1. MANAGEMENT OF WORN TEETH
Chipped and broken teeth are not only unsightly but can potentially cause harmful injuries to the tongue and cheek. They must be restored with the right material considering both function and aesthetics. More often, this may be complex (multiple teeth) and require the care of a prosthodontist. A single worn tooth may require a simple filling or a full coverage crown or a veneer depending on the extent of tooth structure lost.
Teeth when subjected to acidic foods (cordial, coke, frizzy, citrus, vinegar, salad dressings) and excessive forces, can wear rapidly. Whilst some wear is normal, excessive wear can occur following grinding and clenching. Frequently, this happens while sleeping. Diseases, such as gastric reflux or bulimia could also accelerate tooth wear.
Teeth lack the ability to rebuild lost structure. Dental restorations are used to restore lost structure. Cases involving generalised tooth wear require careful treatment planning. Under such circumstances, your dentist may recommend treatment by a specialist prosthodontist.
3. COSMETIC ENHANCEMENTS:
a.) Replacement of stained restorations and crowns
A number of problems could occur with restorations and or the tooth itself. Problems could also occur with gums. Replacement of old restorations could enhance the life of a tooth, especially if the tooth has secondary decay.
One of the most common complications is gum recession where shrinkage of the gum above the crown could lead to exposure of the crown/tooth interface. This often results in exposure of the darker, unaesthetic root surface.
Other reasons for replacement of restorations are broken, chipped or discoloured restorations.
b.) Treatment of chipped and broken teeth
Teeth consist of 3 layers: enamel, dentine and the pulp or nerve chamber. The treatment of a chipped tooth simply depends on the extent of damage. Simple fillings can be used to repair minor injuries restricted to enamel. When the injury extends into dentine a larger sized filling or a restoration made in the dental laboratory maybe necessary. Further extension of the injury into the pulp chamber would involve root canal treatment and a crown to hold the tooth together. An extremely destructed tooth may require extraction and replacement with an implant or a denture.
c.) Treatment of stained and discoloured teeth
Stains can be broadly categorised into external or internal stains. External stains include those caused by tobacco, coffee, spices, chlorhexidine mouthwash etc. Internal stains can occur as a result of developmental causes or result from an injury. The treatment of discoloured teeth depends on the cause and degree of discolouration. External stains can be treated with various methods ranging from simple dental cleaning/ polishing to procedures such as bleaching and micro-abrasion. Heavy stains would necessitate coverage of the discoloured area with restorations such as veneers and crowns. Internal stains may require similar treatment methods as well as treatment of the cause such as root canal treatment of a dead and hence discoloured tooth.
d.) Improving the gappy smile
Gaps may occur due to poor alignment (malocclusion) of teeth, disproportion between tooth size and space in the jaw or due to ongoing gum diseases. Treatment of the underlying cause is important. Gum diseases should be resolved prior to starting restorative/ prosthodontic treatments. Malocclusion of teeth can be treated with orthodontics (braces) or by prosthodontic means (veneers or crowns). Patients require comprehensive assessment to determine their suitability for these procedures. Further to this, treatment options will be put forth and discussed with the patient.
e.) Treatment of crowded teeth
Crowding can occur due to inadequate space in the jaw, a disproportion between tooth and jaw size or simply relapse following orthodontic treatment. Crowding can be corrected by means of veneers and crowns. Patients require comprehensive assessment to determine their suitability for these procedures. Further to this, treatment options will be put forth and discussed with the patient.
a.) Single missing tooth
I. Dentures – single teeth are rarely replaced definitively with dentures in dentistry today. Dentures have now become more of a temporary replacement until such time that the patient is ready for an implant or bridge.
II. Single implant-retained crowns.
Single implant retained crowns are used to replace a single missing tooth. The implant is surgically inserted into the jawbone. Three-six months later, the crown is inserted in place using the implant as a retentive foundation. These crowns can be made to simulate natural teeth and can last for decades.
b.) Multiple missing teeth
I. Dentures are removable ‘plates’ made of plastic or plastic and chrome cobalt. They can support single or multiple teeth and are ideal for patients who do not mind having a removable set of teeth. They can be cleansed and maintained easily.
II. Bridges are usually inserted to replace 1 or 2 teeth. Longer bridges to do not last-therefore, a maximum of 2 teeth maybe replaced with fixed bridges.
III. Implant-retained restorations are good options for the replacement of multiple teeth, either as single implant-retained crowns or as implant-retained bridges. The site has to be initially scanned to assess the quantity of bone prior to surgery.
c.) Full arch of missing teeth
I. Dentures – when a patient presents with no teeth, the simplest form of treatment they can have is complete dentures. These are 2 removable plates (one upper and one lower) supporting a full complement of teeth
II. Implant retained dentures – when dentures are constantly loose and poorly retentive, particularly in the lower jaw, they can be a source of embarrassment to the patient. 2 implants with retentive devices called ‘locator attachments’ maybe used to retain the denture in place. The denture can be removed, cleansed and secured back into place onto the locator attachments in the mouth.
III. Implant-supported bridges are used as a ‘fixed’ replacement of all teeth. Here, 2-6 implants are placed in the mandibular and/or maxillary arch. These implants support the bridge by means of screws. This prosthesis can only be removed by the dentist when needed.
IV. ‘All on four’ is a popular and reliable immediate replacement option for complete denture wearers or for those people who have a debilitating dentition and are most likely to lose all their teeth. Here, implants are immediately restored with a temporary plastic bridge followed by a permanent titanium bridge in the near future. In short, the patient receives a full complement of teeth within 3 days of implant placement.
A debilitating dentition simply refers to a set of teeth, which have decay and gum disease. Such teeth can appear discoloured, stained, broken down and feel loose. Under these circumstances, it is often seen that the dentition is in poor condition and reconstructive treatment may be difficult given the poor foundation and minimal existing tooth structure. In such cases, a staged treatment approach may be carried out wherein some teeth maybe preserved and dentures or fixed implants or crowns used to replace the missing teeth. If however, the dentition as a whole is of poor prognosis, then implants maybe used to restore the entire jaw.
A second opinion allows another professional view on a specific treatment plan given by a dental practitioner. This allows the patient to be sure they trust in the opinion given or that there may potentially be other options for them. At MEP, we evaluate each patient’s case individually. We also assess the findings a patient may have been previously given to plan the best out come for them. In addition, we offer alternative options where possible so that the patient can make definitive decisions on the final plan they decide upon. We involve our patient’s during the treatment planning phase to ensure full transparency with procedure details and costs. We understand this can play a major role in the final decision for the patient.
Oral and Maxillofacial Surgery
Oral surgery is the branch of dentistry that deals with simple extractions of teeth to complex treatments such as placement of dental implants. For large and complex treatments, surgeons and prosthodontists plan and carry out the treatment as a team. Implant surgery is an important branch of dentistry that requires careful planning. Implantology involves multiple specialties, all of which have come under one roof at our centre to carefully plan and execute complex implant treatments.
Endodontics (Root-Canal) Treatment
When a tooth is infected or has extensive dental caries extending into the pulp/ nerve chamber, the nerve has to be removed and the root/s inside filled with an inert material. This is referred to as root canal/ endodontic treatment. This treatment is not always straightforward. Complex and curvy canals often presenting challenging scenarios which are best treated by a specialist endodontist. At MEP we work closely with endodontists to help patients with these treatments.
The periodontium is the tissue surrounding a tooth. It forms the supporting foundation of our dentition. An unhealthy periodontium can result in poor support, loose teeth and eventual loss of the teeth concerned. Periodontal treatment is performed by referral to an experienced and qualified specialist who works closely with our centre to bring you the best care possible. Implants in difficult areas such as the upper front teeth should be carefully planned and placed by a periodontist with great precision and highly aesthetic outcomes.