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BlogNEWS AND DENTAL EDUCATION
We share informative articles and news.
A case of mal-alignment of teeth treated with fix appliance
A case of mal-alignment of teeth treated with fix appliance
18 months after orthodontic treatment (below)….
Topics
- Consultation
- Examination
- Other Investigation
- Diagnosis
- Treatment
- Other Options
- Warnings
- Financial Arrangements
Consultation
A consultation for braces by dentist/orthodontist is a necessary to determine the need for braces, to size the braces and decide on various other factors concerning the impending braces. The consultation will last about a half an hour and cover various aspects of the braces as well as provide patients and their parents with all the necessary information.
During consultation, you will be asked questions such as:
- What you don’t like about your teeth/face?
- What do you want to achieve at the end of the treatment?
- You expectation form the treatment
Examination
Next, the orthodontist will examine your face profile (such as skeletal pattern, facial height and symmetry) , position of you nose, upper and lower lips and position of you chin.
Then, he will looks into your mouth to see the position of the upper front teeth; how much the teeth inclined, whether they are in front or behind the lower front teeth. He will examine each segment of your teeth; whether the teeth overlap each other (insufficient space) or spacing, any tooth tilted, submerge
Finally, oral hygiene, any teeth need to be restored, decayed teeth or impacted wisdom teeth to be extracted.
Other Investigations
To complete the assessment, photos of your face and teeth as well as X-rays of the mouth will be taken at the consultation, and a molding of the teeth may be taken.
Two radiographs that required you to have are the dental panoramic tomography (OPG) and lateral cephalometry radiograph. Dental panoramic tomography (OPG) allows orthodontist to examine the whole upper and lower jaw; to look of any missing teeth, impacted or embedded teeth. It is a good radiograph to look for any pathological lesion in the jaw bone. Lateral cephalometry radiograph is used to determine the upper and lower jaw relationship. Computer software is used to analyze the severity of jaws discrepancy and is it important for treatment planning.
Diagnosis
The main focus at the braces consultation is determining the need for braces. This diagnosis is often obtained before the consultation appointment but will be discussed in reference to treatment plans for your orthodontic problems.
Treatment
Each specific treatment plan will be discussed and outlined at the braces consultation. Treatment plans may include wearing a retainer for a few weeks before having the braces placed. The amount of time the braces will need to remain in place will also be discussed at the consultation. It is during the discussion of treatment when the orthodontist will explain to you the necessary care for braces. At the consultation visit, you will be allowed to decide the types of braces (metal or crystal) and the colors of each brackets.
He will also discuss with you other dental treatments that you needed before orthodontic treatment such as scaling, restoration work and extraction. Sometime, you are required to undergo minor surgery to remove impacted or embedded tooth prior orthodontic treatment.
Other Options
Alternative treatments will also be discussed at the braces consultation. Alternative treatments may include only wearing a retainer or wearing a clear mouth guard apparatus.
Warnings
At the consultation appointment, the orthodontist will discuss the risks and complications associated with wearing braces. The orthodontist will then warn you about pain and discomfort associated with the braces and possible problems the braces can create, such as the removal of enamel from the teeth and gum soreness and bleeding. He will ask you to clean your teeth very well to prevent teeth decay during orthodontic treatment. You will have to wear a retainer at the end of the treatment to minimize relapse.
Financial Arrangements
Because braces are expensive, it is important that payment arrangements be discussed at the consultation appointment. At the consultation, the orthodontist may ask the patient and guardians if the patient has dental insurance. If the patient does not have dental insurance, the orthodontist may be able to set the patient up on a payment plant or may require the total cost of the braces be paid up front or by installment.
More info
- Orthodontic Treatment
- Orthodontic Consultation
- Fix appliance vs. Removable appliance
- Cases with fix appliance
- Orthodontic with Damon System
- Clear Bracket System
- Clear Aligner with Invisalign® — Invisible braces
- Clear Aligner with MBrace® — Invisible braces
- Orthodontic Limitations & Potential Risks
- Braces for young children
- Braces for jaw surgery
- FAQ on orthodontic
Topics
- Benefits of Orthodontic Treatment
- Nature & Purpose of Orthodontic Procedures
- Orthodontic Treatment Risks
- Possible Alternative Treatments
As a rule, positive orthodontic results can be achieved by informed and cooperative patients. Thus the following information is routinely supplied to all who consider orthodontic treatment. While recognizing the benefits of healthy teeth and a pleasing smile, you should also be aware that orthodontic treatment has limitations and potential risks. These are seldom enough to avoid treatment, but should be considered in making the decision to undergo orthodontic treatment. Orthodontic treatment usually proceeds as planned; however, like all areas of the healing arts, response to treatment and results cannot be guaranteed.
Benefits of Orthodontic Treatment
Orthodontics plays an important role in improving overall oral health. Orthodontics also helps create balance and harmony between the teeth and face for a beautiful, healthy smile. An attractive smile enhances one’s self esteem, which may actually improve the quality of life itself. Properly aligned teeth are easier to brush, and thereby may decrease the tendency to decay, or to develop diseases of the gum and supporting bone.
Nature & Purpose of Orthodontic Procedures
Orthodontics strives to improve the bite by helping to direct forces placed on the teeth. This protects the teeth from trauma during ordinary everyday activities, such as chewing and stress. Properly aligned teeth also help minimize excessive stress on bones, roots, gum tissues and the temporomandibular joints. Orthodontic treatment has the potential to eliminate future dental problems including the problem of abnormal wear. Treatment can facilitate good oral hygiene to minimize decay and future periodontal problems. In addition, orthodontics can provide a pleasant smile, which may enhance one’s self-image.
Orthodontic Treatment Risks
All forms of medical and dental treatment, including orthodontics, have some risks and limitations. Fortunately, in orthodontics complications are infrequent and when they do occur they are usually of minor consequence. Nevertheless, they should be considered when making the decision to undergo orthodontic treatment. The major risks involved in orthodontic treatment may include, but are not limited to:
1. DECALCIFICATION: (Permanent enamel markings) Tooth decay, gum disease, and permanent markings (decalcification) on the teeth can occur if orthodontic patients eat foods containing excessive sugar and/or do not brush their teeth frequently and property. These same problems can occur without orthodontic treatment, but the risk is greater to an individual wearing braces.
2. ROOT SHORTENING: In some patients the length of the roots may be shortened during orthodontic treatment. Some patients are prone to this happening, some are not. Usually this does not have significant consequences, but on occasion it may become a threat to the longevity of the teeth involved.
3. GOOD ORAL HYGIENE: The health of the bone and gums which support the teeth may be affected by orthodontic tooth movement if a condition already exists, and in some rare cases where a condition does not appear to exist. In general, orthodontic treatment lessens the possibility of tooth loss or gum infection due to misalignment of the teeth or jaws. Inflammation of the gums and loss of supporting bone can occur if bacterial plaque is not removed daily with good oral hygiene.
4. RELAPSE TENDENCY: Teeth may have a tendency to change their positions after orthodontic treatment. This usually is only a minor change and faithful wearing of retainers as instructed should help reduce this tendency. Throughout life the bite can change adversely from various causes, such as: eruption of wisdom teeth, growth and/or maturational changes, mouth breathing, playing of musical instruments and other oral habits, all of which may be out of the control of the orthodontist.
5. JAW JOINT PROBLEMS: Occasionally problems may occur in the jaw joints, i.e., temporomandibular joints (TMJ), causing joint pain, headaches or ear problems. These problems may occur with or without orthodontic treatment. Any of the above-noted symptoms should be promptly reported to the orthodontist.
6. LOSS OF TOOTH VITALITY: Sometimes a tooth may have been traumatized by a previous accident or a tooth may have large fillings, which can cause damage to the nerve of the tooth. Orthodontic tooth movement may in some cases aggravate this condition and in rare instances may lead to root canal treatment.
7. POST-ADJUSTMENT PAIN: Sometimes orthodontic appliances may accidentally be swallowed or aspirated or may irritate or damage oral tissues. The gums, cheeks and lips may be scratched or irritated by loose or broken appliances or by traumatic blows to the mouth. Usual post adjustment tenderness should be expected, and the period of tenderness or sensitivity varies with each patient and the procedure performed. Typical post-adjustment tenderness may last 24 to 48 hours. You should inform our office of any unusual symptoms, broken or loose appliances, as soon as they are noted.
8. MINOR INJURIES: On rare occasions, when dental instruments are used in the mouth, the patient may inadvertently get scratched, enamel abrasions, poked or receive a blow to a tooth with potential damage to or soreness of affected oral structures. Abnormal wear of tooth structures is also possible if the patient grinds their teeth excessively. We will use extreme care to avoid minor injuries.
9. ADJUNCTIVE SURGERY: Sometimes oral surgery; tooth removal or orthodontic surgery, is necessary in conjunction with orthodontic treatment, especially to correct crowding or severe jaw imbalances. Risks involved with treatment and anesthesia should be discussed with your general dentist or oral surgeon before making your decision to proceed with this procedure.
11. UNFAVORABLE GROWTH: Atypical formation of teeth, or insufficient or abnormal changes in the growth of the jaws may limit our ability to achieve the desired result. If growth becomes disproportionate during or after treatment, or a tooth forms very late, the bite may change, requiring additional treatments or, in some cases, oral surgery. Growth disharmony and unusual tooth formations are biological processes beyond the orthodontist’s control. Growth changes that occur after orthodontic treatment may alter the quality of treatment results.
12. TREATMENT TlME: The total time required to complete treatment may exceed the original estimate. Excessive or deficient bone growth, poor cooperation in wearing the appliance(s) the required hours per day, poor oral hygiene, broken appliances and missed appointments can lengthen the treatment time and affect the quality of the end results.
13. CERAMIC BRACES: When clear and tooth colored brackets (ceramics) have been utilized, there have been some reported incidents of patients experiencing bracket breakage and/or damage to teeth, including attrition and enamel flaking or fracturing on debonding. Fractured brackets may result in ceramic remnants, which might be harmful to the patient especially if swallowed or aspirated.
14. ADJUNCTIVE DENTAL CARE: Due to the wide variation in the size and shape of teeth, achievement of the most ideal result (for example, complete closure of excessive space) may require restorative dental treatment (in addition to orthodontic care). The most common types of treatment are cosmetic bonding, crown and bridge restorative dental care and/or periodontal therapy. You are encouraged to ask questions regarding dental and medical care adjunctive to orthodontic treatment of those doctors who provide these services. (i.e. general dentist, periodontist, oral surgeon).
15. MEDICAL PROBLEMS: General medical problems can affect orthodontic treatment. You should keep your orthodontist informed of any changes in your medical health.
16. PERFECTION IS OUR GOAL: In dealing with human beings and problems of growth and development, genetics and patient cooperation, achieving perfection is not always possible. Orthodontics is an art, not an exact science; therefore, a functionally and esthetically adequate result, not 100% perfection, must be acceptable. Your comments in regard to your expectations prior to, during and after orthodontic treatment will help us understand your concerns. Please keep us regularly informed of your feelings, concerns and results that do not meet your expectations.
Possible Alternative Treatments
For the vast majority of patients, orthodontic treatment is an elective procedure. One possible alternative to orthodontic treatment is no treatment at all. You could choose to accept your present oral condition. The specific alternative to the orthodontic treatment of any particular patient depends on the nature of the individual’s teeth, supporting structures and appearance. Alternatives could include:
| 1. Extraction versus treatment without extraction(s);2. Orthodontic surgery versus treatment without orthodontic surgery; 3. Possible prosthetic solutions (bridges, implants, partials, replacement teeth); and 4. Possible compromised approaches (To be discussed with you, if applicable) |
More info
- Orthodontic Treatment
- Orthodontic Consultation
- Fix appliance vs. Removable appliance
- Cases with fix appliance
- Orthodontic with Damon System
- Clear Bracket System
- Clear Aligner with Invisalign® — Invisible braces
- Clear Aligner with MBrace® — Invisible braces
- Orthodontic Limitations & Potential Risks
- Braces for young children
- Braces for jaw surgery
- FAQ on orthodontic
…
Resin Veneers or better know as composite veneers are thin shells of tooth-colored, translucent filling, custom made to fit over teeth and improve their color, shape and overall appearance. Placement of composite veneers can dramatically improve your smile and appearance.
Composite veneer technique
Types of problems that composite veneers can correct
Placement of dental veneers is sometimes referred to as “instant orthodontics” because they can be used to cover a variety of dental problems involving teeth in the “smile zone” including:
- Spaces between the teeth.
- Conical or ‘peg’ shape lateral incisor.
- Poorly shaped or crooked teeth.
- Broken or chipped teeth.
- Permanently externally stained and/or internally stained teeth.
- Unsightly or stained fillings.
Dental veneers (either composite or porcelain veneer) can improve the appearance of the teeth but they cannot realign the jaw or correct overbites and underbites. Orthodontics are required to correct these more complicated problems.
The advantages of composite resin veneers vs. porcelain veneers
- Composite veneers can be done on the spot. The time spent might be from 30 minutes to 2 hours or more depends on the number of tooth involved. They do not required second visit.
- Composite veneers produce the same aesthetic result as porcelain veneers. Therefore, no one can tell whether you have a composite or porcelain done except your dentist!
- Composite veneers can be repair if there is any chipping or fracture.
- Composite veneers are very cheap (From MYR150 toMYR250 per tooth; depends on how difficult and big the defect is).
The major disadvantages of porcelain veneers over composite resin include the following:
- Porcelain veneers are not made at chairside. Porcelain veneers are fabricated in a dental laboratory and therefore require at least two visits. Composite resin veneers are accomplished in one visit. An adequate amount of tooth structure is removed to allow for placement of composite resin in the desired shape without added tooth bulk. Bonding agent is applied. Composite resin is then added, light cured, then finished and polished.
- Porcelain veneers are more expensive than composite veneers. The placement of veneers requires more time, expertise and resources in order to fabricate and bond and therefore cost more.
- Porcelain veneers cannot be repaired. If they break porcelain veneers must be replaced.
The advantages of porcelain veneers
Porcelain veneers have several advantages compared to composite resin including:
- Porcelain veneers are very durable. Although porcelain veneers are very thin, usually between 0.5 – 0.7 millimeters and inherently brittle, once bonded to healthy tooth structure it becomes very strong. Porcelain veneers can last for many years, usually 10-15 years, if you take good care of them using good oral hygiene and avoiding using them to crack or chew hard objects like ice.
- Porcelain veneers create a very life-like and natural tooth appearance. The translucent properties of the porcelain allows the veneers to mimic the light handling characteristics of enamel giving it a sense of depth which is not possible with other cosmetic bonding materials such as composite resin.
- Porcelain veneers resist staining. Unlike other cosmetic dental bonding materials, porcelain is a smooth, impervious ceramic and therefore will not pick up permanent stain from cigarette smoking or from dark or richly colored liquids or spices.
- Porcelain veneers are conservative. Only a small amount of tooth structure is removed, if any during the procedure.
Cases done in our practice using composite veneers…
Case 1
This young man complaint of generalized spacing and a peg-shaped right lateral incisor. Composite material was used to close all the gaps between his teeth (Below).
Case 2
This patient fell down and broke her front teeth while playing spot. The tooth was restore with composite veneer. ‘Stained’ or chalky white patches resin composite was place on the front surface of the veneer to mimic the neighbour teeth (Below).
Case 3
Old filling at the center of his upper front teeth looked yellowish and rough. Those fillings were removed and replaces by new composite veneers (Below).
Case 4
Yellow stain due to uneven surface at the front teeth and old yellow filling were replace by composite veneers (Below).
Case 5
Multiple decays at the front teeth were treated with composite veneer (Below).
Case 6
Defect of the lateral incisor was repaired with resin composite (Below).
Case 7
Generalize unevenness of this young man front teeth gave a older look. With composite veneer correction, he looks youthful again!! (Below).
Case 8
Old composite veneers on all the six front teeth on this lady was stained at the margin. The composite were removed and were replaced with the new one (Below).
Are you a good candidate for dental veneers?
Dental veneers are not appropriate for everyone or every tooth. Case selection is an extremely important factor in the success of this technique. Veneering teeth is not a reversible procedure if tooth structure must be removed to achieve your desired result Only an examination by your dentist can determine whether dental veneers are appropriate for making the changes you want. Some of the situations where certain teeth or people are not good candidates for dental veneers include:
- Unhealthy teeth. Dental decay and active gum disease must be treated prior to fabricating and bonding dental veneers.
- Weakened teeth. If a significant amount of tooth structure is missing or has been replaced by a large filling the teeth will not be strong enough to function with a dental veneer.
- Teeth with an inadequate amount of enamel present. Dental veneers are more successfully bonded onto tooth enamel.
- People who habitually clench or grind on their teeth. Habitual clenching and grinding of the teeth can easily chip or break dental veneers. Dental nightguards may be a solution for this in some cases.
- Persons without a stable bite.
- Severely malpositioned teeth or misaligned teeth. Orthodontic treatment may be required to achieve the desired result.
How to maintain Dental Veneers?
Dental veneers can chip or come off if not cared for properly. To improve their durability and longevity you need to maintain consistent good oral hygiene and have regular dental examinations and cleanings at least twice each year. In addition, you must avoid using them to bite or crack hard objects like nuts and ice.
What are the alternatives to composite veneers?
The closest cosmetic alternative to composite veneers is porcelain veneers which are more durable and more resistance to staining. However, they are more costly and require at least 2 visits. On top of that, there is another method to improve smile: Snap-on Smile, a multi-purpose restorative appliance that requires no preparation or altering of tooth structure, no injections, and no adhesives. It is non-invasive, making it completely reversible.
Dental crowns may also be used to correct the same problems that dental veneers correct, however it is a much less conservative procedure.
More info..
…
ZOOM!! Whitening System
The Zoom! ™ In-Office Whitening System is a revolutionary tooth whitening procedure. It’s safe, effective and fast, very fast. In just over an hour, your teeth will be dramatically whiter. Zoom!™ Whitening is ideal for anyone looking for immediate results. The convenience of Zoom!™ in comparison to days of wearing trays and gradual whitening makes it the perfect choice for the busy individual.
Get ready to Zoom!
The Zoom! ™ Whitening procedure is simple and painless. It begins with a short preparation to isolate your lips and gums. The Zoom! ™ clinician then applies the proprietary Zoom!™ Whitening Gel, which is activated by a specially designed light. Teeth typically become at least six to ten shades whiter, sometimes more. A fiveminute fluoride treatment completes the procedure. You’ll be amazed with the results. In most cases, teeth get even whiter the first few days after the procedure.
How Zoom! works
The Zoom!™ light activated gel was developed after years of research by Discus Dental, the leaders in professional take-home tooth whitening. The gel is a scientifically formulated, pH balanced Hydrogen Peroxide that, when activated by the Zoom!™ light, gently penetrates the teeth to remove deep stains and discoloration. With proper care and an occasional touch-up at home, your whiter smile will sparkle for years.
Zoom! Teeth Whitening procedure
The Zoom! Whitening procedure is simple. It begins with a short preparation to isolate your lips and gums.
The accredited and trained dentist then applies the proprietary Zoom Whitening Gel, which is activated by a specially designed light.
Teeth typically become at least six to twelve shades whiter, sometimes more. A fluoride treatment for a few minutes completes the procedure. You’ll be amazed with the results. In most cases, teeth get even whiter the first few days after the procedure. We recommend a consultation and a thorough clean around one or two weeks before the Zoom! Teeth Whitening procedure if you have tartar or superficial stains.
Tune in to Zoom!
Ask your dental professional how the Zoom!™ In-office Whitening System will work for you. Take your first step to feeling good, looking great and making a memorable impression every time you smile. You owe it to yourself!
Frequent Asked Questions
Q. What is Zoom!™ tooth whitening?
A. Zoom!™ is a bleaching process that lightens discoloration of enamel and dentin.
Q. What causes tooth discoloration?
A. There are many causes. The most common include aging and consumption of staining substances such as coffee, tea, colas, tobacco, red wine, etc. During tooth formation, consumption of tetracycline, certain antibiotics or excessive fluoride may also cause tooth discoloration.
Q. Who may benefit from tooth whitening?
A. Almost anyone. However, treatment may not be as effective for some as it is for others. Your dental professional can determine if you are a viable candidate for this procedure through a thorough oral exam, including a shade assessment.
Q. Do many people whiten their teeth?
A. More people than you might imagine. A bright, sparkling smile can make a big difference for everyone. The Zoom!™ Whitening System makes it easier and faster than ever before.
Q. Is whitening safe?
A. Yes, extensive research and clinical studies indicate that whitening teeth under the supervision of a dentist is safe. In fact, many dentists consider whitening the safest cosmetic dental procedure available. As with any tooth whitening product, Zoom!™ is not recommended for children under 13 years of age and pregnant or lactating women.
Q. How does Zoom!™ work?
A. The Zoom!™ light-activated whitening gel’s active ingredient is Hydrogen Peroxide. As the Hydrogen Peroxide gel is broken down, oxygen enters the enamel and dentin bleaching colored substances, while the structure of the tooth is unchanged.
Q. What does a patient experience during the Zoom!™ procedure?
A. During the procedure, patients may comfortably watch television or listen to music. Many actually fall asleep. Individuals with a strong gag reflex or anxiety may have difficulty undergoing the entire procedure.
Q. How is exposure to the Zoom!™ light controlled?
A. The Zoom!™ procedure requires that all soft tissue in and around the mouth be protected. The clinician is required to monitor the procedure to insure any exposed skin or tissue is isolated and protected. Protective eyewear is required during the procedure. Light sensitive individuals including those undergoing PUVA therapy (Psoralen+UV Radiation) or other photochemotherapy, as well as patients with melanoma, should not undergo the Zoom!™ in-office procedure. Also, patients taking any light sensitive drugs or substances, whether over-the-counter, prescription or homeopathic, should consult their primary physician prior to procedure.
Q. How long does Zoom!™ Whitening take?
A. The complete procedure takes just over an hour. The procedure begins with a preparation period followed by one hour of bleaching. A five minute fluoride treatment completes the procedure. (A cleaning is recommended prior to the actual Zoom!™ Whitening session)
Q. Are there any side effects?
A. Sensitivity during the treatment may occur with some patients. The Zoom!™ light generates minimal heat which is the usual source for discomfort. On rare occasions, minor tingling sensations are experienced immediately after the procedure but always dissipate.
Q. How white will my teeth become ?
A. The results are spectacular. Clinical studies have shown that the Zoom teeth whitening treatment achieves up to 12 shades lighter with the average being 8 shades (On Vita-Shade guide). Individual results may vary and will depend upon your age, type of stain, initial tooth colour and any visible restorations (White fillings, crowns etc). Please ask our qualified dental staff how much whiter your teeth can be and we will show you what is possible on a tooth shade guide as shown below.To boost your results we recommend using custom made whitening trays for only 30 minutes a day for 5 to 10 days.
Some whitening clinics will only recommend either surgery whitening or home whitening. We have found that combining both methods is the best way to get the most dramatic results and keep them for life.
Q. How long do the results last?
A. By following the Zoom!™ Post Whitening Care Instructions, your teeth will always be lighter than they were prior to the procedure. The Zoom!™ whitening procedure includes a take-home touch-up kit and trays that can be used whenever discoloration is noticed. Most often a touch-up once a year will maintain a whiter smile that sparkles for years.
A Note of Assurance
Tooth whitening is a well-established procedure in cosmetic dentistry. Hydrogen Peroxide, the active agent in Zoom!,™ has also been safely used for many years in the treatment of gums and other oral soft tissue. The whitening process is effective on most discolored teeth. Darker stains, such as those caused by antibiotics, are more difficult to whiten. The degree of whiteness will vary from patient to patient, depending on the structure of the teeth. If you have any questions, please ask your dental professional who is there to help maximize your smile using the Zoom!™ Whitening System.
Read More
- Teeth Whitening
- Causes of tooth discolouration
- ZOOM!! Whitening System
- Cases with ZOOM!! Whitening System
- Cases with ZOOM!! Whitening System (II)
- Non-Vital (Internal) Bleaching
- Tooth Crystal
What is an apex locator?
An apex locator (or electronic apex locator – EAL) is an electronic device used in endodontics/root canal therapy to determine the position of the apical foramen and thus determine the length of the root canal space. The apex of the root has a specific resistance to electrical current, and this is measured using a pair of electrodes typically hooked into the lip and attached to an endodontic file. The electronic principle is relatively simple and is based on electrical resistance; when a circuit is complete (tissue is contacted by the tip of the file), resistance decreases markedly and current suddenly begins to flow. According to the device, this event is signaled by a beep, a buzz, a flashing light, digital readouts, or a pointer on a dial. – source from wikipedia
Role of Electronic Apex/ Foramen Locators
Working length determination during root canal therapy has been greatly aided by Electronic apex locators (EALs). They can save time in determining initial working length, save on the number of X rays taken, and can be particularly helpful when the periapex is unclear on radiographs or when there is a question about whether a perforation has occurred.
As the matter of fact, foramen does not coincide with the anatomical apex in most teeth. You can confirm this fact by examining the morphology of extracted teeth. One of the earliest brands was Root ZX by JMorita of Japan which still is the gold standard in accuracy as confirmed by various studies. We have been using it for many years. Intraoral radiographs do not show the apical foramen and are often misleading, leading to compromising results, see below. Picture shows how radiographs can be deceptive in determing correct working length-WL, you will never be able to assess correct WL without a good apex locator.
Root ZX II – Accurate apical foramen measurement
Currently, we are using Root ZX apex locator for our root canal treatments.
Invented in 1992, the J. Morita Root ZX II is currently one of the best selling apex locators. It has proven itself safe and accurate, and was the first unit providing dentists the capability to work in wet canals. Blood and other fluids do not typically affect measurements.
Root ZX II patented technology offers an accuracy rate above 96%. LCD readout is large and easy to read. Action of the meter in the display corresponds to the tactile sensation of using the file.
Other Root ZX II Features:
- slim, lightweight file holder
- no zero-adjustment
- automatic calibration
- battery power indication
- automatic power off function
An in vitro comparison of three apex locators concluded that the Root ZX II was significantly more accurate at finding the apical foramen than competitive models.
Read more
Dental Panoramic Tomogram or OPG is a sophisticated x-ray machine used to take radiographic images of the teeth and jaws bone which is in a arch position. We used to call this machine as OPG (which stands for ORTHOPANTOGRAM), which was named after the first x-ray unit.
OPG performed by using a technique called “tomography”.
The X-ray tube moves around the head, the x-ray film moves in the opposite direction behind your head. This generates an image slice where the mandible and teeth are in focus, and the other structures are blurred.
Anatomy
The anatomy consists of the body, ramus and angle of mandible, coronoid process, mandibular notch, condyle of mandible, alveolar ridge, symphysis menti, maxillary sinuses, nasal fossae and 16 upper and 16 lower teeth, as shown in the image below.
Reasons for OPG requests
Dental Disease
- Caries – appear as different shaped areas of radiolucency in the crowns or necks of teeth.
- Peridontioiditis – when inflammation extends into the underlying alveolar bone and there is a loss of attachment.
- Peridontal Abscess – Radiolucent area surrounding the roots of the teeth.
Impacted or embedded teeth (eg. wisdom teeth)
- OPG shows angulation, shape of roots, size and shape of crown, effect on other teeth.
- To look for impacted canine
Teeth Abnormalities
- Eg. Developmental, to show size, number, shape and position.
Lesions in the jaw bone
- Cyst of jaw bone – shape, size, extension, involving nearby structure
- Tumour/growth – benign, malignant
Trauma to teeth and facial skeleton
- Mandible fractures are often bilateral.
- Panoramic view of mandible to view the fracture.
- Determine site and direction of fracture lines.
- Relationship of teeth to fracture lines.
- Alignment of bone fragments after healing.
- Evidence of infection or other complications post intervention.
- Follow up to assess healing.
Planing for implant placement
- To identify the position and location for implant placement
- Bone quality and quantity
- Anatomical structure that should be avoided such as the maxillary sinus and the inferior dental nerve
Other Radiograph Modalities…
- CBCT (Cone Beam CT)
- Lateral Cephalometry Radiograph
- Dental Panoramic Tomogram (OPG)
- Intra-oral Radiograph
What is root canal treatment
Root canal treatment or sometimes refers as RCT is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form (below).
What is root canal?
Root canal is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth’s nerve lies within the root canal.
A tooth’s nerve is not vitally important to a tooth’s health and function after the tooth has emerged through the gums. Its only function is sensory — to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.
What Damages a Tooth’s Nerve and Pulp in the First Place?
A tooth’s nerve and pulp can become irritated, inflamed, and infected due to:
- deep decay
- repeated dental procedures on a tooth and/or large fillings
- a crack or chip in the tooth
- or trauma to the face.
How does dentist know whether the tooth needs RCT?
There are several symptoms that usually lead dentist to conclude that the tooth requires RCT:
- Pain which is severe and prolong that affect daily activities
- Throbbing pain that usually disturb sleep at night
- Feel painful when biting on the affected side
- Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)
- Discoloration (a darkening) of the tooth
- Swelling and tenderness in the nearby gums
- A persistent or recurring pimple on the gums (gum abscess)
From dental examination:
- A very large cavity or deep restoration on that tooth
- Feels very painful on percussion on that tooth
- Not responsive to the vitality test using a Pulp Tester
- A radiolucency lesion over the tip of the root on radiograpghic examination
How does Root Canal Treatment done?
Step-by-step of root canal treatment
A) Placing the rubber dam.
After local anaesthetic is given, dentist usually need to “isolate” your tooth. He will first punch a small hole in a sheet of rubber. Then, he will then slip this sheet over the affected tooth and position a small tooth clamp to hold it there. The purpose of a rubber dam is to keep the tooth saliva-free therefore, avoid contamination of bacteria from saliva .
B) Creating the access cavity.
As a starting point for performing root canal treatment, dentist must first gain access to the nerve space (or the pulp chamber) within the tooth.
He do this by using a dental drill to create an access cavity. This hole will extend into the interior of the tooth to its pulp chamber. It’s the hole through which the dentist will perform their work.
On the molar teeth, the access cavity is made on the chewing surface of the tooth and for the front teeth, the access hole is made on the tooth’s backside.
The overall size of the access cavity will vary according to factors such as the location of the individual canals and how hard it was for the dentist to find them. Additionally, beyond just that portion of the tooth that must be removed for access, the dentist will also need to remove any decay that’s present and any loose or exceptionally fragile tooth parts or fillings.
C) Cleaning and shaping the tooth’s root canals.
The next step of the root canal process involves “cleaning and shaping” the interior of your tooth (the pulp chamber and all root canals). In regard to the cleaning process, its purpose is to remove bacteria, toxins, nerve tissue, and related debris that are harbored inside the tooth.
The shaping process refers to how the tooth’s canals are enlarged and flared, so the have a shape that facilitates the filling and sealing process.
What instruments are used?
For the most part, a tooth is cleaned and shaped using endodontic files. These files look like straight pins but on closer inspection you will find that their surface is rough, not smooth. These instruments literally are files and are used as such.
How are the files used?
Dentist works the file up and down, with a twisting motion, in each of your tooth’s root canals. This action will scrub, scrape and shave the sides of the canals, thus cleaning and sculpting them. He will perform this same type of action using a series of files, each having a slightly larger diameter.
The idea is that each consecutive file is used to slightly increase the overall dimensions of the root canal. Since some canal contaminates are embedded within a canal’s walls, this enlargement assists with both the procedure’s cleaning and shaping goals.
While performing this work, the dentist will also periodically flush out (irrigate) the tooth. This helps to wash away accumulated debris and contaminants. While a number of different solutions can be used for this purpose, sodium hypochlorite (bleaching agent) is the most common one. An added benefit of bleach is that it is a disinfectant.
Some dentist may have a handpiece that can manipulate the files for them.
Traditionally, files have been hand instruments. This simply refers to the fact that the dentist creates their filing action by manipulating them with their fingers. Some dentist may, however, have a special dental drill (handpiece) that produces the needed file motion for them.
As a variation on this same theme, there is yet another type of dental handpiece that produces a cleaning motion by way of holding a root canal file and vibrating it vigorously.
Measuring the length of the root canals.
The goal of root canal treatment is to achieve cleaning of the entire length of each of the tooth’s root canals, but not beyond.
As a means of determining the precise length of a canal, dentist will use apex locator to get the measurement for the length of the tooth (from the crown to the tip of the root). By doing so, the dentist wouldn’t go beyond during cleaning.
Usually, he will confirm the measurement by taking a x-ray of the tooth with a file placed in the tooth. The x-ray picture will show if the file extends the full length of the canal or not.
D) Sealing the tooth – Placing the filling material.
Once the interior of the tooth has been thoroughly cleansed and properly shaped, it is ready to be sealed (have its hollow interior filled in). In some cases, the dentist will want to place the filling material immediately after they have finished cleaning the tooth. With other cases, they may feel that it is best to wait about a week before performing this procedure.
What type of root canal filling material is used?
The most frequently used root canal filling material is a rubber compound called gutta percha. It comes in preformed cones whose dimensions match the size (diameter, taper) of the files that have been used to shape the tooth’s canals.
A root canal sealer (a paste) is usually used with the gutta percha. It is either applied to a cone’s surface before it is placed into a canal, or else applied inside the root canal itself before the cone is inserted. Several individual cones of gutta percha may be needed to fully fill the interior of the tooth.
Dentist will warm the gutta percha (either before or after it has been placed into the tooth) to soften it. This way it can be molded to closely adapt to the shape of the tooth’s interior.
As an alternative, a dentist may place the gutta percha via the use of a “gun.” This apparatus is somewhat similar to a hot-glue gun. It warms a tube of gutta percha. The softened material can then be squeezed out into the tooth.
Once your dentist has finished sealing your tooth, they will place a temporary filling, so to seal off the access cavity created at the beginning of your treatment.
How long does root canal treatment take?
The total amount of time that’s needed for a tooth’s root canal therapy will of course hinge on how many appointments are needed (one visit, or two or more) and how long each one will take. Usually, root canal treatment for molar usually take about 3 to 4 visits. Each visit takes around an hour. For the front teeth, usually take fewer visits as they are simpler and located at the front region.
Summary of Root Canal Treatment:
Cases of root canal treatments
E) Post Root Canal Treatment
At this point, while the individual steps of performing the root canal process have been finished, the tooth’s treatment is not yet complete. The tooth is no longer alive since the pulp has been removed. And this can make the tooth brittle and more prone to fracture.
Therefore, a permanent restoration must still be placed. Choosing the right type of dental restoration, and having it placed promptly, will help to insure the long-term success of the tooth’s endodontic therapy.
There are a few options:
1) Crown (recommended) as it is strong, durable and more aesthetic
2) Dental filling – cheap, can be done on the spot (doesn’t required 2 visits)
F) Final words…
Tooth infection can recur in treated teeth (even RCT treated tooth), hence, good oral hygiene, including brushing, flossing and regular dental examination are necessary to prevent further problems. For more info on good oral hygiene click here.
More info on General Dental Treatment
- Dental check-up
- Kids Dentistry
- Scaling and Polishing
- Fillings with composite resin
- Root Canal Treatment
- Crown
- Bridge
- Denture
- Dental Implant
…
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