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05-22-11 | Posted by

Meet NYC’s Dental Implant Expert

A board-certified dentist and periodontist, Dr. Nicolas Toscano received his D.D.S. from Columbia University School of Dental Medicine in New York City, after receiving his B.S. in biology from the University of Scranton in Scranton, Pennsylvania. During a subsequent 13 year tour with the United States Navy, he completed a General Practice Residency at the prestigious National Naval Medical Center (“The President’s Hospital”). Today, he maintains a practice in Manhattan where he treats diseases of the gum, and specializes in implant surgery. Considered the plastic surgeons of the mouth, periodontists can perfect smiles with implants and even lengthen the appearance of teeth. Dr. Toscano is a frequent contributor to professional journals and serves as the co-editor-in-chief for the Journal of Implant and Advanced Clinical Dentistry.


How does periodontisry differ from general dentistry?

A periodontist is a surgeon that supports the general dentist in caring out his/her restorative plan for their patients. Periodontists are dental specialists in the prevention, diagnosis, and treatment of periodontal diseases and oral inflammation, and in the placement and maintenance of dental implants. They go to three years of surgical training beyond dental school.

A periodontist is also considered the plastic surgeon of the mouth restoring lost gum tissue, bone and placing implants to restore a patients lost smile through advanced periodontal plastic surgery techniques.

What are the leading causes of periodontal disease?

The leading cause of periodontal disease is bacteria and bacterial plaque that overwhelms the patient’s immune system and results in destruction of the bone and soft tissue around the teeth, which ultimately leads to tooth loss.

Secondary causes of periodontal disease include, smoking, poor oral hygiene, diabetes and immunodeficiency. New research shows that periodontal disease may lead to heart disease, stroke, pre term low birth weight babies and respiratory disease.

When should one choose an implant over a bridge?

One should always choose an implant over a bridge. The advantages of an implant compared to conventional fixed bridges are many. Implants preserve the underlying jawbone and therefore preserve the overlying facial structures, preventing them from collapsing. Once a tooth is lost and the jawbone is no longer stimulated by the pressure from chewing, the body reabsorbs that area of jawbone.

Thus implants are more esthetic both in retaining the patient’s natural appearance within their mouth and also their overall facial structure. Implants are more conservative than fixed bridges since the teeth on either side of the space do not have to be cut down as abutments. Thus a bridge permanently and irreversible destroys the two adjacent teeth in order to replace the missing tooth. The advantage of the implant is you can replace the missing tooth without touching or hurting the teeth on the adjacent sides.

Implants make it easier for patients to maintain their periodontal health than fixed bridges because home care is facilitated by being able to floss between the implants, therefore avoiding the floss threaders that are required for fixed bridges.

Implants are more cost effective over time because although they have a higher initial cost their life expectancy, retrievability, immunity to disease processes and independence of other teeth make their long-term maintenance less expensive than conventional fixed bridges.

Fixed bridges have a mean life expectancy of 10 years and will have to be replaced by more costly procedures often resulting in more loss of teeth. Implant fixtures have an osseointegration success rate of 98.5% and tend to last a life time if properly cared for.

Do implants always work and why?

Implants have a 98% success rate; they are made of medical grade titanium and are readily accepted by the body with no rejection. Titanium is used in both medical and dental procedures throughout the body.

What is Sedation Sleep Dentistry?

Some people have fear of going to the dentist and may avoid going to the dentist all together because of those fears. Sedation sleep dentistry can be utilized for patients such as these. This usually entails either giving the patient relaxation medication either, orally, via a gas that the patient breathes in or through an IV placed in the patient’s vein.

Once the medications are delivered, the patient is relaxed usually sleeping gently while their dental work is being done.

This can only be done by specially trained individuals and you should consult with your dentist to see if they have this training.

Are periodontal procedures ever selected for purely cosmetic reasons?

Peridontal procedures are often selected for a cosmetic reason. If you look at before and after photos of George Clooney, Demi Moore, Leann Rimes and many others they all have needed the periodontist to perfect their smile. The Hollywood smile consists of a less gummy smile where we see more teeth which are asymmetrically proportioned to ones facial structure. The teeth are bright and white with less of a gummy appearance. Through periodontal plastic surgery procedures the surgeon can either take away unneeded gum tissue where overabundant to enhance symmetry between the teeth and the gums or they can regenerate lost gum tissue and bone to fix the receding gum line to bring about a more youthful appearance. Taking away some gum tissue around the teeth may also give the general dentist more tooth to work with making it more healthy long term around your crowns. Lost teeth can be replaced with implants that periodontists have advanced training in.

What are best ways to preserve one’s smile and avoid the periodontist’s chair?

The best way to preserve ones smile is to go to your dentist regularly (at least twice a year, if you have periodontal disease you should go 4 times a year) and brush twice a day and floss every day.

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