DENTAL CARE

Jeffrey Gross, DDS, FAGD

Q: My Screws are Stripped? I Need A Consultation. A: Now I know what all of you are thinking. The people who set up this column mixed up my dental information with the local handyman’s column. However, that isn’t the case. I met this damsel in distress when I was making a denture for her father. He was a veteran of both World War II and the Korean War. I have to tell you that he is an inspirational and charming gentleman. Anyways, she came with him to one appointment and told me of her dilemma. She had implants placed for a “teeth in a day case” like you see on TV and unfortunately developed problems. When her dentist went to remove the tops of the implants, she was not successful. In fact, she even referred the case back to the specialist who placed the implants. Yes, this was a two doctor situation. Between the two of them, the tops of the implants were stripped. The screws holding the top fitting onto the implants were tightened so much that they could not be budged. She needed to go from a total screw-in set of teeth to something different. The problem that she now had was this. As long as those specialized tops were on the implants, she could never use those implants in a different fashion. At that moment in time, she had 4 non-functional implants in her mouth with no way to utilize them as they were designed.

Her dentist could not let her walk around without teeth so she made her a denture to wear. That was an appropriate solution given the circumstances except for one factor. This patient had a gag reflex that made wearing a regular denture a challenge. She wore it on rare occasions and had been dealing with this for quite a while. So why were the screws stripped? They were stripped because the screws were too tight and the problem occurred while trying to remove the screws. Why were they tightened so much? The patient explained to me that she continually had problems with her implant screws coming loose. The natural response to that issue is to tighten the screws. When the screws loosed again, what happens? We tighten them even more until we get to a point that they are too tight. However, we are reacting as opposed to finding out the cause of the continual loosening.

Hold that thought for a moment. I saw another patient who wanted a new denture that same week. He showed me his upper denture. It was cracked in half. The breakage had occurred several times and it was repaired several times. He went to a “big box denture office” and they just kept on repairing and charging for the cracked denture that they made. Why do I bring up this patient? The answer lies in the fact that both he and the implant patient have things in common. They both are spending a lot of time visiting office with no one searching for the cause. In both cases, the patients were missing all of their upper teeth and had a full set of natural teeth on the bottom. When I saw this, the problem was obvious to me.

The amount of force that we can gather when we have our own teeth is so much greater than what we can exert with artificial teeth. Both patients have tremendous bites generating a lot of force. In one case, all of the implant screws were jarred loose. In the other case, the denture simply cracked under the pressure of the bite. We have spoken many times about how deleterious a strong bite can be. Here we have two classic examples of this issue. I needed to address the source of the problem to create a long lasting solution for both of them.

Not to keep you in suspense, I was successfully able to remove the stripped screws on our first patient. She will now have a new set of upper teeth without a gagging back. I can reuse her upper implants now that I removed the tops of them. My second patient is having a new denture made with a special reinforcement to avoid cracking. In both cases, I recommended a mouth guard and some behavioral modification to reduce the stress and pressures coming from the natural lower teeth. Everyone in my office is really happy at the way these cases are progressing.

November is almost half gone. I’m reminding everyone to take advantage of our “Better than “Insurance” program that I mentioned in the last couple of columns. Rule do apply in this program that saves you 20% of your fee with no maximum limit. Call Megan today at 440.951.7856 and find out about our “Better Than Insurance” initiative to save you money and preserve your smile for a lifetime.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine. The Healthy Smile 34586 Lakeshore Boulevard (¼ mile west of Route 91 on Lakeshore Blvd) Eastlake, Ohio 44095 440-951-7856 Severance Medical Arts, Suite 603 5 Severance Center Cleveland Heights, Ohio 44118 216-371-2333 www.jeffreygrossdds.com