Specialty Services in Richland, WA

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Periodontal disease is the leading cause of bone loss in the oral cavity, though there are others such as ill-fitting dentures and facial trauma.  The bone grafting procedure is an excellent way to replace lost bone tissue and encourage natural bone growth.  Bone grafting is a versatile and predictable procedure which fulfills a wide variety of functions.

A bone graft may be required to create a stable base for dental implant placement, to halt the progression of gum disease, or to make the smile appear more aesthetically pleasing.

There are several types of dental bone grafts.  The following are the most common:

  •  Autogenous bone graft – In this type of graft the bone is removed from elsewhere in the body and implanted in the mouth.  Common donor sites for bone grafting include the iliac section of the pelvis, the chin and the posterior third molar areas of the jaw.  If large amounts of bone need to be harvested, the hip or the shin bone (tibia) is generally used.
  •  Allograft – Synthetic bone (manmade) can be created in the laboratory and used in the bone grafting procedure.  Bone can also be obtained from a bone bank (cadaver bone).
  •  Xenograft – This is the implantation of bovine (cow) bone. A xenograft is perfectly safe and has been used successfully; ample bone can be obtained, and a secondary donor site is not necessary.

Reasons for bone grafting:

There are a wide variety of reasons why bone grafting may be the best option for restoring the jaw bone.

Dental implants – Implants are the preferred replacement method for missing teeth because they restore full functionality to the mouth; however, implants need to be firmly anchored to the jawbone to be effective.  If the jawbone lacks the necessary quality or quantity of bone, bone grafting can strengthen and thicken the implant site.

Sinus lift – A sinus lift entails elevating the sinus membrane and grafting bone onto the sinus floor so that implants can be securely placed.

Ridge augmentation – Ridges in the bone can occur due to trauma, injury, birth defects, or severe periodontal disease.  The bone graft is used to fill in the ridge and make the jawbone a uniform shape.

Nerve repositioning – If the inferior alveolar nerve requires movement to allow for the placement of implants, a bone grafting procedure may be required.  The inferior alveolar nerve allows feeling and sensation in the lower chin and lip.

What does bone grafting treatment involve?

Bone grafting is a fairly simple procedure that can be performed under local anesthetic; however, if large amounts of bone area need to be grafted, general anesthetic may be required.

Initially, the grafting material needs to either be harvested or prepared for insertion.  A small incision is made in the gum tissue and then gently separated from the bone.  The bone grafting material is then placed at the affected site.

The bone regeneration process may be aided by:

  •  Gum/bone tissue regeneration – A thin barrier (membrane) is placed below the gum line over the grafting material.  This barrier creates enough space for healthy tissue to grow and separates the faster growing gum tissue from the slower growing fibers.  This means that bone cells can migrate to the protected area and grow naturally.
  •  Tissue stimulating proteins – Enamel matrix proteins occur during natural tooth development.  Emdogain is a matrix protein product which is usually placed on the affected site before the gum is sutured.  It mediates the formation of accellular cementum on the tooth which provides a foundation to allow periodontal attachment to occur.  Tissue stimulating proteins help create lost support in areas affected by periodontal defects.
  •  Platelet-rich growth factors – A high platelet concentration liquid can be used to create a blood clot at the site of a wound.  It has recently been discovered that PRGF also stimulates bone growth – meaning a denser graft in a shorter time period.

The gum is sutured in place and a follow-up appointment will need to be made within 10 days to assess progress.  Bone grafting is a highly successful treatment and a good base for further periodontal restorations.

A woman with endodontics

Endodontics is a specialized branch of dentistry that deals with the complex structures found inside the teeth. The Greek word “Endodontics” literally means “inside the tooth” and relates to the tooth pulp, tissues, nerves, and arterioles.  Endodontists receive additional dental training after completing dental school to enable them to perform both complex and simple procedures, including root canal therapy.

Historically, a tooth with a diseased nerve would be removed immediately, but endodontists are now able to save the natural tooth in most cases. Generally, extracting the inner tooth structures, then sealing the resulting gap with a crown restores health and functionality to damaged teeth.

Signs and symptoms of endodontic problems:

  • Inflammation and tenderness in the gums.
  • Teeth that are sensitive to hot and cold foods.
  • Tenderness when chewing and biting.
  • Tooth discoloration.
  • Unexplained pain in the nearby lymph nodes.

Reasons for endodontic treatment

Endodontic treatment (or root canal therapy) is performed to save the natural tooth. In spite of the many advanced restorations available, most dentists agree that there is no substitute for healthy, natural teeth.

Here are some of the main causes of inner tooth damage:

Bacterial infections – Oral bacteria is the most common cause of endodontic problems. Bacteria invade the tooth pulp through tiny fissures in the teeth caused by tooth decay or injury. The resulting inflammation and bacterial infection jeopardize the affected tooth and may cause an abscess to form.

Fractures and chips – When a large part of the surface or crown of the tooth has become completely detached, root canal therapy may be required. The removal of the crown portion leaves the pulp exposed, which can be debilitating painful and problematic.

Injuries – Injuries to the teeth can be caused by a direct or indirect blow to the mouth area.  Some injuries cause a tooth to become luxated or dislodged from its socket. Root canal therapy is often needed after the endodontist has successfully stabilized the injured tooth.

Removals – If a tooth has been knocked clean out of the socket, it is important to rinse it and place it back into the socket as quickly as possible. If this is impossible, place the tooth in special dental solution (available at pharmacies) or in milk. These steps will keep the inner mechanisms of the tooth moist and alive while emergency dental treatment is sought. The tooth will be affixed in its socket using a special splint, and the endodontist will then perform root canal therapy to save the tooth.

What does an endodontic procedure involve?

Root canal therapy usually takes between one and three visits to complete. Complete X-rays of the teeth will be taken and examined before the treatment begins.

Initially, a local anesthetic will be administered, and a dental dam (protective sheet) will be placed to ensure that the surgical area remains free of saliva during the treatment. An opening will be created in the surface of the tooth, and the pulp will be completely removed using small handheld instruments.

The space will then be shaped, cleaned, and filled with gutta-percha.  Gutta-percha is a biocompatible material that is somewhat similar to rubber. Cement will be applied on top to ensure that the root canals are completely sealed off. Usually, a temporary filling will be placed to restore functionality to the tooth prior to the permanent restoration procedure. During the final visit, a permanent restoration or crown will be placed.

If you have questions or concerns about endodontic procedures, please contact our office.

Invisalign - Richland Smiles

The Invisalign® system is virtually invisible, and straightens your teeth to achieve the smile you’ve always dreamed of.

What Is Invisalign?

The Invisalign® system is virtually invisible, and straightens your teeth to achieve the smile you’ve always dreamed of.

Using advanced 3-D computer-imaging technology, Invisalign® designs your complete treatment plan, from the initial position of your teeth to the final desired position. All this is based on your specific needs. Then a series of clear aligners, also called invisible braces, are custom-made for your teeth – to gradually move them.

Invisalign clear aligners are made of flexible plastic — specifically, a patented thermoplastic material called SmartTrack® created exclusively for Invisalign treatment.

Invisalign clear aligners are FDA-approved and contain no BPA, BPS, latex, or gluten. They are thin, clear, and fit snugly over your teeth, making them virtually invisible.

What Kind of Problems Can Invisalign® Correct?

Invisalign® corrects the same dental problems as traditional metal braces; the only difference is that Invisalign® trays are almost invisible to the naked eye, and can be removed at will.

Here are some problems that are commonly corrected with Invisalign®:

  • Overcrowding: This occurs when there is too little space for the teeth to align normally in the mouth.  Overcrowding can cause tooth decay and increase the likelihood of gum disease.
  • Large gaps between teeth: This can sometimes occur because teeth are missing or because the jaw continues to grow abnormally.
  • Crossbite: This common dental problem occurs when one or multiple upper teeth bite inside the lower teeth.  As a consequence, uneven wear can lead to bone erosion and gum disease.
  • Overbite: This problem occurs when the upper teeth project further than, or completely cover, the lower teeth.  Eventually, jaw pain and TMJ may occur.
  • Underbite:  This is the inverse of the overbite; the lower teeth project further than, or completely cover, the upper teeth.  Eventually, jaw pain and TMJ can occur.

How Does Invisalign® Work?

Align itero scanner

Invisalign treatment starts with a consultation at our Richland dental office with our Invisalign-trained doctor. Your doctor will evaluate your smile and then map out a precise, customized digital treatment plan that showcases the step-by-step transformation of your smile. Our office uses the latest technology, an iTero scanner to create 3D images of your teeth in just minutes. You’ll be able to see first hand the entire treatment without even wearing the first aligner. By using a 3D scanner, we’re able to more accurately create your aligners, and more do it more comfortably. That means fewer impressions, and no more goop or gagging.

Once you approve your plan, your unique aligners will be created. You will wear each set of aligners for 20 to 22 hours a day, changing to a new set of aligners every 1 to 2 weeks, as directed by your doctor. Each set of aligners will gently and gradually shift your teeth into place, according to your treatment plan, until you reach your beautiful new smile.

Schedule an Invisalign Consult in Richland

Ready to explore the benefits of Invisalign, and achieving the smile you deserve? Call our Richland dentist office today for a consult, and get your 3D scan.

Picture of a lady undergoing sedation dentistry

A significant number of Americans do not visit the dentist for regular checkups because they are too fearful or suffer from dental anxiety. Sedation dentistry offers an excellent way to provide a safe, anxiety-free, dental experience to those who are afraid of the dentist. Sedation dentistry is often mistakenly thought to induce sleep. In fact, most sedatives allow the patient to stay awake during the procedure.  Sleepiness is a side effect of some medications, but nitrous oxide, oral conscious sedation and IV sedation only work to calm anxiety throughout the dental visit. Sedation dentistry is popular because most sedatives can be taken by mouth, meaning no injections, no anxiety and no pain.  Some sedatives work so effectively that even the smells and details of the procedure cannot be recalled afterwards.  Safety and compliance are two important aspects of treatments, so sedation dentistry offers both the individual and the dentist the best alternative. Whatever the form of sedative, it is essential to be accompanied by a caregiver.  Sometimes, sedatives are provided the night before the dental visit, which means that driving to or from the appointment is not advisable.

Some Advantages Associated With Sedation Dentistry:

  •  Anxiety is alleviated.
  •  Few side effects.
  •  More can be accomplished during each visit.
  •  No needles.
  •  No pain.
  •  Perfectly safe.
  •  Procedures seem to take less time.

What Kinds of Sedatives Are Available?

The most popular types of dental sedatives are nitrous oxide, oral conscious sedation, and IV sedation.  Different levels of sedation (mild, moderate and deep) can be utilized depending on individual needs.  Before administering any sedative, the dentist must analyze the full medical history of the patient, taking note of any current medications.

Overview of Some of the Most Common Types of Dental Sedatives:

  • Nitrous Oxide – Nitrous oxide, or “laughing gas,” is used as a mild sedative.  It is delivered through a nose hood, and is administered throughout the entire procedure.  Nitrous oxide elevates the general mood and can evoke a general sense of well-being.  Most importantly, it relieves anxiety and reduces pain during the procedure.  In addition, some tingling and numbness may be felt. There are few side effects associated with nitrous oxide, and it has been safely used in dentistry for many years.
  • IV Sedation – Intravenous sedation is a moderate type of sedation.  Patients who have previously experienced IV sedation often report feeling like they slept through the entire procedure.  Generally, IV sedation is used for shorter treatments.  It is administered via direct injection into the bloodstream, which means the effects are immediate.  Sometimes patients feel groggy and sleepy when the IV sedatives are withdrawn.  This is why it is important to bring a designated driver for the drive home.
  • Oral Conscious Sedation Dentistry – Oral conscious sedation is an excellent choice for people who fear needles.  Oral medication is provided prior to treatment in order to induce a moderate state of sedation.  Though oral sedatives do not cause sleep, they usually dull the senses.  This means that most patients cannot remember the pain, smells or noises associated with the procedure.  Usually, a dose of medication is taken prior to the appointment, and then topped up during the procedure as required.

What Types of Drugs are Used in Oral Conscious Sedation?

Most of the drugs used in sedation dentistry are classified as benzodiazepines.  Benzodiazepines reduce anxiety, muscle spasms, insomnia and seizures.  Each medication has a different half-life, meaning that the effects last for varying amounts of time.  The estimated length of the procedure determines which type of drug is going to be most effective.

Some of the Most Common Drugs Used in Oral Conscious Sedation Dentistry Include:

  • Valium® – This sedative has amnesic properties and a long half-life. It is usually used for time-consuming, complex procedures.
  • Halcion® – Usually used to treat insomnia, Halcion is an effective sedative with amnesic properties.  A short half-life makes this sedative useful for shorter procedures.
  • Ativan® – This sedative is best known for reducing anxiety.  It has amnesic properties and a medium half-life.  Ativan is typically used for treatments shorter than two hours.
  • Versed® – This sedative has the shortest half-life and is therefore less commonly used.  It alleviates anxiety in much the same way as nitrous oxide, and is used for visits that will take less than 30 minutes.