Tuesday, November 16, 2010

New Course By Dr Boudet

A new course by Dr. Boudet for continuing education for dentists has been posted in Dentaltown, one of the most popular forums for dentists worldwide.
The title of the course is Minimal Preparation Porcelain Veneers and Smile Design Principles.
The course is one hour long and is free to view. If you desire continuing education credits for your dental licensure, there is a minimal charge from Dentaltown.
If you are interested in viewing it, the link to the course is shown below:


Tuesday, May 18, 2010

Latest News From Our Office

We would like to announce two recent accomplishments by Dr. Boudet for the benefit of his patients:

In April 2010, Dr Boudet attended the International Congress of Oral Implantologists in New Orleans, Louisiana, where he received the status of Diplomate of the International Congress of Oral Implantologists, the highest level of accreditation given by that organization, and further testimony of his desire to improve his knowledge and expertise in his profession.

As a result of his accomplishments in implantology, and his love for teaching, Dr Boudet was recently chosen as one of a handful of experts to answer questions about Dental Implants in ChooseDentalImplants.com a new website dedicated to help the consumer obtain advise about Dental Implants and information on just about every topic related to implants.The website address is http://www.choosedentalimplants.com/
If you have any questions, please visit our website at: http://www.boudetdds.com/

Monday, April 19, 2010

Bone Grafting in Dentistry

The knowledge that we have developed in the science of dental implantology has grown tremendously in the past couple of decades, and bone grafting has developed into an integral part of it, allowing dentists to develop procedures and achieve outcomes that would not have been possible without grafting.

Bone grafting is utilized routinely in day to day procedures such as ridge preservation after tooth extraction, ridge augmentation, guided tissue regeneration in periodontal defects, ridge repair of ailing or failed implants, sinus augmentation procedures, and repair and reconstruction after surgical resection in the treatment of neoplasms.

For the average dentist, bone grafting is used most commonly in ridge preservation after extractions and associated with implant placement.
A basic understanding of the available bone grafting materials , their similarities, their differences and how they work will allow the dentist to select the best material for a particular situation, since they all have their advantages and disadvantages.

Starting with the basic classification of bone grafting materials which distinguishes them by the source or where the material comes from, we have:
Autografts: Graft material comes from the same patient (which means usually a second surgical site). Autografts are the best choice since it is the only osteogenic material.
Allografts: Graft material comes from a different patient (human, usually a cadaver) This material undergoes extensive processing to reduce or eliminate the chances of antigenicity and disease transmission. Allografts carry bone morphogenetic proteins in a limited amount and are considered osteoinductive (can produce chemotactic signals that stimulate mesenchymal cells to differentiate into osteoblasts and form bone) and osteoconductive.
Xenografts: This graft material comes from a different species, usually porcine or bovine and is also treated to reduce or eliminate the chances of antigenicity and disease transmission. Xenografts are osteoconductive and slower to resorb.
Alloplasts: This is synthetic material such as tricalcium phosphate, and has the advantage of carrying no risk of antigen or disease transmission. This material is osteoconductive (acts as a matrix which maintains graft space and gets replaced by viable bone).

The easiest and most predictable bone grafting procedure is socket preservation. Here the dentist has a five walled defect which, when treated properly by removing any soft tissue, fibrous of granulation tissue, infection*, cystic lesion, etc...and creating a bleeding bone surface, which will be the source of bone progenitor cells, growth factors and angiogenesis that will allow the replacement of the graft material placed in the socket by new bone called woven bone. *If an active infection was the cause of the extraction and there is doubt as to the complete removal of all the tissue infiltrated by the infection, it is prudent to postpone grafting for a period of four to six weeks.
The alloplast materials such as beta tricalcium phosphate are well suited for these socket preservation procedures.

The type and morphology of the bone defect is an important factor. If the graft is an onlay graft, such as a narrow posterior ridge that requires augmentation in width, it is basically a one walled defect, and the only source of cells, vaculature and bmp's come from preparing a bleeding surface on that wall. Since the morphology of the defect is not conducive to particulate materials, these are only possible when you only need a couple of millimeters of additional width and requires tenting and a membrane. A decision to split or expand the ridge may be a better choice when only a couple of millimeters of additional width is needed.

Sinus grafting procedures utilize a much larger quantity of grafting material which is usually packed to a height of about ten millimeters. It has been proposed that bone will grow in the sinus regardless of what type of material is used, but some authorities recommend allograft material that will contain bone morphogenetic proteins for bone induction, or at least a mixture of allograft, alloplast, and ideally some autograft content also.

There has been concern recently pubicized about the safety of bone allografts due to the possibility of disease transmission to the recipient. The author is not aware of literature reports of any disease transmission by bone allograft in dentistry.It is this author's opinion that the current FDA regulations and the donor tissue handling protocols in place today make the chance of antigen or disease transmission from allograft bone almost non-existent.
An interesting paper about the safety of bone allografts used in dentistry was published in the ADA journal and a link is provided below:


Bone grafting will continue to advance and help improve the outcome of modern dental procedures.
If you need a bone graft in west palm beach please call our office or visit our website.
West Palm Beach Dentist
Carlos Boudet, DDS, DICOI

Saturday, March 6, 2010

Information About Silver Amalgam Fillings

What are amalgam fillings?
Amalgam fillings, also called silver fillings because of their silver color and content, have been used for a very long time (over 150 years) and for a long time they were considered the material of choice for fillings done in the molar areas, where the chewing forces were very strong and the material used needed to be able to withstand them.

Dental amalgam contains approximately 50% elemental mercury, which when mixed with other metals like silver, tin, and copper, the resulting alloy will harden into a “silver filling”. Once hard, the mercury in the filling does not come out. It has been shown that there are very low levels of mercury vapor that are released, but these levels are so low that are well below the levels shown to cause any adverse effects. High levels of mercury vapor exposure are associated with adverse effects in the brain and the kidneys.

Should I be worried about silver fillings?
Based on investigations published for more than 100 years till the present date, there is no evidence that dental amalgam fillings are harmful to patients. The following excerpt from an article published by the Food And Drug Administration and updated in August of 2009 describes their findings:

“The FDA has reviewed the best available scientific evidence to determine whether the low levels of mercury vapor associated with dental amalgam fillings are a cause for concern. Based on this evidence, FDA considers dental amalgam fillings safe for adults and children ages 6 and above. The amount of mercury measured in the bodies of people with dental amalgam fillings is well below levels associated with adverse health effects. Even in adults and children ages 6 and above who have fifteen or more amalgam surfaces, mercury exposure due to dental amalgam fillings has been found to be far below the lowest levels associated with harm. Clinical studies in adults and children ages 6 and above have also found no link between dental amalgam fillings and health problems.”

The ADA has a similar position paper published summarized in this quote:
“Dental amalgam is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans. It contains a mixture of metals such as silver, copper and tin, in addition to mercury, which binds these components into a hard, stable and safe substance. Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness.”

The only definite contraindication to silver amalgam fillings is if the individuals have an allergy or sensitivity to mercury or the other components of dental amalgam (such as silver, copper, or tin).
Recent environmental concerns about the content of mercury in fish may make you wonder if all this mercury used in fillings and other industries have some thing to do with the mercury levels in fish, and I do not know of any studies linking these levels to dental amalgam. Personally, I tend to think that the use of mercury in other industries is more likely the cause, since elemental mercury in dental amalgam produces mercury vapor, and the mercury found in fish is methyl mercury, more likely to be an industrial byproduct.

The next question that comes up is: Should I have my silver fillings replaced?
The FDA has this recommendation: “ If your fillings are in good condition and there is no decay beneath the filling, FDA does not recommend that you have your amalgam fillings removed or replaced. Removing sound amalgam fillings results in unnecessary loss of healthy tooth structure, and exposes you to additional mercury vapor released during the removal process.” The guidelines that I follow in my practice are these:

1.If the silver filling is in a non-cosmetic area and is visibly and functionally good, I do not recommend replacing it.
2.If the filling is in a cosmetic area, or shows signs of deterioration, open margins or other signs of problems, I recommend replacing them.
3.If the filling is older than 10 or 15 years old, I may recommend selectively replacing a couple of the oldest ones to determine if the rest should be replaced.
Strategic replacement of selected silver fillings allows me to catch areas of decay that are not evident in radiographs and at the same time, keep the size of the tooth preparation as small as possible and the tooth stronger as a result. This Minimally Invasive Dentistry is something that I believe in and the way I would like my family and myself to be treated when we need these services. Having said that, let me make it clear that if a patient requests having all the silver fillings replaced, we will gladly comply with that request.

Do you place silver Fillings or tooth colored fillings?
No. Our office presently utilizes porcelain and a material called composite instead of silver amalgam in our fillings, because these materials, in conjunction with the bonding techniques that are currently utilized allows us to create better restorations for our patients.

If you would like to read the actual articles quoted in this writing, they will be listed below.

For the FDA article on silver amalgam fillings, see the following webpage:

The final rule for dental amalgam (long paper) is here:

For the ADA position paper on Dental Amalgam see this webpage:

For any additional information or any questions that we may help you answer please visit our website at: http://www.boudetdds.com/contact.htm

Sunday, February 7, 2010

Xylitol: The Sweetener That Reduces Cavities

It’s estimated that the we consume over one hundred pounds of sugar each year, and sugar is one of the main factors that contribute to bad teeth, weight gain, hypoglycemia and diabetes.

Xylitol is a natural, low calorie sweetener that tastes and looks like sugar but has 40% less calories than sugar. It’s approved by the FDA and the World Health Organization as being safe for adults and children.
Xylitol is considered a healthy alternative to sugar and lacks major side effects. In fact, most users experience no side effects.
Because it is a low glycemic sweetener, Xylitol has only small effects on blood sugar and insulin release, and it is considered a safe alternative to sugar for diabetic individuals. Dieters also can benefit from using it in low carb diets.

The greatest benefit of using xylitol as a sweetener, and the reason I am writing this is related to the teeth. Certain types of bacteria that normally live in the mouth, break down the sugars in what we eat and drink. They produce acid that decalcifies or softens the enamel on teeth. The decalcified area allows the bacteria to get inside the tooth and creates a cavity. Studies show that Xylitol inhibits the growth of the bacteria that cause cavities. These bacteria (Streptococcus mutans) cannot utilize Xylitol to stick to the surfaces of the teeth and create cavities.
Another beneficial effect of Xylitol is in the reduction and control of candida yeast infections in the mouth.

Other Xylitol studies have also shown that it can reduce ear infections and upper respiratory infections by affecting the streptococcus bacteria that cause these problems.

Xylitol is widely used in Europe as a sweetener in candies and gum, but it is not very widespread in the United States.
In order to avoid endorsing any products, I won't mention them here, but you can do a search on the web for Xylitol and you will get several reputable companies that manufacture and sell xylitol gum, mints and sugar substitute products.

One last note worth mentioning is that you need to keep any and all Xylitol products away from your pet, as it does have some harmful effects on them.

I encourage you to do your own research and take advantage of this wonderful sweetener that reduces cavities by just using a mint or a piece of gum 4 or 5 times a day.

If you have any questions or comments, please visit our website at http://www.boudetdds.com

Sunday, January 10, 2010

I have been been a member of the Atlantic Coast Dental Research Clinic for over sixteen years, and have participated in the Implantology section for many years. Recently I was fortunate to be given the opportunity to co-author and publish an article with the chairman of the Implantology section, Dr. Robert Miller, on the subject of mandibular anatomy. The article was published in Titanium Magazine, a magazine dedicated to Dental Implantology. A brief summary of the article follows:
"Placement of dental implants in the anterior mandible is considered by many clinicians to be a relatively low risk procedure. However, hemorrhagic episodes following implant placement in the mandibular symphysis are regularly reported and can have serious consequences. The use of high resolution focused cone beam scanners has given us the ability to visualize the intricate neurovascular network of the intraforaminal region without distortion and in greater detail. Knowledge of the arterial supply, and navigated implant placement in the mandibular symphysis, can help to avoid these potentially life-threatening emergencies."
A copy of the article can be found here:
Please note that this article contains terminology or dental nomenclature that is intended for dental professionals.