Cosmetic Restorative Dentistry
SECTIONS
- Composite Fillings
- Dental Implants
- Porcelain Crowns
- Porcelain Fixed Bridges
- Porcelain Inlays and Onlays
- Porcelain Veneers
- Tooth Whitening
- Maintenance
- Periodontal Disease and its Treatment
- Gum Regeneration
- Guided Tissue Regeneration
- Guided Bone Regeneration
- Gum Lift and Crown Lengthening
Composite Fillings
TO
A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc. The decayed or affected portion of the tooth will be removed and then filled with a composite filling.
There are many types of filling materials available, each with their own advantages and disadvantages. You and your dentist can discuss the best options for restoring your teeth. Composite fillings, along with silver amalgam fillings, are the most widely used today. Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.
As with most dental restorations, composite fillings are not permanent and may someday have to be replaced. They are very durable, and will last many years, giving you a long lasting, beautiful smile.
Reasons for composite fillings:
· Chipped teeth.
· Closing space between two teeth.
· Cracked or broken teeth.
· Decayed teeth.
· Worn teeth.
How are composite fillings placed?
Composite fillings are usually placed in one appointment. While the tooth is numb, your dentist will remove decay as necessary. The space will then be thoroughly cleaned and carefully prepared before the new filling is placed. If the decay was near the nerve of the tooth, a special medication will be applied for added protection. The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.
It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.
You will be given care instructions at the conclusion of your treatment. Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.
Dental Implants
This should be linked to page on Implant Dentistry
Porcelain Crowns
A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size. A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.
Although there are several types of crowns, porcelain (tooth colored crown) are the most popular, because they resemble your natural teeth. They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced. Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.
Reasons for crowns:
· Broken or fractured teeth.
· Cosmetic enhancement.
· Decayed teeth.
· Fractured fillings.
· Large fillings
· .Tooth has a root canal.
What does getting a crown involve?
A crown procedure usually requires two appointments. Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown. A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.
While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown. Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.
At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.
You will be given care instructions and encouraged to have regular dental visits to check your new crown.
Old Un-attractive Crowns New Aesthetic All Porcelain Crowns
Porcelain Fixed Bridges
A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.
There are several types of bridges. You and your dentist will discuss the best options for your particular case. The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal. Porcelain fixed bridges are most popular because they resemble your natural teeth. This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.
Dental bridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear.
Reasons for a fixed bridge:
· Fill space of missing teeth.
· Maintain facial shape.
· Prevent remaining teeth from drifting out of position.
· Restore chewing and speaking ability.
· Restore your smile.
· Upgrade from a removable partial denture to a permanent dental appliance.
What does getting a fixed bridge involve?
Getting a bridge usually requires two or more visits. While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown. Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated. In addition, a temporary bridge will be made and worn for several weeks until your next appointment.
At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit. Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge. The new bridge will be permanently cemented at a later time.
You will receive care instructions at the conclusion of your treatment. Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.
Old Bridge Bridge Removed New Bridge Fitted
Porcelain Onlays
An inlay or onlay restoration is a custom made filling made of composite material, gold, or tooth-colored porcelain. Porcelain inlays or onlays are popular because they resemble your natural tooth. An onlay is sometimes also referred to as a partial crown. Porcelain inlays or onlays are made by a professional dental laboratory and is permanently cemented onto the tooth by your dentist.
Inlays and onlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma. Inlays and onlays are an ideal alternative to crowns (caps) because less tooth structure is removed in the preparation of them. Onlays are essentially identical to inlays with the exception that one or more of the chewing cusps have also been affected and need to be included in the restoration.
As with most dental restorations, onlays are not always permanent and may someday require replacement. They are highly durable and will last many years, giving you a beautiful long lasting smile.
Reasons for onlay restorations:
· Broken or fractured teeth.
· Cosmetic enhancement.
· Decayed teeth.
· Fractured fillings.
· Large fillings.
What does getting an onlay involve?
An inlay or onlay procedure usually requires two appointments. Your first appointment will include taking several highly accurate impressions (moulds) that will be used to create your custom onlay and a temporary restoration.
While the tooth is numb, the dentist will remove any decay and/or old filling materials. The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an onlay restoration. A temporary filling will be applied to protect the tooth while your inlay or onlay is made by a dental laboratory.
At your second appointment, your new inlay or onlay will be carefully and precisely cemented into place. A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable.
You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new onlay.
Natural looking Porcelain Onlay
Porcelain Veneers
Veneers are very thin pieces of durable, tooth shaped porcelain that are custom made (for shape and color) by a professional dental laboratory. They are bonded onto the front of teeth to create a beautiful and attractive smile.
Veneers can completely reshape your teeth and smile. They can often be alternatives to crowns and the ideal solution in treating many dental conditions.
As with most dental restorations, veneers are not permanent and may someday need replacement. They are very durable and will last many years, giving you a beautiful long lasting smile.
Reasons for porcelain veneers:
- Cosmetically, to create a uniform, white, beautiful smile.
- Crooked teeth.
- Misshapen teeth.
- Severely discolored or stained teeth.
- Teeth that are too small or large.
- Unwanted or uneven spaces.
- Worn or chipped teeth.
What does getting porcelain veneers involve?
Getting veneers usually requires two visits to complete the process, with little or no anesthesia required during the procedure. The teeth are prepared by lightly buffing and shaping the surface to allow for the thickness of the veneer. A mold or impression of the teeth is taken and a shade (color) will then be chosen by you and the dentist.
On the second visit the teeth will be cleansed with special liquids to achieve a durable bond. Bonding cement is then placed between the tooth and veneer and a special light beam is used to harden and set the bond.
You will receive care instructions for veneers. Proper brushing, flossing and regular dental visits will aid in the life of your new veneers.
Case 1: Achieving a younger more youthful smile with veneers
BEFORE AFTER
Case 2: A combination of porcelain crowns and veneers are used to restore this lady’s smile which was subject to tooth grinding and associated wear.
BEFORE AFTER
Case 3: Veneers used to close gaps and to completely change a smile
BEFORE AFTER
Tooth Whitening
Tooth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the colour of natural tooth enamel and is an ideal way to enhance the beauty of your smile.
Because having whiter teeth has now become the number one aesthetic concern of most patients, there are a number of ways to whiten teeth. The most popular method is using a home tooth whitening system that will whiten teeth dramatically. Since tooth whitening only works on natural tooth enamel, it is important to evaluate replacement of any old fillings, crowns, etc. Replacement of any restorations will be done after bleaching so they will match the newly bleached teeth.
Tooth whitening is not permanent. A touch-up maybe needed every several years, and more often if you smoke, drink coffee, tea, or wine.
Reasons for tooth whitening:
- Fluorosis (excessive fluoridation during tooth development).
- Normal wear of outer tooth layer.
- Stained teeth due to medications (tetracycline, etc.).
- Yellow, brown stained teeth.
What does tooth whitening involve?
This type of tooth whitening usually requires two visits. At the first appointment, impressions (moulds) will be made of your teeth to fabricate custom, clear plastic, trays.
At your second appointment, you will try on the trays for proper fit, and adjustments will be made if necessary. The trays are worn with special whitening solution either twice a day for 30 minutes or overnight for a couple of weeks depending on the degree of staining and desired level of whitening. It is normal to experience tooth sensitivity during the time you are whitening your teeth, but it will subside shortly after you have stopped bleaching.
You will receive care instructions for your teeth and trays, and be encouraged to visit your dentist regularly to help maintain a beautiful, healthy, white smile.
Case 1 Case 2
Maintenance
It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)! Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.
Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.
In addition to your periodontal cleaning and evaluation, your appointment will usually include:
- Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
- Examination of existing restorations: Check current fillings, crowns, etc.
- Examination of tooth decay: Check all tooth surfaces for decay.
- Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
- Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
- Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.
Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control.
Periodontal (Gum) Disease
What is gum disease?
Periodontal disease (gum disease) is a chronic bacterial infection of the gums and bone supporting the teeth. It is a major cause of tooth loss in adults. However, because gum disease is usually painless, you may not even know you have it. Gum disease is caused by plaque bacteria which form a sticky film on the tooth surface. These plaque bacteria release toxins that can damage the gums. As the amount of plaque increases the saliva in your mouth can begin to mineralise the plaque to form tartar (calculus). These hard deposits on the roots of the teeth only serve to promote more plaque formation and further damage to the gums.
Types of Gum disease
There are two main types of gum disease- gingivitis and periodontitis. Gingivitis is very common and may affect up to 70% of the population. Periodontitis affects around 30% of adults over age of 30. Both these infections can be treated and controlled, but the earlier they are diagnosed and managed, generally the better the prognosis for your teeth.
This is the primary reason that you need to stay regular with your dental visits, so that a dental hygienist can keep your teeth clean and monitor the health of your gums. Most people who lose their teeth lose them to periodontal disease. Take it seriously!
The warning signs of gum disease
If you notice any of the following signs, you probably have gum disease and need treatment:
· Gums (gingiva) that bleed easily.
· Red, swollen or tender gingiva.
· Gums that have pulled away from the teeth.
· Pus between the teeth and gingiva when the gingiva are pressed.
· Persistent bad breath or bad taste.
· Permanent teeth that are loose or separating.
· Any change in the way your teeth fit together when you bite.
· Any change in the fit of partial dentures.
Risk Factors for Gum Disease
The main cause of periodontal disease is bacterial plaque. Oral bacteria form a sticky, colourless film on your teeth. These bacteria release various toxic by-products which irritate your gum tissues. While plaque bacteria are the main cause of periodontal disease there are other factors, such as those outlined below, that can also affect the health of your gums.
Other Risk Factors
· Smoking and Tobacco Use
· Genetics
· Pregnancy & Puberty
· Grinding or Clenching your Teeth
· Diabetes
· Stress
· Medications e.g. antidepressants, oral contraceptives
· Poor Nutrition
· Other Systemic Diseases . e.g. uncontrolled diabetes, corticosteroid use
A patient with generalised gingivitis. Note the red, swollen, inflammed gum tissues around the teeth. These gums bleed easily on brushing.
A case of advanced Periodontitis. Very swollen gums, loose teeth, staining and heavy plaque and calculus deposits on all the teeth.
Periodontal (Gum) Treatment
Scaling & Root Planing
Scaling refers to the professional removal of soft plaque and hard calculus (tartar) deposits from the teeth and around the gum line. It is undertaken using hand instruments (scalers or curettes) and/or sonic/ultrasonic instruments which use high frequency vibrations to help remove these deposits from the tooth surface.
Root planing is really an extension of scaling which involves getting down further under the gum line to remove plaque and calculus from the tooth root surface. This is usually undertaken while the gum tissues are numb with dental anesthetic so that the treatment can be performed painlessly. Scaling and root planing aim to provide a clean smooth tooth and root surface in order that the gum tissue/ attachment has a chance to heal around the tooth. Both scaling and root planing are non-surgical treatments. Scaling and root planing may sometimes be combined with antibiotic treatment to assist in the management of the gum infection.
Pocket Elimination & Periodontal Flap Surgery
In certain circumstances, scaling and root planing alone may not be sufficient to deal with the periodontal disease, especially in patients who present with more severe periodontitis. Such patients will normally require further treatment in the form of periodontal surgery. Modern surgical treatments are generally minimally invasive and generally well tolerated by patients. There are a variety of surgical techniques used in the management of severe periodontitis each having their specific indications. Only a qualified periodontist such as Dr Mehta has the specialist surgical skills to recommend and provide the periodontal surgery required for your specific circumstances.
Performing Proper Oral Hygiene
Being able to clean your teeth properly is not necessarily as easy as it sounds. Being able to removal plaque from certain areas in you mouth can be challenging. Professional advice and the right tools for the job can go a long way to ensuring that the time you do spend cleaning your teeth and gums is time well spent. Here are some preliminary suggestions to get you started.
Tooth brushing-twice daily.
Brushing removes the sticky film of bacteria from the teeth and from around the gum line. A soft-bristled toothbrush that is in good condition is recommended. Electric toothbrushes can also be of tremendous benefit for many patients providing they are used appropriately. The use of toothpastes containing fluoride helps to strengthen the teeth and prevent decay. Certain toothpastes can also help reduce tooth sensitivity.
Cleaning between teeth daily.
Dental floss or interdental brushes can be used to remove bacteria and food particles from between the teeth where a toothbrush can't reach. The early signs of gum disease (gingivitis) may be reversed by careful daily brushing and flossing. The use of interdental brushes requires instruction by a trained professional to prevent injury to the gum tissues and to ensure effective plaque removal.
Regular Dental Visits
Visiting your dentist or hygienist and having professional cleaning is important in the prevention of both tooth decay and periodontal diseases.
Gum Regeneration
Gingival Recession
Exposed tooth roots are the result of gum recession. Gum recession may lead to exposure of a darker, yellow root surface and may also result in an uneven gum line. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or maybe you're not bothered by the appearance of these areas, but your exposed roots are sensitive to hot or cold foods and drinks.
Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. Drs’ Darfoor and Mehta can help you identify the factors contributing to the problem. Once these contributing factors are controlled, a delicate gum grafting procedure can be used to repair the area of recession and help to prevent further gum recession and subsequent bone loss.
Gum grafts can be used to cover roots or develop gum tissue where it is missing due to gum recession. Gum grafting involves a procedure known as a connective tissue graft which is a delicate procedure where a small piece of gum tissue is taken from the palate or another donor site and transplanted to cover the exposed root.
This can be done for one or more teeth to even up your gum line and/or reduce root surface sensitivity. The benefits of gum grafting include: reducing further recession and bone loss, cover exposed roots to protect them from decay, reduce tooth sensitivity and improve the esthetics of your smile.
Case 1: Treatment of Gum Recession localised to a Canine tooth
Before After
Case 2: Upper Incisor teeth with recession. A gum graft was used to repair this recession
Regenerative Treatments
Guided Tissue Regeneration (GTR)
Periodontal disease (periodontitis) is an infection which can result in damage to the normal gum attachment and bony support around your teeth. Loss of gum attachment and bony support around teeth can result in teeth becoming loose and ultimately being lost.
In certain situations it may be possible to regenerate damaged bone and gum attachment around teeth by undertaking guided tissue regeneration. By regenerating gum attachment and bony support around the roots of teeth, the prognosis for the teeth may be improved.
Guided tissue regeneration is an intricate procedure which involves carefully teasing back a small area of gum next to the tooth, while the gum is numb with dental anesthetic.
This allows for careful cleaning of the tooth root surface to remove any calculus (tartar) and plaque bacteria. Once the root surface of the tooth is clean, the damaged area of bone is bone grafted to assist with the bony healing.
A small barrier membrane (resorbable) is then placed over the bone-grafted area and the gum tissue gently stitched over the top. This procedure creates an ideal healing environment around the tooth to optimize healing of the bony support and the gum attachment to the tooth root.
The results of this state-of-the-art reconstructive surgery are demonstrated in the diagrams and x-rays below.
Guided Bone Regeneration.
Loss of jaw bone following the loss of teeth or traumatic injury may result in a number of different problems. Most commonly, areas of bone loss may result in difficulties in dental implant treatment due to a lack of bone into which to place a dental implant.
Bony defects elsewhere may be unsightly and compromise other dental treatments such as a dental crown and bridgework. Guided bone regeneration (GBR) is a surgical procedure which involves carefully lifting a small area of the gum overlying the bony defect. The area is then bone grafted with either bone taken from elsewhere in the mouth or with synthetic bone graft.
The bone graft particles placed into the bony defect act as scaffolding into which the bone cells can grow. The bone graft is then covered with a very thin barrier membrane prior to repositioning the gum tissue over the top and gently stitching it back into place. This regenerative procedure helps to promote bone growth in areas previously devoid of bone. Developing bone in this way can help to increase the amount of bone for subsequent dental implant treatment.
Gum Lift & Crown Lengthening
Do you have a 'Gummy Smile' ?
Do you have a gummy smile? Excessive gum and short teeth can often be corrected by undertaking crown lengthening. The procedure involves gently adjusting the gumline around the teeth. This delicate and precise surgery can result in a much fuller smile and reduce that ‘gummy smile’
Short upper front teeth with excess gum. Final result following gum lift procedure.
Cosmetic Restorative Dentistry
SECTIONS
- Composite Fillings
- Dental Implants
- Porcelain Crowns
- Porcelain Fixed Bridges
- Porcelain Inlays and Onlays
- Porcelain Veneers
- Tooth Whitening
- Maintenance
- Periodontal Disease and its Treatment
- Gum Regeneration
- Guided Tissue Regeneration
- Guided Bone Regeneration
- Gum Lift and Crown Lengthening
Composite Fillings
TO
A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc. The decayed or affected portion of the tooth will be removed and then filled with a composite filling.
There are many types of filling materials available, each with their own advantages and disadvantages. You and your dentist can discuss the best options for restoring your teeth. Composite fillings, along with silver amalgam fillings, are the most widely used today. Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.
As with most dental restorations, composite fillings are not permanent and may someday have to be replaced. They are very durable, and will last many years, giving you a long lasting, beautiful smile.
Reasons for composite fillings:
· Chipped teeth.
· Closing space between two teeth.
· Cracked or broken teeth.
· Decayed teeth.
· Worn teeth.
How are composite fillings placed?
Composite fillings are usually placed in one appointment. While the tooth is numb, your dentist will remove decay as necessary. The space will then be thoroughly cleaned and carefully prepared before the new filling is placed. If the decay was near the nerve of the tooth, a special medication will be applied for added protection. The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.
It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.
You will be given care instructions at the conclusion of your treatment. Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.
Dental Implants
This should be linked to page on Implant Dentistry
Porcelain Crowns
A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size. A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.
Although there are several types of crowns, porcelain (tooth colored crown) are the most popular, because they resemble your natural teeth. They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced. Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.
Reasons for crowns:
· Broken or fractured teeth.
· Cosmetic enhancement.
· Decayed teeth.
· Fractured fillings.
· Large fillings
· .Tooth has a root canal.
What does getting a crown involve?
A crown procedure usually requires two appointments. Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown. A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.
While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown. Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.
At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.
You will be given care instructions and encouraged to have regular dental visits to check your new crown.
Old Un-attractive Crowns New Aesthetic All Porcelain Crowns
Porcelain Fixed Bridges
A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.
There are several types of bridges. You and your dentist will discuss the best options for your particular case. The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal. Porcelain fixed bridges are most popular because they resemble your natural teeth. This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.
Dental bridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear.
Reasons for a fixed bridge:
· Fill space of missing teeth.
· Maintain facial shape.
· Prevent remaining teeth from drifting out of position.
· Restore chewing and speaking ability.
· Restore your smile.
· Upgrade from a removable partial denture to a permanent dental appliance.
What does getting a fixed bridge involve?
Getting a bridge usually requires two or more visits. While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown. Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated. In addition, a temporary bridge will be made and worn for several weeks until your next appointment.
At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit. Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge. The new bridge will be permanently cemented at a later time.
You will receive care instructions at the conclusion of your treatment. Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.
Old Bridge Bridge Removed New Bridge Fitted
Porcelain Onlays
An inlay or onlay restoration is a custom made filling made of composite material, gold, or tooth-colored porcelain. Porcelain inlays or onlays are popular because they resemble your natural tooth. An onlay is sometimes also referred to as a partial crown. Porcelain inlays or onlays are made by a professional dental laboratory and is permanently cemented onto the tooth by your dentist.
Inlays and onlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma. Inlays and onlays are an ideal alternative to crowns (caps) because less tooth structure is removed in the preparation of them. Onlays are essentially identical to inlays with the exception that one or more of the chewing cusps have also been affected and need to be included in the restoration.
As with most dental restorations, onlays are not always permanent and may someday require replacement. They are highly durable and will last many years, giving you a beautiful long lasting smile.
Reasons for onlay restorations:
· Broken or fractured teeth.
· Cosmetic enhancement.
· Decayed teeth.
· Fractured fillings.
· Large fillings.
What does getting an onlay involve?
An inlay or onlay procedure usually requires two appointments. Your first appointment will include taking several highly accurate impressions (moulds) that will be used to create your custom onlay and a temporary restoration.
While the tooth is numb, the dentist will remove any decay and/or old filling materials. The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an onlay restoration. A temporary filling will be applied to protect the tooth while your inlay or onlay is made by a dental laboratory.
At your second appointment, your new inlay or onlay will be carefully and precisely cemented into place. A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable.
You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new onlay.
Natural looking Porcelain Onlay
Porcelain Veneers
Veneers are very thin pieces of durable, tooth shaped porcelain that are custom made (for shape and color) by a professional dental laboratory. They are bonded onto the front of teeth to create a beautiful and attractive smile.
Veneers can completely reshape your teeth and smile. They can often be alternatives to crowns and the ideal solution in treating many dental conditions.
As with most dental restorations, veneers are not permanent and may someday need replacement. They are very durable and will last many years, giving you a beautiful long lasting smile.
Reasons for porcelain veneers:
- Cosmetically, to create a uniform, white, beautiful smile.
- Crooked teeth.
- Misshapen teeth.
- Severely discolored or stained teeth.
- Teeth that are too small or large.
- Unwanted or uneven spaces.
- Worn or chipped teeth.
What does getting porcelain veneers involve?
Getting veneers usually requires two visits to complete the process, with little or no anesthesia required during the procedure. The teeth are prepared by lightly buffing and shaping the surface to allow for the thickness of the veneer. A mold or impression of the teeth is taken and a shade (color) will then be chosen by you and the dentist.
On the second visit the teeth will be cleansed with special liquids to achieve a durable bond. Bonding cement is then placed between the tooth and veneer and a special light beam is used to harden and set the bond.
You will receive care instructions for veneers. Proper brushing, flossing and regular dental visits will aid in the life of your new veneers.
Case 1: Achieving a younger more youthful smile with veneers
BEFORE AFTER
Case 2: A combination of porcelain crowns and veneers are used to restore this lady’s smile which was subject to tooth grinding and associated wear.
BEFORE AFTER
Case 3: Veneers used to close gaps and to completely change a smile
BEFORE AFTER
Tooth Whitening
Tooth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the colour of natural tooth enamel and is an ideal way to enhance the beauty of your smile.
Because having whiter teeth has now become the number one aesthetic concern of most patients, there are a number of ways to whiten teeth. The most popular method is using a home tooth whitening system that will whiten teeth dramatically. Since tooth whitening only works on natural tooth enamel, it is important to evaluate replacement of any old fillings, crowns, etc. Replacement of any restorations will be done after bleaching so they will match the newly bleached teeth.
Tooth whitening is not permanent. A touch-up maybe needed every several years, and more often if you smoke, drink coffee, tea, or wine.
Reasons for tooth whitening:
- Fluorosis (excessive fluoridation during tooth development).
- Normal wear of outer tooth layer.
- Stained teeth due to medications (tetracycline, etc.).
- Yellow, brown stained teeth.
What does tooth whitening involve?
This type of tooth whitening usually requires two visits. At the first appointment, impressions (moulds) will be made of your teeth to fabricate custom, clear plastic, trays.
At your second appointment, you will try on the trays for proper fit, and adjustments will be made if necessary. The trays are worn with special whitening solution either twice a day for 30 minutes or overnight for a couple of weeks depending on the degree of staining and desired level of whitening. It is normal to experience tooth sensitivity during the time you are whitening your teeth, but it will subside shortly after you have stopped bleaching.
You will receive care instructions for your teeth and trays, and be encouraged to visit your dentist regularly to help maintain a beautiful, healthy, white smile.
Case 1 Case 2
Maintenance
It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)! Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.
Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.
In addition to your periodontal cleaning and evaluation, your appointment will usually include:
- Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
- Examination of existing restorations: Check current fillings, crowns, etc.
- Examination of tooth decay: Check all tooth surfaces for decay.
- Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
- Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
- Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.
Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control.
Periodontal (Gum) Disease
What is gum disease?
Periodontal disease (gum disease) is a chronic bacterial infection of the gums and bone supporting the teeth. It is a major cause of tooth loss in adults. However, because gum disease is usually painless, you may not even know you have it. Gum disease is caused by plaque bacteria which form a sticky film on the tooth surface. These plaque bacteria release toxins that can damage the gums. As the amount of plaque increases the saliva in your mouth can begin to mineralise the plaque to form tartar (calculus). These hard deposits on the roots of the teeth only serve to promote more plaque formation and further damage to the gums.
Types of Gum disease
There are two main types of gum disease- gingivitis and periodontitis. Gingivitis is very common and may affect up to 70% of the population. Periodontitis affects around 30% of adults over age of 30. Both these infections can be treated and controlled, but the earlier they are diagnosed and managed, generally the better the prognosis for your teeth.
This is the primary reason that you need to stay regular with your dental visits, so that a dental hygienist can keep your teeth clean and monitor the health of your gums. Most people who lose their teeth lose them to periodontal disease. Take it seriously!
The warning signs of gum disease
If you notice any of the following signs, you probably have gum disease and need treatment:
· Gums (gingiva) that bleed easily.
· Red, swollen or tender gingiva.
· Gums that have pulled away from the teeth.
· Pus between the teeth and gingiva when the gingiva are pressed.
· Persistent bad breath or bad taste.
· Permanent teeth that are loose or separating.
· Any change in the way your teeth fit together when you bite.
· Any change in the fit of partial dentures.
Risk Factors for Gum Disease
The main cause of periodontal disease is bacterial plaque. Oral bacteria form a sticky, colourless film on your teeth. These bacteria release various toxic by-products which irritate your gum tissues. While plaque bacteria are the main cause of periodontal disease there are other factors, such as those outlined below, that can also affect the health of your gums.
Other Risk Factors
· Smoking and Tobacco Use
· Genetics
· Pregnancy & Puberty
· Grinding or Clenching your Teeth
· Diabetes
· Stress
· Medications e.g. antidepressants, oral contraceptives
· Poor Nutrition
· Other Systemic Diseases . e.g. uncontrolled diabetes, corticosteroid use
A patient with generalised gingivitis. Note the red, swollen, inflammed gum tissues around the teeth. These gums bleed easily on brushing.
A case of advanced Periodontitis. Very swollen gums, loose teeth, staining and heavy plaque and calculus deposits on all the teeth.
Periodontal (Gum) Treatment
Scaling & Root Planing
Scaling refers to the professional removal of soft plaque and hard calculus (tartar) deposits from the teeth and around the gum line. It is undertaken using hand instruments (scalers or curettes) and/or sonic/ultrasonic instruments which use high frequency vibrations to help remove these deposits from the tooth surface.
Root planing is really an extension of scaling which involves getting down further under the gum line to remove plaque and calculus from the tooth root surface. This is usually undertaken while the gum tissues are numb with dental anesthetic so that the treatment can be performed painlessly. Scaling and root planing aim to provide a clean smooth tooth and root surface in order that the gum tissue/ attachment has a chance to heal around the tooth. Both scaling and root planing are non-surgical treatments. Scaling and root planing may sometimes be combined with antibiotic treatment to assist in the management of the gum infection.
Pocket Elimination & Periodontal Flap Surgery
In certain circumstances, scaling and root planing alone may not be sufficient to deal with the periodontal disease, especially in patients who present with more severe periodontitis. Such patients will normally require further treatment in the form of periodontal surgery. Modern surgical treatments are generally minimally invasive and generally well tolerated by patients. There are a variety of surgical techniques used in the management of severe periodontitis each having their specific indications. Only a qualified periodontist such as Dr Mehta has the specialist surgical skills to recommend and provide the periodontal surgery required for your specific circumstances.
Performing Proper Oral Hygiene
Being able to clean your teeth properly is not necessarily as easy as it sounds. Being able to removal plaque from certain areas in you mouth can be challenging. Professional advice and the right tools for the job can go a long way to ensuring that the time you do spend cleaning your teeth and gums is time well spent. Here are some preliminary suggestions to get you started.
Tooth brushing-twice daily.
Brushing removes the sticky film of bacteria from the teeth and from around the gum line. A soft-bristled toothbrush that is in good condition is recommended. Electric toothbrushes can also be of tremendous benefit for many patients providing they are used appropriately. The use of toothpastes containing fluoride helps to strengthen the teeth and prevent decay. Certain toothpastes can also help reduce tooth sensitivity.
Cleaning between teeth daily.
Dental floss or interdental brushes can be used to remove bacteria and food particles from between the teeth where a toothbrush can't reach. The early signs of gum disease (gingivitis) may be reversed by careful daily brushing and flossing. The use of interdental brushes requires instruction by a trained professional to prevent injury to the gum tissues and to ensure effective plaque removal.
Regular Dental Visits
Visiting your dentist or hygienist and having professional cleaning is important in the prevention of both tooth decay and periodontal diseases.
Gum Regeneration
Gingival Recession
Exposed tooth roots are the result of gum recession. Gum recession may lead to exposure of a darker, yellow root surface and may also result in an uneven gum line. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or maybe you're not bothered by the appearance of these areas, but your exposed roots are sensitive to hot or cold foods and drinks.
Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. Drs’ Darfoor and Mehta can help you identify the factors contributing to the problem. Once these contributing factors are controlled, a delicate gum grafting procedure can be used to repair the area of recession and help to prevent further gum recession and subsequent bone loss.
Gum grafts can be used to cover roots or develop gum tissue where it is missing due to gum recession. Gum grafting involves a procedure known as a connective tissue graft which is a delicate procedure where a small piece of gum tissue is taken from the palate or another donor site and transplanted to cover the exposed root.
This can be done for one or more teeth to even up your gum line and/or reduce root surface sensitivity. The benefits of gum grafting include: reducing further recession and bone loss, cover exposed roots to protect them from decay, reduce tooth sensitivity and improve the esthetics of your smile.
Case 1: Treatment of Gum Recession localised to a Canine tooth
Before After
Case 2: Upper Incisor teeth with recession. A gum graft was used to repair this recession
Regenerative Treatments
Guided Tissue Regeneration (GTR)
Periodontal disease (periodontitis) is an infection which can result in damage to the normal gum attachment and bony support around your teeth. Loss of gum attachment and bony support around teeth can result in teeth becoming loose and ultimately being lost.
In certain situations it may be possible to regenerate damaged bone and gum attachment around teeth by undertaking guided tissue regeneration. By regenerating gum attachment and bony support around the roots of teeth, the prognosis for the teeth may be improved.
Guided tissue regeneration is an intricate procedure which involves carefully teasing back a small area of gum next to the tooth, while the gum is numb with dental anesthetic.
This allows for careful cleaning of the tooth root surface to remove any calculus (tartar) and plaque bacteria. Once the root surface of the tooth is clean, the damaged area of bone is bone grafted to assist with the bony healing.
A small barrier membrane (resorbable) is then placed over the bone-grafted area and the gum tissue gently stitched over the top. This procedure creates an ideal healing environment around the tooth to optimize healing of the bony support and the gum attachment to the tooth root.
The results of this state-of-the-art reconstructive surgery are demonstrated in the diagrams and x-rays below.
Guided Bone Regeneration.
Loss of jaw bone following the loss of teeth or traumatic injury may result in a number of different problems. Most commonly, areas of bone loss may result in difficulties in dental implant treatment due to a lack of bone into which to place a dental implant.
Bony defects elsewhere may be unsightly and compromise other dental treatments such as a dental crown and bridgework. Guided bone regeneration (GBR) is a surgical procedure which involves carefully lifting a small area of the gum overlying the bony defect. The area is then bone grafted with either bone taken from elsewhere in the mouth or with synthetic bone graft.
The bone graft particles placed into the bony defect act as scaffolding into which the bone cells can grow. The bone graft is then covered with a very thin barrier membrane prior to repositioning the gum tissue over the top and gently stitching it back into place. This regenerative procedure helps to promote bone growth in areas previously devoid of bone. Developing bone in this way can help to increase the amount of bone for subsequent dental implant treatment.
Gum Lift & Crown Lengthening
Do you have a 'Gummy Smile' ?
Do you have a gummy smile? Excessive gum and short teeth can often be corrected by undertaking crown lengthening. The procedure involves gently adjusting the gumline around the teeth. This delicate and precise surgery can result in a much fuller smile and reduce that ‘gummy smile’
Short upper front teeth with excess gum. Final result following gum lift procedure.
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