The Plastic Man

Have you accidently ever bitten on a small piece of stone, or plastic while chewing on your delicious meal? Its like a jolt of pain shooting to your head, blowing your brains apart!! Now imagine biting through this piece of plastic everyday for 25 years. Can you bare the discomfort of chewing your meals with a heavy piece of acrylic for your breakfast, lunch, tea, dinner, and supper??  The answer is = DREADFUL ! 

Mr. Akram has been trying to get comfortable with his upper dentures for at least 25 years now. He has literally celebrated a silver jubilee of 25 years of horror, trying to eat and chew through that heavy piece of acrylic! Mr. Akram didn’t have the best options for treating his teeth when he was very young due to unethical decisions made by his previous dentist. He had lost most of his upper teeth as a result of extraction.

Dentures had been his only option to replace his missing teeth back then. Ever since, he had to suffer to learn how to eat using a set of false teeth, with his tongue constantly in contact with the acrylic on his upper palate. He couldn’t taste his food, since his tongue does not touch his palate ( the upper part of the mouth ). His speech was affected, where he had to learn to speak and pronounce words clearly with the presence of the denture. Overtime, the denture got loose once the bone started to resorb. This occurs as a result of loosing teeth over a period of time, as the bone around the extracted tooth socket tends to resorb due to absence of the tooth. This causes a change to the anatomy of the gum and mouth resulting in reduced support to the denture. It is a series of unfortunate events that a denture wearer has to live with, not forgetting the fact that they will have to remove their dentures at night before their sleep.

                                

Mr. Akram had decided to end his tourment. He paid us a visit, seeking advice on his dental dilemma. He was keen on getting rid of the denture for once and for all.  He asked for some professional advice, and we started analyzing his case. We ran a full dental examination on him, observing his smlie line, width of mouth opening and his facial profile.

            

We had then begin our cosmetic treatment for Mr. Akram. We planned an upper Zicornia bridge for him, mimicking his original teeth shape, size and profile as much as possible. Within 2 weeks, his new bridge had arrived. It looked like a set of polished diamonds, ready to be installed.

            

The bridge was inserted into his mouth. It was a MATCH ! The color, texture and fitting was perfect, and Mr. Akram was overwhelmed. He was very happy with his new prosthesis. He had now a new set of teeth, feeling like brand new ones.

           

            

Mr. Akram was satisfied with his new set of teeth. They were better, stronger, whiter and much lighter than his previous denture. He was able to speak comfortably, smile confidently, and above all, he could now TASTE HIS FOOD! What a relief … no more plastic tastes, no more rocks to bite from !! With his new Zicornia bridge, he was able to appreciate his food better… say Good Bye to plastic roof!

                  

        

  

            

A Good Day to Smile - Understanding the Law beyond Just a Beautiful Smile...

Not everyone is born with a perfect set of teeth, beaming white and crystals glowing as they smile. A good smile comes from a beautiful lip line, high cheek bones and an attractive set of teeth. But what happens if you were blessed with such a fortune of a smile, but with defected teeth??

Smiles are just mesmerising when it feels right...

Rampant caries is a very common disease of the dentition. It is an aggressive, devastating type of  decay of the teeth due to invasive bacteria, and the lack of  protective mechanism to the teeth itself. Very simply, we prevent decay  (demineralization of the enamel and dentine) by our day to day routine of brushing and flossing. What we do not realize is that there are more than just this 2 methods to restore balance to your oral hygiene. Its connected to our daily activities and lifestyle, which plays a big role in keeping our teeth healthy and protected.

Study the list of options below. Interesting as it may be, these might just enlighten us on the complexity and the dynamics on how tooth decay can be prevented.

1.              Proper diet – less sugar and starchy food, flruoride

2.              Proper brushing method

3.              Brushing frequancy – 2 times daily

4.              Flossing

5.              Mouth rinse

6.              Eating timing

7.              Eating frequancy

8.              Adequate rinsing

9.              Water intake

10.          Frequant visits to the dentist

Lets take number 8 for instanse. Adequate rinsing simply means cleansing the teeth with a form of liquid ( water,mouthwah,saliva ) to remove any reminants of food particles or pelicle layers over the tooth surface.  Any cause of deficient rinsing, or inability to rinse efficiently would be a major causative factor for decay to form. So could you imagine a child with impaired salivary production sufering the consequences of rampant caries due to his/her inability to produce adequate saliva to wash away all the food particles? The impact to the child is severe, as while he suffers from lack of confidence to smile and interact with children of  his age, his teeth is undergoing damage every second. Such cases require good dental intervention and a proper treatment plan for the child.

We had a patient, 19 year old male from Perth who had similarly suffered from xerostomia (inabillity to produce saliva) and faced issues with his teeth. He had generalized caries, some of which has caused his teeth to be non-vital and presented with dental abcess. It was quite sad to see a young individual sufering from multiple carious lesions due to his natural inability to produce adequate saliva.

 He has a good long future ahead of him. However looking at his current condition, he might not even pass 25 before all his teeth are fully damaged. This young man needed help, and the sooner he received it the better it would be. So we designed a treatment plan for him, bearing in mind about his diet, hygiene level and most importantly his inability to produce enough saliva. It was not an easy task as if also involved smile designing. Our team had initially proposed veneers and fluoride therapy.

 However we realised that his with state of tooth decay, the palatal and lingual surface where the veneers end were at risk of having recurrent caries- thus causing the veneers to vulnerable to failure. Despite being the best and most minimally invasive treatment, veneers were perhaps not the best option for him. Well, given the limitations at this point, the only option left were Zicornia crowns. This is simply due to their nature of being compatible with his  gums, which were going to help him in the long run, and as well as securing his teeth from any further damage due to lack of salivary flow.  The saliva acts as a source of lubricant to wash away food particles and sugar that might adhere to the tooth surface, as well as providing the first line of defence against regular oral bacterias. It was absolutely necessary to now protect the whole tooth for this reason. 

teeth with normal salivary flow

teeth with limited or no salivary flow

Mr. Marten Stroh, our German technician was designated with the job task to design a precise set of Zicornia crowns for our patient. It was constructed to match his teeth profile, size and shape. These new crowns were measured and fabricated from the Zicorn core, then later adjusted with the overall occlusion for the patient. Finally, they were given a superior polish touch with a glaze to it that made the crowns very smooth - ideally for easy cleansing. 

When the crowns were finally fitted in for the patient, the results were satisfying. He looked amazing, with his new set of white crowns dominating his smile. A job of such precision, deserved a moment of joy for both the patient and our team. We were just glad we were able to make a difference to a persons life. 

... before and after ...

A Whole New Smile

One fine morning, we received an email from a lovely couple living in Perth, Australia. Juliana, had wrote to us inquiring about our dental centre and was keen on getting some dental work done. She was interested in getting her upper front teeth treated as they were yellow, chipped and started to show gaps between them. She expressed her desire that she wanted to get herself a nice set of natural looking teeth that would return her smile to how it was 10 years ago. Understanding her needs were important as she was about to embark a 5 hour journey up to Malaysia just to get her teeth done. She had sent us a couple of pictures to show me how her smile looked like.

We understood her need to get her teeth fixed almost immediately

Juliana arrived in Malaysia the following month. She was excited as she was really looking forward to her brand new set of teeth. We were very happy to meet her and her husband. We carried out a thorough check up for Juliana and inquired about her expectations as we wanted to Deliver What She Wanted. Judging from the condition of her teeth and from the her dental history, Juliana had undergone multiple cosmetic treatment for her upper anterior teeth. She was never truly satisfied with the results and was seeking for a permanent solution. So we assembled our cosmetic team together with our German technician to start our dental odyssey in getting Juliana the smile she needed.

We... had work to do!

Our team started doing the necessary ground work of digital records and radiographic examination to determine the health status of her dentition. Juliana needed 3 root canal treatment followed by 10 Zicornia crowns designed by our very best German technician. Her treatment was done is stages, to reduce her chair side time and also to allow proper healing in between her dental visits. 

Finally, her crowns had arrived and was ready for installation. She was amazed by the natural architecture of the Zicornia crowns, designed to give her a natural smile. These crowns are made from Zicornia core, finished with Noritake porcelain and finally glazed to perfection.

The final results were stunning. Juliana was really happy with her new set of teeth that had changed her smile, moreover her husband couldn't stop complementing her and was really pleased with the crowns. 

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.