This procedure is conducted to remove excess gum tissue that may be overgrown on the teeth to provide a better aesthetic result and a better area to clean the teeth.
Gingiva Overgrowth
Several reasons why there is an overgrowth of gum:
Inflammatory-induced:
Biofilm (bacteria) and the host response, resulting in familiar forms of periodontal disease such as gingivitis and periodontitis. Swelling, erythema, and bleeding are signs of these diseases.
Usually due to poor oral hygiene, orthodontic appliances
Some mediation might trigger the growth of the gum tissue, such as:
Anticonvulsants (phenytoin, phenobarbital, lamotrigine, vigabatrin, ethosuximide, topiramate, and primidone)
Antihypertensives (calcium channel blockers such as nifedipine, amlodipine, and verapamil)
Immunosuppressant (cyclosporine)
Systemic diseases such as:
Pregnancy or puberty and vitamin deficiencies (mostly vitamin C) are some of the more common causes in this category.
Benign neoplasms—such as giant cell granuloma, papillomas, and fibromas—can cause enlargement of the gingiva.
Other more serious causes of gingival enlargement include leukemias, malignant neoplasms/carcinomas, as well as many forms of granulomatous diseases.
All these gum overgrowth can be corrected by reduce the cause factors or gum surgery (gingivectomy)
A case of Gingivectomy
A young lady complained that she didn’t have great smile. On examination, we found out that she had a very short teeth. Oral hygiene just moderate.
Using a dental chi gauge, it was confirmed that the patient had a short crown height
Dental scaling was done to improve oral hygiene
After taken radiograh to determain the bone height and biological width, surgical excision of 2mm of gum tissue above the gingiva margin.
Tooth loss is a serious oral health problem that can have a significant effect on overall quality of life, making it difficult to chew or embarrassing to smile. Dental implants are a solution for people who have lost one or more teeth due to periodontal disease, trauma or injury, or other reasons. Implants are artificial tooth roots that are placed into the jaw bone and are used to support the crowns.
Dental Implant
Traditionally, a dentist will create impressions of a patient’s teeth and gums. X-ray will also be done in order to get an image of the mouth structures before placing the dental implants free hand. These technique require the dentist’s experience and expertise. Computer guided implant surgery represents a giant step forward in the replacement of teeth with dental implants.
What is Computer guided dental implant surgery?
Computer-guided implant surgery is a great advance in dental implant treatment planning. A computer program, cone-beam CT 3D X-ray and intraoral scanner will be used for planning an accurate position of dental implants. The computer program will combine x-ray images, intraoral scans and cone-beam 3D CT images and translate into a 3D model of the jaw. The dentist will be able to plan the placement of dental implants and determine their optimum position with a high degree of accuracy. A surgical guide will be fabricated by our in house 3D printer for use during implant surgery for accurate placement according to computer planning.
Benefit of computer guided implant surgery:
Reduced Risks Computer-guided implant technology makes it possible to see the anatomical structures of the jaw, teeth, and surrounding tissue, thereby reducing the risks of unexpected complications during surgery as well as allowing the dentist to know exactly where the implant should be placed.
Reduced Surgical Time Because a precise surgical guide is created, there is no guesswork with guided implant surgery. This allows the procedure to be completed faster than traditional dental implant surgery so patients can start the recovery process sooner.
Better Patient Education Computer-guided implant technology is based on detailed scans of the oral structures. These images may be used to explain the dental implant procedure as well as to educate patients about their oral health.
Case Example: Patient of ours requesting for dental implant to replace his lower left first molar tooth.
Situation before dental implant placementComputer planning of implant placement on lower left first molar combining 3D CT X-ray, intraoral scan. Dental Implant planning is done virtually and surgical guide is designedSurgical guide printed out by our in house 3D printer in patient’s mouthDental implant placement according to computer planningFinal Implant crown screwed into place
At Prestige Dental, we are fully equipped with Cone Beam 3D CT X ray machine, Intraoral scanner and 3D printer to fabricate the surgical guides
Our new CBCT, OPG and Lat Ceph X-Ray unitIntraoral 3D scanner available in Prestige Dental3D printer for fabricating surgical guide available at Prestige Dental
These computers can also be a valuable tool when it comes to our explanation of how exactly your implants will be placed. The patient will be able to look at clear images, as well as ask any questions.
With the help of computer guided surgery, we able to better pinpoint the exact location within your mouth for each implant, considerably simplifying the overall procedure. As our patient, you can look forward to a less invasiveness procedure, safer with less complications, a shorter recovery time, and an overall process that is much smoother from beginning to end.
Cone Beam CT (CBCT) is an X-ray based imaging technique that, like a conventional medical CT scan, provides fast and accurate visualisation of bony anatomical structures in three dimensions. In another words, CBCT produces a 3-dimensional images of your teeth and jaws.
It is also sometimes called “Digital Volumetric Tomography” (DVT) or other alternative names.
Unlike CT-scan, CBCT scanning resolution is higher, with less artefact and scatter. The scan field of view can also be reduced to image smaller volumes and lower the radiation dose associated with each scan.
CBCT image in 3D, with vertical, coronal and axial cross-section plane
CBCT scans are useful in many different types of dentistry, especially for dental implant planning, managing impacted teeth and root canal treatments, basically to get the 3D images of the teeth and jaws. It is used by general dentists and specialists to improve diagnosis and treatment planning in the following cases:
Dental implants
Size and shape of ridge, quantity and quality of bone
Relationship of third molar roots to mandibular canal
Evaluation of facial fractures and asymmetry
Oral and maxillofacial pathology
Localization and characterization of lesions in the jaws
Effect of lesion on jaw in 3rd dimension: expansion, cortical erosion, bilateral symmetry
Relationship of lesion to teeth and other structures
Orthodontics
Treatment planning for complex cases when 3D information needed to supplement (or substitute for) other imaging
Patients with cleft palate
Impacted/missing teeth
Root angulation, root resorption
Temporomandibular joint
Osseous structures of TMJ
Relationship of condyle and fossa in 3D
CBCT image can be used to determine the position of the ID nerve in the jaw bone
FAQ on CBCT
When should CBCT be used?
Whenever information in the 3rd dimension is needed for the diagnosis, treatment planning, or management of conditions in the jaws and the maxillofacial complex.
What does the scan look like when it is done?
The CBCT examination produces 3-dimensional pictures of the hard and soft tissue of your face. The size of the volume depends on the scanner and your particular clinical needs. The information can be viewed on a computer screen in different cross-section plane and can be rotated by the dentist to help plan treatment.
What is the difference between ordinary X-ray pictures and CBCT?
Ordinary X-ray images (such as OPG) are 2-dimensional, flat, pictures. Your teeth and jaws are 3-dimensional, so 2-dimensional images may not give the best information.
3D image of the jaw bones
Where do I go for a scan?
You can come to us for CBCT scan
or certain hospital X-ray Department in Klang Valley with CBCT unit
What are the advantages of CBCT?
Lower radiation dose than medical CT
Equivalent to ~1 Full mouth series of intra-oral radiographs or 6-7 panoramic radiographs
Comfortable for patient
Patient standing
Only 20 second scan
Wheelchair accessible
Images available almost immediately on screen
Images can be imported into other software
What will happen when I attend for the scan?
First, you will be asked to wear a lead apron to protect your body from radiation. Next, you will be positioned carefully in a standing position. You will then be ready for the scan itself.
The machine will move around your head in a circular motion, but will not touch you. Once the scan is finished, you will be asked to stay in the chair until the images are checked.
How long does the scan take?
The scan itself takes only a minute or so but, in most cases, the preparation and positioning will mean that the complete scan will take about 20 minutes.
Is there anything I need to do before I come for my appointment?
If you have earrings or other facial jewellery or piercings, these may need to be removed before the scan, so doing this in advance of your visit will save time. If you wear dentures, you will probably be asked to remove these before the scan.
Should the amount of X-rays I will receive worry me?
No. All CBCT referrals should be justified and only carried out when it is judged that the scan is appropriate. Although the X-ray exposure with CBCT is greater than with a traditional dental X-ray examination, it is almost always much less than you would get with a “medical” CT scan that might be the only alternative.
Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.
People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don’t have their diabetes under control are especially at risk.
A study in the Journal of Periodontology found that poorly controlledtype 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.
Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.
Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.
This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.
-Source: perio.org-
Electrosurgery is the application of a high-frequency electric current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. (These terms are used in specific ways for this methodology—see below). Its benefits include the ability to make precise cuts with limited blood loss. Electrosurgical devices are frequently used during surgical operations helping to prevent blood loss in hospital operating rooms or in outpatient procedures.
In electrosurgical procedures, the tissue is heated by an electric current. Although electrical devices may be used for the cauterization of tissue in some applications, electrosurgery is usually used to refer to a quite different method than electrocautery. The latter uses heat conduction from a probe heated to a glowing temperature by a direct current (much in the manner of a soldering iron). This may be accomplished by direct current from dry-cells in a penlight-type device. Electrosurgery, by contrast, uses alternating current to directly heat the tissue itself. When this results in destruction of small blood vessels and halting of bleeding, it is technically a process of electrocoagulation, although “electrocautery” is sometimes loosely and nontechnically used to describe it. (Source from Wiakipidia)
Electrosurgery unit
Using electrosurgery in oral surgery procedures
Electrocautery is a very useful tool to make a cut or excise soft tissue just like a scaple blade does. While a cut is made; at the same time, electrosurgery coagulate the surrounding blood vessels make surgery bloodless. This will improve visibility during surgery and less blood loss. More over, healing of a wound with electrosurgery is proven to be faster that wound made by scaple blade.
Electrosurgery: Coagulating the gum area before impression taking during tooth preparation for crown fabrication
Dental procedure which can be done with
Excision of lesions (eg. cysts, tumors)
Gum surgery
Implant placement
Crown lengthening
Coagulating the gum area before impression taking during tooth preparation for crowns/bridges
Advantages of using electrocautery
Less bleeding
Can be use to control bleeding
Wound heal faster with electrosurgery than using scaple blade
I’m sure some of you have been wondering about it. So here’s why dentist takes photo of your teeth and even portraits sometimes.
Photostudio in our clinic
Photography act as a vital communicating tool between dentist and the patient so that a clearer message or explanation can be delivered.
Imperfections that are not readily visible to the patient will be apparent in still photographs, patient get to visualise his/her oral condition.
Establish a baseline so that dentist able to monitor any recession or suspicious lesions that you may have in your mouth to discover if these conditions are getting better or worse.
Document cases by dentist for recording purpose.
DSLR Camera
Multiple system can be choose for dental photography and generally work well for practices. However, the digital single lens reflex (DSLR) camera still the most ideally suited for practices that to use photography for documentation for lectures or publications.
Basic kit for dental photography:
DSLR camera system
Macro lens (85–105 mm)
External ring flash / Dual Flash
Retractors
Mirror
Contrastor
Digital SLR Camera
105mm lens
Retractors and mirrors
Intra-Oral Photos
Multiple views of intra-oral photos will be taken. The basic views are:
Front view without retractor
Front view with retractor
Left buccal view
Right buccal view
Upper occlusal view
Lower occlusal view
Example of Intra-oral Pictures
Dentist might take some extra photos which specifically focus on a tooth/ area to focus on the problematic part.
Studio Photography
Sometimes additional extra-oral photos are needed. In our clinic, there’s a room set up with some additional tools for portraits such as NiceFoto TB-400C Flash with a diffuser/ softbox, and a white lighting board mounted on a wall.
Studio flash kit
Extra Oral Photos
For extra-oral, pictures of patient must include full face. The basic views are:
Types of dentureBasically, denture (false teeth) is prosthesis device to replace missing teeth. The denture is supported by the surround soft and hard tissue. It is the most economical and easy-to-make prosthesis. Denture can be further divided into complete denture (denture to replace all missing teeth) or partial denture (denture to replace a few missing teeth)
Beside denture, there are other options to replace missing teeth:
Root planing is a non-surgical treatment that usually done together with deep dental scaling. It is done after the supragingival (or superficial) plaque and calculus were remove through gross scaling. The aim of this treatment is to removes the roughened cementum and surface dentin that is impregnated with calculus, microorganisms and their toxins leading to the creation of a clean smooth root surface. Usually this implies that some cementum and dentin are removed. Deep scaling and root planing are done under local anaesthesia and requires 25-45 minutes per quadrant. If the pockets are deeper, the procedure becomes more significantly more difficult and more time is needed.
Introduction
Generally, dentists do everything within their power to preserve your natural teeth. However, in cases of advance caries or periodontitis, a tooth may have to be extracted. Teeth may also be removed for the purposes of orthodontics when teeth are straightened using braces. For example, your front teeth may be skew because there is not enough room for them in your mouth. An orthodontist may, therefore, suggest extraction of certain teeth to make space for teeth in your jaw.
Reasons for Extraction
The most most common reason for extraction is tooth damage due to breakage or decay. There are additional reasons for tooth extraction:
Severe tooth decay or infection.
Extra teeth which are blocking other teeth from coming in.
Severe gum disease which may affect the supporting tissues and bone structures of teeth.
In preparation for orthodontic treatment (braces)
Teeth in the fracture line
Fractured teeth
Insufficient space for wisdom teeth (impacted third molars).
Receiving radiation to the head and neck may require extraction of teeth in the field of radiation.
Deliberate, medically unnecessary, extraction as a particularly dreadful form of physical torture.
Types of Extraction
Extractions are often categorized as “simple” or “surgical”. 1.) Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the Periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force. 2.) Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding jawbone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal. Surgical extractions are usually performed under a general anaesthetic.
Simple Extraction
To extract a tooth, your dentist first administers a local anaesthetic in the area. Next, he firmly places extraction forceps over the crown of the tooth. He manually loosens the tooth, and then removes it. This is the most basic method of tooth extraction. Alternatively, he places an elevator between the tooth and the tooth socket, and carefully levers the tooth out.
However, sometimes it is impossible to remove a tooth using these methods, and then surgical intervention is required. Under local or general anaesthetic, the gum is cut over the relevant area, and the bone exposed. A section of bone is then removed to expose the root of the tooth, which is removed. Finally, the gum is stitched back together again.
What can I Expect After an Extraction?
It is critical to keep the area clean and prevent infection immediately following the removal of a tooth. Your dentist will ask you to bite down gently on a piece of dry, sterile gauze, which you must keep in place for up to 30 to 45 minutes to limit bleeding while clotting takes place. For the next 24 hours, you shouldn’t smoke, rinse your mouth vigorously, or clean the teeth next to the extraction site.
Sterile gauze to be placed at the extracted socket to stop bleeding
A certain amount of pain and discomfort is to be expected following an extraction. In some cases, your dentist will recommend a pain killer or prescribe one for you. It may help to apply an ice pack to the face for 15 minutes at a time. You may also want to drink through a straw, limit strenuous activity, and avoid hot liquids. The day after the extraction, your dentist may suggest that you begin gently rinsing your mouth with warm salt water (do not swallow the water). Under normal circumstances, discomfort should lessen within three days to two weeks. If you have prolonged or severe pain, swelling, bleeding or fever, call your dentist at once.
Instructions after tooth extraction
These are the instruction usually given to reduce complication such as excessive bleeding or infection after extraction:
Please don’t spit or rinse after extraction for today.
Make sure to bite gauze which ha s been placed over the extracted socket.
Please bite the gauze for 30 minutes to allow bleeding ceased.
Please not to change gauze too often.
Take pain killer given if painful.
Avoid taking food or drink which is too hot.
If socket still bleeds; not to be too worry. You can rinse gently with some cold water.
You can brush your teeth but gently and avoid the extraction site.
Some ladies may feel that their gums are uncomfortable than usual during pregnancy. Their gums are sore or tender, or if they bleed when brushing or flossing, they may have a condition called pregnancy gingivitis. Pregnancy gingivitis is a very common occurrence during pregnancy however; if it is not treated it can lead to complications with their pregnancy. If you are pregnant and notice any of the symptoms of pregnancy gingivitis it is important that you visit with your dentist in order to get appropriate treatment.
Pregnancy gingivitis is an hyperplastic reaction to microbial plaque. Elevated estrogen or progesterone levels resulting from hormonal shifts enhance tissue vascularity, which permits an exaggerated inflammatory reaction to plaque.
What is Gingivitis?
Gingivitis is more commonly referred to as gum disease, and it will affect over 90% of Americans at some point in their lives. Caused by the sticky plaque that accumulates on our teeth and gums, it can leave your gums swollen and tender, and even cause them to bleed. Gingivitis can also make brushing and flossing extremely painful. Gingivitis is one of the earliest stages of a more severe type of gum disease, called periodontal disease. Untreated gum diseases will progress into periodontal disease, which can cause irreversible damage to your gums and teeth. (More info on gingivitis)
What is Pregnancy Gingivitis?
Pregnancy gingivitis is simply gingivitis that occurs during pregnancy. More than 50% of all pregnant women experience some form of pregnancy gingivitis. Though gingivitis disease is annoying, it is usually harmless, unless it is left untreated. Pregnancy gingivitis is an hyperplastic reaction to microbial plaque. Elevated estrogen or progesterone levels resulting from hormonal shifts enhance tissue vascularity, which permits an exaggerated inflammatory reaction to plaque. Pregnancy gingivitis produces fiery red, swollen and tender marginal gingiva and compressible and swollen interdental papilla. If pregnancy gingivitis progresses to periodontal disease, it can increase your risk of going into preterm labor.
Causes of Gum Disease in Pregnancy
There are a number of causes of gum disease in pregnancy. One such reason is increased blood flow. During pregnancy, your blood flow actually increases by between 30% and 50%. This is to ensure that your baby is provided with the appropriate nutrients to grow and develop. Unfortunately, this increased blood flow can also cause you gums to swell and become very tender. It may even cause your gums to bleed, leaving them at increased risk for gingivitis.
The rise in your hormones can also play a role in you developing pregnancy gingivitis. These higher levels of hormones leave your gums and teeth more sensitive to the bacteria that hide in plaque. This is one reason why gingivitis is so common in pregnancy.
Morning sickness may also play a small role in contributing to pregnancy gingivitis. Many women find that they can no longer stand the smell or taste of toothpaste, making it difficult to maintain good oral hygiene. Increased vomiting during pregnancy can also take its toll on your gums. Vomit contains stomach acid which can eat away at your gums and teeth, making your mouth very sensitive.
Symptoms of Pregnancy Gingivitis
There are a few symptoms of gum disease to keep an eye out for. If you notice any of these symptoms, it is important to seek treatment as soon as possible.
tender, swollen gums
red or purple-red gums
gums that look shiny
bleeding gums after brushing or flossing
persistent bad breath
a bad taste in the mouth that won’t go away
mouth sores
Complications of Pregnancy Gingivitis
Generally speaking, pregnancy gingivitis is nothing to worry about. However, if your gingivitis is left untreated it could cause potential health problems for both you and your baby.
Sometimes, gum disease can cause sores to form on your gums. These sores are often called pregnancy tumors. These tumors can grow up to three-quarters of an inch in size and may cause discomfort or even pain. If ruptured, pregnancy tumors can become infected. Most tumors can be easily removed though, before they cause any complications.
It is important to take pregnancy gingivitis seriously because, if untreated, it will lead to periodontal disease. Periodontal gum disease is an advanced form of gingivitis that attacks the bones and tissues supporting the teeth. This disease can cause permanent damage to your mouth, and can cause you to lose both your gums and teeth. Periodontal disease has also been linked to a higher risk of premature birth – in fact, women with periodontal disease are seven times more likely to give birth prematurely.
Treating Gingivitis in Pregnancy
There are no cures for gum disease although its damage can sometimes be reversed or halted. All pregnant women should receive at least two thorough dental cleanings during pregnancy. This should help to reduce your chances of developing pregnancy gingivitis or periodontal disease.
If you already have gingivitis, the best gum disease treatment is to have a complete cleaning at your dentist’s office. Your dentist will scale your teeth using a variety of instruments. This will remove excess plaque from your teeth and around your gum line. Serious gingivitis may also require root planning, a process during which the roots of your teeth are cleaned of plaque completely.
Prevention
As always, the best treatment for gingivitis is prevention. Maintaining a good oral hygiene routine will ensure that you have healthy gums and teeth for a long time to come. Try following these tips:
brush twice a day for at least five minutes
use a soft bristle brush – this will prevent you from irritating your gums
floss once a day or use an anti-bacterial mouthwash to get rid of plaque from between your teeth
avoid eating large amounts of refined sugar – this will cut down on plaque and tartar buildup
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If you have any question, don’t hesitate to contact us, we are more than glad to provide you with the information you need!
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