Treatments | Boston MA | Stuparich and Nouel Dental Associates

The Link between Oral Health and Overall Health

Periodontal diseases, including gingivitis and periodontitis, are serious infections that, if left untreated, can lead to tooth loss. Signs of gingivitis include red, swollen gums that bleed easily. With gingivitis, the gums are irritated due to bacteria living in plaque and tartar which is present at or under the gumline.

Untreated gingivitis can lead to periodontitis. Periodontitis is a more severe form of periodontal disease, in which bone loss has occurred. The toxins present in the gums stimulate a chronic inflammatory response and the tissues and bone that support the teeth break down. Gums separate from the teeth, forming periodontal pockets which can become infected.

As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. With ongoing bone loss, the affected teeth become loose and must be extracted.

Patients with periodontal disease are often unaware of the disease process occurring in their mouth. Routine dental care and good oral hygiene habits are the most effective way of maintaining healthy gums.

Hygiene maintenance appointments

Dental prevention should serve as a lifestyle model for overall health. It results in improved long-term oral health and reduced costs. Prevention is your insurance policy for a healthy, pain-free way of life.

Keeping a regular schedule for hygiene maintenance appointments is the best way to keep optimal oral health and to prevent any dental troubles before they begin. It is recommended that you come for a hygiene appointment at least twice a year, and often more frequently than that.

During your hygiene maintenance appointment, we will thoroughly examine your mouth for cavities, gum disease and any abnormal conditions that could affect your health. Our dental hygienist will customize a daily oral hygiene program especially for you. We will review what your routine is at home, and determine if any habits need to be modified in order to improve your oral health. We will clean and polish your teeth to remove plaque and tartar above and below the gumline. This eliminates bacteria that can cause cavities, gum disease and bad breath.

Tackling tomorrow’s problems today will give you great peace of mind. If you have put off or missed your last hygiene maintenance appointments, keep in mind that it’s not simply a cleaning - it is an investment in your overall health.

Periodontal Examination

Periodontal disease is the leading cause of tooth loss in the United States. At your initial visit and during hygiene visits, a full periodontal exam will be done to determine the health of your gums and check for bone loss.

One of the greatest indicators of gum disease is to test whether periodontal pockets exist in your mouth. A periodontal pocket is a space in between the tooth and the gum that easily traps food, plaque, and bacteria. They are a result of periodontal disease, and are a sign that a bacterial infection is present. Areas of periodontal pocketing become extremely difficult for patients to clean themselves, and must be treated by a dentist or dental hygienist.

Therapy for periodontal pockets is a two-step process: The first step is to have a deep cleaning which removes plaque and calculus from under the gumline. This cleaning is called scaling and root planing, and most patients are given local anesthesia in order to be comfortable during this type of cleaning. The second step to treat a periodontal pocket is to place antibiotics locally at the depth of the pocket. This is done immediately following the scaling and root planing to give your body the best chance at fighting the infection and returning to health.

Soft Tissue Grafting with AlloDerm

Soft tissue grafting is a procedure which covers root surface that has become exposed due to receding gums. Receding gums can result in tooth sensitivity, unsightly appearance, and bacterial infections. Traditionally, soft tissue grafting was accomplished by taking gum tissue from the palate and suturing it to the site of recession.

With new medical advances, creating coverage in areas of recession can be accomplished with less trauma to the patient, by using a collagen matrix material called AlloDerm. With the AlloDerm procedure, healthy tissue which was traditionally taken from the patients’ palate is no longer removed. Instead, AlloDerm is attached to the areas of the gum that need treatment. In time, the AlloDerm becomes incorporated with the patient’s natural gum tissue, and proper root coverage is achieved. The protective qualities of the gums are restored, and the look of healthy gums is achieved.

Sealants

Sealants are designed to protect the chewing surfaces of the back teeth. They should be applied while the permanent teeth erupt. Although sealants are generally placed on children’s teeth, as long as there is no sign of decay, adult molars can be sealed as well.

Fluoride treatments

Fluoride helps to strengthen tooth enamel, making it more difficult for cavities to form. Children should receive fluoride applications every six-months.

Tooth Desensitization

For adults, fluoride can help decrease the pain and discomfort caused by receding gums. Regular application helps eliminate root sensitivity. Our patients have found it beneficial to have a series of fluoride treatments in the office, as well as at-home applications.

Single Tooth or Multiple Tooth Implants

Dental implants are an important aspect of dentistry, as they are the best option for replacing missing teeth, and are one of the most successful treatments.

Why are implants important today?

Seventy percent of the U.S. population is missing at least one tooth. Missing teeth can be a result of genetics, decay, or periodontal problems. In the past, options for missing teeth were limited to removable dentures or fixed bridges. Today, placing implants in areas of missing teeth has become the best choice for patient comfort and long-term success.

Replacing a missing tooth with an implant is considered the best option for the following reasons:

Implants with restorations are more aesthetic than gaps caused by missing teeth.
Chewing function is restored.
Bone loss is prevented.

Implants are placed on patients from teenage years until well beyond retirement. Placing implants on seniors is common because aging has a direct correlation with tooth loss. Seniors no longer settle for living with removable dentures or gaps between their teeth, and they want to retain the chewing function and aesthetics that they are accustomed to living with.

What is an implant?

There are three parts that compose an implant. The implant is the screw that goes into the bone. The abutment is the part which connects the implant to the crown. A crown is placed on top of the abutment to look and feel like a natural tooth.

Implants are made of titanium, because it is lightweight and durable,and integrates into the bone well.It is the same material that is used in orthopedic joint replacements.

Who is a candidate for implants?

Most people are candidates for implants. Patients with medical conditions are usually okay, as long as the condition is controlled. For example, diabetics are permitted to receive implants as long as their blood sugar is controlled.

Adequate bone must be available in the area of the implant for it to be successful. Within the first year that a tooth is extracted, there is an average of 30% loss of bone width and a 4mm loss in bone height due to lack of stimulation. The rate of bone loss decreases after the first year, but bone continues to be lost throughout life. Through procedures such as sinus lifts and bone grafting,we can create healthy bone for the implant to be placed in.

How does the implant process work?

Initially,an i-CAT scan will be taken to determine the amount of bone present and the surrounding anatomy. For your convenience, this scan can be completed in our office in an open environment. Implant surgeries are completed by Dr. Stuparich in a sterile field in our office. During the surgery, patients are generally sedated in order to be more comfortable.

After the implant is placed into the bone, a certain amount of time must be waited for the bone to osseointegrate, or become part of the jaw bone. The waiting time is four to six months for implants on the upper jaw and three to four months for the lower jaw. After the appropriate healing time, a crown is attached to the implant to look and feel like a natural tooth.

What you need to do to care for implants

Implants should be cared for like natural teeth by brushing and flossing daily. Regular hygiene appointments are necessary to monitor the health of your teeth and implants.

Benefits of Implants versus other restorations :

Advantages of implants over fixed bridges

After ten years, implants have a success rate of over 97%, while fixed bridges have a 50% success rate after ten years.
Surrounding teeth are not affected when a single tooth implant is placed. However, surrounding healthy teeth are affected by bridge placement. In addition, bridges are often not successful if the adjacent teeth have decay or root canal treatment.
Implants integrate into the bone, which means they stimulate and preserve bone. However, bridges cause more bone loss, because there is no stimulation to the underlying bone.

Advantages of implants over removable dentures

After ten years, implants have a success rate of over 97%, while dentures have a success rate of only 35% after ten years.
Implants enable the underlying bone to maintain its form and density. Dentures cause the width and height of the bone to decrease.
Implants do not alter the shape of the patient’s faith. On the other hand, when full dentures are placed, lips become inverted, the face becomes thinner and the cheeks become hollow, which means the face loses its normal, healthy appearance; causing the patient to appear older.
Implants restore normal biting and chewing function, enabling the patient to maintain a normal diet. On the other hand, the biting and chewing function of denture wearers decreases by 75%. Food choices are limited, which impacts the patient’s overall health.
Implants have no effect on surrounding teeth. However, removable dentures cause an extra strain on surrounding, supporting teeth. These teeth have problems with decay, mobility and gum disease, and there is a 44% chance they will be extracted within ten years.
Implants and attached crowns are fixed restorations, while removable dentures must be removed and properly cleaned every night.
Implants do not impact speaking ability. However, 88% of denture wearers have trouble speaking.
Implants match the color and shape of natural teeth, while dentures do not have a natural look.

i-Cat Scan

Drs. Stuparich and Nouel use the i-CAT 3-D imaging system to obtain images necessary for implants, complex tooth extractions or impactions, orthodontics, and TMJ issues. The i-CAT is located in our office so that patients do not have to travel to a different location in order to have this important X-ray taken. The scan is completed in 20 seconds or less, and patients are seated in an open environment. This is the highest image quality on the market today with significantly less radiation than other CAT scans.

Crowns

A crown restoration covers a tooth. It strengthens the tooth, and restores it to its normal shape and size. A crown may be placed in the following instances:

to protect and/or restore fractured teeth
when a large filling has weakened remaining tooth structure
serve as an attachment for bridge placement and
when root canal therapy is performed

Most of our crowns are completed in one visit and made from durable porcelain using CEREC technology.

Crowns in a Day- Cerec restorations

Cerec restorations are quite a breakthrough in modern dentistry as they allow the patient to have a restoration completed in the office in one visit, and allows the dentist to create an ideal restoration in both fit and appearance. This process uses CAD/CAM technology and digital imaging and is currently used for crowns, onlays, inlays, and veneers.

Benefits of Cerec restorations include:

They preserve the most amount of healthy tooth structure.
Most Cerec restorations are completed in one visit, versus traditional crowns which take at least two visits.
Temporary crowns and messy impressions aren't necessary.
They fit comfortably, and are created to have a natural look which blends in with the surrounding teeth.
Restorations are biocompatible, long-lasting, and durable.
The porcelain materials closely match the composition of natural tooth structure. This means that when you eat hot food and then drink something cold, the restoration will expand and contract at almost equal rates. This decreases the chance that your tooth will crack.

Dr. Nouel has taken several Cerec courses at the Scottsdale Center for Dentistry, and has received advanced training in creating Cerec restorations for both anterior and posterior teeth. Back to Top

Bridges

A fixed bridge is used to replace missing teeth. With a bridge, an artificial tooth is created in the site of the missing tooth, and this is connected to sound teeth on either side. With advances in implant dentistry, implants are becoming the leading choice for the replacement of missing teeth, and bridges are not used as commonly as they previously were.

Veneers

Veneers are thin, semi-translucent facings that are permanently bonded to the front of the teeth. They are generally customized from porcelain. Veneers have a natural appearance, are durable and are stain-resistant. They are used to treat teeth that are broken, chipped, discolored, crooked or misshaped. In addition, veneers cover spaces between teeth. Veneers are a great aesthetic solution to your smile that may even help you avoid orthodontic treatment.

Onlays

When a significant area of a tooth needs to be restored but a full crown isn’t necessary, an onlay may be the solution. Onlays cover the cusps of the teeth, but do not go all the way to the gumline. They are created from porcelain or gold, and can usually be completed in one visit at our office. Dr. Nouel creates onlays to conserve as much healthy tooth structure as possible, and give the appearance of a natural tooth.

Inlays

Inlays are restorations that cover an area of the biting surface of the tooth, but not the entire biting surface. They are a good solution for treating certain areas of decay and replacing existing fillings. Inlays are usually made from porcelain and can be completed within one day as a CEREC restoration. They are a durable restoration which match well with the shade of the surrounding tooth.

Composite Fillings

The concept of a filling is replacing and restoring tooth structure that is damaged due to decay or fractures. We replace old, broken-down amalgam/metal fillings with white composite fillings to restore your smile and teeth to a more natural look and feel.

With today’s advancements, you will no longer have to suffer the embarrassment of unsightly and unhealthy amalgam fillings or the metal margins of the past. Eliminate the dark, black appearance in your teeth with new-age, state-of-the-art, tooth-colored resin or porcelain materials.

Composite fillings are a great choice if there is a small area of the tooth to be restored. When larger areas of the tooth require a restoration, however, CEREC restorations are often the better choice.

Bonding

Bonding is an ideal treatment option for patients with minor tooth imperfections. During this procedure Drs. Nouel and Stuparich apply a tooth-colored material to the surface of a tooth. The material is then shaped, hardened and polished to match the appearance of the natural teeth. Bonding can be used to close gaps between teeth, restore fractured or chipped teeth and disguise discolored teeth. The procedure is completed in one office visit. No anesthesia is required. However, composite bonds are not as durable and long-lasting as veneers and crowns and may need to be re-touched or replaced in the future.

Nightguard Therapy

Nightguards prevent damage to the chewing surfaces of teeth as a result of grinding and clenching. Dr. Stuparich and Dr. Nouel will create a nightguard that protects your teeth from unnecessary wear and possible fractures, while remaining comfortable to wear while you sleep.

Tooth Whitening

Your teeth will darken over time. Changes in the color of your teeth can be caused by such factors as the food and beverages consumed (like coffee, tea, and soda). Other known factors for discoloration may include childhood medications or illnesses, tobacco use, or improper oral hygiene. Restoring your natural white smile is a priority for our dental whitening team. We offer either Zoom! in-office or take home whitening options for your convenience.

Zoom! Whitening is an excellent choice for patients who want a fast jumpstart to their whitening! This bleaching process results in an average of eight shades lighter, and can be completed in our office in a couple of hours. We include bleaching trays with the Zoom! procedure, so that you can touch up the whitening at your convenience

We provide an at-home whitening system, which is a great way for you to whiten your teeth with customized bleaching trays. With bleaching trays, you whiten your teeth in the comfort of your own home until you are happy with their shade. You can get refills of whitening gel at our office anytime.

Restylane

Restylane is a cosmetic procedure which is often used in conjunction with dental implants to restore a patient’s youthful, healthy look. Restylane is a substance that is used to fill in aging lines on the face. It is made of hyaluronic acid and water. The hyaluronic acid closely resembles the natural material which has been depleted in the area of facial lines. Restylane does not affect facial expression, and is not a permanent procedure. This is a treatment which can be touched up at each recall appointment.

Extractions

It is sometimes necessary to take teeth out of the mouth due to decay, periodontal disease, or malposition of the tooth. Third molars, commonly called wisdom teeth, are often extracted because they are prone to decay and periodontal problems. A CT scan may be taken to determine the anatomy around the extraction site.

Dentures

Dentures are often used as an interim solution during the implant procedure to ensure that the patient does not have the appearance of missing teeth. Full dentures cover an entire arch, whereas partial dentures are indicated when the arch has remaining intact teeth. All dentures are removable prostheses which must be taken out and cleaned regularly.