20/Feb/2016

Our new CBCT, OPG and Lat Ceph X-Ray unit

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 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
Position and orientation of implants insertion
Location of anatomic structures: mandibular canal, submandibular fossa, incisive canal, maxillary sinus
Need for bone graft, sinus lift
Acquire for implant planning software

Oral and maxillofacial surgery

Orthognathic surgery planning
Localization of impacted teeth, foreign objects
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

ID-nerve — 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.

CBCT-3D-image — 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.

Other Radiograph Modalities…

Shai Li Seun

16/Jul/2013

After the age of 35, gum disease or periodontitis is the major cause of tooth loss in adults, far more so than tooth decay. In fact, about 80% of tooth loss can be ascribed to periodontal disease in this age group. A lot of time and money could be saved by early detection and treatment of the disease and many more people would keep their teeth if they were aware of this fact.

Periodontal disease affects the support structures of the teeth: the bone, gums and ligament (Click here for Dental Anatomy). It is long-term and slow-moving disease: painless in its initial stages, but later presenting as a chronic inflammation that damages both the gums and bone holding the teeth in place. Bacterial plaque is the main culprit here, and only fastidious daily brushing and flossing can effectively remove it.
The most common form of periodontitis is adult periodontitis. It can be localized or generalized and appears to progress episodically. During periods of exacerbationthere is advancing loss of epithelial attachment, increase periodontal pocket depth, increased gingival crevicular fluid, loss of alveolar bone and connective tissue attachment and gingival bleeding.
The predominant species associated with adult periodontitis ace Actinobaccillus actinomycetemcomitans (25-30%), Actinomyces naeslundii, Bacteriods forsythus, Campylobacter rectus, Eikenella corrodens, Eubacterium species, Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella intermedia, Prophyromonas gingivalis, Selenomonas sputigena, Streptococcus intermedius and Treponema species

Types of periodontitis

Adult periodontitis can be devided into 3 types base on severity:

i) Mild (Early) Adult Periodontitis

Mild periodontitis. From Colour Atlas of Common Oral Disease — **Mild periodontitis**. From Colour Atlas of Common Oral Disease

Clinical features:

3mm epithelial attachment loss or less (gum recession)
periodontal pocket depths of 3-5mm (determine by using a periodontal probe)
class I furcation involvement
alveolar bone loss of 2mm or less (Alveolar bone loss is determined by vertical periapical bitewing radiograph)

ii) Moderate Adult Periodontitis

Moderate periodontitis. From Colour Atlas of Common Oral Disease — **Moderate periodontitis**. From Colour Atlas of Common Oral Disease

Clinical features:

4-5mm epithelial attachment loss
periodontal pocket depths of 4-6mm
alveolar l bone loss of 3-5mm
gingival exudate and bleeding
horizontal, vertical bone loss and osseous defects
mobile teeth and class II furcation involvement

iii) Advanced Adult Periodontitis

Advanced periodontitis. From Colour Atlas of Common Oral Disease — **Advanced periodontitis**. From Colour Atlas of Common Oral Disease

Clinical features:

At least 6mm epithelial attachment loss
periodontal pocket depths exceed 6mm
alveolar crestal bone loss is more than 5mm
gingival recession
significant tooth mobility and class III furcation involvement (A through-and-through bony defect)

Other types of periodontitis

Early-onset periodontitis which can be prepubertal periodontitis and juvenile periodontitis
Rapidly progressing periodontitis
Necrotizing ulcerative periodontitis (HIV periodontitis)
Responsiveness to therapy (refactory periodontitis)

Treatment

Treatment depends on the causal factors but generally involves:

the removal of plaque, calculus and diseased cementum by scaling, curettage and root planing
Topical antibiotics, short-course therapy with systemic antibiotics (tetracycline and metronidazole)
periodontal surgery

More info

Treatments of gum disease:

Scaling and polishing
Air Polishing – A way to eliminate staining due to smoking, coffee or tea
Root Planning
Gum Surgery
Fear of Dental Treatment? How to overcome it..?

Shai Li Seun

20/Feb/2011

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:

Pro and cons of having a denture:

Pro:

Simple to make (no surgery/cutting your adjacent teeth)
Economical
Easy to clean
Produce good aesthetic and function

Cons:

Feels like a fake teeth (Can be taken out of the mouth)
Uncomfortable for the first time wearer
Cannot bite very hard or sticky food
Interfere with your speech initially
Need to be taken out at night
It can be loose (if the remaining alveolus bone is less)
Have to make a new one with it’s loose and uncomfortable

Basically we have 3 types of denture:

Conventional acrylic denture (Plastic denture)

The ‘pink’ part is purely made of plastic
Look natural
Simple
Thicker on the palate and tongue
Sometimes loose and needed stainless wire to grab hold to the remaining teeth

Cobalt chromium denture (Metal denture)

The ‘pink’ part is supported by a metal frame with clasps to attach to the remaining teeth
Thin especially on the palate area and more comfortable
Rigid and quite retentive
Not so aesthetic as you can see some clasp coming out

Valplast^® Flexible denture (Flexible denture)

Comfortable
Flexible slight
Quite retentive
The clasps to hold the nature teeth are part of material from the ‘pink’ part thus, more aesthetic
For more information on Valplast, click here…

More info on General Dental Treatment

…

Shai Li Seun

20/Feb/2011

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.

Shai Li Seun

22/Jan/2011

Prestige Dental Care

Topics

To read on dental bridge click here
Crown – What is it?
How do we do it?
Picture on cases done in our clinic
Maintenance

Crown – What is it?

A crown is a replacement of the outside casing of your teeth that is permanently fixed to the tooth below. In other words, the decayed or damaged area of your tooth is removed and replaced by synthetic material, such as porcelain, to create a new ‘tooth’ with permanent results.

crowns2 — A crown is a replacement of the outside casing of your tooth

Crowns are often used after a root canal treatment, because the removal of a nerve causes a tooth to discolour. However, there are other reasons your dentist might crown one or more of your teeth: to restore a damaged or fracture tooth, to protect a weakened tooth so that it does not fracture under stress or to reinforce a large filling where there is not enough tooth structure left below.
Crowns are also made out of various material: gold or non-precious alloy, porcelain or ceramics, acrylic or composite resin, or even a combination of porcelain on metal. Obviously the material chosen will be in line with what will work best for your particular problem.

Currently, most dentist use porcelain fused to metal crown or full porcelain crown as both crowns produce good aesthetic result

How do we do it?

When crowning a tooth, your dentist starts by filing away away between 1mm and 2mm on every surface of your teeth, and then the entire surface is smoothed. Next, an impression is taken of the prepared tooth by syringing an impression material into the space around the tooth and holding an impression tray in position until the material has set. This gives the laboratory a perfect negative copy of your tooth, which allows them to make up the permanent crown. The dentist also ensures he sends the laboratory details of what the colour porcelain to use, to ensure the crown looks natural.

tooth prep — 1) Tooth are prepared and smoothen

impression1 — 2) Impression material is syringed into the space around the tooth to get the copy of the tooth

impression2 — 3) Negative copy of the teeth produced by impression material which is hardened on the impression tray

4) The crowns are fabricated on the model by laboratory technician

4.1.1 — 5) Finally, the crown is cemented onto the prepared tooth

Your are then fitted with a temporary crown, which is really just a rough space-filler, while you wait for the laboratory manufacture the permanent fixture.
At the following appointment, the dentist will have taken delivery of the permanent crown. The temporary crown is then removed, and the prepared tooth below thoroughly cleaned and dried. Then the new, permanent crown is cemented onto the tooth below. Any excess cement is removed, and the treatment completed.

Picture on cases done in our clinic

Here is a example of a discolour tooth that is replaced with a full porcelain crown (E-Max)

The young gentleman dislike his front discolour right central incisor

His tooth discolouration was due to old filling and the tooth is non-vital

After the tooth is prepared, colour of the porcelain crown is chosen to match his neighbour teeth

The full porcelain crown is cemented onto the tooth

Final Result – natural looking crown!! (Treatment done by Dr. H.W.NG)

Maintenance

You do need to take care of your crown and not overstress it by biting or chewing very hard food. You can also floss normally around a crown. If at a later stage, your crown should break, you need to see your dentist as soon as possible, especially if the tooth inside becomes sensitive. Save the fractured piece if you can, as this can be glued back on temporarily until a new crown is made.

More info on General Dental Treatment

…

Shai Li Seun

22/Jan/2011

Pregnancy-gingivitis — Pregnancy Gingivitis

Topics

What is Gingivitis?
What is Pregnancy Gingivitis?
Causes of Gum Disease in Pregnancy
Symptoms of Pregnancy Gingivitis
Complications of Pregnancy Gingivitis
Treating Gingivitis in Pregnancy
Prevention

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
visit your dentist regularly

More info

Treatments of gum disease:

Scaling and polishing
Air Polishing – A way to eliminate staining due to smoking, coffee or tea
Root Planning
Gum Surgery
Fear of Dental Treatment? How to overcome it..?

Shai Li Seun

30/Dec/2010

Sterilization

Dental instrument that are used or contaminated have to be cleaned and bacteria-free before reuse. Therefore, they need to be sterilized before use. Sterilization is a term referring to any process that eliminates (removes) or kills all forms of life, including transmissible agents (such as fungi, bacteria, viruses, spore forms, etc.) present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media. Sterilization can be achieved by applying the proper combination of heat, chemicals, irradiation, high pressure, and filtration. (Source from wikipedia)

Autoclave

In dentistry, we use autoclave to sterilize our dental instruments. Autoclave is a device to sterilize equipment and supplies by subjecting them to high pressure saturated steam at 121 °C or more, typically for 15–20 minutes depending on the size of the load and the contents. It was invented by Charles Chamberland in 1879, although a precursor known as the steam digester was created by Denis Papin in 1679. The name comes from Greek auto, ultimately meaning self, and Latin clavis meaning key — a self-locking device. (Source from wikipedia)

Most dental clinic use autoclave unit to sterilize their instruments. According to the European Standard EN 13060, autoclave are divided into:

Type B- It has 3-times per-vacuum preceding vacuum drying. It can be used on wrapped and hollow instruments, which means a piece of equipment can be sterilized now for use later. This is the most effective autoclave as the steam able to penetrates deep into the pouches/wrappers or even double pouched instruments.

Type S – Comes with a one times pre-vacuum and vacuum drying function and efficient quick spraying steam generator. It can’t be used to sterilize instruments which are double pouch or the instruments which are wrapped in the thick wrapper/pouch.

Type N – This autoclave comes without vacuum function, it can be used for hollow instruments and solid instruments.This autoclaves are only suitable for a specific type of

load–for solid, unwrapped instruments.

Type B European Standard Autoclave – It has the highest standard among the type S and type N. It allows deep penetration into pouched/wrapped instrument. Type B Autoclave used widely in operating theater and it is used by our clinic too.

Dental implants

Oral and maxillofacial surgery

Orthodontics

FAQ on CBCT

When should CBCT be used?

What does the scan look like when it is done?

What is the difference between ordinary X-ray pictures and CBCT?

Where do I go for a scan?

What are the advantages of CBCT?

What will happen when I attend for the scan?

How long does the scan take?

Is there anything I need to do before I come for my appointment?

Should the amount of X-rays I will receive worry me?

Other Radiograph Modalities…

Types of periodontitis

i) Mild (Early) Adult Periodontitis

ii) Moderate Adult Periodontitis

iii) Advanced Adult Periodontitis

Other types of periodontitis

Treatment

More info

Treatments of gum disease:

Pro and cons of having a denture:

Basically we have 3 types of denture:

Conventional acrylic denture (Plastic denture)

Cobalt chromium denture (Metal denture)

Valplast® Flexible denture (Flexible denture)

More info on General Dental Treatment

Topics

Crown – What is it?

How do we do it?

Picture on cases done in our clinic

Maintenance

Read more

More info on General Dental Treatment

Topics

What is Gingivitis?

What is Pregnancy Gingivitis?

Causes of Gum Disease in Pregnancy

Symptoms of Pregnancy Gingivitis

Complications of Pregnancy Gingivitis

Treating Gingivitis in Pregnancy

Prevention

More info

Sterilization

Autoclave

Valplast^® Flexible denture (Flexible denture)