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.
With our new Rainbow-Mill Clinic machine, we can now produce natural and functional ceramic indirect restorations (crowns, onlays, inlays) within a day!
Our miller machine!!
The creation and placement of indirect restoration is one of the most commonly performed procedures in dentistry today. Like traditional crowns and onlays, digital crowns and onlays are ideal for teeth which are badly decayed or broken and commonly used as routine finishes for procedures like Root Canal Therapy.
However, anyone who has had a standard crown or onlay done will know that it can be a time consuming process which takes a minumum of 1 week or more for it to complete.
The crown that was millerd out from the hybrid-ceramic block
Normally in the case of traditional crowns, impressions are taken and sent off to a dental lab for crown fabrication. It may take a week or two for the lab to receive the impression, make the crown and send it back to us. The waiting time and having a temporary crown in the mouth are the drawbacks of this method.
With Digital crowns/ onlays, we can shorten the entire process significantly. The biggest advantage of digital crown is that it can be designed and milled right here in our clinic. Using the latest CAD/CAM technology and state of art equipment, patients receive a perfect crown/onlay in just one day! In addition to that, the crowns are incredibly accurate as we scan your tooth instead of taking impressions.
So how does a Digital Crown work?
Your dentist will prepare your tooth for a crown as per usual and instead of having you bite down on gooey plasticine like impression materials which are messy and uncomfortable, your tooth will be scanned with our intra oral scanner that takes a 3D image of your tooth, which is then fed into a computer programme. After designing your crown, we will use our milling machine to cut out or “mill” the exact crown that was designed out of a ceramic block. Once milled, the crown is then fitted, polished and bonded to your tooth- all on the same day.
A Digital crown fabricated from the unit
So there you go.. now that you know about Digital crowns that can be milled (cut out) in our own clinic, you can consider giving it a go next time to save an extra visit to the clinic! Talk to your dentist about this if you have more questions or make an appointment to find out more.
Now we can just prepare your tooth and you will get your crown on the SAME DAY!!
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-
Researchers have found that people with gum disease are almost twice as likely to suffer from coronary artery disease. – American Academy of Periodontology
Heart Disease
Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.
Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.
Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.
Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.
Stroke
Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.
-Source: perio.org-
When you have heart disease, maintaning goor oral health is important. Remember:
Make sure your dentist and hygienist know you have a heart problem
Have regular dental checkups
Maintain good oral health by brushing and flossing twice a day
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:
Dental intra-oral radiographs a.k.a X-rays. Dentists use radiographs for multiple reasons: to find hidden dental structures, malignant or benign masses, bone loss, and cavities.
How does x-ray of your teeth formed?
X-ray of your teeth is formed by a controlled burst of X-ray radiation which penetrates oral structures at different levels, depending on varying anatomical densities, before striking the film or sensor.
Teeth appear lighter because less radiation penetrates them to reach the film.
Dental caries, infections and other changes in the bone density, and the periodontal ligament, appear darker because X-rays readily penetrate these less dense structures.
Dental restorations (fillings, crowns) may appear lighter or darker, depending on the density of the material.
Should Patients Have Concerns About Radiation Exposure?
The dosage of X-ray radiation for dental is typically safe, around 0.150 mSv for a full mouth series, according to the American Dental Association website. It is equivalent to a few days’ worth of background environmental radiation exposure, or similar to the dose received during a cross-country airplane flight (concentrated into one short burst aimed at a small area).
Incidental exposure is further reduced by the use of a lead shield, lead apron, sometimes with a lead thyroid collar. Operator exposure is reduced by stepping out of the room, or behind adequate shielding material, when the X-ray source is activated.
Types of intra-oral radiographs
Bitewing
Periapical
Bitewing radiograph
Bitewings
Bitewing radiograph designed the placement of the film packet to reveal the coronal halves of the maxillary and mandibular teeth, inter-proximal contacts and portions of the interdental septa.
It is indicated primarily to detect or monitor interproximal caries if the proximal surfaces of the teeth cannot be visually or tactilely examined.
Occlusal caries, crestal alveolar bone level and secondarily for eruption patterns, caries and restoration proximity to pulp spaces, primary molar furcation pathology and developmental anomalies may also be detected with bitewing radiographs.
Periapical Radiograph
PA radiography describes intra-oral techniques designed to show individual teeth and the tissues around the apices. Each image usually shows two to four teeth and provides detailed information about the teeth and the surrounding alveolar bone.
Anterior PA
Posterior PA
Indications for PA radiograph are:
Detection of apical infection/inflammation
Assessment of the periodontal status
After trauma to the teeth and associated alveolar bone
Assessment of the presence and position of unerupted teeth
Assessment of root morphology before extractions
During endodontics
Preoperative assessment and postoperative appraisal of apical surgery
Detailed evaluation of apical cysts and other lesions within the alveolar bone
Tartar (calculus) are deposits that have built up on the teeth over time. Dental cleanings involve removing plaque (soft, sticky, bacteria infested film) and tartar (calculus) deposits that have built up on the teeth over time. Your teeth are continually bathed in saliva which contains calcium and other substances which help strengthen and protect the teeth. While this is a good thing, it also means that we tend to get a build-up of calcium deposits on the teeth. This chalky substance will eventually build up over time. Usually it is tooth coloured and can easily be mistaken as part of the teeth, but it also can vary from brown to black in colour.
If the calculus (or tartar, as dentists like to call it) is allowed to accumulate on the teeth it will unfortunately provide the right conditions for bacteria to thrive next to the gums. The purpose of the scaling and polishing is basically to leave the surfaces of the teeth clean and smooth so that bacteria are unable to stick to them and you have a better chance of keeping the teeth clean during your regular home care. Also it leaves your teeth feeling lovely and smooth and clean, which is nice when you run your tongue around them.
Dental surgeon or dental hygienist uses specialized instruments to gently remove these deposits without harming the teeth.
1) Ultrasonic instrument (Scaler)
Ultrasonic Scaling
Commonly used first is an ultrasonic instrument or scaler unit which uses tickling vibrations to knock larger pieces of tartar loose. It also sprays a cooling mist of water while it works to wash away debris and keep the area at a proper temperature. The device typically emits a humming or high pitched whistling sound. This may seem louder than it actually is because the sound may get amplified inside your head, just like when you put an electric toothbrush into your mouth.
The ultrasonic instrument tips are curved and rounded and are always kept in motion around the teeth. They are by no means sharp since their purpose is to knock tartar loose and not to cut into the teeth. It is best to inform the operator if the sensations are too strong or ticklish so that they can adjust the setting appropriately on the device or modify the pressure applied.
With larger deposits that have hardened on, it can take some time to remove these, just like trying to remove baked-on grime on a stove that has been left over a long time. So your cleaning may take longer than future cleanings. Imagine not cleaning a house for six months versus cleaning it every week. The six-month job is going to take longer than doing smaller weekly jobs.
2) Air polishing
After the dentist has done scaling using the ultrasonic scaler, he will proceed with polishing either using air polishing or polishing cup. Air polishing is an alternative more advance method than the polishing cup and paste method. It requires a special ultrasonic unit (e.g. Air Flow from EMS) that allows use of this insert in the handpiece.
EMS Air polishing unit
Air polishing uses medical-grade sodium bicarbonate and water in a jet of compressed air to “sandblast” the surface of the enamel leaving your teeth smooth and clean.
Indications for air polishing
Heavily smoking stain on the teeth
Staining due to coffee or tea
To remove fine tartar that are still attached to the teeth surface after scaling
Tobacco and coffee stain
Video: Air polishing method with EMS Air Flow®
Advantages of using air polishing
There is no physical contact with the tooth, therefore thermal injury is of no concern.
It is ideally suited for teeth separated by wide diastemata and considerable in shape and size.
Particularly good for cats where teeth are so small that standard cups can create gingival damage.
They are very efficient at removing stains from teeth.
Is scaling & air polishing going to be painful?
Most people find that cleanings are painless, and find the sensations described above – tickling vibrations, the cooling mist of water, and the feeling of pressure during “scraping” – do not cause discomfort. A lot of people even report that they enjoy cleanings and the lovely smooth feel of their teeth afterwards! There may be odd zingy sensations, but many people don’t mind as they only last a nanosecond.
Be sure to let your dentist/hygienist know if you find things are getting too uncomfortable for your liking. They can recommend various options to make the cleaning more enjoyable.
Painful cleaning experiences can be caused by a number of things: a rough dentist or hygienist, exposed dentine (not dangerous, but can make cleanings unpleasant), or sore gum tissues.
In case you may have had painful cleaning experiences in the past, switching to a gentle hygienist/dentist and perhaps a spot of nitrous oxide can often make all the difference. You could also choose to be numbed. If you find the scaling a bit uncomfortable because the gum tissues (rather than the teeth themselves) are sensitive, topical numbing gels can be used.
Full porcelain crown is a crown frabricated for highly aesthethic demand patient as people today want to see their crown to be as natural as possible and bleanch to the rest of his/her teeth.
This is where full porcelain material comes in!! It is made mostly of Zirconia or E-Max (lithium disilicate) material. The conventional porcelain is made of porcelain layer fused to a metal surface which make is less transucent and greyish.
With zirconia or E-Max material , no metal use, therefore, no greyish appearance and more natural!!
A crown is a replacement of the outside casing of your teeth that is permanently fixed to the tooth below. They are few types of crown depends on the material used:
Crown
Full porcelain (highly aesthetic crown)
Porcelain fused to metal (commonly used)
Full metal crown (either precious/non-precious metal crown)
Indications
Because full porcelain crown is highly aesthetic, it is used to improve the appearance of the front teeth. For those that are insecure about the appearance of their teeth or their smile, porcelain crowns can be a one-fix-for-all-problems solution.
Full porcelain crown mainly used :
to brighten teeth
to make the tooth slight translucent thus making it more natural
indicated for the front teeth where aesthetic demand is higher
close gap narrowing
fix teeth that stick out
reduce crowding in the mouth
The procedure
To fit the crowns, a thin layer is shaved off teeth that are to receive treatment, and this prepares them for the crowns. On the patient’s first visit of the treatment a mould is taken of their teeth in order to get the perfect shape for the next session. The crowns are then bonded onto the teeth using a bonding material of some sort. Once the bonding has taken place, which will normally take one session at the dentist, the patient’s can eat as normal.
Cases of Full Porcelain done in our clinic
Case 1
Before
This young lady presented with a discolour right lateral incisor and her right central slanting inwards. Two full porcelain crowns were fabricated to change the colour of the lateral incisor as well as to change the shape of the right central incisor (below).
After
Case 2
After tooth preperation
A case for prepared tooth (right lateral incisor) for impression taking. A full porcelain crown was fabricated and cemented onto the tooth (below).
Full porcelain crown cemented onto the tooth
Case 3
Before
This young gentleman presented with poorly restore filling material on his front teeth. The fillings were removed and the front teeth were prepared for porcelain crown.
Full porcelain crowns fabricated on the model
The full porcelain crowns were constructed on the model and finally cemented into patient’s mouth (below).
After
Case 4
Before
Another case of discolour tooth which was treated with full porcelain crown.
After
Case 5
Before
This man had a non-vital tooth (left central incisor) which was root treated had showed badly discolouration. The tooth was treated with porcelain crown.
After
Case 6
Before
Another case of discolouration which was treated with full porcelain crown
After
Advantages of full porcelain
Crowns are very popular because they have an excellent history of fixing dental issues, and their track record is proven to work in all countries in the world. Up until quite recently, crowns were bonded to the tooth using a metal-based framework (porcelain fused to metal) so that the crown could withstand the pressures involved with daily chewing of food in the mouth. Today, most of the time the metal framework is not required, since modern technology has advanced up to the point where pure porcelain is strong enough even for use on hard working molar teeth. The metal framework had an issue – after a few years the gum line of a patient would recede with age, revealing an ugly grey line at the top of the crowned tooth. Due to the color of the metal showing through, it was difficult to make crowned teeth look natural for more than a few years.
The advantage of using pure porcelain is that the crowns are near identical in color to the existing colors of the patient’s teeth, making it nigh on impossible for others to discern a crowned tooth from a real one. A dentist will match the color of the crown to the tooth color already in the mouth, and then they will place an order with a lab to create the tooth with the perfect color and shape, taken from the previously mentioned mold, and patients are very happy with the results, and their new smile.
Book an appointment with our doctors now!! Click here
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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