Quantitative Approach to Surgery
Oct
08
2009
A Quantitative approach (a game of millimeters)
There is always an art to good treatment of a disease. The skill, experience, and knowledge of the clinician is imperative to a good outcome. There are however objective quantitative measurements which guide proper periodontal therapy. All measurements in the mouth are done in millimeters. The following are a few examples of how dentists use millimeters in their care of the human mouth.
Periodontal pocket depths: Every tooth emerges through the skin of the gum and into the oral cavity in essence breaking the seal of the skin. This breach in the skin in compensated for by a tough ring of collagen and immune cells which surrounds every tooth 360 degrees. This forms a shallow pocket which also goes around every tooth 360 degrees. If the depth of this pocket is maintained shallow, typically less than 3 millimeters, with good daily cleansing, then the tissues remain healthy and the ring of collagen which goes around the teeth is tight and healthy. If however, bacterial colonies settle into the pockets and are not removed the 3 millimeter critical depth increases. Both by virtue of gum swelling, and collagen and bone breakdown. As the pocket depth increases to 4, 5, 6, or more millimeters, the cleaning of the pocket becomes more difficult. This in turn allows the bacterial colony to grow more and even worst select for nastier anaerobic bacteria to thrive. It is a viscous downward spiral of increasing pocket depth and worsening inflammation. Thus it is imperative to keep all pockets of all teeth less than 3 millimeters.
Size of Implants: One of the best ways to replace missing teeth is with the use of dental implants. A dental implant is a small titanium screw which replaces the root of a missing tooth. Once anchored into the jaw bone the implants fuse to the surrounding bone and become very strong roots. (This procedure is so common and minimally invasive that it is performed under local anesthesia in the dental chair, and most patients only take some advil after the procedure to get rid of any discomfort) These implants come in many combinations of sizes to suite the tooth they are replacing. The measurement sizes are in millimeters. A dental implant is described by two separate millimeter dimensions its height and diameter. For example a typical molar root in an adult male would require a 5mm X 11mm dental implant. This means the root is 5 mm in diameter and 11 mm in height. Implants are truly small but mighty, considering that the bite force can be as high as 150 pounds per square inch! Yet implants function great for many years.
Cat Scan resolutions: When planning more complicated dental procedures such as dental implants, bone grafting, sinus surgery, wisdom teeth extractions or orthodontics, often dentists can use the help of CT scans to help them diagnose and treatment plan. The CT scan provides doctors with a three dimensional exact digital model of the patients bones and teeth. The resolution is so high that a CT scan is viewed in millimeter slices. Each “slice” is a millimeter section of the human body.
Root Canals: There are canals inside the tooth. These canals house a small piece of tissue called the pulp. When a “root canal” is done, the doctor cleans out the remnants of the tissues and disinfects the canals. The exact length of the canal is measured with an apex locator down to the half millimeter. This is important because the entire canal system must be disinfected and filled with a sealing material exactly to the end of the tooth.
Amir Ahmadi DDS Diplomae, American Board of Periodontology
There is always an art to good treatment of a disease. The skill, experience, and knowledge of the clinician is imperative to a good outcome. There are however objective quantitative measurements which guide proper periodontal therapy. All measurements in the mouth are done in millimeters. The following are a few examples of how dentists use millimeters in their care of the human mouth.
Periodontal pocket depths: Every tooth emerges through the skin of the gum and into the oral cavity in essence breaking the seal of the skin. This breach in the skin in compensated for by a tough ring of collagen and immune cells which surrounds every tooth 360 degrees. This forms a shallow pocket which also goes around every tooth 360 degrees. If the depth of this pocket is maintained shallow, typically less than 3 millimeters, with good daily cleansing, then the tissues remain healthy and the ring of collagen which goes around the teeth is tight and healthy. If however, bacterial colonies settle into the pockets and are not removed the 3 millimeter critical depth increases. Both by virtue of gum swelling, and collagen and bone breakdown. As the pocket depth increases to 4, 5, 6, or more millimeters, the cleaning of the pocket becomes more difficult. This in turn allows the bacterial colony to grow more and even worst select for nastier anaerobic bacteria to thrive. It is a viscous downward spiral of increasing pocket depth and worsening inflammation. Thus it is imperative to keep all pockets of all teeth less than 3 millimeters.
Size of Implants: One of the best ways to replace missing teeth is with the use of dental implants. A dental implant is a small titanium screw which replaces the root of a missing tooth. Once anchored into the jaw bone the implants fuse to the surrounding bone and become very strong roots. (This procedure is so common and minimally invasive that it is performed under local anesthesia in the dental chair, and most patients only take some advil after the procedure to get rid of any discomfort) These implants come in many combinations of sizes to suite the tooth they are replacing. The measurement sizes are in millimeters. A dental implant is described by two separate millimeter dimensions its height and diameter. For example a typical molar root in an adult male would require a 5mm X 11mm dental implant. This means the root is 5 mm in diameter and 11 mm in height. Implants are truly small but mighty, considering that the bite force can be as high as 150 pounds per square inch! Yet implants function great for many years.
Cat Scan resolutions: When planning more complicated dental procedures such as dental implants, bone grafting, sinus surgery, wisdom teeth extractions or orthodontics, often dentists can use the help of CT scans to help them diagnose and treatment plan. The CT scan provides doctors with a three dimensional exact digital model of the patients bones and teeth. The resolution is so high that a CT scan is viewed in millimeter slices. Each “slice” is a millimeter section of the human body.
Root Canals: There are canals inside the tooth. These canals house a small piece of tissue called the pulp. When a “root canal” is done, the doctor cleans out the remnants of the tissues and disinfects the canals. The exact length of the canal is measured with an apex locator down to the half millimeter. This is important because the entire canal system must be disinfected and filled with a sealing material exactly to the end of the tooth.
Amir Ahmadi DDS Diplomae, American Board of Periodontology
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