RESTORATIVE/COSMETIC

Zoom and Invisalign are some of the products we have partnered with to help create the best smile for you. Click on any of the below links to learn more about other cosmetic dentistry procedures we perform here at Bischoff Dentistry.

 
 teeth whitening     cracked teeth     dental crowns    
 

Teeth Whitening
The most commonly prescribed cosmetic dental procedure, many whitening options are now available to consumers in a wide range of prices. Dentist-supervised treatments remain the AACD's recommendation for lightening discolored teeth.

We offer 2 Options of the same products that you see on the popular television series Extreme Make Over.
Option 1     $600
Zoom® in office whitening

Advantages:
A Single one hour office visit for an average improvement of 4-6 shades.

Disadvantages:
More expensive.
May require yearly maintenance, unless combined with the other Option.
Minor post visit sensitivity for a few days.

Option 2     $199
Nite White® custom tray and whitening gel
This Option is the most widely utilized method with best long term results.

Advantages:
Apply for 1 hour a day for 10 days.
Can use while sleeping.
Various Options of strength and flavors.
Has zero sensitivity formulas.
 

Cracked Teeth
With their more sophisticated procedures, dentists are helping people keep their teeth longer. Because people are living longer and more stressful lives, they are exposing their teeth to many more years of crack-inducing habits, such as clenching, grinding, and chewing on hard objects. These habits make our teeth more susceptible to cracks.

How do I know if my tooth is cracked?
Cracked teeth show a variety of symptoms, including erratic pain when chewing, possibly with release of biting pressure, or pain when your tooth is exposed to temperature extremes. In many cases, the pain may come and go, and Dr. Bischoff may have difficulty locating which tooth is causing the discomfort.

Why does a cracked tooth hurt?
To understand why a cracked tooth hurts, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is the inner soft tissue called the pulp. The loose pulp is a connective tissue that contains cells, blood vessels and nerves.

When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.

How will my cracked tooth be treated?
There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent of the crack.

Craze Lines
Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearances.

Fractured Cusp
When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. Your tooth will usually be restored with a full crown by Dr. Bischoff.

Cracked Tooth
This crack extends from the chewing surface of the tooth vertically towards the root. A cracked tooth is not completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp. Dr. Bischoff will then restore your tooth with a crown to hold the pieces together and protect the cracked tooth. At times, the crack may extend below the gingival tissue line, requiring extraction. A nontreatable tooth is shown in the graphic above.  Early diagnosis is important. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.

Split Tooth
A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth cannot be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by Dr. Bischoff may be used to save a portion of the tooth.

Vertical Root Fracture
Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment may involve extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.

After treatment for a cracked tooth, will my tooth completely heal?
Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your endodontist about your particular diagnosis and treatment recommendations. S/he will advise you on how to keep your natural teeth and achieve optimum dental health.

What can I do to prevent my teeth from cracking?
While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

  • Don't chew on hard objects such as ice, unpopped popcorn kernels or pens.
  • Don't clench or grind your teeth.
  • If you clench or grind your teeth while you sleep, talk to Dr. Bischoff about getting a retainer or other mouthguard to protect your teeth.
  • Wear a mouthguard or protective mask when playing contact sports.

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Dental Crowns
A dental crown is a tooth-shaped "cap" that is placed over a tooth – covering the tooth to restore its shape and size, strength, and/or to improve its appearance.

The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

Why Is a Dental Crown Needed?
A dental crown may be needed in the following situations:
  • To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth
  • To restore an already broken tooth or a tooth that has been severely worn down
  • To cover and support a tooth with a large filling when there isn't a lot of tooth left
  • To hold a dental bridge in place
  • To cover misshapened or severely discolored teeth
  • To cover a dental implant

What Types of Crowns Are Available?
Permanent crowns can be made from all metal, porcelain-fused-to-metal, all resin, or all ceramic.  Metals used in crowns include gold alloy, other alloys (for example, palladium).  Compared with other crown types, less tooth structure needs to be removed with metal crowns. Metal crowns withstand biting and chewing forces well and probably last the longest. Also, metal crowns rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.

Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). The crown's porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown's porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.

All-ceramic or all-porcelain dental crowns provide the best natural color match than any other crown type and may be more suitable for people with metal allergies.  All-ceramic crowns are the best & most asthetic choice for front teeth.

Temporary versus permanent. Temporary crowns can be made in Dr. Bischoff's office whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by the dental laboratory.

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Removable Partial Dentures
An important step in maintaining a healthy smile is to replace missing teeth. When teeth are missing, the remaining ones can change position, drifting into the surrounding space. Teeth that are out of position can damage tissues in the mouth. In addition, it may be difficult to clean thoroughly between crooked teeth. As a result, you run the risk of tooth decay and periodontal (gum) disease, which can lead to the loss of additional teeth.

A removable partial denture fills in the space created by missing teeth and fills out your smile. A denture helps you to properly chew food, a difficult task when you are missing teeth. In addition, a denture may improve speech and prevent a sagging face by providing support for lips and cheeks.

Here are answers to common questions about partial dentures:

 

How do you wear a removable partial denture?
Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps, or tooth colored clasps. Precision attachments are generally more esthetic than metal clasps and they are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. Dentures with precision attachments generally cost more than those with metal clasps. Consult with Dr. Bischoff to find out which type is right for you.

How long will it take to get used to wearing a partial denture?
For the first few weeks, your new partial denture may feel awkward or bulky. However, your mouth will eventually become accustomed to wearing it. Inserting and removing the denture will require some practice. Follow all instructions given by Dr. Bischoff. Your denture should fit into place with relative ease. Never force the partial denture into position by biting down. This could bend or break the clasps.

How long should I wear the partial denture?
We will give you specific instruction about how long the partial denture should be worn and when it should be removed. Initially, you may be asked to wear your partial denture all the time. Although this may be temporarily uncomfortable, it is the quickest way to identify those denture parts that may need adjustment. If the denture puts too much pressure on a particular area, that spot will become sore. Dr. Bischoff will adjust the denture to fit more comfortably. After making adjustments, Dr. Bischoff will probably recommend that you take the denture out of your mouth before going to bed and replace it in the morning.

Will it be difficult to eat with a partial denture?
Replacing missing teeth should make eating a more pleasant experience. Start out by eating soft foods that are cut into small pieces. Chew on both sides of the mouth to keep even pressure on the denture. Avoid foods that are extremely sticky or hard. You may want to avoid chewing gum while you adjust to the denture.

Will the partial denture change how I speak?
It can be difficult to speak clearly when you are missing teeth. Consequently, wearing a partial denture may help. If you find it difficult to pronounce certain words with your new denture, practice reading out loud. Repeat the words that give you trouble. With time, you will become accustomed to speaking properly with your denture.

How do I take care of my partial denture?
Handling a partial denture requires care. It's a good idea to stand over a folded towel or a sink of water just in case you accidentally drop the denture. Brush the denture each day to remove food deposits and plaque. Brushing your denture helps prevent the appliance from becoming permanently stained. It's best to use a brush that is designed for cleaning dentures. A denture brush has bristles that are arranged to fit the shape of the denture. A regular, soft-bristled toothbrush is also acceptable. Avoid using a brush with hard bristles, which can damage the denture.

  • We recommend any denture cleaner with the American Dental Association (ADA) Seal of Acceptance.
  • Some people use hand soap or mild dishwashing liquid to clean their dentures, which are both acceptable. Other types of household cleaners and many toothpastes are too abrasive and should not be used for cleaning dentures.
  • Clean your dentures by thoroughly rinsing off loose food particles. Moisten the brush and apply the denture cleaner. Brush all denture surfaces gently to avoid damaging the plastic or bending the attachments.
  • A denture could lose its proper shape if it is not kept moist. At night, the denture should be placed in soaking solution or water. However, if the appliance has metal attachments, they could be tarnished if placed in soaking solution. Dr. Bischoff can recommend the proper method for keeping your dentures in good shape.

Will my partial denture need adjusting?
Over time, adjusting the partial denture may be necessary. As you age, your mouth naturally changes, which can affect the fit of the denture. Your bone and gum ridges can recede or shrink, resulting in a loose-fitting denture. Partial Dentures that do not fit properly should be adjusted by Dr. Bischoff. Loose partialdentures can cause various problems, including sores or infections. See Dr. Bischoff promptly if your denture becomes loose.

Can I make minor adjustments or repairs to my partial denture?
You can do serious harm to your partial denture and to your health by trying to adjust or repair your denture. A denture that is not made to fit precisely by a dentist can cause irritation and sores. Using a do-it-yourself kit can damage the appliance beyond repair. Glues sold over-the-counter often contain harmful chemicals and should not be used on a denture.

If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose, see Dr. Bischoff immediately. In many cases, dentists can make necessary adjustments or repairs, often on the same day. Complicated repairs may require that the denture be sent to a special dental laboratory.

Must I do anything special to take care of my mouth?
Brushing twice a day and cleaning between your teeth daily help prevent tooth decay and gum disease that can lead to tooth loss. Pay special attention to cleaning teeth that fit under the denture's metal clasps. Plaque that becomes trapped under the clasps will increase the risk of tooth decay. We will demonstrate how to properly brush and clean between teeth. Selecting a balanced diet for proper nutrition is also important.

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Root Canal
A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form.

 

"Root canal" is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth's nerve lies within the root canal.A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory – to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.

Why Does the Pulp Need to Be Removed?
When nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause:
  • Swelling that may spread to other areas of the face, neck, or head
  • Bone loss around the tip of the root
  • Drainage problems extending outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.
What Damages a Tooth's Nerve and Pulp in the First Place?
Nerve and pulp can become irritated, inflamed and infected due to deep decay, repeated dental procedures on a tooth and/or large fillings, a crack or chip in the tooth, or trauma to the face.
 
What Are the Signs that a Root Canal Is Needed?
Sometimes no symptoms are present; however, signs to look for include:
  • Severe toothache pain upon chewing or application of pressure
  • Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)
  • Discoloration (a darkening) of the tooth
  • Swelling and tenderness in the nearby gums
  • A persistent or recurring pimple on the gums

What Happens During the Procedure?
A root canal requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist's comfort level in working on your tooth. Dr. Bischoff will discuss who might be best suited to perform the work in your particular case.

The first step in the procedure is to take an x-ray to see the shape of the root canals and determine if there are any signs of infection in a surrounding bone. Dr. Bischoff or endodontist will then use local anesthesia to numb the area near the tooth. Anesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetize the area to make the patient more relaxed and at ease.

Next, to keep the area dry and free of saliva during treatment, Dr. Bischoff will place a rubber dam (a sheet of rubber) around the tooth.

An access hole will then be drilled into the tooth. The pulp along with bacteria, the decayed nerve tissue and related debris is removed from the tooth. The cleaning out process is accomplished using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.

Once the tooth is thoroughly cleaned, it is sealed. Some dentists like to wait a week before sealing the tooth. For instance, if there is an infection, Dr. Bischoff may put a medication inside the tooth to clear it up. Others may choose to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep contaminants out between appointments.

At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth's root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed.

The final step may involve further restoration of the tooth. Because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness,  a crown, crown and post or other resortation often needs to be placed on the tooth to protect it, prevent it from breaking and restore it to full function. Dr. Bischoff will discuss the need for any additional dental work with you.

How Painful Is the Procedure?
Root canal procedures have the reputation of being painful.  Actually, most people report that the procedure itself is no more painful than having a filling placed.

What Should One Expect After the Root Canal?
For the first few days following the completion of treatment, the tooth may feel sensitive due to natural tissue inflammation, especially if there was pain or infection before the procedure. This sensitivity or discomfort usually can be controlled with over-the-counter pain medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Most patients can return to their normal activities the next day.

Until your root canal procedure is completely finished – that is to say, the permanent filling is in place and/or the crown, it's wise to minimize chewing on the tooth under repair. This step will help avoid recontamination of the interior of the tooth and also may prevent a fragile tooth from breaking before the tooth can be fully restored.

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Tooth Restoration - Fillings
As far as oral health care is concerned, brush and floss as you regularly would and see Dr. Bischoff at normally scheduled intervals.  To treat a cavity Dr. Bischoff will remove the decayed portion of the tooth and then "fill" the area on the tooth where the decayed material once lived.  Fillings are also used to repair cracked or broken teeth and teeth that have been worn down from misuse (such as from nail-biting or tooth grinding).

 

What Steps Are Involved in Filling a Tooth?
First, the dentist will numb the area around the tooth to be filled with a local anesthetic. Next, a drill, air abrasion instrument, or laser will be used to remove the decayed area. The choice of instrument depends on the individual dentist's comfort level, training, and investment in the particular piece of equipment as well as location and extent of the decay.

Next, Dr. Bischoff will probe or test the area during the decay removal process to determine if all the decay has been removed. Once the decay has been removed, Dr. Bischoff will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, Dr. Bischoff may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. Generally, after the filling is in, Dr. Bischoff will finish and polish it.

Several additional steps are required for tooth-colored fillings and are as follows. After Dr. Bischoff has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that "cures" or hardens each layer is applied. When the multilayering process is completed, Dr. Bischoff will shape the composite material to the desired result, trim off any excess material, and polish the final restoration.

What Types of Filling Materials Are Available?
Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic and glass materials called composite resin fillings. The location and extent of the decay, cost of filling material, patients' insurance coverage, and Dr. Bischoff's recommendation assist in determining the type of filling that will best address your needs.

Does Dental Insurance Cover the Cost of Composites?
Most dental insurance plans cover the cost of the composites up to the price of the silver filling, then the patient must pay the difference.
 
What Are Indirect Fillings?
Indirect fillings are similar to composite or tooth-colored fillings except that they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when not enough tooth structure remains to support a filling but the tooth is not so severely damaged that it needs a crown.

During the first visit, decay or an old filling is removed. An impression is taken to record the shape of the tooth being repaired and the teeth around it. The impression is sent to a dental laboratory that will make the indirect filling. A temporary filling (described below) is placed to protect the tooth while your restoration is being made. During the second visit, the temporary filling is removed, and the dentist will check the fit of the indirect restoration. Provided the fit is acceptable, it will be permanently cemented into place.

There are two types of indirect fillings – inlays and onlays.

  • Inlays are similar to fillings but the entire work lies within the cusps (bumps) on the chewing surface of the tooth.
  • Onlays are more extensive than inlays, covering one or more cusps. Onlays are sometimes called partial crowns.

Inlays and onlays are more durable and last much longer than traditional fillings – up to 30 years. They can be made of tooth-colored composite resin, porcelain, or gold. Inlays and onlays weaken the tooth structure, but do so to a much lower extent than traditional fillings.

Another type of inlay and onlay - direct inlays and onlays - follow the same processes and procedures as the indirect, the difference is that direct inlays and onlays are made in the dental office and can be placed in one visit. The type of inlay or onlay used depends on how much sound tooth structure remains and consideration of any cosmetic concerns.

What's a Temporary Filling and Why Would I Need One?
Temporary fillings are used under the following circumstances:
  1. For fillings that require more than one appointment – for example, before placement of gold fillings and for certain filling procedures (called indirect fillings) that use composite materials
  2. Following a root canal
  3. To allow a tooth's nerve to "settle down" if the pulp became irritated
  4. If emergency dental treatment is needed (such as to address a toothache)

Temporary fillings are just that; they are not meant to last. They usually fall out, fracture, or wear out within 1 month. Be sure to contact Dr. Bischoff to have your temporary filling replaced with a permanent one. If you don't, your tooth could become infected or you could have other complications.

Are Amalgam-Type Fillings Safe?
Over the past several years, concerns have been raised about silver-colored fillings, otherwise called amalgams. Because amalgams contain the toxic substance mercury, some people think that amalgams are responsible for causing a number of diseases, including autism, Alzheimer's disease, and multiple sclerosis.  The American Dental Association (ADA), the FDA, and numerous public health agencies say there's no proof that dental fillings cause harm to consumers. The causes of autism, Alzheimer's disease, and multiple sclerosis remain unknown. Additionally, there is no solid, scientific evidence to back up the claim that if a person has amalgam fillings removed, he or she will be cured of these or any other diseases.  Although amalgams do contain mercury, when they are mixed with other metals, such as silver, copper, tin, and zinc, they form a stable alloy that dentists have used for more than 100 years to fill and preserve hundreds of millions of decayed teeth.  In June 2008, the FDA dropped much of its reassuring language about dental amalgam. It's added: "Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses."  And there's more. "Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner," the FDA web site now says.  The changes come in response to a lawsuit filed by consumer groups and individuals concerned about mercury exposure. To settle the suit, the FDA agreed to update its web site.  And the federal agency also agreed to rule within one year on exactly how dental amalgam products should be regulated, and exactly what warnings consumers should receive from their dentists and doctors.
 
How Should I Care for My Teeth With Fillings?
To maintain your fillings, you should follow good oral hygiene practices – visiting Dr. Bischoff regularly for cleanings, brushing with a fluoride toothpaste, and flossing at least once daily. If Dr. Bischoff suspects that a filling might be cracked or is "leaking" (when the sides of the filling don't fit tightly against the tooth, this allows debris and saliva to seep down between the filling and the tooth, which can lead to decay), he or she will take x-rays to assess the situation. If your tooth is extremely sensitive, if you feel a sharp edge, if you notice a crack in the filling, or if a piece of the filling is missing, call Dr. Bischoff for an appointment.
 
 

Dental Bridge
What is a dental bridge?
A dental bridge is a false tooth, known as a pontic, which is fused between two porcelain crowns to fill in the area left by a missing tooth. The two crowns holding it in place that are attached onto your teeth on each side of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth. Fixed bridges cannot be taken out of your mouth as you might do with removable partial dentures.

In areas of your mouth that are under less stress, such as your front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space. Bridges can reduce your risk of gum disease, help correct some bite issues and even improve your speech. Bridges require your commitment to serious oral hygiene, but will last as many ten years or more.

Who is a candidate for dental bridges?
If you have missing teeth and have good oral hygiene practices, you should discuss this procedure with your cosmetic dentist. If spaces are left unfilled, they may cause the surrounding teeth to drift out of position. Additionally, spaces from missing teeth can cause your other teeth and your gums to become far more susceptible to tooth decay and gum disease.

Overview of dental bridge procedure
If you a space from a missing tooth, a bridge will be custom made to fill in the space with a false tooth. The false tooth is attached by the bridge to the two other teeth around the space - bridging them together.

How is dental bridge accomplished?
Your cosmetic dentist will prepare your teeth on either side of the space for the false tooth. You will be given a mild anesthetic to numb
the area, and the cosmetic dentist will remove the an area of each abutment (teeth on either side of the space) to accommodate for the thickness of the crown. When these teeth already have fillings, part of the filling may be left in place to help as a foundation for the crown.

The dentist will then make an impression, which will serve as the model from which the bridge, false tooth and crowns will be made by a dental laboratory. A temporary bridge will be placed for you to wear while your bridge is being made until your next visit. This temporary bridge will serve to protect your teeth and gums.

Your cosmetic dentist may have you use a Flipper appliance. A Flipper is a false tooth to temporarily take the place of a missing tooth before the permanent bridge is placed. A Flipper can be attached via either a wire or a plastic piece that fits in the roof of your mouth. Flippers are meant to be a temporary solution while awaiting the permanent bridge.

On your second appointment, the temporary bridge will be removed. Your new permanent bridge will be fitted and checked and adjusted for any bite discrepancies. Your new bridge will then be cemented to your teeth.

Types of Dental Bridge Procedures
There are three types of dental bridges:
Traditional Fixed Bridge
A dental bridge is a false tooth, known as a pontic, which is fused between two porcelain crowns to fill in the area left by a missing tooth. There two crowns holding it in place that are attached onto your teeth on each side of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth. Fixed bridges cannot be taken out of your mouth as you might do with removable partial dentures.

Resin Bonded Bridges
The resin bonded is primarily used for your front teeth. Less expensive, this bridge is best used when the abutment teeth are healthy and don't have large fillings. The false tooth is fused to metal bands that are bonded to the abutment teeth with a resin which is hidden from view. This type of bridge reduces the amount of preparation on the adjacent teeth.
Cantilever Bridges
In areas of your mouth that are under less stress, such as your front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space. This procedure involves anchoring the false tooth to one side over one or more natural and adjacent teeth.
Advantages & Disadvantages of Dental Bridges

Advantages of dental bridges:
Bridges are natural in appearance, and usually require only two visits to Dr. Bischoff. If you maintain good oral hygiene, your fixed bridge should last as many as ten years or more.

Disadvantages of having a dental bridge:
It is common for your teeth to be mildly sensitive to extreme temperatures for a few weeks after the treatment. The build up of bacteria formed from food acids on your teeth and gums can become infected if proper oral hygiene is not followed.



Dental Bonding
Introduction to dental bonding
The dental bonding procedure utilizes a composite resin and is used for a variety of structural as well as cosmetic purposes. One can draw a parallel between dental bonding materials and a sculptor's clay. By using dental composite resin bonding Dr. Bischoff can restore chipped or broken teeth, fill in gaps and reshape or recolor your smile. To learn more about the dental bonding procedure, choose from the selections below, or simply click the "Continue" arrow to begin.
 
 

Tooth Bonding
What is tooth bonding?
Bonding is a composite resin filling placed in the back teeth as well as the front teeth. Composites are the solution for restoring decayed teeth, making cosmetic improvements and even changing the color of your teeth or the reshaping of teeth. Bonding will lighten any stains you may have, close up minor gaps and can be used to correct crooked teeth. Basically, bonding will cover any natural flaws applying a thin coating of a plastic material on the front surface of your teeth. After this, your cosmetic dentist will apply a bonding material and sculpt, color and shape it to provide a pleasing result. A high-intensity light then hardens the plastic, and the surface is finely polished.

How long does tooth bonding last?
While the traditional silver fillings last about seven years, these composites should last about seven to eleven years.

How is Tooth Bonding Accomplished?
A very mild etching solution is applied to your teeth to create very small crevices in the tooth's enamel structure. These small crevices provide a slightly rough surface permitting a durable resin to bond materials to your teeth. The resin is then placed on your tooth and high-intensity light cures the resins onto your tooth's surface - with each individual layer of resin hardening in just minutes. When the last coat has been applied to your tooth, the bonded material is then sculpted to fit your tooth and finely polished.

The resin comes in many shades so that we can match it to your natural teeth. Due to the layers involved, this procedure will take slightly longer than traditional silver fillings because multiple layers of the bonding material are applied. Typically bonding takes an hour to two hours depending on your particular case.

Types of Tooth Bonding Procedures
There are two types of bonding. What type is indicated in your situation depends upon whether you have a small area or a larger area that requires correction.

For small corrections
These are one appointment fillings which are color-matched to the tooth and are bonded to the surface for added strength. These are most appropriate for small fillings and front fillings as they may not be as durable for large fillings.

For larger corrections
Dental lab-created tooth-colored fillings require two appointments and involve making a mold of your teeth and placing a temporary filling. A dental laboratory then creates a very durable filling to custom-fit the mold made from your teeth. These fillings are typically made of porcelain. The custom-fit filling is then bonded to your tooth on your return visit. This type is even more natural looking, more durable and more stain resistant. (For more information on these types of fillings, please see About Cosmetic Dentistry's section on dental fillings.)

Who is a candidate for tooth bonding?
If you have close, small gaps between your front teeth, or if you have chipped or cracked teeth, you may be a candidate for bonding. Bonding is also used for patients who have discolored teeth, uneven teeth, gum recession or tooth decay. Bonding material is porous, so smokers will find that their bonding will yellow. If you think you are a candidate for bonding, discuss it with Dr. Bischoff.

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Implants
As we age, some of us will lose teeth due to disease, injury, or simple daily wear. In addition to bringing about unwanted changes to a person's facial appearance, missing teeth have a negative effect on that person’s confidence and self-esteem. With the advent of implant dentistry, however, those who are missing one, two or several teeth no longer have to accept a lifetime of embarrassment and inconvenience. Dental implants, sturdy titanium posts that are anchored directly into the jawbone and topped with realistic replacement teeth, provide the security and usability of permanently placed teeth.

 

What are Dental Implants?
Dental implants are a restorative dentistry option that allows patients to replace missing teeth with ones that look, feel, and perform like their own. During the first step of this procedure, a doctor skilled in implant dentistry surgically places a titanium screw or post in the patient's jaw. After the gums have healed around the embedded post, a replacement tooth is attached to the top of it.

Dental Implants - Benefits and Possible Complications
Dental implants are a vast improvement over conventional dentures. They're more stable and user-friendly than many other teeth replacement options, and because the posts that secure dental implants in place are integrated into the jaw, they also help prevent bone loss and gum recession (because the pressure of chewing on the implant’s crown stimulates the underlying bone and prevents it from deteriorating from disuse). However, some medical circumstances – including radiation therapy in the mouth area, and diseases such as diabetes -- lower the success rate for implant dentistry. For that reason, patients must undergo a rigorous screening process before they may proceed with implant dentistry.

Alternatives for Replacing Missing Teeth
Patients can choose from a variety of options to replace missing teeth. In addition to dental implants, there are removable partial dentures held in place by wire clips; fixed dental bridges cemented into position by crowns placed on the teeth adjacent to an empty space; and traditional full dentures.

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Dental Veneers
Dental veneers (sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-colored materials designed to cover the front surface of teeth to improve your appearance. These shells are bonded to the front of the teeth changing their color, shape, size, or length.

 

Dental veneers can be made from porcelain or from resin composite materials. Porcelain veneers resist stains better than resin veneers and better mimic the light reflecting properties of natural teeth. Resin veneers are thinner and require removal of less of the tooth surface before placement. You will need to discuss the best choice of veneer material for you with Dr. Bischoff.

What Types of Problems Do Dental Veneers Fix?
Veneers are routinely used to fix:

  • Teeth that are discolored -- either because of root canal treatment; stains from tetracycline or other drugs, excessive fluoride or other causes; or the presence of large resin fillings that have discolored the tooth
  • Teeth that are worn down
  • Teeth that are chipped or broken
  • Teeth that are misaligned, uneven, or irregularly shaped (for example, have craters or bulges in them)
  • Teeth with gaps between them (to close the space between these teeth)
What's the Procedure for Getting a Dental Veneer?
Getting a dental veneer usually requires three trips to the dentist – one for a consultation and two to make and apply the veneers. One tooth or many teeth can simultaneously undergo the veneering process described below.
  • Diagnosis and treatment planning. This first step involves active participation between you and Dr. Bischoff. Explain to Dr. Bischoff the result that you are trying to achieve. During this appointment Dr. Bischoff will examine your teeth to make sure dental veneers are appropriate for you and discuss what the procedure will involve and some of its limitations. He or she also may take x-rays and possibly make impressions of your mouth and teeth.
  • Preparation. To prepare a tooth for a veneer, Dr. Bischoff will remove about ½ millimeter of enamel from the tooth surface, which is an amount nearly equal to the thickness of the veneer to be added to the tooth surface. Before trimming off the enamel, you and Dr. Bischoff will decide the need for a local anesthetic to numb the area. Next, Dr. Bischoff will make a model or impression of your tooth. This model is sent out to a dental laboratory, which in turn constructs your veneer. It usually takes 1 to 2 weeks for Dr. Bischoff to receive the veneers back from the laboratory. For very unsightly teeth, temporary dental veneers can be placed for an additional cost.

Bonding.Before the dental veneer is permanently cemented to your tooth, Dr. Bischoff will temporarily place it on your tooth to examine its fit and color. He or she will repeatedly remove and trim the veneer as needed to achieve the proper fit; the veneer color can be adjusted with the shade of cement to be used. Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished, and etched -- which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and the veneer is then placed on your tooth. Once properly position on the tooth, Dr. Bischoff will apply a special light beam to the dental veneer, which activates chemicals in the cement causing it to harden or cure very quickly. The final steps involve removing any excess cement, evaluating your bite and making any final adjustments in the veneer as necessary. Dr. Bischoff may ask you to return for a follow-up visit in a couple of weeks to check how your gums are responding to the presence of your veneer and to once again examine the veneer's placement.

What Are the Advantages of Dental Veneers?
  • Veneers offer the following advantages:
  • They provide a natural tooth appearance.
  • Gum tissue tolerates porcelain well.
  • Porcelain veneers are stain resistant.
  • The color of a porcelain veneer can be selected such that it makes dark teeth appear whiter.
  • Veneers offer a conservative approach to changing a tooth's color and shape -- veneers generally don't require the extensive shaping prior to the procedure that crowns do, yet offer a stronger, more aesthetic alternative.
What Are the Disadvantages of Dental Veneers?
  • The downside to dental veneers include:
  • The process is not reversible.
  • Veneers are more costly than composite resin bonding.
  • Veneers are usually not repairable should they chip or crack.
  • Because enamel has been removed, your tooth may become more sensitive to hot and cold foods and beverages.
  • Veneers may not exactly match the color of your other teeth. Also, the veneer's color cannot be altered once in place. If you plan on whitening your teeth, you need to do so before getting veneers.
  • Though not likely, veneers can dislodge and fall off. To minimize the chance of this occurring, do not bite your nails; chew on pencils, ice, or other hard objects; or otherwise put excessive pressure on your teeth.
  • Teeth with veneers can still experience decay, possibly necessitating full coverage of the tooth with a crown.
  • Veneers are not a good choice for individuals with unhealthy teeth (for example, those with decay or active gum disease), weakened teeth (as a result of decay, fracture, large dental fillings), or for those who have an inadequate amount of existing enamel on the tooth surface.
  • Individuals who clench and grind their teeth are poor candidates for porcelain veneers, as these activities can cause the veneers to crack or chip.
How Long Do Dental Veneers Last?
Veneers generally last between 5 and 10 years. After this time, the veneers would need to be replaced.
 
Do Dental Veneers Require Special Care?
Dental veneers do not require any special care. Continue to follow good oral hygiene practices including brushing and flossing as you normally would.  Even though porcelain veneers resist stains, Dr. Bischoff may recommend that you avoid stain-causing foods and beverages (for example, coffee, tea, or red wine).
 
Are There Alternatives to Dental Veneers?
Yes, alternatives to veneers include bondings and crowns. Veneers offer a nice intermediate option. Veneers may be best suited for individuals who want to change the shape of their teeth more than just a little bit -- as is done with bonding -- but not enough to require a crown.