Monday, July 18, 2011

Sterilization and Disinfection Procedures in our Dental Office

SAN DIEGO PROSTHODONTICS is proud to offer the latest in modern sterilization and disinfection techniques. Vigorous safeguards, exacting cleaning procedures and controlled professional standards are designed to protect the health and welfare of both patients and practitioners.

Some of our patients have questions regarding the protocol followed during disinfection and sterilization of instruments, hand pieces and treatment rooms. You will find our office follows the "universal precautions" as outlined by the American Dental Association and Center of Disease Control.

All instruments are thoroughly pre-cleaned ultrasonically before they are put into a steam autoclave. The steam autoclave uses heated, pressure and vaporized water to sterilize instruments in a closed chamber. Each instrument is then hand dried.

Dental assistants are responsible for cleaning and disinfecting surfaces in each operatory. We use disinfection procedures on surfaces and equipment that cannot be removed for cleaning and sterilization, such as counter tops, drawer handles, x-ray unit heads and light handles. A sterile disinfectant cleaning solution, Birex, is used to wipe down all counters, suction hoses, and hand piece connectors before and after each patient. You will also notice that we use disposable barriers on surfaces such as light handles that are touched during treatment.

The use of a closed dental unit water system which operates independently from municipal water supplies prevents mineral deposits from adhering to our instruments and in our water lines. Our dental units are not connected to municipal water supplies. This prevents contamination of the inside of the water lines used in each treatment operatory. We use distilled water in all of our operatories.

We want you to be assured that we are committed to providing you with a safe and healthy environment when you visit our office for dental treatment. The health and safety of our patients is our number one priority.

Thursday, June 2, 2011

E.Max Crowns—All Ceramic Dental Crowns Providing Beauty Without Compromising Strength and Durability

Dr. Harold Gulbransen at SAN DIEGO PROSTHODONTICS is proud to offer the latest techniques in Crown and Bridge Dentistry.

Significant new developments in all-ceramic materials have led to the introduction of the e.max dental crown. Previously, dental crowns made from the most natural appearing materials weren’t as durable as those made of less esthetic materials like gold or other precious metals.

However, e.max crowns are fabricated with the newest in cosmetic porcelain, a lithium disilicate glass ceramic material that is natural in appearance yet strong enough to withstand the pressures and demands of the human mouth. Researchers at the Department of Biomaterials and Biomimetics at the New York University College of Dentistry (NYU) found that the lithium disilicate ceramic material used in e.max crowns was far less likely to chip or fracture when compared to veneered zirconia-based crowns.

E.max dental crowns are designed using efficient pressed ceramic technology. They represent the ultimate in metal-free esthetics and durability. Unlike traditional crowns, there are no copings or metal substrates. This means that e.max crowns are more natural in appearance and do not have the telltale “black line” of the crown’s metal substructure at the gumline like traditional crowns do. In effect, the patient benefits from the best of both worlds—the beauty of all-ceramic crowns without compromising strength or durability.

Friday, May 13, 2011

What are the Advantages of an Immediate Denture?

An immediate denture is a complete or partial denture that is inserted on the same day as teeth are extracted, immediately following removal of natural teeth. There are several advantages that immediate dentures provide for patients. First and foremost, immediate dentures provide an important psychological advantage because patients never have to appear in public without teeth. The immediate or temporary dentures are fabricated before the patient’s natural teeth are removed, so they are ready to be inserted at the time of the extractions.

Immediate dentures reduce post operative discomfort after extraction of teeth because they cover and protect the surgical site. In effect, the temporary or immediate dentures act as a Band-Aid and protect the extraction sites, reducing pain.

Studies have also shown that patients who wear an immediate denture have broader, fuller gums after healing which ultimately provides better support for all subsequent denture prostheses.

It is important to note that an immediate denture is an approximation of what the mouth will look like post-surgery. As a result, an immediate denture does not fit as precisely as the final denture will fit. Dr. Gulbransen will use a soft liner material to line the immediate denture after surgery to provide better fit and retention.

This will require a few adjustment visits. As the gums heal following the extractions, they will continue to shrink. Changes can continue for several months. Once the gum and bone healing is completed, the patient is ready to have the final dentures made, generally 4 – 6 months after tooth extractions.

Friday, April 22, 2011

What is an Immediate or Temporary Denture?

An immediate denture is a complete or partial denture that is inserted on the same day as teeth are extracted, immediately following removal of natural teeth. An immediate denture is actually made prior to extracting natural teeth. When a patient is due to have some teeth extracted, prior to surgery, an appointment is made with Dr. Gulbransen.

At this initial appointment, impressions are made with the teeth to be extracted still present. A model is made from this impression and mounted on an articulator, a mechanical device that replicates the upper and lower jaw relationships. Then, in our in-house dental laboratory, the teeth to be extracted are ground off the stone model and the resulting altered model is used to fabricate the immediate denture. This entire process takes place within our in-house dental laboratory, insuring quality control as well as timely delivery.

It is important to note that an immediate denture is an approximation of what the mouth will look like post-surgery. As a result, an immediate denture does not fit as precisely as the final denture will fit. Dr. Gulbransen will use a soft liner material to line the immediate denture after surgery to provide better fit and retention.

This will require a few adjustment visits. As the gums heal following the extractions, they will continue to shrink. Changes can continue for several months. Once the gum and bone healing is completed, the patient is ready to have the final dentures made.

Wednesday, March 30, 2011

Precaution Against Denture Adhesives Containing Zinc

In February 2011, the U.S. Food and Drug Administration (FDA) sent a letter to all denture adhesive manufacturers, recommending removal of zinc from denture adhesive products and/or making significant label changes to warn consumers of potential dangers. This was in response to a number of scientific studies that suggest that zinc contained in some denture adhesives may contribute to zinc toxicity and neurologic disease.

Zinc is a mineral which is necessary to maintain your health. It is required to help regulate growth and metabolism in tissues where new cell development occurs, such as in the bone marrow and the intestinal lining. However, an excess amount of zinc, known as hyperzincemia, can contribute to copper deficiency, zinc toxicity and neurological damage. In the August 2008 publication of Neurology, researchers at the University of Texas Southwestern Medical Center in Dallas, linked use of large amounts of zinc containing denture adhesives to symptoms of neuropathy and zinc toxicity. It should be noted that patients in this study used a minimum of two tubes of denture adhesive weekly. Other researchers in the Department of Neurology at Vanderbilt University report in Neurotoxicology November 2009, patients experiencing progressive neurological symptoms following chronic overuse of zinc-containing denture adhesives.

The two primary manufacturers of zinc-containing denture adhesives in the U. S. are GlaxoSmithKline, which makes Super Poligrip, and Proctor & Gamble, which makes Fixodent. A small amount of zinc is used in these products to provide denture hold. Last year, GlaxoSmithKline agreed to reformulate Super Poligrip to remove zinc.

In 2009 the American College of Prosthodontists (ACP) formed a task force to establish evidence-based guidelines for the care and maintenance of complete dentures. At the conclusion of their study, they published a guideline for denture care in the Journal of Prosthodontics (Vol 20, Supplement1, February 2011)
Even with well-fitting dentures, they found that denture adhesives, when properly used, can improve the retention and stability of dentures and help seal out accumulation of food particles under the denture. However, the authors of the article caution against improper use of zinc-containing denture adhesives due to adverse systemic effects. So as a precautionary measure, they advise patients not to use zinc-containing denture adhesives.

The ACP further states that denture adhesives should be completely removed from the denture and the oral cavity on a daily basis. If increasing amounts of adhesives are required to achieve the same level of denture retention, patients should see their dentist or prosthodontist to evaluate the fit and stability of the dentures. Annual checkups with the dentist or prosthodontist are advised for denture wearers to achieve optimal fit and function of the dentures

References:

Denture cream: an unusual source of excess zinc, leading to hypocupremia and neurologic disease. Nations SP, Boyer PJ, Love LA et al. Neurology.2008; 71:639-643

Myelopolyneuropathy and pancytopenia due to copper deficiency and high zinc levels of unknown origin II: the denture cream is a primary source of excessive zinc. Hedera P, Peltier A, Fink JK, el al. Neurotoxicology 2009; 30:996-999

Evidence-Based Guidelines for the Care and Maintenance of Complete Dentures: A Publication of the American College of Prosthodontists. Felton D, Cooper L, et al. Journal of Prosthodontics Vol 20, Supplement 1, February 2011

Thursday, March 3, 2011

The Importance of Pre Radiation Dental Evaluations

When the treatment for cancer of the head and neck requires radiation therapy, a thorough dental examination before treatment begins, by a dentist trained in this area, can help patients avoid many complications and achieve optimal results. To understand why it is imperative to have a pre radiation evaluation, it is first necessary to understand how radiation affects the oral cavity, salivary glands, teeth and bone.

Because it is very difficult to exclude the salivary glands from the radiation fields in the head and neck, radiation therapy may affect the salivary glands and the result is a change in the quantity and quality of the saliva. Saliva is important when discussing oral health because it both lubricates the mouth and balances the mouth’s acidity, thereby preventing tooth decay. Many patients experience dry mouth, called xerostomia.

Another more serious effect of radiation is to decrease the size and number of blood vessels in the area of radiation. This causes a decrease in the ability of irradiated tissue and bone to heal following surgery, injury or infection. Post radiation infections can be very serious with prolonged healing times, occasionally resulting in osteoradionecrosis.

For this reason, it is very important to thoroughly evaluate a patient’s dentition prior to radiation. To avoid future complications after radiation of the head and neck, any questionable teeth within the field of radiation may need to be extracted prior to initiation of radiotherapy. Extraction of teeth following radiotherapy could place the patient at risk for infections and osteoradionecrosis. In addition, during the pre radiation evaluation, custom topical fluoride trays are fabricated. These trays allow application of topical fluoride daily to help decrease the incidence of dental caries and infection. Patients should also be aware of the need for meticulous oral hygiene, as remaining teeth are usually at risk for dental caries secondary to their xerostomia, or lack of saliva. Long term maintenance includes three month visits to the family dentist or periodontist for cleaning and checkups. This is a lifelong commitment that patients need to make for optimal oral health.

In summary, the goal of the pre radiation dental evaluation is to avoid or minimize post radiation complications. By precluding many complications that could jeopardize treatment options and slow recovery, a thorough pre radiation dental examination is very important.

Wednesday, February 16, 2011

Custom Dental Implant Abutments Using CAD-CAM Technology

The dental implant abutment transfers the load from the dental prosthesis to the titanium dental implant fixture. Over the years dentists have been frustrated by the lack of different abutment choices available for their patient’s implant restoration. Stock abutments were the only available choices. New advances in CAD-CAM procedures are now making it possible for dentists to create abutments that are customized for each of their individual patients needs.

CAD-CAM stands for Computer Aided Design and Computer Aided Manufacture. This technology allows the dentist and the laboratory to design very specific abutments that are custom manufactured to suit the individual needs of each patient. Using CAD-CAM technology, custom abutments are manufactured using scan data from the patient’s dental castings in conjunction with state of the art software and milling equipment.
Why is this so exciting? Dentists are now able to take into account individual differences in patient’s anatomy and implant restorations. In short, it customizes every patient’s treatment plan.

Dental Implants

There are three main parts that make up a dental implant: the implant itself, the dental implant abutment and the dental prosthesis, which generally refers to the dental crown or dental bridgework that the implant supports. Dental implants, together with dental abutments, can be used to support single teeth, a group of teeth, or even all of the teeth.
Let’s discuss the three parts of a dental implant in more detail.

1.) The dental implant fixture: The dental implant fixture is the portion of the implant that is embedded in and becomes anchored to the jawbone. This process is called osseointegration and provides stability and support for the dental prosthesis. The dental implant fixture is constructed out of titanium and is that portion of the dental implant that lies below the gum line.

2.) The dental implant abutment: The dental implant abutment is a cylinder that is screwed on top of the dental implant fixture. The abutment aspect of an implant lies at or above the gum line. This stub portion is used to attach and support the crown, dental bridgework or denture that makes up the final restoration.

3.) The dental prosthesis: The dental prosthesis refers to the dental crown, dental bridgework, or denture that the implant fixture supports. This can be either screwed or cemented in place, depending on the design.

Monday, February 14, 2011

What are the advantages of an Implant-Supported Denture over conventional dentures?

Dental implants provide several advantages when used to anchor implant-supported full bridges and implant-supported dentures. Implants prevent bone loss by transmitting load forces during the chewing process down into the jawbone. The jawbone reacts to this loading by increasing the bone density. Implants are well known in their ability to stop bone loss. With conventional dentures, the bone that previously surrounded the tooth roots begins to resorb(deteriorate). Over time, the dental ridges required to support a conventional denture will shrink, creating a problem with regards to retention and stability of the denture. Dental implants integrate with your jawbone, helping to keep the bone healthy and intact.

Implant supported full bridges and dentures are more comfortable and stable than conventional dentures, allowing patients to retain a more natural biting and chewing capacity. This often results in improved nutrition in many patients.

What is an Implant-Supported Denture?

An implant-supported denture is a type of overdenture that is supported by and attached to implants, while a conventional denture rests on the gums. An implant-supported denture is used when a person doesn’t have any teeth in the jaw, but has enough bone in the jaw to support implants. Special attachments are used to snap the denture onto the implants.
Although it is easy to remove an implant-supported denture from the mouth, some patients prefer to have fixed (permanent) crown and bridgework in their mouths which cannot be removed. Your prosthodontist will consider your specific needs and preferences when suggesting fixed or removable options.

It is important to understand the “behind the scenes” processing that is required for implant-supported dentures. Your prosthodontist has an in-depth knowledge of human anatomy and chewing function as well as an artistic talent to produce teeth that are both natural in appearance and esthetically pleasing. This also requires an extensive knowledge of quality dental materials.

At San Diego Prosthodontics, all removable prostheses, whether conventional or implant-supported dentures are fabricated in our in-house dental laboratory. This insures a high degree of quality control as well as timely delivery of prostheses to our patients.

Tuesday, February 8, 2011

Why go to a Prosthodontist?

Prosthodontics is one of nine dental specialties recognized by the American Dental Association. Prosthodontists are experts in the restoration of natural teeth or the replacement of missing teeth and adjacent oral and facial tissues with artificial substitutes. Prosthodontic treatment may include the use of removable partial or full dentures, caps, crowns, bridges, implant anchored restorations, or combinations of the above.

After completing 4 years of dental school, prosthodontists receive an additional 2-3 years of intense specialized training in an American Dental Association (ADA) accredited graduate program based either at a hospital or a university. This advanced training includes reviews of the literature, lectures, and treatment of patients. Prosthodontists are also trained in the hands-on technical aspects of laboratory fabrication of complex dental prosthetics and complex restoration of dental and facial esthetics. Prosthodontists have a comprehensive knowledge of dental materials and techniques, insuring both function and esthetics when it comes to your treatment.

I like to think of the prosthodontist as the ‘quarterback’ of your dental restorative team. Prosthodontists take a whole-mouth approach to your dental care. They supervise your treatment from your initial consultations to your follow-up care after treatment. It is your prosthodontist who interacts with other dentists, specialists and technicians to coordinate your dental treatment plan.

Whether your care requires single crowns, fillings, veneers, dental bridges, dentures or complex implant restorations, you can be assured that you are receiving state-of-the-art dentistry from your prosthodontist, who is dedicated to the highest standards of care in restoration and replacement of teeth.

Monday, January 31, 2011

IN-HOUSE DENTAL LABORATORY

At SAN DIEGO PROSTHODONTICS we have a fully equipped prosthetic laboratory on premises, staffed with two full-time, experienced dental laboratory technicians. This ensures complete control and timely delivery of superior quality customized crowns, bridges, dental implant restorations, dentures and facial prostheses.

**We have the ability on site to accomplish all phases of complete denture fabrication, most implant supported restorations and cast precious metal crowns and bridges. A custom milling machine is available for the fabrication of high-end implant supported restorations. All phases of fabrication of silicone facial prostheses, from sculpting to processing and painting are handled in our laboratory.

Our dental laboratory technicians, Fred and Ian are vital components of our oral health care team. The skill and knowledge they have represents over 50 years of experience in the field of dentistry. If you are having a restoration on an implant or a tooth; if you are receiving crowns (caps), bridges, inlays, onlays, partial or complete dentures (plates),or nightguards, you have been helped by these valuable individuals who are dedicated to restoring the beauty and function of your mouth.




Friday, January 28, 2011

Advantages of Digital Dental X-Rays

I am often asked by patients about the advantages of digital radiography when used in my dental office. Digital radiography is a form of x-ray imaging where sensors are used instead of traditional photographic film. There are two types of dental radiological examinations—intraoral, with sensors placed inside the mouth, and extraoral, where the sensor is outside the mouth. An extraoral X-ray image is commonly referred to as a Panoramic X-ray and is used to visualize a larger region.

When we moved to our new office, we purchased both a digital intraoral x-ray machine as well as a digital extraoral panoramic machine, commonly referred to as a digital Panorex . After more than 25 years practicing dentistry using conventional X-ray technology, I am excited to share the benefits of digital radiology with my patients.

First and foremost, digital radiography reduces my patient’s exposure to radiation—usually 70 to 80 percent. Many patients are very relieved that digital radiology significantly lowers the amount of radiation they will receive.

In addition, there is no chemical processing of the x-rays, eliminating the inconvenience and environmental impact associated with disposal of conventional film developers

Thirdly, digital X-rays facilitate communication with patients as well as other practitioners. The digital images are immediately available to view. Using current technology, it is very easy to enhance, enlarge, or refine the X-ray images. Brightness, color and/or contrast of digital X-rays can be adjusted without re-exposing the patient for another film. Patients are now able to view their X-rays instantaneously on the computer monitor screens located in each operatory.

One of the most useful advantages, is that I can send the digital image to other doctors in a few minutes. Often, while a patient is still seated in the dental chair, I can call other referring doctors to discuss their treatment plan. This can understandably save time for both patients and doctors alike.

Finally, digital X-ray images can be stored in each patient’s database on the computer. This process saves time and allows me to easily retrieve this information when necessary.

As you can see, digital radiology offers many advantages when compared with traditional film based X-rays. The decision to ‘go digital’ in our new office has both enhanced and improved patient care.

Wednesday, January 26, 2011

Visit our new location. 8860 Center Drive, Suite 460, La Mesa.,CA

January 1, 2011, we celebrated our one year anniversary at our new office location, 8860 Center Drive, Suite 460, La Mesa, CA  91942.  We are conveniently located next to Sharp Grossmont Hospital.