniques:

Especially with the availability of 3D imagery, minimal surgical techniques are becoming more popular. Only a small hole is needed in the tissues for implant placement. Healing is more rapid, and there is very little or no pain afterwards. Although it is not possible to use these techniques with every patient, but this is our preference.

Mini Dental Implants

Small diameter implants, commonly known as mini dental implants, were first used as a temporary implant to support a temporary crown or bridge until the regular implants healed, however, because of the success of these implants, in 1997 the FDA approved these smaller diameter implants (less than 3mm in diameter) for use as a definitive implant for use in final restorations.

Because of the significantly smaller size of these implants, a minimal surgical procedure is needed, hence, very little pain and fast healing is usually the case. Because of their smaller size, these types of implants can be placed into areas of thinner bone, without the necessity of additional bone grafting that may be needed than if regular sized implants were to be placed. Also, medically compromised patients, who may not cope well with conventional implant placement, may do better with this minimal surgical placement technique.

However, because of their significantly smaller size, these implants have less surface area, and thus cannot support loads as well as conventional implants, therefore, their use is limited in cases where there is limited load placed upon these implants. But with proper design and use, these types of implants have a very high success rate, similar to conventional implants in excess of 95%.Some common applications include support for crowns, bridges, and overdentures. Similar to conventional implants, it is possible to immediately place the temporary or final restorations on the same day the implants are placed in many situations.

How Long Do Dental Implants Last?

This is a complex question with several factors to keep in consideration. If done properly, with the correct implant, in the correct circumstances, in the correct conditions, and with the proper maintenance, the implant should last a very long time. Here are some of the factors that can affect implant (and crown) life expectancy.

  1. The health of the patient

    It may be obvious that the patient should be in relatively good health.  As long as the patient is able to heal in a relatively normal way, dental implants can be very successful. This includes patients that are controlled diabetics, patients taking medications commonly used for osteoporosis, and other conditions that result in slower healing, can still have successful results.
  2. Any parafunctional habits

    Grinding and clenching can be very destructive to dental work and implants. There are many ways to compensate for this, such as splinting of the implants, modifying the bite, fabricating dental implant guards, and other techniques.
  3. The implant

    All implants are not created equal. There are significant differences between them. This is a science all to its own that few people (including dentists) really understand.  Some factors to consider are: The seal between the implant and crown (abutment), the screw thread design, the surface coating design, the taper or straight design, and the implant material itself. It is best to select an implant system tailored specifically unique to the patient, and not try to use one implant system for everybody; every persons situation and body is different.
  4. Quality and quantity of bone

    Research has shown that not only should there be at least 2.5mm of bone surrounding the implant for long term success, the density should also be adequate to support the biting force for eating. Patients are often told that they cannot have implants because there is not enough bone.  This is not true any longer. We can now grow the necessary bone with new technology.
  5. Quality and quantity of the surrounding soft tissue

    One of the problems that sometimes lead to implant loss, is inflammation around the neck of the implant (implantitis) leading to loss of bone, and the possible loss of the implant. One way to reduce this possible problem, and make the implant more resistant to this is to make sure that the gums around the implant is of the thicker tough type of gums (keratinized gingiva).  If there is not enough of this tissue, there are many ways to also grow this tissue.
  6. Maintenance

    Maintenance is probably the most important factor. If the area is not kept clean, the bacteria, plaque, tarter, and the resulting inflammation will destroy the tissues around the implant. Regular teeth/implant cleanings are mandatory. This may be the most difficult factor of all. Frequently, the dentistry is the easy part. Changing the habits of people is the more difficult part. It is important to realize that these are generalizations. It is best to think to long-term results. You only want to do this once, do it the correct way, and do not take shortcuts.

Does Teeth Whitening Damage Teeth?

Teeth bleaching, better known as teeth whitening has become very popular, but frequently, there are questions regarding the safety of these products on the teeth and gums.

The way these products work, is by oxidizing the stains that have been collecting on the surface of teeth, and within the enamel crystals of teeth. The active ingredient is peroxide based. Hydrogen peroxide, urea peroxide, or carbamide peroxide are the most popular, and are available in strengths between 3% to 35%.  Because, these products cause teeth sensitivity, and will soften the tooth enamel, manufacturers will often add ingredients to reduce the sensitivity, and tooth softening.  Sodium Fluoride, Calcium Gluconate, Strontium Chloride, and Silver Nitrate are some of the more common additives.

Two application techniques are commonly used: In-office bleaching, and take home bleaching. Each work equally well. In-office bleaching involves shining a powerful light on the bleach-coated teeth.  Because peroxide reacts to light, and a higher strength bleach is used,  quicker results will occur. However, this technique is usually less comfortable and more costly. The second technique is to have bleaching trays made, and the patient applies the bleach into the tray themselves. This is a more convenient technique. Any unused bleach can be stored in the refrigerator for touch-ups later.  Over the counter bleaches can also be used in the tray for significantly lower cost, however, it will take longer to reach the desired result when compared to the in-office bleaching technique.

Used as directed, Tooth enamel hardness and any tooth sensitivity should return to normal within a week. The use of desensitizing toothpastes and fluoride mouthwashes will speed the recovery of any sensitive teeth. There should be no lasting damage to the teeth or dental work.  If color matching is desired for upcoming dental work, It is recommended to whiten the teeth weeks before the dental procedure so that the color will be stable.

Dental Implants are Not the Same

This is a complicated subject that even most Dentists don’t understand. In summary, because there is no “best” implant for all situations, it is important to use an implant that has a scientific documented high success rate (not just an advertising claim),  be from a reputable company that will probably still be here many years from now, for spare parts if needed, and the use of a particular brand design optimized for each particular patient. This is better than trying to use one kind of implant for everyone. Some systems we use are from: Nobel Biocare, Astra, Zimmer, HiOssen, Neoss, Alpha Bio, Dentis, Sweden & Martina, Straumann, Neodent, and Ankalos.

Also, we use manufacturers original restorative parts; no 3rd party parts are used. Unfortunately, the implant manufacturers world has become very complicated. Because many of the manufacturer’s patents have expired, many independent companies are cloning each other’s designs, however, it is unlikely that they are exact copies, as proprietary metallurgic treatments are still secret. Complicating matters further, Laboratories can now copy parts. This may result in poor tolerances and poor quality control, as now even small labs can do as they please. This may result in increased microleakage between parts resulting in bone loss around the implant over time.

To stress the complexity of this subject, for example:

Most implant designs use grade 2, 4, 5, or 23 titanium. Other designs cryo treat the titanium or use other materials, such as tantalum. Implant macro design topology include thread pitch angle, thread depth, thread number, and thread cross sectional designs. Micro design topologies are the microscopic surface roughness of various forms created by acid etching, surface blasting, and chemical treatments. Active chemical treatments involve using calcium, phosphorous, fluoride, and other compounds to create a bioactive surface. The design of the implant-abutment interface, usually categorized as an external, or internal connection, may be proprietary depending upon the implant system. Platform switching designs are the mismatch of a smaller diameter abutment mated to a larger diameter implant body interface and may have beneficial biological effects.

Gregory Louie DDS, DICOI, AAAID 520 La Gonda Way, Suite 101 Danville, CA 94526 925-837-2300

About the Doctor

Dr. Louie first started his dental experience as a dental laboratory technician in 1976. Triple majoring in the Biological Sciences, Psychology, and History, he graduated with an undergraduate Bachelor of Arts Degree in 1983, before attending his dental training at the University of the Pacific in San Francisco, completing his dental degree in 1986. After practicing as a general dentist for several years, he completed an advanced training residency in dental implants at Brookdale Hospital in Brooklyn, NY, and at NYU, before receiving advanced specialty training in Prosthodontics at the University of Illinois at Chicago.

Some of his active associations and organizations include the: American College of Prosthodontics, American Dental Association, California Dental Association, Regional Dental Associations, American Academy of Implant Dentistry (Fellow), International Congress of Oral Implantologists (Diplomat), American Academy of Cosmetic Dentistry, Las Vegas Institute for Continuing Education, Dental Organization for Conscious Sedation, and the American Academy of General Dentistry.

Dr. Louie lectures extensively about dental implants and dental reconstruction techniques and procedures. He was past director of the Hi Ossen Implant Manufacturer’s Dental Implant Training Center in Walnut Creek, and the director of the Tri Valley Dental Implant Training Center, and has lectured extensively domestically and internationally. He has taught many dentists the art and science of dental implants and restorations.

The Future

True to our current philosophy, as we continue on in life’s travels, I see our office keeping up with technology in providing the latest dental techniques for our patients. As far as for my personal interests, I find myself spending time with my family and raising my son. I still find time for my interests in playing music, Guitar and Piano, as well as occasionally ice-skating. Some of my earlier accomplishments included ice-skating in Skate America 1990, and Worlds 1991.

Our Practice

Our practice is team orientated, and it is our policy to give comprehensive, compassionate care with reasonable fees.  Although Dr. Louie has had many years experience as a Dental Lab Technologist, General Dentist, and still enjoys Family Dentistry, as a Prosthodontist Specialist, our office has an emphasis in Dental Implants, complicated restorative reconstruction, advanced bone grafting, advanced tissue grafting, Laser biostimulation, and preventative care.

What Is A Prosthodontist?

A Prosthodontist is a dentist who specializes in prosthetic reconstruction, the specialty of esthetic and reconstructive dentistry. This may include Crowns, Dentures, Fillings, Implants, and Maxillofacial Prosthetics, etc. It is one of one of the lesser known of the nine dental specialties recognized by the American Dental Association. As in the medical field, in the dental field, additional years of full-time specialized training after becoming a dentist is required before being recognized as a specialist in a particular field. Not only does a prosthodontist deal with simple cases, but are specially trained for the more complex cases.  Some examples are patients who need full mouth reconstruction, with real teeth or in combination with dental implants, cancer patients who have lost their jaws, nose, ears, etc. and is not limited to the mouth.

Maintenance and Preventative care

Prevention is probably the most important action regarding teeth and gum problems. Even though our Dental technology is good, it can never be as good as what nature has given us. Proper brushing, flossing, and regular dental visits can prevent most of the common Dental problems we see today. It is common to see serious Dental problems occur when they could have been prevented. The absence of pain does not indicate that everything may be fine. Gum disease, for example, is the most common reason adults loose their teeth, however, it is common not to feel pain until the last stages. There is no cure to re grow back ALL the bone that has been destroyed. This is one example why regular check-ups can be valuable: catch it early.

Cosmetic Dentistry

“Cosmetic Dentistry” used to be a popular “catch word” regarding improving smiles.  Actually, what we do is a combination of form, function, and cosmetics, and they are all interrelated. Having a beautiful smile is very important for self-esteem, and this can have a profound influence in the successfulness of an individual’s social, business, and personal life. With the newer bonding agents, ceramics, and diagnostic technology, cosmetic dental procedures can have great results, but, without the compromises that were common only a few years ago.

Our Services

We offer full dental services. These may include:

  • Exam and Cleanings
  • Cosmetic Dentistry and Teeth Whitening
  • Tooth Colored Fillings, Crowns, and Bridges
  • Gum Treatments
  • Dentures and Partial Dentures
  • Same Day Denture Repair
  • TMJ Problems
  • Complex Restorative Cases
  • Dental Implant Placement and Restorations
  • Bone and tissue reconstruction
  • Laser decontamination and biostimulation
  • Complementary Dental Implant Consultations

Advanced Technology Dentistry

  • Digital 2D radiography
  • Digital 3D radiography, Complimentary implant Consultations
  • Advanced Technology, Ceramic and Metal Crowns and Bridges
  • Dental Implant Placement and Restorations, “Teeth in One Day”
  • Bone and Soft tissue Regeneration Technology
  • Minimally Invasive Surgical Techniques
  • Minimally Invasive Restorative Techniques
  • Periolase Laser: LANAP, LAPIP, BLAST
  • Radiolase Assisted Dentistry
  • Long Wave TENS (Transcutaneous Electrical Nerve Stimulation)
  • Functional and Cosmetic Prosthodontic Therapies
  • Anxiolysis Sedation

Bone Grafts are Not all the Same

People often get confused regarding the many types of bone grafting. Today it is possible to significantly regrow bone that is lost through time, or, it is common occurrence that a bone graft is initially placed when a tooth is extracted, just to find out that there is still not enough bone to place an implant. Thus, there are many other types of bone graft techniques and bone graft materials and technology to address this issue.

Site Preservation Bone Graft: After an extraction, bone graft material is packed into the extraction socket to preserve as much as the existing bone as possible; This type of graft is not designed to regrow a ridge that has shrunk over time, but only to help to preserve as much bone as possible that is already there.

Sinus Lift Bone Graft: Often if an upper tooth is extracted many years ago, the existing bone will shrink, and the sinuses get larger (pneumatization) resulting in a short bone height. If an implant is placed, it will therefore poke into the sinus, however, it is possible to lift the sinus membrane and graft bone so that bone will enclose the whole implant. This will strengthen the support of the implant.

Guided Bone Regeneration Bone Graft: This technique is probably the “gold standard” for regrowing the thin and shorter bone height ridges. Granulated bone is “shaped” and secured with membranes to increase thickness and height of resorbed ridges of bone, enough so, that implants can usually be placed.

Onlay Block Bone Graft: A block of bone is shaped and secured to a resorbed ridge. This technique is usually not as predictable as GBR, and because of the difficulty of the blood vessels to penetrate a block of bone, may result in greater shrinkage when healing.

Bone graft Materials:

As with bone graft types, there are many bone graft materials, each with their advantages/disadvantages. Often we may combine the materials in different ways to get the desired results.

Autograft: Your own harvested bone.

Allograft: This is a Freezed Dried Human Bone product.

Xenograft: This is a Freeze Dried Animal Bone product. The most common animal bone is sourced from cows, pigs, horses, and even camels

Synthetic: The most common synthetic grafting granules are made from tricalcium phosphate (TCP), however other grafting particles such as Hydroxyapatite are not usually used with implant s because their lack of resorption and being “hard as a rock” to drill through; Concrete.

Growth Factors (healing proteins). These are usually grown synthetically, or extracted from your blood and combined with the bone particulates listed above.

It’s Not Only The Bone, It’s the Soft Tissue Too!

For long-term life and stability, there must be adequate soft tissue (gums) around the implant for bacteria seal. As the “Bone sets the Tone, the Soft Tissue is the Issue”. There are basically two kinds of soft tissue, the thin easily movable type, and the thicker non-movable “keratinized” type. The thicker “keratinized” type of gums is more desirable.

Also for long-term stability, there must be adequate thickness above the implant. As with bone, be can grow tissue as we need it in most cases.

All Crowns Are Not Created Equal

Crowns (Caps) are usually done when there is not enough tooth structure to hold a filling. A filling is only as strong as the remaining tooth to hold it in. Because a crown goes over the entire remaining tooth, it can be much stronger, more resistant to breakage than a filling. However, there are many different types of crowns, each with their own advantages and disadvantages. Crowns can be full coverage or partial coverage. They can be fabricated by casting, milling, sintering, pressed into a mold, or a combination of the above. Here are some popular types:

  • All metal crowns

There are different kinds of metal alloys used in dentistry. Each specific alloy composition is usually a trade secret by each manufacture, but the American Dental Association classifies them into 3 basic categories: Non-precious metal, Semi-precious metal, and Precious metal alloys.  

Non-precious alloys are strongest, but are not as biocompatible. There is no gold or other precious metals, but may contain some silver. They may have a large composition of nickel. This can cause problems with allergic reactions, especially with females who wear a lot of nickel containing jewelry. Casting fabrication accuracy can be a challenge, especially with large bridges.

Semi-precious alloys contain precious metals such as Gold, Platinum, Palladium, and Silver. These alloys are more biocompatible with tissues, are easy to fabricate accurately, especially with large bridges, and are stronger than Precious metal crowns.

Precious alloys contain a high amount of Gold, and may be slightly more biocompatible than Semi-precious metals, but are significantly weaker. Because of this, they are not used often with porcelain fused to metal crowns (PFM) or large bridges. They also tend to wear faster. However, plaque and tarter do not adhere to the surfaces well, compared to actual tooth structure, thus it is easier to keep clean.

  • Porcelain fused to metal (PFM)

PFMs consists of an inner metal coping, with tooth-colored porcelain baked on top. The primary reason that these crowns were popular, is that they are tooth-colored, not metal colored, as with all-metal crowns. These crowns have been the “go to” crowns for tooth-colored restorations for many years, however, because the metal coping blocks the light, if there is any future shrinkage of the gums, there will be a “black line shadow” appearance at the gumline. Cosmetically, this may not be acceptable.

  • All ceramic crowns

The technology for fabricating all ceramic crowns have progressed to the point that for tooth-colored crowns, these are the most lifelike and the most popular. Several types of ceramics are used. Old-fashioned porcelain has the potential of having the best beauty, however, Lithium Disilicate crowns come very close in beauty with 4X the strength. Zirconia crowns are the strongest, with up to 10X the strength of porcelain, but are very opaque, and do not look lifelike. These are usually placed on the back teeth, where it is hard to see them.

  • Composite crowns

At one time these crowns were popular, because of the ease of fabrication. They consist of a composite mix of ceramic powder and a plastic binder. Their strengths are below porcelain, and are not as durable.It is important to discuss with your dentist which crown will be right for you. Dental technology is in the midst of a technology boom, and new materials are on the horizon.