Orthodontics is the dental speciality associated with straightening protruded, rotated or malpositioned teeth in children and adults with fixed or removable braces. An Orthodontist is a dentist who specialises in this treatment.
When a tooth is out of position in the dental arch it absorbs more biting force than its neighbours, causing it to loosen prematurely. An orthodontist starts your treatment by taking a detailed look in your mouth. The next step is often to make a study model of your teeth to do a detailed analysis of your bite. After this detailed analysis starts with the treatment.
Orthodontics physically moves teeth with braces into their proper position by pushing them through bone. When the proper amount of pressure is exerted on teeth bone, disappears in the area where the tooth is being pushed into and reappears in the area where the tooth was originally located.
This is normally done using specially made braces. It is usually healthier to treat malpositioned or crooked teeth orthodontically as orthodontics actually corrects the problem. The major drawback to orthodontics is that treatment involves six or more months of annoying braces.
Dental Braces
These deformities could also be treated by non-orthodontic means, but non-orthodontic methods focuses on hiding the problem rather than correcting it. However, main advantage with non-orthodontic treatment is that it usually takes only one to two weeks. Malpositioned teeth can be made to appear in proper position with non-orthodontic methods of sculpting, bonding, porcelain laminates (veneers) and/or porcelain crowns.
Sculpting is gentle reshaping the teeth with a drill. This technique can simply and dramatically reshape crooked teeth. The benefits of this technique are its simplicity and cost-effectiveness. However, it cannot be used to treat more severe cosmetic problems.
Denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.
Partial Dentures
Candidates for complete dentures are patients who have lost most or all of their teeth. Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position. Complete dentures are either “conventional” or “immediate.” A conventional denture is placed in the mouth about a month after all the teeth are removed to allow for proper healing, whereas an immediate denture is placed as soon as the teeth are removed. The drawback behind an immediate denture is that it may require more adjustments after the healing has taken place. A partial denture is suitable for those who have some natural teeth remaining.
Upper Jaw : Patient wears Complete Denture
A dentist can make a full conventional denture when all teeth have been lost or all extraction sites have healed (up to eight weeks or longer.) The process takes about one month and would involve the following steps. After the initial diagnosis an impression and a wax bite are made to determine vertical dimensions and proper jaw position. Then a “try-in” is made and placed to assure proper colour, shape and fit. Then the final denture is made and placed.
Implants & retaining bar in place
New denture wearers need time to get accustomed to their new “teeth” because even the best fitting dentures will feel awkward at first. While most patients can begin to speak normally within a few hours, many patients experience discomfort for several days to a few weeks. It is often advised to start with soft, easy-to-chew foods. In addition to the discomfort, denture wearers often experience slight change in facial appearance, increased salivary flow, or minor speech difficulty.
Retaining bar with retentive clips, ready to be transferred to denture
A denture is fragile, so it is important to handle it with care. Remove and brush the denture daily, preferably with a brush designed specifically for cleaning dentures, using either a denture cleanser or toothpastes. Never use harsh, abrasive cleansers, including abrasives toothpastes, because they may scratch the surface of the denture. Sterilisation with boiling water is also to be avoided, because it may cause it to become warped. If you wear a partial denture be sure to remove it before brushing your natural teeth. When not in use, soak it in a cleanser solution or in water. Get in the habit of keeping the denture in the same safe and handy place to reduce the likelihood of misplacement.
Retentive Clips
While you may be advised to wear your denture almost constantly during the first two weeks- even while you sleep-under normal circumstances it is considered best to remove it at night. Research has shown that removing the denture for at least eight hours during either the day or night allows the gum tissue to rest and allows normal stimulation and cleansing by the tongue and saliva. This promotes better long-term health of the gums.
Complete Dentures
It is important to continue having regular dental checkups so that a dentist can examine oral tissues for signs of disease or cancer. As of aging, your mouth will continue to change as the bone under your denture shrinks or recedes. To maintain a proper fit over time, it may be necessary to adjust your denture or possibly remake your denture. Never attempt to adjust a denture yourself and do not use denture adhesives for a prolonged period because it can contribute to bone loss. When you are in doubt, consult your dentist.
Over Dentures fixed into implants
Fixed partial dentures or FPD are tooth replacements that are fixed permanently in the mouth and cannot be removed for routine cleaning by the patient. These dentures are made to take support from adjacent natural teeth. Unfortunately these dentures can replace only a few missing teeth. When a large number of teeth are missing one has to go in for a removable partial denture.
Lower implants in place
Fixed partial dentures are of various types. They can be made of porcelain or metallic alloys. The metallic FPD’s are made of either gold alloys or chrome cobalt alloys. Metallic FPDs are fixed partial dentures that are made of metal alloys such as gold alloy or chrome cobalt alloy. The metallic FPD’s are used mostly in the back teeth, as they are not esthetic in appearance. In case aesthetics is important the metal crowns can be given an acrylic or porcelain facing over the areas that are visible to the exterior so as to make them esthetically acceptable.
Lower jaw: Fixed denture secured to implants with screws
Removable partial dentures or RPD usually consist of replacement teeth attached to pink or gum-coloured plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments are generally more aesthetic than metal clasps and they are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. Dentures with precision attachments generally cost more than those with metal clasps. Consult with your dentist to find out which type is right for you.
Dentures are no longer the only way to restore a mouth that has little or no non-restorable teeth. Strategically placed support, or implants, can now be used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble the “feel” of real teeth. Dental implants are becoming the alternative of choice to dentures, but not everyone is a candidate for implants.
Root canal treatment, which is also known as Endodontic treatment, is needed when the blood and nerve supply of the tooth is infected or inflamed. This can be caused by decay or injury. The infection may spread throughout the entire root canal system and can eventually lead to an abscess. Root canal treatment is required to stop the spread of the infection and should prevent the tooth from being extracted.
Tooth Structure
When your tooth’s nerve chamber becomes infected by decay, root canal treatment is often the only way to save your tooth. Inside your tooth’s hard outer shell is a nourishing pulp of blood vessels, lymph vessels and nerves. The root’s canal, allow these vessels and nerves to extend to the bone. Deep tooth decay, or injury can cause serious damage and infection to the pulps nerves and vessels.
Infected & Inflamed Pulp Tissue
In Root canal treatment the infected pulp chamber and canals are cleaned. The treatment is carried out with the use of local anaesthetic and is generally pain free. The treatment involves the removal of all infected tissue from the root canal, by cleaning and filling to prevent any further infection. This procedure normally takes more than one visit and a temporary filling is usually inserted to give the tooth and surrounding area time to settle. The tooth is checked on a later visit and permanently filled. Occasionally the tooth can darken after root canal treatment but if this does occur there are several procedures that may be carried out to restore the natural appearance of the tooth.
Damaged Pulp & Abscess
Spontaneous pain or throbbing
Pain while biting or chewing
Sensitivity to hot and cold
Severe decay or injury that causes an abscess (infection) in the bone surrounding the tooth.
Endodontic treatment can often be performed in one or two visits and involves the following steps:
Endodontist start with local anesthesia on the tooth on which root canal treatment is to be performed. This primarily avoids any pain and helps you be cooperative to the treatment. After your tooth is numb, the endodontist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
The endodontists makes an opening in the crown of the tooth. Very small instruments are used to clean and shape the pulp chamber and root canals, to prepare the canals for filling. On back teeth this hole is made on the chewing surface of the tooth. On front teeth the access hole is made on the tooth’s backside.
After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually with a rubber-like material called “gutta-percha” The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored.
After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to it’s full function. If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may place a post inside the tooth.
Signs of needing root canal treatment include pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes as well as nearby bone and gingival tissues. Sometimes, however, there are no symptoms.
Crowns & Bridges are the two ways to repair or replace the missing teeth.
Crown or a ‘cap’ is a restoration that is used to replace a single tooth. A series of crowns can be used to replace several teeth. The Crown can be made to fit over an existing tooth or can be attached to a dental implant. A crown (or cap) completely covers a damaged tooth to restore it to its normal size and shape.
Dental Crowns
Crowns are often recommended in conjunction with root canal treatment, as the tooth tends to become brittle and is more likely to fracture. Crowns strengthen and protect the remaining tooth structure and improve the appearance of your teeth.
Crowns are used to restore both anterior and posterior teeth that have been broken or are at high risk of doing so due to over-sized old fillings or fractures.
Before a dental crown can be placed the tooth must first be trimmed so it is tapered in shape. This tapered aspect of the tooth will extend up into the dental crown’s center and is a very important factor in the crown’s stability. After the needed shape has been achieved your dentist will take an impression of the tooth, which in turn is sent to a dental laboratory, which will create the crown. Once the dental lab has completed your crown your dentist will cement it in place.
Filling
Cavities (decay, Dental caries) start mainly as a result of bacterial action on the food particles that stick to teeth. Certain types of bacteria break down these food particles, producing acidic substances, which erode the enamel of the teeth and roughen it. The enamel is made up of calcium compounds mostly) More food particles stick to these roughened areas which get colonized by the bacteria, eroding the enamel and then the second layer, dentine.
Tooth decay or caries usually starts on the crown and the filling or restoration is limited to the crown if the decay has not reached the pulp. Once the decay (and bacteria) get into the pulp, the root canal has to be cleaned, disinfected and filled. This may require one or many sittings depending on whether the infection is limited to the root canal or if it has spread into the bone, beyond the root canal.
Silver amalgam (a mixture of mainly silver and mercury), composite resins, Glass ionomers etc are some of the main materials used for restoring decayed teeth. Metals and ceramic, prepared to the exact dimensions of the cavity also are used.
Bridge is a way to replace one or more missing teeth and is permanently fixed in your mouth. Spaces left by missing teeth affect the rest of your teeth. Replacement of missing teeth makes it easier to chew, improves your appearance and also keeps your teeth, gums and jaws healthy. Even if only one tooth is out of place other teeth may slowly shift, in turn changing the way your teeth meet (your bite).
The maximum number of teeth that can be replaced by a bridge is two to three. Much depends upon the health of the remaining teeth and in which area the teeth are missing. Bridges are fixed on non-removable prosthesis constructed to replace one or more missing teeth. The teeth on either side of the existing space are used to anchor the bridge to restore functionality as well as aesthetics.
Beautiful porcelain over metal bridges as well as full porcelain and resin-based bridges are available producing the best results depending on the particular situation and requirement.
Missing & gaped teeth replaced with Bridge
The missing tooth in the above pictures could be replaced with a bridge. The teeth either side of the gap are prepared for crowns that will support a bridge across the gap. Here, the finished bridge has been placed in the mouth using permanent glue.
Unlike a normal bridge that is attached to teeth on both sides, a cantilever bridge is one that is attached only on one side to the remaining teeth. The other side is free or unattached. These cantilever bridges are indicated when the tooth to be replaced is the last one and does not have remaining teeth beyond it. These bridges have poor prognosis in the long run.
Bonded Bridge
The resin bonded fixed partial dentures are those that are bonded to adjacent teeth using acrylic resins. Unlike the conventional bridges these resin bonded ones need less reduction of the adjacent remaining teeth and are therefore more conservative.
In the past, dentists used to keep or replace teeth with treatments such as root canals, bridges and fixed or removable dentures. Unfortunately, root canal treated teeth fail, as those are still prone to tooth decay. In the case of bridges healthy adjacent teeth are cut down. Removable dentures are often unstable and fixed dentures require the use of sticky adhesives. Dental implants are a solution to these problems.
Dental Implant, Abutment & Crown
A dental implant is a small man-made titanium screw that serves as the replacement for the root portion of a missing natural tooth. Dental Implants eliminate many of the concerns associated with natural teeth including tooth decay.
A missing lateral incisor restored with an Implant and an all-ceramic Crown
A dental implant replaces the root of a missing tooth and is made from surgical-grade titanium to exacting specifications. Initially, the implant is placed into the jawbone either immediately after the loss of a tooth or after an extended period of time. If there is insufficient bone, various bone enhancing procedures can be performed prior to the implant placement.
A missing lateral incisor replaced with an implant and an Abutment Crown
An abutment, which acts as a base for a prosthetic tooth replacement such as a crown, is inserted into the implant at the time of implant placement, or subsequently after a period of healing.
Two teeth restored with implants and two individual Abutment Crowns
Dental implants offer many benefits never before available for the treatment of missing teeth. In short, dental implants will look, feel and function like your real teeth.
Dental implants can be used to replace a single lost tooth or many missing teeth.
Dental implants are a proven restorative option with a long clinical history. Dental implants preserve the integrity of the facial structure and reduce the inconvenience associated with tooth loss. The implant is placed in the bone of the upper or lower jaw. It is allowed to bond with the bone and serve as an anchor for the replacement tooth.
Three teeth restored with implants and individual Abutment Crowns
If you are missing one or more teeth then you are a candidate for dental implants. The placement of a dental implant is typically completed in less than an hour with only local anesthesia. Post-operative discomfort is normally less than that of a tooth extraction. For aesthetic reasons, a fixed transitional restoration is done immediately after implant placement, so that you are never without a tooth. A period of three to six months is allowed for healing. Then the temporary healing abutment is removed from the implant and a final abutment is inserted. A crown or removable denture is then secured to this abutment completing the restoration.
Restored Upper teeth with twelve implants and individual Abutment Crowns
Implant supported replacement teeth look, feel and function like natural teeth allowing you to eat your favourite foods with increased chewing ability. It also improves your appearance, speech and thus your self-esteem.
Complete teeth restored with multiple implants and individual Abutment Crowns
The benefits of implant treatment include appearance, the enhanced ability to chew and enjoy your food, and often protection of your remaining teeth and jawbone.
Retention of a denture with implants and without covering the palate
A full upper denture covers the palate of the mouth and reduces the ability to taste foods.
Dental implants require less maintenance than a natural tooth. Simple brushing as with natural tooth is good enough for restored tooth.
