Florida Periodontist Discusses New Technology

Florida Periodontist Dr. Frederic J. Norkin discusses new technology such as digital x-rays, Tekscan, and high resolution digital photography to plan treatment for patients.

We use a number of tools for diagnosis and treatment.  Those include digital radiography that allows us to take X-rays that are at the lowest possible radiation dose for our patients.  We are also able to use what’s called a “T” scan, a Tekscan, and that essentially is a tool that we use to digitally check a patient’s occlusion—in other words, their bite.

Most dentists use what is called articulating paper that just makes marks on teeth but does not tell much about the biting force.  Particularly when we are dealing with patients with implants, bite and biting force are critical.  It is not just a matter of seeing where the patient bites but, most importantly, how hard and whether the bite is balanced properly.  We can use this digital technology, the “T” scan, to make sure that we can deliver a balanced and protective occlusion for our patients.  This technology really improves our treatment outcomes, particularly when dealing with patients with full arch and full mouth restorations.

In many instances, we also use digital impressions, so that we can take accurate impressions of our patients without having to necessarily take conventional impressions that require us to fill trays and sometimes trigger the gagging reflex in patients.  Digital impressions are appropriate in some instances but not, unfortunately, in every instance yet. When we use it, however, it is exceedingly accurate.

We also photograph many of our cases. Diagnostically, photographs are tremendous for us to be able to observe a patient’s lip line and smile.  A photo lets us see where we are starting from and, very importantly, it allows us to share this information with the patient.

Many people have guarded smiles, particularly when they have a broken down dentition, and we try to retract the teeth and see areas that they do not ordinarily see.  Digital photography with high resolution and magnification allows us to have a clear indication of how to rebuild their smile their confidence.

We are always on the forefront of these new technologies to better serve our patients.

 

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Dr. Frederic J. Norkin
South Florida Center for Periodontics & Implant Dentistry
www.flsmile.com

New Dental X-Rays Offer Great Advantages

CT scan technology combined with new computer programs allows periodontists to plan dental cases in advance, get better results, and shorten treatment time.

We have been using CT scan technology in our practice now for about a decade.  It is perhaps the single most important tool that we have in our office.  It literally lets us see through the bone, very much the way I would take an apple, cut that apple in half and be able to open it up and look inside.  With the CT scan, I have that same ability to take an image of your jaw, cut it in half and look at the inside of your jaw.  In doing so, we have so many advantages.  Diagnostically, we can find certain types of lesions that are related to root canals or failing root canals that we may not ordinarily see on regular dental X-rays.  We can certainly see the anatomy much better.  We can find where the sinuses are with great accuracy.  We can find where certain nerves are located, so we can avoid them during surgery.

We also have planning software that works with these images that allows us to use our computer to plan out an entire case in advance, whether it is for a single implant or for many implants and make sure that we place the implant in the most ideal position.  That planning lets us do a much better job, more accurately, more efficiently when it comes to doing the actual surgery.

Beyond that, in many instances, we then mill guides that allow us to take our plan that we made on the computer and with tremendous accuracy replicate t through a CAD cam, meaning a computer-assisted design, computer-assisted milling process.  We mill a guide and replicate our plan that we made without the patient there and then deliver  on the day of treatment the same exact plan that we designed in advance.

This process allows us to do certain procedures that may require going around a nerve or a sinus much more accurately and safer than we would ordinarily.  It also allows us the opportunity to maximize what little bone some patients may have remaining.  It also lets us place implants in the most ideal position.  Finally, with high-tech x-rays and software, we work much more efficiently and we can do less invasive procedures.  By taking advantage of CT scan technology, we minimize chair time for the patient.

In sum, we are able to take CT scan information, combine it with computer planning ahead of time, and then ultimately deliver a superior outcome for our patients.

 

IMG_3490_lowDr. Frederic J. Norkin
South Florida Center for Periodontics & Implant Dentistry
www.flsmile.com

After Dental Implants, Mom Has First Photo With Son In 13 Years!

After dental implants, a mom gained the confidence after 13 years to have her photo taken with son—only the second photo since the day he was born.

Dental implants have many benefits.  Essentially, a dental implant is a tooth root replacement. Dental implants can support one new individual tooth, a full arch, or even a full mouth of teeth.  The teeth that are affixed to dental implants are fixed and not removable, except when dental implants support dentures that literally snap in, like a snap on a shirt.

Dental implants also have the advantage that they help to maintain bone.   When a tooth is missing, the bone shrinks.  It literally reabsorbs over just a few months.  As much as 50 percent of the bone can literally shrink away to nothing.  However, when bone is under pressure, whether from having a natural tooth or a dental implant, the bone is stimulated.  This process is analogous doing weight-bearing exercises for the rest of your body which help to maintain strong. healthy bone.

There are also psychological advantages that go along with dental implants.  Studies show that using dental implants can make patients feel more confident psychologically because they are  not worried that a denture, for instance, is going to fall out of their mouth in social situations.

We can also use dental implants to literally take care of years of dental problems for patients whom we often describe as a dental cripple and change their lives.   I have a patient who came in with what appeared to be a very pleasing smile, but all of her teeth were loose.  Her tooth concern was that she really could not eat—at least that is what she told me.

I took out all of her teeth and placed a number of implants in both the top and lower jaw What I didn’t know until much later on was that this patient had never had a picture taken with her then 13-years-old son after he was born.  She had one picture taken when her son was born.  Even though her teeth looked good when she smiled, she lacked confidence due to her loose teeth, and she did not have any more pictures taken until, literally, the day that we delivered, not only her implants, but her immediate fixed teeth, meaning we took the teeth out in a single visit, placed the implants and made temporaries for her right away that we screwed in place.

That was actually the first time in almost 13 years that she had a picture with her son.  I had no idea that we were making that kind of an impact.  I thought I was simply helping a woman who was having trouble chewing due to failing dentition.  The implant dentistry treatment gave her confidence and changed her life in more ways than one.

 

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Dr. Frederic J. Norkin
South Florida Center for Periodontics & Implant Dentistry
www.flsmile.com

Boca Raton Periodontist Explains Board Certification

Boca Raton Periodontist Dr. Fred Norkin explains the rigorous board certification process and how it makes him a better clinician.

After completing dental school at Tuft University, in Boston, Massachusetts, a general practice residency at the Miami Veterans Administration Hospital, in Miami, Florida, and a periodontal residency at Nova Southeastern University in Fort Lauderdale, Florida, I went on to become board-certified.  Becoming a board certified periodontist is essentially a two-step process.  First, you take and pass a written examination, and the next step is an oral examination.  At that point, the periodontist is board certified and becomes what is called a “diplomate” of the American Board of Periodontology.

Many people are surprised to learn that only about 50 or 60 percent of all practicing periodontists become board-certified.  Every seven years diplomates must be recertified in our specialty through a written examination.  This is the process we use to maintain our board certification.

The value of this voluntary and prestigious credential is that it forces us, as periodontists, to hone our specialty knowledge and make sure that we are current on all of the recent studies and scientific literature.  We need to show that we are able to weave that knowledge into thoughtful, sensible treatment plans and outcomes for our patients.

There may be many ways to treat a patient or an individual problem, and I may not agree completely with another colleague.  The board certification process essentially makes sure that different potential treatment plans put forth by various periodontists for particular case plans make sense.  By constantly challenging ourselves to think through all the treatment issues in depth and be prepared to defend our conclusions in front of our colleagues, we help ensure that patients are getting the best we have to offer.

I know from experience that my commitment to board certification has caused me to sharpen my skills and stay on the leading edge of periodontal and dental implant treatment.

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Dr. Frederic J. Norkin
South Florida Center for Periodontics & Implant Dentistry
www.flsmile.com

Sinus Lift: what is it and do you need one?

A sinus lift is recommended when there is not enough bone height in the upper jaw or not enough room between sinuses for dental implants to be placed. The surgery adds necessary bone to the jaw and the sinuses on either side of your nose to build a stronger foundation in preparation for dental implants. The sinus membrane is lifted by a dental specialist (oral surgeon, endodontist or periodontist) to make room for the bone transplant.

Do I Need a Sinus Lift? Maybe…

You may be a candidate for a sinus lift if you have bone loss due to periodontitis or resorption of bone after a prolonged period of having missing teeth (sunken jaw). It’s often necessary in these circumstances to augment the existing bone in the jaw in preparation for dental implants. The donor bone may come from your own body or other medically appropriate substitute. If the bone comes from your own body, it is most often taken from your hip or tibia. You will have x-rays taken to determine the anatomy of your jaw and sinuses, as well as a CT scan to accurately measure the height and width of your existing bone.

How’s a Sinus Lift Done?

The actual sinus lift procedure starts with your dental specialist creating an incision in the back of your mouth to reveal the bone, raising the sinus membrane up and away from your jaw. Then a small, circular shaped hole in the bone is opened. Granules of the bone graft are packed into this hole, and the tissue will then be closed with stitches.

don't sneezeAftercare Instructions for Sinus Lift

After the procedure it is important to avoid blowing your nose or sneezing forcefully. These place you at risk for loosening the graft and stitches. You’ll have a saline wash to keep the inner lining of your nose wet, as well as an antimicrobial mouthwash that helps prevent infection at the incision site. Pain meds will be prescribed as will antibiotics. Be sure to complete the full round of antibiotics.

After a sinus lift, contact us if swelling or pain gets worse over time. Should bleeding not stop after two days or if the blood is bright red and continuous, your bone graft may have become dislodged, call us immediately. Also let us know if you develop a fever as this could be a sign of infection. The healing process generally takes between four to nine months. This allows the bone graft to mesh with your bone, and after it’s healed, you will be ready for your dental implants.

If you are interested in dental implants or have questions about the sinus lift procedure, call us today at (561) 912-9993

index_dr_ganales-xsDr. Jeffrey Ganeles
Periodontist
South Florida Center for Periodontics and Implant Dentistry
Boca Raton, FL
New Patients Welcome
www.flsmile.com

Implant Dentistry Advancing Rapidly—Robotic Assisted Surgery Coming Soon

Implant dentistry is advancing so quickly that soon almost all patients will have same-day teeth and robotics will help make surgery less invasive.

 In general the trends in implant dentistry have been placing implants in more difficult places or more difficult circumstances, using less drastic procedures, having them heal faster and look better.  It was considered a crazy idea 20 years ago to think that patients could walk out of an office with teeth the same day of treatment.  We do that routinely now.

In the future, we will be able to do that even more frequently than we do now.  We probably can do it three quarters of the time today based on the circumstances of the case.  I imagine we will be doing it 90% of the time in a couple of years and replace almost any tooth and load it immediately, which means it will be functional that same day.

There is also a trend toward doing fewer bone grafts because shorter and smaller implants seem to be as successful as longer and wider ones which require more bone.  In a sense, we are developing the ability to do more with less.

Some of the challenges we have had in the past, particularly in terms of complications with dental implants, have been cement getting stuck around implants and causing bone loss and infections.  We are going to see different attachment mechanisms that no longer require screwing a crown or cementing a crown to an implant.  We are just going to snap them into place, which is going to be quicker, simpler, and more trouble free.

On another exciting front, I am involved with a company that is developing robotic guidance in order to place implants extremely precisely using a very minimally invasive approach.  It is computer assisted surgery and it is similar to what is being done in orthopedics.  This new robotic approach will be on the market probably a year from now and although its first generation is rather large, the second and third generations of that unit will be much smaller.  This process is also going to allow us to prepare a temporary restoration in advance so that everything is a little bit faster and more streamlined in the treatment process.

index_dr_ganales-xsDr. Jeffrey Ganeles
Periodontist
South Florida Center for Periodontics and Implant Dentistry
Boca Raton, FL
New Patients Welcome
www.flsmile.com

Raton Periodontist Provides Long-Term Commitment to Dental Implants

Boca Raton periodontist Dr. Jeffrey Ganeles provides a long-term commitment to repair or replace dental implants as needed as long patients do their part.

We are certainly committed to maintaining the patient’s health, and we have an office policy that says if you lose an implant within ten years we will take some responsibility for that and make sure that we credit you towards replacing the implant.  For instance if you lose an implant within the first two years we will replace it for you. We essentially own that as long as you meet certain criteria.  Those criteria are that we have to check the final cap and you have to maintain professional cleanings at a dentist’s office.  The cleanings do have to be done in our office, but the patient needs to have those cleanings done professionally in the dental office of their choice.

If the patient has the cleanings done in another office, then we like to see x-rays on these patients periodically.  We often get x-rays on patients whom we have not seen for a while and it gives us a chance to check and to make sure that everything is fine.  If for some reason there is  a problem, then we can always call a patient back and say we got an x-ray from your dentist and the implant does not look as good as it used to.  We can ask the patient to please come in so we can take a look and resolve a small problem before it becomes a big concern.

After two years or between two years and ten years, we will give you a percentage or will credit you a percentage of the value of what you paid for that procedure toward any replacement or toward correcting a problem around that implant.  We feel this is a very fair policy, because we are accepting some long-term financial responsibility for the implant.

 

index_dr_ganales-xsDr. Jeffrey Ganeles
Periodontist
South Florida Center for Periodontics and Implant Dentistry
Boca Raton, FL
New Patients Welcome
www.flsmile.com