My Sweet 16 Smile...

Jennifer, a 40 year old beautiful woman works in a reputed university in Kuala Lumpur. She lectures in  Human Psychology, speaks 7 different languages and specializes in Sociology. Having to face almost 200 students a day, her outlook consciousness begun to rise. DAY AFTER DAY she looked at her smile and realize she needed to do something about it. WHY exactly ? Here is why...

Jennifer was desperate to get her teeth done up. Her self esteem started to get affected, while she was finding hard to smile confidently. He next step was to search form a cosmetic dentist to seek advice on how to fix her problem. She visited MalaysiaCosmeticDentist, and called in to make an appointment.

On a beautiful Sunday afternoon, she walks in for the 1st time to get her teeth checked. We had a long talk about what she worked as, what were her problems and how they affected her lifestyle. She addressed all her dental issues, as we LISTENED carefully and patiently. At the end of the conversation, we finally decided to take a closer look into her dilemma and a detailed picture of her mouth. She had some moderate crowding of her upper teeth, where her lateral incisors were sticking out prominently, giving her a cold sharp look whenever she smiled.

It is said that Sometimes... Small changes gives great results! In her case, it was just a matter of correcting her crowded teeth and changing the angulation. A set of 4 Zicornia crowns were made for her upper front teeth, setting it straight and white. Together with some minor gum treatment
( Gingivoplasty ) the results were stunning and the patient loved it ! We had custom made the crowns according to what Jennifer wanted. Together with Mr. Marten; German technician, we constructed beautiful strong crowns for our patient and engineered it as how she wanted, as in the color texture and the length of the tooth.

She now parades happily with her new set of teeth. She has put behind her days of sorrow for a new tomorrow, and she is a happy woman now!

When in dOUBT ...

They say... When in doubt, Cut it OUT !! Extension for prevention has always been a way round doubtful circumstances in the healthcare industry. Fortunately,  things have changed over the decads from barbaric gory procedures to minimally invasive interventions. 

In the world of dentistry today, the technology advancement allows everyone to have the luxury of saving their teeth. Each one of us have a choice of keep our infected  tooth rather than it being extracted. Conventional treatment for badly decayed or broken tooth would suggest the latter. Given the choice today, root canal treatment is a better  and smarter choice. Nothing comes close to chewing food with your own original teeth. The luxury of retaining your real teeth rather than removing and replacing them with false teeth is
indescribable.

The common dilemma among many of us these days  is NOT whether to save, or not to save the tooth, but saving the tooth in the most minimally invasive method possible. That brings us to ponder upon the efficacy of a root canal treatment. Understanding what a root canal treatment is, how it works, and how effective is it is important. A root canal treatment is basically removal and debridment of infected nerves and tissues in the roots of the tooth. Our tooth comprises of three layers,

Enamel - outer most layer, strongest substance in 
                  the body 

Dentin - comprises most of the tooth substance, 
                 lying under the enamel, forming the roots
                 and body of the tooth, and the roof/base/
                 walls of the nerve plexus
Pulp - the center containing nerve plexus


Most of the time, caries development goes undetected. It progresses over time, setting of different symptoms and sensation as it infests deeper into the tooth. The right question we should be asking here is, HOW do we know if we have a cavity infesting in our "healthy" dentition? Well for a start, your reaction towards cold drinks and food would indicate if there are any activities going on in your teeth.


INITIAL CARIES ( early stage )

ADVANCED CARIES

LATE STAGE CARIES ( with pulp involvement )

These are just indications to the severity of the decay. A thorough dental examination followed by proper digital imaging usually helps in diagnosing existing cavities, and as well as initial caries lesions. Initial caries lesions are usually reversible ( provided no cavitation are present ), and are treated by practicing good oral hygiene together with fluoride therapy. Advanced caries simply means there is a sign of cavitation and the decay has progressed beyond the enamel into the dentin, without breaching the pulp chamber. At this stage, the tooth can still saved by doing a filling in order to restore its function back to normal. However a late stage carious tooth could not be restored with a filling, the reason being the nerve plexus ( the pulp chamber ) has been breached and requires further treatment. This is when the dentist usually advices the patient to do a Root Canal Treatment.

At many occasions, deep cracks (complicated fractures) or gum disease involving the pulp (nerve plexus) would require a root canal treatment as well. RCT usually requires 2 or more clinical visits, unless it is a prophylactic endodontic treatment on a sound (healthy) tooth, in which it can be done in a single visit. 



During the 1st visit, a through examination is carried out based on the patients chief complain. An investigation is done on the patient's medical history, followed by an extraoral and intraoral examination, and finally studying the problematic tooth itself. A good Periapical radiograph or  panoramic imaging (OPG, X-ray) is done to aid in the diagnosis. When the final treatment plan is done, the root canal treatment (if indicated) is then carried out. This is after analyzing all the circumstances and factors influencing the
prognosis of the tooth. A good diagnosis and treatment plan will determine a good outcome of the treatment. This one of the most crucial stage in determinating the fate of the tooth.

A good local anesthesia is administered to numb the tooth and the surrounding tissues. Next, the pulp chamber of the tooth is accessed in order to carry out pulpectomy (removal of the nerves) and debridment of any discharge or infected tissues in the root canal. The canals are cleaned and shaped using rotary and hand instruments to remove any infected debris or tissues within the canal. It also helps widen the diameter of the canal, to aid disinfection and filling of the canal later on. By the end of the 1st visit, the dentist would have placed an intracanal medicament and sealed the canal orifice with a temporary filling material. 

At the 2nd visit, the seal is removed and intracanal
medication washed out. The canal, if not presenting with any sign or symptom of infection, is then filled with an obturating material (gutta perca). The final restoration is then placed, awaiting a prosthesis to further strenghten the tooth. 



The entire procedure is carried out under local anaesthesia. To treat a tooth with RCT requires few  considerations :-

a) the degree of tooth fracture - vertical fractures respond poorly to RCT due to bacterial 
    invasion beneath the gums
b) extend of decay - severe decay extending below the alveolar bone level might 
    compromise root canal treatment
c) exisiting sinus tract - how severe
d) existing chronic periapical abcess
e) pathological lesions - cyst, ameloblastoma,OKC
f) tooth mobility - Grade 3, poor prognosis of survival
g) periodontal disease - perio-endo lesion, causing periodontal abcess
h) other limiting factors , such as limited mouth opening, very poor oral hygiene, root caries, 
    xerostomia.

A RCT is only carried out once all pathological influence is removed. The fundamentals of a good root canal treatment is to do it under asepsis method, where a good isolation of the tooth (infection control) using proper and specific instruments is needed. The use of proper irrigation material and procedure together with good intracanal medication is necessary. A good root canal treatment done could determine the fate of the tooth treated. The chances of reinfection of the tooth depends on how well the tooth was treated, medications and irrigation system used and above all identifying and treating the causative factor of
the infection within the tooth. Early evaluation on the condition of the tooth, together with a good dental history has a big role in treating the source of infection. 

Having known now all the considerations before carrying out a root canal treatment, it is crucial that the root canal treatment is then performed optimally to ensure a high success rate. The astute dental clinician has to have enough knowledge and expirience in order to carry out the treatment efficiently and successfully. For further inquiries regarding root canal treatment,  please email Dr. Yogesh at
dryogeshbds@yahoo.com.

OMG ! My Teeth ... ?!!

LOOKS FAMILIAR ??? No way he is going on a date till he gets that tooth fixed ! 

Nobody wants to have a missing tooth, especially if its right in front ! It stares right at you, like a scar. Fortunately the technology today gives us the privilege to replace any defects from missing teeth any the palms of our hands. We just have to decide how we want to replace it, with a removable or fixed prosthesis.



Replacing a  missing tooth basically means restoring a false toothin the location of the missing one. In order to support the false tooth, there are mainly three means of doing so :-

1. Denture - acrylic base platform supporting false 
                       tooth
2. Bridge - metal/porcelain/zicornia base platform 
                    using neighbouring teeth as anchorage 
                    supporting false tooth
3. Implants - titanium screws placed into the jaw
                     supported by the bones to prepare a platform
                     for the placement of future prosthesis


  It is essential to recognize the difference between these three types of dental intervention. 

Dentures...

   ... are the one of the earliest and oldest dental prosthesis used to restore missing teeth. It could be used to replace any number of missing teeth, from as big as the whole arch to as small as one tooth. The main physics of how a denture functions is basically retention, suction and neuromuscular control of an individual with the denture. It is more like a plastic plate held in place by those 3 factors, restoring  dentition for functional purpose. The problem with a denture however is the extensive acrylic plate covering the gums. This can really be annoying especially when it comes to the lower jaw -interference with the tongue and cheeks. As for the upper jaw, a full palatal coverave denture causes disturbance with
speech ( especially on pronouncing words containing letters such as "S", "T", "L" ). Some even claim that wearing a denture gives them a retching sensation, while others complain about not being able to taste food properly ( as some taste and smell receptors are located in the palate ). Wearing dentures would not prevent bone resorption at missing tooth site, so eventually the denture will becomes loose overtime due to ill fitting denture bearing surface. 

  Well enough about dentures, the question these days is whether to restore a missing tooth, or teeth  with a bridge and whether we choose an implant. 

                
                                                                             VS

Previously, we discussed about Whether Or Not to restore a tooth that has a low prognosis to survive. 

In case of removal of a "hopeless" tooth, with a
good justification and consent from the patient, we then have to decide which dental intervention would be best for the patient. The factors that mainly decides the treatment depends on :-

1. Longevity of prosthesis installed
2. Duration of treatment (number of visits and time
    frame required)
3. Cost of treatment
4. Conditional restrictions - severe loss of bone, 
    space with opposing tooth, smile line, soft 
    tissue condition, number of teeth needs
    replacement
4. Medical problems - diabetes, gum disease

 
   Considering all the above, deciding on the type of prosthesis that best suits the patient it is very subjective from one case to another. A simple bridge construction would require shaving down a substantial amount of  the neighbouring tooth
structure in order to support the incoming prosthesis. 

In modern dentistry today, the objective of a dental treatment is to restore function and aesthetics for the patient with the most minimal invasive procedure. Bridging in this case does not comply to that,although in quite a few cases it is wise to do a bridge when the neighbouring teeth is indicated or due for a crown. The advantage of a bridge over an implant is mainly the time frame needed to construct the prosthesis. An implant would require a window peroid of 2 monthsor more for a full healing and restoration of the tooth, where else a bridge only requires around 2 weeks of waiting period before the prosthesis is ready to be installed. Also a properly constructed bridge on vital teeth (not root canal treated with posts) has a 10 year success rate as much as 86%. 




As far as implants are concerned,  they hold the
highest survival rate. The bone surrounding the titanium plate of the implant undergoes osteointergration and ankyloses with the implant., giving it strength 10 times stronger than a normal teeth. To achieve good aesthetics for the anterior region, it is crucial that the implant is placed properly with good bone grafting and soft tissue augmentation ( if needed ). In cases of severe bone loss due to traumatic accidents or extractions, other alternatives can be considered besides an implant alone. A proper treatment plan must be drawn up to maximize the results for the patient. 

Conclusion ... the option to restore a missing tooth fairly relies upon several factors as discussed earlier. Eventually the decision to restore it would be either to :-

1)    Wear a denture
2)    Construct a bridge 
3)    Place an implant
4)    Orthodontic treatment - provided the gap that needs closure is small and manageable






HISTORY
The implants that we know of today didnt appear overnight, but they came from a long historic transition. The early implants ages back as far as the Maya civilization around 1350 years ago. Back then, there were evidence of implants used to replace missing lower incisors on a young woman using shells. This evolved through time, inspiring researches to invent an implant system that could be used in the medical field.This research caught Per-Ingvar Branemark's attention. He started developing implants for knee and hip surgery, but soon after he decided to concentrate on constructing dental implants. His 1st implant was placed in 1965. However the 1st dental implant ever placed in the modern world of dentistry is by Dr. Leonard Linkow in 1952 ( known as the father of modern dentistry ). After an article published in 1966 by Stefano Melchiade Tramonte, the fear towards dental implants started to fade away, and many people started to embrace the concept of having a dental implant placed in the mouth. However, the implants back then were much larger, longer and wider as in compared to the ones now.   Many research has been done over the decades
to improve the quality of dental implants  manifacture. The research caught Pen-Ingvar Branemark's attention. After Stefano Melchiade Tramonte's published article in 1966 on his successful cases on titanium dental implant placement, the concept of dental implants was more widely accepted. Branemark started placing his own implants in 1965, soon after he started doing research on dental implants. He entered a commercial partnership with a Swedish defense company, Bofor AB. This  company was later restructured as Nobel Industries, giving birth to  NobelBiocare in 1981. They were the leading implant suppliers for many years. These days other implant suppliers such as Strauman, backed up by decades of case studies and research are among the leading dental implant supplier in the market.