What is a Sinus Intrusion?

The Consultation

Several years ago, a new patient presented for an implant consultation. The “spirit of the conversation” went something like this……..According to her, she was in desperate desire to chew again, on her right side. Her two previous dentists told her that in order for her to get the desired dental implant in the upper right side, she would need to get a full blown sinus lift procedure. She implored,” I don’t want that big surgery. The thought of it makes me cringe. My friend had it done and she was swollen for days. Can you help me?”  

My Introspective Thought

After that sincere plea for help it got me thinking about an alternative procedure being promoted at a dental seminar several months prior. I was thinking, rhetorically, can I do this for this beautiful lady? In brief, it was a minimally invasive procedure. Generally, I could potentially create sizable bone for the future implant. Lastly, there would be a minimal discomfort. After all, I wanted to help her. I had the motivation and glimmer of curiosity. In short, I said, “Let’s take a radiograph and I will see what I can do for you.”

The Lateral Wall Sinus Lift Procedure

A Lateral Wall Sinus Lift procedure is probably the most invasive procedure we execute in dentistry. Essentially, the dentist breaks into the maxillary sinus compartment with a drill, teases a thin delicate membrane off the floor of the fractured sinus and raises it, utilizing a set of specifically designed curved curettes. That’s to say, once the Synerderian membrane is gently displaced, cadaver bone is furthermore augmented to the newly created space to create a pseudo sinus floor. Subsequently, this augmented site provides the footing foundation for the future implant fixture. (I write about this in great detail in a previous blog. See “Sinus Lift” or visit my You Tube Channel Robert Emilio DDS & Associates, to witness the actual procedure live).

By the way, the implant can not be immediately placed until this new bone matures. Grafted bone needs to heal. Ordinarily, post operative swelling lasts about 3 days. Furthermore, this newly grafted bone can take up to six months to heal. Lastly, there’s a needed secondary surgery. Similarly, the implant must get inserted later on. Oh yes. Then there is an additional healing period of three months.

Evaluation & Discussion of the Cat Scan

To summarize, I said, “No problem”, with confidence. Furthermore, I continued on.”To begin with, how does it sound if I make a tiny incision and work thru a little tiny hole of 5.0 mm diameter? Next, I will then gently plunge saline water thru this little access hole to “push” the sinus membrane off the sinus floor. In short, it goes like this. Usually, one shot of local anesthetic is all that is needed. Incidentally, one small incision. So I then, push away the sinus membrane off the floor. Lastly, I will insert the bone graft and then finally, simultaneously, place the implant fixture. In short, does that sound agreeable? ” This is called a Sinus Intrusion Crestal Approach. To sum up, as I explained,” I can do it for you. I do it regularly(in my head)! Furthermore, book it today.”

Check it Out Live, If you Dare!

( You can see this procedure live on my You Tube Channel Robert Emilio DDS & Associates. Sinus Intrusion The Crestal Approach

Needless to say. She came in the other day for routine hygiene check. In conclusion, everything looked great. Likewise, see below radiographic progression

The Two Year Radiographic Follow Up

Pre Op Schematic. Tooth #3 Missing
Post Op. Fabulous Bone height achieved on Implant #3 (part of the bridge (#3-#5)

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your  Friends

A Late Night Emergency. Ouch! The Split tooth.

Almost Gone……..

Notes for the day written up, jacket on, briskly heading out and almost at the exit door last night. “Where you going? Didn’t you look at the schedule?” Natalie, pulled me aside and said, “wait, we got an emergency.”

Emergency Radiograph

Bicuspid Tooth. Upper Right. A two rooted tooth split down the middle
Clinically fractured tooth. Almost split in 1/2. Ouch!

First of all, the patient had no idea how it happened. Furthermore, it just hurt real bad. Sharp pain upper right side. An incessant throbbing pulse originating from a single tooth. It seemed like the radiograph revealed no decay, although there was a very small amalgam filling. Clinically, it was grotesquely obvious. I did not need my high powered eyeglasses. There was a rude fracture running front to back through the tooth. Subsequently, Dr Swanson and myself concluded that the tooth had to go.

Restorative Options

Unfortunately, an extraction was only treatment “option”. Likewise, restorative options were limited. The No tooth option was discussed. In contrast, the patient was reluctant to be toothless. The dread of a removable partial appliance was not desired either. For that reason, the only non removable options were either a bridge or an implant. Certainly the cemented “fixed” bridge option was discussed, but we’d have to section off and further extend a perfectly healthy, functional, existing bridge anterior to this hopeless tooth. It seemed obvious. Almost instantly we agreed. He said,”Let’s do what we did several years ago; another implant.”

Treatment

The Immediate Implant was opted

Surgical Removal of fractured Tooth

Above all, local anesthetic consisting of 2% Lidocaine was delivered by Dr. Swanson. Subsequently, I surgically removed the tooth in total in an uneventful manner.

This tooth was split all the way down to the trunk aspect. Very difficult to do.

The immediate Implant Placed

Hence, a (4.1 x 12mm) Straumann BLT Dental Implant was immediately placed by me in replacement/substitute of his hopeless tooth.

Bone Graft and Collagen Barrier Placed

In addition, I carefully grafted cadaver donated bone material to fill the remaining “empty space” ie, socket void. Finally, I like to layer a bio-resorbable collagen barrier over the graft to direct the maturation of the new gingival growth. This is called a Guided Bone Regeneration Technique (GBR). I really enjoyed demonstrating the nuance of this technique to Dr. Swanson. Dr Swanson is currently enrolled in a prestigious Implant training Program in Florida. In addition to working full time here at the practice, she’s a full time mom. Way To Go Collisha!

Implant Placed in lieu of removed fracture tooth
Grafted and Barrier in Place prior to closure
Implant Placed in it’s proper position in solid bone.

Conclusion and Analysis

Hence, 7:30 PM presented a perfect opportunity for an immediate implant. The tooth area was free from underlying infection due to the timing of the acute injury. This patient was a non smoker; therefore extremely healthy with no underlying metabolic disease. His bone quality and quantity was ideal.

The most obvious advantage of the immediate implant is my ability to preserve bone integrity and “fake the body out”. The seamless switching a natural root for a man made one(implant) is a nifty trick. We know that loss of a tooth cascades into an immediate and rapid dissolution of surrounding bone structure. Therefore, it’s imperative to replace a tooth immediately, when one can, to minimize future degenerative changes.

Actually, his timing couldn’t have been better, for an expected excellent outcome. It would seem that immediate access to me was critical. Certainly, it was the end of a long day. The thought making a positive impact in my patients’ life is what energized my enthusiasm to do the right thing. Emergencies, as such, are untimely. Rather, this is the nature of my job. It appears that I am always on call. Who would of thought? I am a dentist not a medical doctor? LOL. I love what I do and it seems that it really is not work when you are doing what you love to do any time of the day/night.

It would have been easy for me to dismiss the patient with a prescription and a reappointment. Time with the onset of the inevitable acute infection would have transpired within a short time if the tooth was not immediately extracted limiting our restorative options further. Most note worthy, we did what we had to do to get the job done. Consequently we ultimately provided a tremendous service to another great patient.

As a result, in 3 months, the implant will be restored by Dr.Swanson to function with a perfectly functional crown.

Credits

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your 

OMG. Be Careful. It’s Killing Me!

The New Patient Introduction

A new patient, female of middle age, came in today complaining of excruciating pain emanating from the internal aspect of her lower lip. The first and only thing she said with urgency, was not Hello. Instead, in brief, “Be careful. It’s killing me. My lip is on fire. It must be an abscess or worse.” In light of the urgency, I dispensed with the formalities of the introduction.

Evaluation

Visual inspection of the area took me all of 2 seconds to make the diagnosis. The teeth were fine in the area, moreover, no obvious decay. No need for the routine radiograph. Oh yeah. It was bad. No joke. Very bad. Raised and fire engine red in outline. Not to mention the yellow jellylike cratered center in form. Yes, very painful to experience. I rarely get them. Equally important, my wife suffers with them and is at their mercy.

Diagnosis

In the final analysis, Aphthous Ulcer/ A.K.A. Canker Sore

Who/What/When/Where/Why

Location/size

Canker sores are NOT the same as cold sore ulcers. In fact, canker sore ulcerations develop in the non keratinized tissues of your mouth. Moreover, they are observed in the movable cheek areas (base of your gums, soft palate, under your tongue and inner lips).

Most canker sores uniquely are outlined in red with a yellow core, oval in shape, very painful because of the inherent movable tissues they are imbedded in.

Causes:

Who knows? Viral in nature perhaps? Its probably related to STRESS….. Stress, of course presents in many aspects. I frequently see patients present with canker sores this time of year especially when life gets hectic, Cold weather, change in season, lack of sleep, subtle exposure to irritating viruses, Christmas gift bills to pay, poor diet…. It’s a cumulative series of stressful events that culminate with a manifestation of ulcerations of the mouth.

NOTE: I have personally experienced the onset of aphthous ulcerations with the use of a certain toothpaste.

Who gets them?

Mostly women and teenagers contract canker sores. They are not contagious.

Foods To Avoid?

Canker sores may be brought on by certain acidic foods such as pineapple, grapefruit and oranges.

Duration:

12-14 days from onset time.

Treatment:

In the final analysis, nothing really. Get some stress relief. Yoga? Hit a heavy bag? T.M.?

If there is really BAD pain, I can help. When quality of life is severely compromised, I can always write a prescription (like our Friend who presented as a new patient today) for Magic Mouthwash. I request the pharmacist to make a concoction rinse that has a combination of three components in equal parts: Benedryl, Malox and Viscous 2%Lidocaine. I generally require patients to utilize this mixture as a rinse and expectorate as needed for pain relief.

There is some literature that taking a daily amino acid supplement of Beta Lysine may prevent the formation of the ulceration.

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

My goal is to keep my patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your 

Why Do My Teeth Feel Sensitive?

The Story

My second patient of the day was complaining of tooth sensitivity. “It’s up there, up there on the left top, some place. When I drink cold water, it bothers me”, as she pointed upward towards my ceiling with vague clarity.

The Evaluation

During my clinical exam with my trusty explorer instrument, I ticked off my mental checklist. Exam revealed nothing out of the ordinary for this 40 year old individual. Existing fillings looked good and sealed, no cracks in the enamel of the teeth. No obvious decay. Some wear of cusps. Recession of the gums on the molar was noted. The radiograph showed nothing obvious, otherwise boring.

The Subsequent Questions I asked of my patient and my Silent Mental Response (S.M.R.) was as follows:

Q: First of all, does it hurt when you chew,,,,, just straight up and down?

A: No

S.M.R. : Good. Hence, no dying nerve requiring a root canal procedure. When a tooth’s nerve is in the early stage of dying, it swells within the pulp chamber. As a result, the tooth “pushes” itself out of the tooth’s socket only the slightest bit. Consequently, when one bites straight down on the tooth, the bruised pulp nerve with its surrounding supporting tissues get compressed. This is interpreted as, “pain on chew”. Combine chewing pain with cold sensitivity that means root canal.

Q: Similarly, Does it hurt when you chew side to side?

A: No

S.M.R. : Good. Not a fractured tooth or a fractured restoration. Either fracture would illicit the same cold sensitivity. A fractured anything, most noteworthy, allows a wicking of cold liquid within the seam of the fracture. The cold liquid gets intimately close to the sensing nerve when it is drawn thru the crack. As a result, one can feel the cold temps..

Q: Does the cold linger or does it shoot away very quickly?

A: Quickly

S.M.R. : Very Good. A healthy nerve will respond quickly and rapidly dissipate in response when the stimuli is removed ( in this case- cold water is swallowed).

The Diagnosis:

I said, “Hmmm , X-ray looks good. No decay noted radiographically. The nerve is healthy. No cracks anywhere. Some recession of the gum line of those teeth. I’m not a mind reader and it’s difficult for you to pin down which tooth……It seems like recession of the gums sensitivity. Go with the over the counter for sensitive teeth stuff and go easy on the brushing!”

The 411

A tooth’s root is poros. Within these microscopic pores, lie extended from the pulp core, tiny nerve fibers suspended in a gelatinous sea. These fibers reach out to the surface of the root and are in a direct communication with the outside world. Toothpaste for Sensitive Teeth formulas essentially are toothpastes containing microscopic boulder elements that are sized exactly to plug perfectly into the dentin pores. These microscopic pores thereby, in effect, are closed “off” isolating the nerve fiber denticles from the outside world. Subsequently, you and I interpret that effect as— O.M.G, no more pain when we drink cold water. In effect, a mechanical barrier is created (sort of like Trump’s proposed border wall). Application of this toothpaste over time creates layer upon layer of pore closings with the desired effect of less and less cold sensitivity.

Other Causes Of Cold Sensitivity :

As mentioned previously above

Aggressive brushing, decay, cracked tooth and/or a cracked dental restoration

Acidic Foods

Tooth Grinding

Tooth Whitening Toothpaste

Recent dental work

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your 

Does Charcoal Toothpaste Work?

The Setting

Last night, my wife and I were invited for dinner at a dear friend’s house. The occasion was nothing other than a post holiday chill evening. We had a fabulous time reminiscing enjoying excellent food, great wine and light conversation. “Kimberly you have a dazzling white smile” my wife said, admiring in awe . “It’s the charcoal toothpaste”, Kimberly replied. ” I just brush it on and leave it there for a bit, then brush off .”

I’ve got to admit, Kim’s teeth were very white but not just white: they were an opulent natural white. I was thinking that perhaps I should further investigate this magical dentrifice.

The Research

Charcoal is everywhere. It’s incorporated into a range of products from cosmetic facial astringents to supplemental pills for colon cleansing. Essentially, think of the charcoal molecule as a large porous sponge molecule that is capable of straining smaller microscopic particles through a physical exchange of motion. In other words, as particle ridden fluid washes through the bigger charcoal (sponge) molecule, they get trapped or absorbed within the physically convoluted configuration of the charcoal molecule. This thereby allows the fluid carrying the tiny debris to exit the larger charcoal molecule clear and debris free because the smaller caustic debris was trapped behind within the charcoal molecule.

The Test and Results

Charcoal powder on a wet toothbrush and brushed regularly.One time for about 60 seconds.

Before…..Not Too Bad…
Give me a Kiss
After One minute brush application

Conclusion

Charcoal product does not whiten teeth. It just removes the surface stains exposing the underlying natural luster of nature’s best. 

The Charcoal is just another abrasive cleanser , albeit organic, when it’s on the end of a toothbrush.

There is No fresh tingly taste to the charcoal product. In fact, there is NO TASTE.

There was no sensitivity in the application or post application of the charcoal paste. Many people suffer from tooth sensitivity to cold temperatures soon after at home or professional tooth whitening. However, charcoal toothpaste may be a nice simple organic measure to lighten up without the hassle of that dreaded tooth pain post whitening.

It made a big mess in the bathroom vanity. Be prepared for a cleanup of your work area. Keep paper towels nearby for the cleanup. Most importantly, the mess may be worth the result!

Credits

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com