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What Causes Mouth Breathing and How to Fix it Permanently

Posted on by Dr Adams

People breathe through their mouth out of necessity and literally because they cannot get enough oxygen through their nose. This can be due to poor tongue posture or a nasal obstruction. The mouth is a bigger hole and more oxygen can fit through a bigger space. People open there mouth because they need to. It is that simple. What is the best way to fix mouth breathing permanently?

how to stop mouth breathing

Is there a cure for Mouth Breathing?

How can we stop mouth breathing? Improving and increasing airflow through the nose is pivotal in fixing mouth breathing. And decreasing airway resistance is the other more complicated thing that needs to happen. The tongue causes 90% of airway resistance problems during sleep. The muscles in the tongue relax in deep sleep and the tongue can fall back into the throat and block the airway.  When the tongue blocks the airway, it makes it more difficult to pass air to the lungs. Hence the concern of the tongue causing airway resistance, breathing problems and ultimately, mouth breathing.

So what specifically can be done to fix mouth breathing? This article will go over very specific things that can be done to stop mouth breathing once and for all.

The specific things that can be done to stop mouth breathing:

  • Increase airflow through the nose with orthodontic palatal expanders. The palate bone is the bone that forms the internal base of the nose. Dental expanders will increase the size of the nasal passageways and improve airflow through the nose. It is amazing how little this solution is discussed. Palatal expansion permanently increases nasal airflow.
  • Myofunctional therapy is like physical therapy for tongues. The goal is to train the tongue to stay in the mouth during sleep. If the tongue is not falling into the throat, blocking the airway, it will be much easier meet oxygen demands via nose breathing.
  • Breathing exercises and mouth taping. Sometimes people breathe through the mouth out of habit. Very rarely is mouth breathing only a habit. Habitual mouth breathing can be cured with breathing exercises and mouth taping strategies.

Correct Mouth Breathing with Palate Expanders

We have a solution. Increase the size of the nasal airway. The size of the nose bone can be increased with an orthodontic appliance called a palatal expander. Palatal expanders stimulate the roof of the mouth to grow wider. The roof of the mouth, aka the palate, is same bone as the nose. But be careful, because not all expanders will solve nasal resistance and airway problems.

 

Contact Dr. Adams for an appliance consultation to stop mouth breathing.

cure kids sleep apnea and mouth breathing problems

How to Stop Mouth Breathing Video

Schwarz expander is a good choice

The Schwarz appliance invented by Dr. Schwarz in 1956. The appliance increases the entire width of the palate. Note how the appliance is shaped like the mouth and tongue so it will grow the palate to a larger natural shape. Many expanders only grow the back part of the palate which will not improve nasal breathing since the nose is above the front part of the palate.

braces after DNA appliance

Vivos DNA Device

Adult Orthodontic Expander Appliances

Newer non-surgical treatments such as DNA appliance therapy the AGGA, and the Homeoblock appliance can work for adults. Adult treatment like the AGGA takes longer and are more complicated. The ALF appliance can also be used for adults, but the above appliances grow more bone volume and are better tolerated by adults. 80% of adults with sleep apnea have tmj symptoms. The most common complaint in adults with sleep problems is TMJ and clenching pain/symptoms.

homeoblock and DNA appliance

Hyrax Rapid Palatal Expander

The Hyrax expander will not improve nasal breathing since it only expands the back part of the palate. We generally do not recommend this appliance.

Hyrax palate expander

James Nestor recommends Homeoblock Expander

Invisalign can treat Mouth Breathing

Invisalign is a great dental expander and it can greatly improve mouth breathing. Invisalign expansion works by using a series of clear, removable aligners that are designed to apply gentle and controlled pressure to the teeth, gradually expanding the width of the upper or lower dental arch.

Palatal expansion with Invisalign creates more space for the tongue to fit in the palate. During deep sleep the tongue muscle relaxes and the tongue can fall back into the throat and obstruct the airway. When the tongue obstructs the airway the patient will need to mouth breathe. The tongue is supposed to suction up onto the palate during rest. Keeping the tongue suctioned onto the palate prevents it from falling into the throat and blocking the airway. Creating more tongue space is one of the main goals of palatal expansion.

Invisalign MA can be used to correct reverse jaw position. Dentists who understand the importance of airway can take advantage of the Invisalign programs for expansion and mandibular repositioning. Invisalign can do a lot more than straighten the teeth but understanding airway is important or the usefulness of these modalities does not occur to the practitioner.

Advantages of Nose Breathing

Breathing is such a natural part of life, you don’t even think about it. People cannot live longer than 4 minutes without breathing oxygen. Many people are unaware that they have perpetual unhealthy breathing patterns. For example, people who preferentially breath through their mouth are exposed to serious health conditions compared to people who use nasal breathing. Do you know whether you breathe through your nose or mouth? The negative consequences of mouth breathing are quite shocking to those who are not aware? The nose filters out bacteria, viruses and foreign particles. It also warms and humidifies the air. People who nasal breath get sick far less often,   have better sleep, posture and smiles.

Top 10 Problems Caused by Mouth Breathing

  1. Sleep Problems
  2. Unattractive Facial Profile and Balance
  3. Bad Posture
  4. Thyroid Problems
  5. Crooked Teeth
  6. Teeth Clenching
  7. Neck and Back Pain
  8. Speech Problems
  9. Slow Metabolism
  10. ADHD symptoms in kids

How can you Stop Mouth Breathing?

Long story-short, we correct tongue function and improve the size and shape of the mouth and jaws for better airflow through the nose. Dr. Adams releases tongue ties and provides myofunctional therapy to improve tongue function. We have different kinds of growth appliances for kids and adults to help optimize the space in the mouth and nasal spaces.

Mouth Tapping to train for nose breathing

And finally, it may be necessary to break the mouth breathing habit. Sometimes improving nasal airway and tongue function is not enough. Mouth breathing can be a hard habit to break. Mouth tapping is a useful tool. Start  tapping your mouth for periods of time during the day. 10 minutes, 30, and finally 1-2 hours while reading or working. Then try light activity to see if it is doable. Then you can try tapping a night.

Correct Mouth Breathing with Mouth Tapping Video

Mouth Breathing Causes Facial Under Development

And, yes, mouth breathing can also adversely affect how your face and jaw structure grow. Mouth breathing can change how your entire body develops, and impact your overall health for the rest of your life. And eventually lead to sleep apnea, bruxism and tmj problems to name just a few. But what causes breathing through the mouth instead of the nose? How can we stop mouth breathing and train ourselves to breath through our noses, as we should? Is there a link between TMJ sleep apnea and tongue ties?

mouth breather face

Mouth Breather Face

Palatal Expansion Improves Nasal Breathing

Dr. Adams treats his patients with a variety of different palatal expanders and growth appliances. Lip and tongue ties need to be released as apart of therapy. Releasing the tongue enables it to help grow the palate and easily rest in the palate where it belongs. When the tongue is tied to the floor of the mouth, it falls back into the throat and blocks breathing during sleep.

tongue tie

Myofucntional Therapy and Improving Tongue Posture

If the tongue rests flush in the palate it is impossible to get air through the mouth. If there is an air leak, then your tongue is not flush on the palate with a proper seal. Tongue posture in the palate creates a nose breather literally by disallowing mouth breathing.

With palatal posture of the tongue, breathing through the nose will persist provided there is enough space in the nasal passageways for adequate airflow.  This is where palate expansion is important to grow the base of the nose wider. The palate or roof of the mouth is the base of the nose.

Our favorite palate expander for kids is the Schwarz Appliance. Dr. Adams also loves the ALF appliance when there is a lot of teeth crowding.

The combination of expansion therapy and tongue exercises promotes more forward, lateral and vertical growth in the mouth. The bigger space allows the tongue to maintain palatal posture. And creates the conditions where breathing is nasal rather than though the mouth. In advanced cases of mouth breathing, the assistance of a myofunctional therapist and and ENT may be necessary.

small nose and mouth breathing

How Dental Appliances Promote Anterior Growth Video

Mouth Breathing Decreases Forward Facial Growth

When the mouth is left open to breathe, the muscles in the cheeks become tight and apply a backwards force on teeth and bone structure. The cheek muscles puts an external force on the upper and lower jaws, which creates a narrowing effect on the upper and lower jaws and the face.  The lip muscles also exert a reverse pressure and pulls the jaws back. These forces resist outward growth of the face.

crozat vs ALF

Tongue Ties Decrease Anterior Growth of Jaw Structures

Mouth breathers keep their tongues on the floor of the mouth and have tongue ties that reduce the tongues range of motion. The tongue is the strongest muscle in the body for its size and is meant to naturally rest at the roof of the mouth and in the palate. The tongue is considered the “natural expander”. When the tongue is in the proper palatal position, it puts pressure on the upper jaw bone and stimulates enough forward bone growth for all the teeth to fit.

The Tongue Naturally Expands the Jaws

The growth is achieved when tongue pressure on the maxilla stimulates bone growth. The jaw grows wider and more forward in response to tongue function. When one breathes through their mouth, the tongue stays in the floor of the mouth and the result is narrow and a high-vaulted palate. But why? Is it staying out of the way of passing air? is it just tied down? Perhaps the palate and upper jaw space are too small for the tongue to fit?

Tongue Tie is linked to Mouth Breathing

When the tongue is tied too tightly to the lower jaw, it’s movement and range of motion is limited and its shape is deformed. A tied tongue can sometimes not even reach the palate. And if it does reach the palate, the pressure on the palate is very minimal and insufficient to stimulate much of any anterior jaw and facial bone growth.

Tongue shape will also be deformed by a tie. As the tongue moves, the tie can draw the edges of the tongue inward and decrease the extension outward and upward. When the tongue is not able to move properly and put pressure on growing bone, development of the jaws and nasal passageways does not happen. When nasal passageways are not large enough to breathe through, people will resort to breathing through their mouths.

tongue tie link to mouth breathing

Tongue Tie & Small Mouth & Crowding

Tongue Tie Release can Stimulate Anterior Growth

Diagnosis and treatment of tongue tie at a young age is critical to airway development, healthy breathing function and overall health. Once the tongue is “untied” it can be trained to reach the palate and move more forward to properly stimulate forward jaw bone growth. We call tongue training, “tongue therapy.” So what causes small mouths, small nasal passageways and airway obstructions in adults? Is it tongue dysfunction caused by tied tongue? Mouth breathing? What came first, the chicken or the egg? What happens is this:

  1. Tongue tie leads to impaired tongue movement and function
  2. The mouth and nasal passageways do not grow because the tongue is not providing growth stimulus
  3. nasal passageways are too small for adequate breathing
  4. mouth breathing occurs instead of nasal breathing
frenectomy tongue tie

Nasal Breathing and Tongue Function

It is important to know that the bone on the roof of the mouth is the same bone as the floor of the nose; therefore, if tongue function does not stimulate the proper growth, nasal breathing will suffer. When the tongue is in the proper position, it applies outward pressures that helps the midface grow properly and in a forward direction. Low tongue and mouth -breathing contribute to the development of a mid-face deficiency because the tongue is not pushing on the facial bones. As a result, facial growth gets off track and turns into a downward and backward growth pattern. This negative growth pattern is a known risk factor for obstructive sleep apnea, TMJ problems and a bad bite. The vicious poor health and growth cycle just feeds on itself unless intervention occurs while there is still child growth.

Kids with pediatric sleep disordered breathing will often clench and grind their teeth. It is not normal for kids to clench teeth during sleep. It is a sign of airway problems and possible sleep apnea.

Why Breathing Through the Mouth is a Problem

  • Mouth breathing patterns are more shallow and there is a tendency towards hyperventilation. Leads to less oxygenation of the lungs and other tissues and less than optimal bodily functions.
  • Dry mouth and a decrease in pH in the mouth. The pH shift leads to more tooth decay and cavities.
  • Nasal breathing stimulates nitric oxide production whereas mouth breathing does not. Nitric oxide increases blood flood for better oxygenation. Nitric oxide also kills bacteria and viruses before they enter the lungs. Finally Nitric oxide also acts as a decongestant to increase air flow through nasal passageways.
  • Air entering the lungs via the mouth is unfiltered, drier and colder. This level or air quality causes inflammation in the tissues of the upper airway. The nasal passageways filters and warms air entering the lungs.
  • causes inflammation in tonsils and adenoids
  • Increases risk of respiratory infections, sinusitis, and ear infections
  • Poor levels of carbon dioxide which causes smooth muscle spasms. Smooth muscle spasms are implicated in gastro intestinal reflux disease, bed wetting in children and asthma.
  • Risk of sleep disordered breathing and poor sleep. This can be anything from UARS to full blown sleep apnea.

Mouth Breathing is linked to Sleep Apnea

“Sleep Disordered Breathing” can be better described as “breathing patterns that cause sleep problems”. As one struggles to get enough oxygen into their body while asleep, often the brain causes the body to wake-up somewhat into a lighter sleep. That is, wake up enough to change position, open the airway or to gasp and take a forced breath. Decreased blood oxygen levels also stimulates teeth clenching. Teeth clenching is a reflex to help bring someone up into a lighter sleep. Usually the first thing that happens in lighter sleep, is the tongue will contract and move out of the airway. People with sleep disordered breathing (SDB), have small mouths and airway spaces. In deep sleep the tongue muscle relaxes and the tongue goes where it finds space and gravity pulls it-that is back into the oropharyngeal space and on top of the airway. Activation of the clench reflex, draws one out of deep sleep and clears the airway of the tongue. Usually the vellum of the tongue occludes the upper part of the airway when it relaxes and is no stimulated.

Video of an Airway Collapsing During Sleep Apnea

Fight or Flight response while Sleeping?

For sleep disordered people, the body is in a state of high alert and fight or flight all night long to make sure breathing does not stop. Breathing is a major effort as the airway collapses or becomes obstructed. Sleep is supposed to be a time of rest, recovery and recharge for all the body’s systems. Instead of having a restful night’s sleep, your body’s heart rate  and pressure increases as oxygenation decreases. You toss and turn, clench your teeth, change body and head positions to open and clear your airway. You gasp, cough and maybe choke. Night time high blood pressure can cause your body to dump fluid volume and there can be a need to get up and urinate during the night.

Deep Sleep is linked to Long-Term Health

People with SDB do not get enough stage 3 deep sleep because they cannot get enough oxygen as their airway collapses. Only when you get enough deep sleep, do you release important growth and reparative hormones that allow your body to sustain bodily processes day after day and year after year. Poor sleep patterns eventually lead to the most threatening health problems: high blood pressure, stroke, heart disease, Alzheimer’s, diabetes and depression. When breathing and sleep is disturbed, so is the essential repair work our bodies do each night to keep us happy, sharp and healthy. The fastest way to prematurely age and die young is to not get enough stage 3 deep sleep.

Why Removing Teeth for Braces is Harmful

Posted on by Dr Adams

Removing teeth for braces can in the long run can ruin your life. There are very few situations where straightening teeth and removing teeth is a good idea. The better strategy is to use expanders to create room for all the teeth to fit.

never remove teeth for braces

The side effects of extraction orthodontics:

  1. Mouth Breathing
  2. Mouth Breather Face
  3. Sleep Apnea
  4. Teeth Clenching and Bruxism
  5. TMJ Pain
  6. Poor Posture

Braces and adult teeth extractions will cause a decrease in facial profile. No one wants to see their lips and chin sink into their face. A better technique is to use orthodontic palate expanders to grow more space in the jaws so all your teeth fit. There are many appliances capable of growing the jaws wider, taller and more forward. Creating better facial structure now will prevent future teeth clenching, sleep apnea, wrinkles and poor facial profile. Maxillary expanders are available for adults and kids. The Vivos and Homeoblock appliances are two examples of adult appliances that should be explored.

Contact Dr. Adams for an appliance consultation

dr gary adams

Dr Gary Adams

Removing Teeth will Ruin Your Bite and Smile

Removing teeth is a mistake with consequences for the rest of your life. It will not only ruin your look, but also cause sleep, breathing and bite problems. Additionally, small jaw spaces is a major cause of bruxism, TMJ pain and premature aging and wrinkling of the face. Look at how the chin doubles as the jaw is stepped back in the picture above. It is almost never a good idea to extract teeth for and use orthodontic retraction. It is much better to use different expanders to stimulate the mouth to grow larger, so all the teeth can fit.

Expanders and Growth Appliances Video

Why not to remove teeth for braces:

  1. Poor reverse profile and shrunken facial bone structure. Watch your jaws fall backwards when they should grow forwards.
  2. A decrease in the size of your mouth and upper airway
  3. Poor speech
  4. Poor tongue function
  5. Obstructed night time breathing
  6. Poor nasal breathing
  7. TMJ pain
  8. Bad Bite. Sometimes TMJ symptoms can be seen after braces.
  9. Sleep Apnea

[author] [author_image timthumb=’on’]https://marylandholisticdentist.com/wp-content/uploads/2013/09/dr-gary-adams.jpg[/author_image] [author_info]Dr. Adams uses a variety of expanders for kids and adults. These appliances are a much better option that extraction and retraction orthodontics. [/author_info] [/author]

Dr. Adams uses a variety of expanders and forward growth in children including the Schwarz, Twin Block, ALF and Crozat appliances. There are also appliances for Adults including the DNA appliance, AGGA forward growth device and the Homeoblock. The DNA appliance by Vivos Therapeutics is a great treatment to reverse the effects of extraction and head gear retraction.

Teeth Extraction and Retraction Braces Video

Removing Teeth Causes Loss of Facial Profile

Some of these problems may not happen right away, but they eventually occur. The main cause is a decrease in the size, volume and position of the jaws. Teeth extractions and braces shrink the mouth. The teeth come backwards and bring bone with them. Much facial bone is lost and deformed during retraction. The tongue space is reduced and the tongue is drawn closer to the airway and the lower jaw is reversed. And all this happens in childhood when the face and the entire body are supposed to be “growing outward.” After braces comes retainers that retain and prevent the jaw structure from growing after the orthodontic treatment is complete. Better wear that retainer forever or your teeth may not stay straight. Forever later you have the same underdeveloped small face for the rest of your life. Sleep apnea and TMJ here we come.

face profile change bicuspid extraction

When Should Kids Get Braces or Invisalign?

Braces are in style, right? All kids want braces until they get them and they get their first adjustment, right? Most kids will need some growth and orthodontic treatment between the ages of 4 and 11 years old. But some children may never need their teeth straightened. It depends on growth, development and cosmetic expectations.

Your child should be evaluated by a qualified dental professional no later than ages of 4- 6. Some kids may be a little small and others may be very small and need a lot of help at a younger age. For one child, orthodontic growth treatment may need to be started at age 3-4 and for others starting at 9 or 10 years old may be fine. 80% of facial growth is done by age 12 and by then the problem will already have happened. Timing is everything. It is best to promote growth prior to getting crowding, crooked teeth and bite problems. At this point, there are already problems. There is not a best or one magical appliance. There are really three issues:

  1. creating enough space for teeth and the tongue
  2. getting the upper and lower jaws to be a compatible size and shape
  3. getting the jaws to grow forward into the correct 3 dimensional position. Having the jaws too far back leaves the tongue on top of the airway. That is bad for sleep and breathing while asleep.

Evaluating the child. Identifying individual needs. Matching specific treatment to the specific needs of the child. Many people are concerned about when kids should get braces. The real question is what needs to be done to prevent the conditions where braces need to be done to begin with.

False Statements About When to Get Braces

There a many different competing theories about when to get braces and how to manage facial growth and orthodontics. Here are a few of the more common ones we discuss.

Don’t Wait till all the adult teeth come in to get Braces

If the baby teeth are crowded there will never be enough room for the adult teeth to be straight. By the time the baby teeth have fallen out, it is too late to take advantage of any of the child’s natural growth during treatment.

Palatal Expanders are Alternatives to Braces

Expanders create more space, but crooked teeth will not be corrected by expansion. Only crowding will be corrected.

Orthondontics compared to Expanders Video

If Teeth Look Straight Orthodontics is not Necessary

The goal is to have room for all the teeth to fit and for there to be enough room for all the functions that happen in the mouth. Most importantly breathing. We are equally concerned about form and function. Proper treatment prevents tmj pain and sleep apnea in the future.

Do Not Blame Orthodontists

Poor growth and under development is the cause of crowded teeth and small facial profiles. Do not wait to go to the dentist until teeth are crooked and crowded. By this time, the problem has already happened. Facial and jaw development is behind and the dentist is playing catch up. When teeth become crowded it is best to use expanders to stimulate the jaws and mouth to grow larger, so all the teeth can fit. Sometimes getting the necessary expansion can be difficult especially with children who are not compliant with treatment. It is best to be patient and only use extractions as a last resort or not at all due to the consequences above.

We Need more Space in the Mouth for teeth and tongue Function?

First, we need to determine why things are not growing properly. No biological dentist in their right mind would start by removing natural teeth. Second-let’s get your smile straight, so your smile looks right and everything in your mouth works properly and is healthy. Bottom line, use anterior growth appliances that will create more space in the mouth and jaws and straighten the teeth and balance the bite. The goal should be to promote growth (at an early enough age) so the conditions where braces become necessary never happen.

Palatal Expander Options for Kids Video

How Expanders Grow the Mouth Jaw and Face

ALF Appliance Video by Dr. Adams

Mouth Expansion vs Removing Teeth

If there is tooth crowding, signs of poor sleep, mouth breathing or teeth clenching, something needs to be done to create more space in the mouth. Another troubling condition is a tied tongue or frenum. Proper growth of the mouth and face is dependent on proper tongue space and function. It is actually proper tongue function that stimulates the facial bones to grow properly in the first place. Conditions such as tongue tie needs to be treated at a young age for normal anterior growth to occur.

tongue tie link to mouth breathing

Tongue Tie & Small Mouth & Crowding

Dr. Adams’ favorite kids palate expander appliances:

The Schwarz appliance can grow the jaws wider, taller and more forward. It can also reposition the lower jaw more forward.

schwarz orthodontic expander

orthodontic palatal expander

ALF Appliance for crowded teeth and jaw balance

The ALF can grow the jaws wider and more forward. The ALF is highly customizable and adjustable. It is the most versatile in correcting severely crowded teeth.

ALF Kids expander appliance

Twin Block Appliance Appliance

In many cases the Twin Block is the best appliance for moving the lower jaw more forward. For severe cases of retrognathia, this may be the best appliance. This appliance requires a very compliant child and a very experienced functional dentist.

kids dental sleep apnea appliances

Crozat Appliance is like ALF but expands the palate better

Crozat Orthodontic Appliance

crozat kids orthodontic appliance

Crozat Orthodontic Appliance

DNA Appliance works the best for older children 14 and older

This DNA appliance is basically a Schwarz appliance with special springs capable of causing bone cells to start growing bone again. The best appliance for older kids and adults.

DNA Appliance and TMJ Videos by Dr. Adams

dna appliance tmj-tmd treatment

DNA Appliance

AGGA Appliance vs Vivos and Homeoblock Devices

Posted on by Dr Adams

AGGA Appliance Compared to the Vivos DNA?

The AGGA has an unproven track record and there are several documented cases of poor treatment outcomes. Most notably, class action lawsuit filed against AGGA, the inventor of the appliance, Dr. Steve Gaella and his Facial Beauty Institute.

The DNA is a more versatile appliance than the AGGA. The DNA Appliance promotes three dimensional growth of adult jaw and facial bones. Facial growth progresses forward and the jaws get wider and taller. In technical terms the DNA increases the vertical dimension of occlusion and promotes growth sagittally and transversely. The Homeoblock works basically the same exact way as the Vivos DNA.

crozat vs ALF

AGGA is a one dimensional appliance

The AGGA promotes forward growth. So basically the AGGA is one dimensional and the Vivos is three dimensional. It is really that simple.

Why not to use the AGGA by Facial Beauty Institute

The AGGA works completely differently than any other appliance on the market. We do not use the AGGA and we have never used the AGGA. The AGGA is basically an orthodontic wire that connects to the back teeth and pushes the front teeth forward. We do not understand how a wire does anything other than push the teeth forward through the alveolar bone. Dr. Gaella has a piece of plastic built into the AGGA that puts pressure on a small part of the middle of the palate. The theory is that this pressure causes bone to grow. It really sounds too good to be true and makes no sense (in our opinion), but we cannot disprove Gaella’s theory. But the idea and theory behind the AGGA makes us nervous and has no scientific basis we understand or subscribe to.

Homeblock DNA and ALF work totally Differently that AGGA

The DNA, Homeoblock appliance and the ALF appliances have been proven to stimulate bone growth in adults and kids. All of these appliances are removable and they all use light springy pressure. This mechanism is completely different than how the AGGA works. The ALF uses a removable wire that flexes into place that moves and springs when the tongue pushes it. The DNA and Homeoblock appliances are basically Schwarz appliances with the addition of a spring that puts light pressure and moves upon tongue pressure. All of these appliances are removable and all have springy action that move upon tongue pressure. The “springy” mechanism activated by the tongue is a familiar and explainable action that grows bone and much different that an orthodontic wire that pushes teeth and has a braces-like mechanism. All these appliances have a proven track record and there are very few bad outcomes. The mechanism of action of theses removable appliances is much different than that of the AGGA which is basically a wire that is pushing constantly with no springy action.

Contact Dr. Adams for a complimentary consultation or 2nd opinion

How Anterior Growth Appliance Work Video

DNA is Easier to Tolerate and Takes less Time

Additionally the DNA appliance is easier for dentists to adjust and easier for patients to tolerate. The Vivos requires fewer adjustments by the dentist and less frequent trips to the dentist. Finally, the AGGA device almost always requires orthodontic treatment such as braces afterwards to get the teeth in proper alignment. And possibly other appliances adding to treatment time and expenses.

Treatment of TMJ Pain and Sleep Apnea

The goal is to increase the volume of space in the mouth and create more room for the tongue and breathing. Also creating more space will help teeth fit better and bite more evenly. Or in short, we need to improve airflow through the mouth by increasing the space in the mouth. The tongue is a large U-shaped whale. Growing the jaws only forward will create more space for the tongue to fit in the front part of the mouth further away from the throat and airway.

Visit our Youtube Video gallery about facial growth and TMJ treatment

Anterior Growth and Airway Appliances ?

AGGA, DNA, ALF, Homeoblock, Biobloc appliances. The fact that we are having this conversation is a breath of fresh air. 5 years ago, I could hardly buy a believer or follower. The most common question I get now is “is the AGGA better than the DNA?”

 DNA Appliance is a versatile appliance that can:

  1. stimulate palatal expansion
  2. promote maxillary anterior growth
  3. act as an occlusal splint – this creates a better more balanced and forward bite position (ideal for TMJ pain relief and lower jaw repositioning) The splint component of this appliance also allows the dentist better control of the vertical dimension of occlusion. Also called the bite plane, is the key to forward growth of the lower jaw when the mandible is retrognathic.
  4. cause functional orthodontic therapy or in-other-words it can be used to correct a retrognathic or reversed lower jaw position by promoting forward repositioning of the lower jaw. Again this correction would not be possible without the bite plane or the acrylic over the back teeth.
agga appliance vs DNA

DNA Appliance

The DNA is a Removable Appliance Worn at Night

The DNA is a removable appliance that is worn mostly at night and 10-12 hours per day. It is easy for a dentist with experience to adjust. And typically in the usual course of treatment the patient will need to be seen by the dentist 6-10 times during the course of treatment. Most treatment courses will last 9-18 months and appointments can be spread-out every 2-3 months. Generally, the older the patient and the smaller the facial bones, the longer the therapy will last regardless of the appliance being used.

The AGGA is “anterior growth guidance appliance.”

The anterior growth guidance appliance does just what it says. It literally grows the upper maxillary jaw forward. And it does a fantastic job at that. In fact such a good job that if time and money and patient compliance were not a factor, I would put everyone into one of these prior to doing the Vivoslife DNA appliance. The only problem is treatment times and costs would be 2-3x greater.

agga appliance

The AGGA is a Fixed Appliance that Stays in the Mouth

The AGGA is a fixed appliance. Usually removable appliances are easier for adults to tolerate. Adults with busy lives who do not want unsightly metal showing in their smile zones. Additionally, the appliance takes up space in the mouth and interferes with speech or at least will cause the average person to lisp and pronounce sounds differently. The anterior growth appliance will remain in the mouth during eating. It is more difficult to clean and can lead to more dental problems such as cavities and gum problems.
Under development of the jaws is usually not in one direction. People with small jaws are usually not tall enough, wide enough or forward enough in the mouth and nasal passageways. In dentistry, we call height vertical dimension of occlusion or VDO. Width is called transverse growth and forward growth is termed sagittal. It is very difficult to control forward growth of the mandible without a bite plane or plastic covering the back teeth. This allows the dentist to control how the jaws close relative to one another. In short, the strategy to get forward growth is to have the patient bite in a more forward position. Otherwise how is the lower jaw going to move forward? The upper jaw is grown forward by the AGGA.

The AGGA appliance may be the ideal appliance for people who have had upper adult teeth pulled and headgear. Most dentists know it is better to create more room in a growing child, so all the teeth will fit. And there needs to be proper space in the mouth and nasal passageways for tongue function and breathing.
Inadequate size of the upper airway (that is the mouth and nasal passageways) is what leads to night clenching of the teeth, TMJ pain and sleep apnea. If growth and development in the oral facial spaces is managed optimally during the ages of 3-16, the incidence of TMJ, sleep apnea and UARs would be much less.

6 Ways to Prevent Sleep Apnea and Crooked Teeth in Kids:

  1. recognize under development of the face and jaws early (3-6 years old)
  2.  Look for crowded teeth
  3. poor nasal breathing and stuffiness
  4. night time teeth clenching
  5. poor sleep
  6. bed wetting

ALF, Schwarz and Twin Block Appliances Kids Expanders

Actually, I lied the DNA appliance is the best one. Seriously, but it is too expensive and the other appliances will work just fine. The DNA appliance has the unique ability to grow bone in adults. Whereas the results with the above appliances will be great with kids. The DNA is a Schwarz appliance with a special proprietary spring system. That is what makes it special and causes it to work so well in adults.

Tongue Tie Release for Kids is very important

Tongue tie is an extra attachment between the tongue and lower jaw. The “tie” prevents the tongue from having proper range of motion. It also causes the tongue to taper and have a deformed and smaller shape during outward movement.

Benefits of Untying the Tongue Video

The Tongue Causes Facial Growth in Children

When the tongue is tied, the result is very poor jaw and facial development.  The #1 most important thing for a growing child’s face is proper tongue function. Crowded teeth, and a reverse lower jaw position means there are already problems. Releasing a tongue tie is an easy procedure that can be done in 30 seconds by a dentist with the proper training and a diode laser. There is no bleeding and minimal pain. After a tongue tie procedure, it is important to perform tongue exercises to train the tongue to move properly. For example the tongue should be able to reach the roof of the mouth. Look up “Mewing.” An exercise and concept created by Dr. Mew.

There are many different expanders and anterior growth appliances for kids. The Schwarz, Twin Block and Crozat to name a few. Lip Ties are less important but may need to be released as well.

tongue untie procedure

When to Untie the Tongue Video

My favorite treatment regimen for kids is

  1. removing tongue ties (frenectomies)
  2. growth therapy with an appropriate growth appliance such as the ALF, Schwarz, or other appliance.

Full Mouth Dental Implants Video – Replacing All Teeth

Posted on by Dr Adams

Video about Replacing All Teeth with Full Mouth Dental implants

How much is it to replace all your teeth with implants? Are you trying to determine how to replace a complete set of teeth with permanent implant teeth? Are you comparing the fees and prices of different full mouth implants options? Clear Choice implant costs are high, but it is important to know what you are getting for your money. It is also important to be informed about the different ways to replace all teeth with implants. Please read further. It is complicated. This page compares the various complete implant options: All on 4 vs Implant Snap on Dentures vs Implant crowns and bridges. Clear choice offers only one of these options.

Full mouth implant options Discussed in Video by Dr. Adams

In the YouTube Video Dr. Adams will educate you on the different options to replace all your teeth. And then compare the costs of the different solutions.  Call 301.421.1996 for a complimentary consultation and 3D Xray. Clear Choice dental implants offers one option. But

There are 3 different ways to do a full set of teeth supported by implants:

All on 4 Dental Implants mouth. Cannot be removed by the patient.

all on 4 complete implants

Implant Snap on Dentures

implant supported dentures

Individual Implants for All Teeth

full mouth of dental implants

ALF Appliance / Advanced Lightwire Functional Video

Posted on by Dr Adams

ALF Appliance Video about Treating Crowded Teeth and Cranial Asymmetry

The ALF appliance Video by Dr. Adams discusses how the ALF is a great alternative to braces when it comes to straightening kids teeth. Because the appliance will create room by stimulating growth of the jaws and teeth have more room to fit. The video shows the appliance and examples of different appliances and their applications. An ALF appliance has five very important benefits when your child’s development is growing askew and teeth are getting crowded and crooked:

  1. stimulate an increase in outward growth of the jaws. creates more space for the teeth to fit
  2. creates more room for the tongue to fit and function properly in the mouth
  3. promotes proper size, shape and dimension to the jaws top to bottom
  4. creates balance and symmetry between the jaws and other facial bones
  5. creates a better fit of the teeth and a better bite.
  6. increases the volume of space in the mouth and nasal passageways

 

The ALF appliance can make a smile look better and prevent many of the causes of TMJ, sleep apnea, orthodontic problems and postural problems. Where braces can retract teeth and more them backwards, the ALF can stimulate an increase in space in the mouth for teeth to fit into a more favorable position.

What are the Treatments for TMJ / Temporomandibular Joint Pain?

Posted on by Dr Adams

Video about TMJ Treatments for Temporomandibular Joint Pain

Video about the Treatments for TMJ including Dr. Adams’ favorite appliance  – Vivos DNA Appliance can correct or improve problems causing TMJ pain, obstructive sleep apnea, orthodontic teeth crowding, upper airway resistance syndrome (UARS) and many postural problems. How and why? Because the root cause of all these problems are closely related. The appliance is unique and novel because it works for adults. The Vivos works by stimulating bone growth in the mouth and nasal passageways. Or simply put, the DNA treatment results in increasing the size of the upper airway and optimizing the spaces about the upper and lower jaws. By increasing the upper airway size and balancing the jaw structures, night time airway obstructions can be cleared. Because airway obstructions are opened, normal sleep and biomechanical function of the jaws and cervical spine can all be restored to normal function.

What is TMJ?

TMJ is more properly called temporomandibular joint dysfunction. The disease has a medical and dental definition, but most of the time people say they have “TMJ” when they suffer from jaw pain and other symptoms stemming from night time teeth clenching and UARS or upper airway resistance syndrome.

Common TMJ Symptoms:

  1. Jaw soreness and tension especially in the morning
  2. Jaw joint popping and clicking
  3. Limited opening and range of motion of jaw joints
  4. Teeth wear, cracking. history of past root canals, tooth implants, crowns and fillings by the gum line
  5. Gum recession
  6. Loose teeth
  7. Ear fullness, feeling of fluid in the ear or it needs to pop and sometimes loss of hearing
  8. Unstable tooth position. Constant need for retainers, teeth that are always shifting
  9. Sleep apnea
  10. Poor Sleep
  11. Tied Tongue or Tied Lip
  12. Headaches, possibly migraines, especially in the Temporal area and up around and behind the eyes
  13. Sinus Pressure or feeling of having a Sinus Infection
  14. Neck and shoulder tension, upper back pain
  15. Tingling in the fingers and extremities
  16. Metabolic Problems
  17. Thyroid dysfunction
  18. Poor Posture

Why not to get dental implants-Alternatives and What can go Wrong

Posted on by Dr Adams

There are many reasons why not to get dental implants including nerve damage, sinus damage, infection and damage to other teeth. Also there are some alternatives to getting an implant. Implant problems are uncommon, but there are many other less than optimal negative outcomes. A good implant surgeon usually does not have negative outcomes, but they can happen.

No one wants to go without teeth. The sales pitch for replacing teeth for dental implants is not a difficult one. And yes, implants are great and there is reason for excitement and hype. But slow down, because there are many things that can go wrong with dental implant procedures:

  1. peri-implantitis
  2. jaw bone infection
  3. bone loss around implants
  4. implant rejection
  5. allergy to titanium or zirconia
dental implant complications

Gary Adams DDS-25 years of Dental Implant experience

dr gary adams

Contact Dr. Adams for a complimentary consultation or 2nd opinion

What is a dental implant?

It is an anchor of foreign material that is put down into your jaw to replace the root of a missing tooth. Think of it as a support system where new teeth can be connected. You can get one or you can get all your teeth replaced with implants.

But here is the important concept – The anchors are surgically put into living jawbone. After that, your bone cells need to do the rest. The bone cells need accept the anchor and grow new bone around and attach to the new implant. It is really that simple. The term for this is “osseointegration.” Literally integration/acceptance of the implant into your osseous/bone tissue. Implants are not screws that are put into jaws like screws go into wood. But rather, foreign elements your body needs to accept and not reject.

There is no magic. Implants do not work like car parts that are bolted together. The bone accepts or rejects the titanium or zirconia dental implant. Implants get accepted into your body and your tissue accepts it by growing bone around and connecting and healing to the implants.

Alternatives to Dental Implants

  1. Teeth Bridges-using existing teeth to support toot replacement.
  2. Removable Bridges aka Dentures.

In general dental implants are the best option to replace missing teeth.

Common Dental Implant Problems:

Peri-implantitis

Peri-implantitis is literally bone loss or inflammation around a dental implant. This term really means nothing other than you have some messed up tissue around an implant. But why is the tissue unhealthy and irritated is the question? Regardless of what causes this condition, it usually leads to implant failure and the need for implant removal and replacement.

Implant infection

Implant Infections can happen around implants for many reasons. Usually it will happen shortly after the implant is placed. If an implant gets infected it will usually lead to implant rejection. The problem is easy to correct as the implant will be loose and can be easily removed and later replaced. Infections around implants if left untreated can become serious and spread to other areas of your body. Healthy patients will usually heal with few complications after an infected implant is removed. You should not get a dental implant if you are not healthy. For example, if you have uncontrolled diabetes or if you have a compromised immune system.

Implant rejection

Implants are a foreign material placed into your body. Not everyone will accept the foreign material placed into their jaw. Implants are generally made of either titanium alloy (titanium mixed with other metals) or zirconia. Titanium is a metal that corrodes very slowing over time into titanium oxides. The titanium oxides leak out into jawbone and can cause the body to reject an implant. Titanium rejection secondary to corrosion will usually will happen years later since the corrosion process is slow. Newer titanium implants have special coatings on the surface to help the metal heal better and resist corrosion. Not all titanium implants are created equal. Zirconia implants do not corrode and may be a better choice for people who have sensitivities.

 Dental Implant Allergies

Implants can experience immediate rejection in the event of allergies and sensitivities to titanium and zirconia. Allergies to the material itself can cause rejection. Material testing such as Melisa and Biocomatibility testing are available. The tests can determine if someone is reactive to zirconia or titanium. In general people are more likely to be reactive to titanium than zirconia, but reactivity to either is rare. Just remember, if you are sensitive you will be better off with a zirconia implant since you will be more likely to reject the titanium later years after it has been placed. Also just because you do not react today does not mean you will not react tomorrow. Allergies sometimes come after exposure to a material days or years later.

Implant Allergies can happen several years post implantation

Getting foreign materials placed into your body is a serious thing. And dental implants are no exception. In general, replacing teeth with implants is quite predictable. Many people have had titanium implants in their bodies for 10, 20 and 30 years without problems or rejection. But, but that is not always the case. Rejection can happen and there is no guarantee that you will not have problems. Don’t drink the cool aide and think you can buy new a new beautiful set of teeth the way you can buy a new care or kitchen.

Peri-Implantitis causes bone loss around Implants:

If you have bone loss around an implant, your body is rejecting the implant. The best treatment is to remove the implant to stop the immunological response, remove infection and prevent further bone loss.

Protocol for treating Peri-Implantitis

  1. Inject ozone O3 and oxygen O2. Ozone will neutralize any bacterial infection that has gotten into the bone around the area of peri-implantitis. It will also reduce some of the inflammation caused by the failing implant.
  2. Remove the Implant in it’s entirety being sure not to leave any small pieces of titanium or zirconia or dental instruments/debris. Often times implant fragments can be left behind if the procedure is not done carefully. Implant particles can be released into many small pieces and fall into the pores of the bone. Particles are foreign bodies and the goal is to remove the foreign material to restore bone health and terminate the immunological response.
  3. Remove cyst and granulation tissue from the implant extraction site. The body will often grow cysts in the areas of bone loss around the failing implant. If the cysts are not removed bacterial and fungal pathogens will remain vital in the extraction site. The cysts have their own blood supply and exchange nutrients and waste with blood supply and lymph.
  4. Place oxygen and ozone into the cleaned implant extraction site. The gases can easily travel through the pores of the bone, killing any infections and promoting healing. Bone lacks a lot of blood supply, so it is very susceptible to infection.
  5. Place PRF or platelet rich fibrin and completely fill the extraction socket. Do not place any foreign or off the shelf bone graft products. The body will more than likely reject the material and there will be further inflammation and immunological consequences.
  6. Place bone graft materials mixed in with the PRF if there are large areas of bone loss. It may also be necessary to place membranes to contain bone graft products and PRF.
  7. Place sutures to proximate as closely as possible any gum tissue that may be loose. The sutures can also act to hold the PRF into the extraction site.
  8. Allow 4 – 12 weeks of healing and re-evaluation the site for proper healing. Administer additional ozone if necessary. Placement of new implants can be considered at this time if there is no infection and adequate bone. If necessary, bone grafting and PRF treatments can be performed. Sometimes implants and grafting can be done at the same time.
  9. Repeat new Implant Surgery

New Implants have less Peri-Implantitis

More often the failed implants will be titanium (older ones). New safer implants should be placed. It is better to use zirconia or new titanium implants with improved and safer surfaces. A biocompatibility test to determine the most suitable material is also necessary. If you react to titanium material another titanium implant should not be placed.

Dental Implants and Bone Grafting

Posted on by Dr Adams

About Bone Grafting and Implants

Bone Grafting is usually necessary for Implant

True. Bone grafts may be necessary to regenerate bone. Implants require healthy bone to work properly. And bone preservation is a major concern when removing teeth. Most extraction sites get grafted to regenerate bone.

All Bone Grafts work the same

False. Bone regeneration materials are either osteoinductive or osteoconductive. Osteoconductive bone grafts work by temporarily filling holes/defects in bone as the body slowly dissolves and replaces the material with natural tissue.

PRF is the Only Osteoinductive Graft Material

Osteoinductive grafts are ones that directly stimulate bone cells to grow bone quickly via its own biological pathways. Platelet rich fibrin is the only osteoinductive graft material. All other materials are osteoconductive. PRF is obtained by drawing a blood sample from the patient and spinning it in a centrifuge for 13 minutes at 2700 RPMs. The holistic bone regenerative technique concentrates a bone growth factor (bone morphogenic protein or BMP) among other natural substances that are used for dental bone grafting.

Many of todays advanced full mouth implant teeth cases would not work as well without PRF and other holistic grafting techniques.

Holistic Bone Graft Video:

All Bone Grafting Techniques are the Same

False. The best bone grafting technique for bone regeneration is a combination of osteoinductive and osteoconductive materials. Or simply put, a mixture of bone factors that repair defects in bone and stimulate bone cells to grow naturally. Osteoconduction is the placement of a material into a bone defect that eventually gets replaced by the body with host bone tissue. Osteoinduction is a material that directly stimulates the body by its own pathways to grow new bone.

Holistic Bone Graft Protocol:

  1. completely extract any tooth fragments or foreign materials such as pieces of filling material or metal, so only bone and gum tissue remain
  2. remove any cyst or irregular scar tissue and diseased/non-vital bone.
  3. use oxygen and dental ozone gas to kill bacterial and fungal infections in the pores of the bone. Oxygen and Ozone also promote healing and reverse an anaerobic environment suitable for disease and pathogens.
  4. Evaluate the size and shape of bone defects or holes.
  5. place a mixture of platelet rich fibrin (PRF) and bone grafting material into the bony void. (generally we will graft any defects larger than 3-4mm)
  6. place PRF and collagen membranes as needed to hold graft products into place.
  7. suture gum tissue into place so it is not loose and closed if at all possible. Membranes will also block gum tissue from growing down into the healing graft or bony holes where it does not belong.

Bone regeneration and grafting is not always an exact science and no case is ever the same. Several factors about the area to be grafted are very considerable:

  1. physical size of the bone missing
  2. actual shape of the bone missing
  3. amount of bone remaining prior to grafting
  4. health of bone remaining prior to grafting
  5. health of patient in need of treatment
  6. how long the bone has been missing

The choice of materials and techniques can be critical to the outcome of the jaw bone regenerative procedures. Careful selection of materials can also improve the chances for success.

Patient health, surgical technique and material selection determine bone graft success or rejection.

All people respond the same to grafting procedures

False. Patient health is also a very big factor in success and dental bone graft recovery periods. Even with the best techniques and materials patients who are not healthy may experience bone graft failures. In order for grafts to be successful, the graft needs to be:

  1. bone graft material accepted by the host and not rejected. PRF is never rejected because it is natural and comes from the patient. Other bone graft products are man made, from other humans or from animals. Clearly the more foreign the material, the greater the chance for rejection.
  2. the patients body needs to have the health and strength to grow new bone tissue in response to dental bone grafting
  3. the patients body needs to fight off any bacteria or other pathogens in the mouth during bone graft recovery and healing periods. The mouth is a dirty place.
  4. the body needs to grow bone and not allow gum or other soft tissue to grow into the bone graft sites. Accordingly, membranes and graft material selection is critical. Membranes create a temporary barrier between growing bone and overlying gum tissue. Sometimes problems occur when the membrane breaks down prior to when the body has finished growing bone underneath. Additionally, if the graft material dissolves before the body has grown bone, there can be opportunity for soft tissue to grow down into the graft site also. Material selections and surgical technical are very important in this regard.

Immediate Zeramex Zirconia XT Implant Surgery

Posted on by Dr Adams

Removal of Zirconia Implant and Replacement with Zeramex XT

Implant surgery cases do not always go as planned. This Zeramex P6 zirconia implant was not placed in a good position. It was placed too close to the tooth behind it and not down deep enough into the gum. In technical terms the zirconia implant was placed too far distally and too high coronally. The placement was initially workable, but when teeth are removed, other teeth can shift. The implant healed well, but the implant was not in a useable position. There literally was not enough room to fit a crown on top of the implant. The implant need to be replaced with a properly positioned implant.

The Zeramex XT and the Nobel Pearl implant are the same exact implant. They are both brands of the same implant manufactured by Dentalpoint.

zirconia implant removal case

Final Zeramex XT Implant Photo

Ceramic implant is too close to neighboring tooth

The implant was too coronal (high in the jawbone) and there was not enough room to put a replacement tooth on top of the implant. The P6 implant requires more room for the crown on top because the connection between the crown and the implant sits up higher than most other implants on the market. This is not a problem if the implant surgeon plans accordingly. Zirconia implant surgery requires the utmost precision due to implant design considerations and limitations in abutments available. Abutments most often can be bought premade, “pre-fabricated abutments” or custom made “custom abutments.” Custom abutments can sometimes correct for poor implant surgery and poor placement issues. Unfortunately most zirconia implant manufacturers only sell pre-fabricated abutments. Limitations in zirconia vs titanium materials and FDA problems have made getting custom abutments for zirconia implants difficult. There are some labs that can create custom abutments from a prefabricated abutment if need be.

implant complications

Zeramex XT Immediate Implant Placement

Notice how the P6 implant has been removed and the new implant is placed deeper into the mandibular jaw bone and more in the middle between the two teeth. Notice also the shape difference between the two different implants. Long story short, without getting too technical, the design of the XT implant allows the implant to be placed deeper into the bone than the P6. And the XT requires much less room for the connection between the implant and the tooth on top. The tapered design makes placing the XT into a stable position much easier (even in tricky shaped bony sites). These three considerations make placing the Zeramex zirconia XT implant much easier than the P6. It also makes placing a zirconia implant much more possible, in situations where previously only titanium implants were possible.

zeramex XT implant after picture

Surgical Removal of Zeramex P6 Implant

P6 implant was flapped open with a minimal full thickness flap, troughed, elevated and reversed with a torque wrench and fixture mount. After P6 removal, a modified osteotomy was performed for placement of the XT implant. The XT implant was placed with a mixture of allograft and PRF into the remaining bony defects.

zeramex P6 removal

Zeramex P6 Extraction Socket

Notice in the implant extraction site how the bone had grown around and attached to the P6 Implant threads. The smaller threads of the P6 likely allowed for easier removal of the implant. An integrated Zeramex XT will not extract as easily.

zeramex p6 implant extraction site

Immediate Zeramex XT Implant Surgery

Implant placement with PRF bone graft in place. Angle of photo is not centered. The implant is centered between the teeth. Below is the final placement with proximation and PRF closure. A cover screw has been place and if need be a secondary uncovering procedure will be performed. The Zeramex XT system has 3mm and 4mm healing caps that can be used coincident with uncovering surgery.

zeramex implant placement final

Post op photo of Zeramex XT Implant Surgery

zeramex xt final placement

Zeramex XT Implant after Healing 3 months

zeramex xt zirconia healing

Zeramex XT Healing after partial uncovering and placement of 3mm tissue former/healing cap.

zirconia implant removal case

Things that stayed the same with P6 and XT implants:

The excellent zirconia (zirconium dioxide ATZ) and Zerafil implant surface technology.

Zeramex XT vs P6

zeramex P6 implant
Zeramex P6
zeramex xt implant
Zeramex XT
  1. XT has a deeper connection between the implant and the abutment. Zeramex has classified this as an “internal connection.” Technically the XT abutment connects internally but the abutment still sits on top of the implant body. Most “internal connection” systems have the abutment sitting completely inside of the implant body. Since the XT sits on top of the implant body, the XT is not truly a “bone-level” implant because an interface of two parts should not occur at bone level. Obviously there can be flexure about the abutment and the implant body during chewing forces. Zeramex recommends the placement of the XT as deep as 0.6mm above bone level and as high as 1.6mm above bone level. More research should be done on how much if any flexure occurs about the abutment/implant interface. Zirconia is a very brittle material that really does not flex like titanium. Perhaps the XT at bone level is not a problem with zirconia as it is with titanium implants.
  2. XT has more implant threads that are larger than the P6 design. More and larger threads means more bone to implant interface and a stronger and faster osseointegration. Such a thread design also means easier and more stable surgical placement.
  3. XT has a tapered design. A tapered design with deep threads is ideal for immediate implant surgery or placement of the implant on the same day as extraction. With a tapered design, the XT can be placed and stabilized into all different sized and shaped bone.
  4. XT has a smaller screw. A smaller screw meaning the screw is not as wide and is not as tall as the P6 screw. This is no “small” detail. Wide screws do not work well when doing screw-retained crowns because the access hole in the crown is large (at least as wide as the screw) and impacts the functional shape of the crown. The P6 works better with cement retained crowns for this reason. The XT screw is also not as tall. In limited height situations, the height of the P6 screw can literally cause the implant design not to work at all because the screw sits up so high there may not be enough height to cement retain a crown. The case presented here is one of those cases, but in this case the implant could have been placed deeper. In some cases the implant cannot be placed deeper and the P6 design is not workable.
  5. XT screw has more threads. More threads means the screw needs to be turned more times around prior to it getting tight and secure. This feature makes it easier to try-in abutments, impression copings and healing caps. More threads means fewer healing caps coming loose when they are hand tightened. And more time to finagle the orientation of an abutment in soft tissue during a try-in.
  6. XT connection is not an “internal hex” but rather an “internal quad”. This means the indexed XT abutments when seated can be placed in fewer different orientations than the P6. Most of the time, this does not matter unless an angled Zeramex XT abutment is placed. Special attention to the final angular position is important to consider. The angular positions for abutment placement with the XT are 12, 3, 6, and 9 O’clock positions or quite literally at 90 degree positions. What if you want the angled abutment at the 45% position or a lot more of the abutment needs to be prepped?

Implant Planning is very Important

In our office we do titanium and zirconia implants. There are many reasons why not to do zirconia implants. And there are many reasons to do zirconia implants. The same can be said of titanium. All things equal, we prefer to use zirconia because the material is more biocompatible, looks better and gum tissue is healthier around it. Since the release of the XT, we have been able to use the Zeramex XT in many more cases that previously required titanium.

  1. Cases with less than 6-8mm of restorative room
  2. Cases requiring screw retention that were not molars or large teeth
  3. Cases where immediate placement was much preferable and primary stability an issue
  4. Cases where 2 stage surgery and bone level placement is indicated
  5. Multi unit bridge cases where screw retention is preferable

Full Mouth Zirconia Implant Teeth

Posted on by Dr Adams

Zirconia Full Mouth All on 4 Dental Implants

zirconia complete implants on titanium
Zirconia complete implants

Full Mouth Zirconia Implant Teeth

A full mouth of implant teeth can now work with metal free zirconia solutions. Look at the before and after pictures of this case where all teeth were removed and replaced with zirconia implant teeth. The final teeth are made from zirconia with custom pink porcelain work and 3D tooth color characterization.

The full upper implant bridge is supported by 6 zirconia implants. As you can see, the gum and bone was in much better condition in the top jaw as less pink porcelain to replace gum was needed.

The full arch lower all on four bridge is supported by 5 zirconia implants. As you can see, much more pink porcelain work was needed to replace gum because of the amount of bone loss.

Zirconia implants saves bone in periodontal disease.

The natural teeth ultimately failed due to gum and periodontal disease. Replacing all teeth with dental implants is the best option for moderate to severe gum disease. Implants are best option for gum disease because implants are not susceptible to gum disease the way natural teeth are. In advanced cases of gum disease, teeth are almost always lost regardless of the amount treatment done to save teeth. And when teeth fail during gum disease, there is lots of dental bone loss. Valuable bone can be saved by removing teeth and replacing teeth with implants in a timely fashion.

Bone Loss Changes the Face and Jaw structure.

bone loss and dental implants
Bone Loss and Face Collapse. Photo Credits to “Dear Doctor, Inc.”

Teeth loss causes facial aging and wrinkles

Nothing can cause a face to collapse faster than losing teeth. Losing all your teeth can cause you to look 10-15 years older over night. Look at the above before and after pictures showing how a face changes after teeth are lost. Unfortunately with aging, teeth can become damaged, decayed, fracture and be lost. If all your teeth need to be removed, dental implants can save you from looking many years older than you really are.

Replacing Teeth with Implants can slow aging and facial wrinkling

If you have suffered tooth loss and you face has begun to sink in and wrinkle, getting complete implants can be an anti-aging potent of sorts.

DNA Appliance is anti-aging and a non-surgical face lift treatment

What if your face is sinking and wrinkling and you have not lost any teeth? I hate to say it, but natural aging does happen and facial wrinkles is part of life. But there is something you can do and especially if you have crooked teeth and small facial bone structure. When people have small bone structure, there is very little bone support in the cheek area for your face. New face-growing procedures can stimulate new bone growth in the lower half of the face to provide bone support where wrinkles are at. One such appliance is called the DNA Appliance. The DNA appliance is used in most cases to treat obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS).  The DNA appliance is an anti-aging and non-surgical face lift treatment.

dna anti-aging appliance

DNA anti-aging treatment

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