Endodontic Treatment/Root Canal

Endodontics is a branch of dentistry, involving the diagnosis and treatment of the internal part of the tooth, called the dental pulp. The most commonly performed procedure in endodontics is a Root Canal Treatment.

When you look at your tooth in the mirror, what you see is the crown. The rest of the tooth, hidden beneath the gum line, is called the root. Though the outer portion of the root is a hard tissue called dentine, the inside channel or “root canal” contains a pulp of soft tissue, blood vessels and nerves. 
Bacteria that gain access into the pulp as a result of tooth decay, periodontal disease, tooth fracture or other problems, can severely damage the pulp. When this happens, endodontic treatment can be carried out to remove the diseased pulp to save the tooth and prevent further infection and inflammation. 
After successful endodontic treatment, the tooth continues to perform normally. Usually the alternative to endodontic treatment is extraction of the tooth.

Our Endodontic Services Include:
– Non-surgical Root Canal Treatment
– Root – Canal Retreatment
– Apicoectomy (An Apicoectomy, or Root-End Resection, is the removal of the root tip and the surrounding infected tissue of an abscessed tooth. This procedure may be necessary when inflammation and infection persists in the area around the root tip after Non-surgical Root Canal Treatment or Root Canal Retreatment) We routinely do a cone beam CT scan of the tooth of interest (scan size 4cm X 5cm) before any endodontic retreatment is carried out.

We utilize Zeiss operating microscope to assist in locating root canals, visualizing tooth structures and aiding diagnosis. TF (SybronEndo) rotary instruments are used by us to prepare root canals, and Elements (SybronEndo) thermoplastic GP obturation system is utilized to fill the canals.

Oral Surgery

The removed tooth can be replaced with an implant, a denture, or a bridge. A bridge is a replacement for one or more (but not all) of the teeth and may be permanent or removable.

Wisdom Teeth Removal
Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.

Wisdom teeth present potential problems when they are misaligned – they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed “impacted.” Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.

The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Frequently a surgical procedure needs to be carried out to extract a molar that is recommended to be removed, especially if it is impacted. Almost routinely, x-rays are required to analyze tooth shape and configuration, prior to any treatment plan formulation or any surgical procedure being carried out. 
This includes sometimes the necessity to do a 3D cone beam CT analysis only of the area of interest (scan volume- 4cm X 5cm).

Biopsies: The procedure maybe carried out without any anesthesia with the WaterLase (Biolase) dental laser or sometimes under local anesthetic, that is, you will be awake and have an injection to numb up the tissue in question. You may need to have stitches at the biopsy site that dissolve over the next 10 – 14 days. You can expect some discomfort and possibly swelling afterwards. These will settle over the next few days. The whole process should take less than 30 minutes. 

Pre-prosthetic Surgery– Alveoplasty (also called an alveoloplasty) is a surgical procedure that smoothes or re-contour the jawbone. An alveoplasty is done in areas where teeth have been removed or lost (especially if a dental clearance has been done). 

Dry Socket, also known as dento-alveolar osteitis, alveolar osteitis, alveolitis, focal osteomyelitis without suppuration, alveolalgia, alveolitis sicca dolorosa and alveolar periostitis, is a well-recognized complication of tooth extraction. It is characterized by increasingly severe pain in and around the extraction site usually starting on the 2 – 4 post- operative day and can last for 10 – 40 days. The pain radiates typically to the ear. The normal post-extraction blood clot is absent from the tooth socket; the bony walls of the socket are bare and exquisitely sensitive to even gentle probing. Bad breath and an unpleasant taste in the mouth are invariably present. The condition probably arises as a result of a complex interaction between surgical trauma, local bacterial infection and various systemic factors. We have a number of treatment protocols to deal with this.

Orthodontic Services

Orthodontic treatment is used to straighten or move your teeth to improve their appearance or function. It can also help to keep your teeth and gums healthy by spreading the pressure of your bite out evenly. Straight teeth are easier to clean and are less vulnerable to tooth decay and gum disease.

Orthodontic treatment usually involves wearing a brace on your teeth. This puts gentle pressure on specific teeth to move them into the right place. You will usually need to wear a brace for between six months and two years. During this time, will monitor you closely and make adjustments to the brace.

Sometimes, if there is not enough room in your mouth, you may need to have teeth taken out before starting orthodontic treatment. If your condition is very severe, you may need to have jaw surgery to correct your bite, but this is rare.

Orthodontic treatment is usually carried out during childhood, but adults can have it as well.

Our orthodontic services include:
Removable Braces: Removable braces are made of plastic and usually have wire clips and springs to move specific teeth. They are most commonly used to move your upper teeth. 

Fixed Braces: Fixed braces (sometimes called ‘train tracks’) cannot be removed from your teeth – except by your dentist when your treatment is finished. They are made of small brackets that are glued to your teeth with filling material and are joined together with a wire. Fixed braces are usually made of metal, but can also be made of plastic or ceramic. You may need to have small elastic bands attached to your brace – these are used to keep the wires in place and are often available in different colors. Fixed braces can be used on both your upper and lower teeth. In our practice, we use MBT prescription Straight wire fixed appliances.

Retainers: Retainers are braces that help your teeth stay in the correct place after your orthodontic treatment has finished. They can be removable or fixed. Without a retainer, your teeth will move back towards their original positions.

Aligners: are removable, plastic moulds that are used to move your teeth into place. They are made from clear plastic so are not very noticeable and aesthetically pleasing. You usually wear a set of aligners for two weeks before having them replaced with a new set. You need to wear your aligners for at least 22 hours a day.

Functional appliances: can only be used for children, particularly in their early teens. The appliances are used before fixed appliances to reduce the discrepancy between the upper and lower jaws and therefore the teeth. These appliances are also applicable for many patients with less severe problems. An example of a functional therapy that we commonly prescribe is wearing of Twin-Block appliance.

Periodontal Services
Periodontal disease (also called periodontitis or gum disease) is a bacterial infection that destroys the supporting structures that hold your teeth in place. Your gums are the first line of defense against bacterial infection, but once the infection has broken through them, it will begin to attack the ligaments and bone that hold the teeth in the mouth. It is in this stage of periodontitis that loss of bone due to bacterial erosion can occur, which will then cause the pocket (space between the gum and tooth) to grow deeper and wider. 

Periodontitis is often a silent disease as those who suffer from it rarely experience pain, and may not even be aware that there is a problem. The early stages of gum disease are seldom painful, and carry with them very few warning signs. Some of the early warnings to look for are slight bleeding while brushing, softening of the gums, and discoloration of the gums (darker red/irritated in appearance rather than a light, healthy pink). As the disease progresses, more noticeable signs may become more predominant. 

Some examples of these more serious indicators are:
– Swollen gums
– Inflamed gums 
– Bright red or purple gums 
– Receding gums that make your teeth look longer 
– Trench mouth (thrush)
– Spaces developing between teeth
– Persistent bad taste
– Sores in the mouth
– Chronic bad breath (halitosis)
– Loose teeth
– Pus between the teeth and gum line (pyorrhea) 
– Tender gums when touched 
– Change in the way teeth fit together when you bite

Our Services Include:
Cleaning and Teeth Polishing: Dental cleanings involve removing plaque (soft, sticky, bacteria infested film) and tartar (calculus) deposits that have built up on the teeth over time. The purpose of the cleaning and polishing is basically to leave the surfaces of the teeth clean and smooth so that bacteria are unable to stick to them and you have a better chance of keeping the teeth clean during your regular home care. A variety of instruments is available to us, which we utilize to carry out this procedure. Amongst them, include hand scalars and curettes, piezo-electric ultrasonic scalers and rotary instruments.

Crown Lengthening:
This is a simple surgical procedure where gum tissue is removed, bone or both to expose more of a tooth.

Osseous Surgery: 
Osseous Surgery is designed to modify and reshape deformities in the alveolar bone surrounding the teeth. It is a common requirement in effective treatment of more involved periodontal diseases. In some instances, the bony support of the tooth assumes an unusual configuration as a result of uneven progression of the disease. When this occurs, modification of the altered bone support may be indicated.

Gingivectomy: 
Gingivectomy is periodontal surgery that removes and reforms diseased gum tissue or other gingival buildup related to serious underlying conditions. For more chronic gingival conditions, gingivectomy is utilized after other non-surgical methods have been tried, and before gum disease has advanced enough to jeopardize the ligaments and bone supporting the teeth.

Dental Implants 
Dental Implants: to replace single or multiple missing teeth. Are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. You will regain the ability to eat like you did with your natural teeth and can smile with confidence. 

A dental implant is an artificial tooth root that can be placed into your jaw to hold a replacement tooth or bridge. Dental implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.

Before an implant is placed, radiographical assessments will be made at our surgery using the latest ProMax 3D (Planmeca) Cone Beam 3D CT scan. This ensures a highly accurate assessment is made of the implant site and the type of implant intended to be used.

Surgical placement of the implant(s) into the bone. This is usually done in our surgery, under local anesthesia. After surgery, there is a healing period of approximately four months. During this time, the implants fuse to the bone by a process known as ‘osseointegration’ Next, there is a minor surgical exposure of the top of the implant, whereby the post to the implant will be attached. The function of the post is to become the support for either one tooth or a set of teeth. This short procedure usually requires only local anesthesia. The last phase is the restorative phase. Impressions will be taken and then the prosthesis will be made that will attach to the implants. This will require several visits. Once completed, your mouth will be restored to natural looking, strong teeth. 

At our practice, we use the Nobel Biocare Replace System; NobelReplace is a versatile, easy-to-use, predictable implant. NobelReplace is the world’s most used implant system and has achieved this by performing well in all indications, through its ease-of-use, and due to its wide range of prosthetic options:

NobelReplace performs well for all indications including soft and hard bone, one- and two-stage surgical protocols, flapless and flapped procedures, and immediate and delayed loading procedures.

NobelReplace offers access to Nobel Biocare’s industry-leading CAD/CAM individualized, temporary and prefabricated prosthetic assortments

Fillings
A dental filling is usually a two-part step. It is first the removal of decaying tooth matter, caused by cavities, or alternately, the removal of damaged tooth matter caused by injury. Secondly, the dentist applies different materials, to fill the removed portion of the tooth, which allows the person to have full function of that tooth.

The types of filling done at our practice include:
Sliver Fillings: Stewart Street practice has stopped doing mercury containing silver amalgam fillings a few years ago, and we are the first practice to go amalgam free.

White Fillings (Tooth-Colored Resins): Composite resin is a filling material designed for aesthetic dental restorations. These fillings resemble the color of your natural tooth and are often used for filling smaller dental cavities or for dental bonding front teeth.

Glass Ionomer Fillings: is made of a specific type of glass material, which chemically bond to teeth. This material is most commonly used for fillings below the gum line and for fillings in young children.

Inlays and Onlays: are similar to fillings but is indirectly made in the lab from a variety of materials, including ceramics, gold, precious metal free alloys and resins.

Crowns

Dental crowns (“tooth caps”) are one of dentistry’s most versatile restorations. They offer a way to rebuild and strengthen damaged or compromised teeth and provide a way by which a tooth’s overall appearance (color, shape and even apparent alignment) can be vastly improved. A crown is a type of dental restoration that, when cemented into place, fully cups over that portion of a tooth that lies at and above the gum line. Since it encases the entire visible aspect of a tooth, a dental crown, in effect, becomes the tooth’s new outer surface. Crowns can be made out of porcelain (tooth-colored dental ceramic), metal (a gold or other metal alloy), or a combination of both (porcelain-fused-to-metal).

A dental crown may be needed in the following situations:
– To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth
– To restore an already broken tooth or a tooth that has been severely worn down
– To cover and support a tooth with a large filling when there isn’t a lot of tooth left
– To hold a dental bridge in place
– To cover mis-shapened or severely discolored teeth
– To cover a dental implant

Veneers
Dental veneers are wafer-thin, custom-made shells of tooth-colored materials designed to cover the front surface of teeth to improve your appearance. These shells are bonded to the front of the teeth changing their color, shape, size, or length.

Dental veneers can be made from porcelain or from resin composite materials. Porcelain veneers resist stains better than resin veneers and better mimic the light reflecting properties of natural teeth. Resin veneers are thinner and require removal of less of the tooth surface before placement

Some of the things that can be corrected with veneers include: 
– uneven or crooked teeth
– teeth that have shapes that are out of proportion
– tetracycline stained teeth that have gray color spaces between teeth
– too much gum when you smile
– yellow teeth that are dark and cannot be whitened or bleached
– teeth that are sensitive can be made much less sensitive
– worn down teeth that make you look old
– bad bite: this is the most complex use of porcelain veneers and requires bite reconstruction without grinding down you natural teeth

Inlays and Onlays

Inlays
Dental inlays are used to treat teeth that have decay or damage lying within their indented top surfaces. They can also be used to replace old or damaged fillings. Inlay placement is usually carried out over two appointments. During your first visit, an impression of your tooth will be taken, and a temporary inlay will be placed over the tooth. The inlay will be created in our lab to match your tooth’s specifications. In your next visit, the temporary inlay will be removed and the permanent one will be placed over your tooth. Since dental inlays can be made from durable, tooth-colored porcelain, they offer much more enduring and natural-looking results than normal fillings. In addition, their customized nature provides a secure bond between them and the tooth surface, adding structural integrity and preventing bacteria from entering and forming cavities.

Onlays
Onlays are used to treat decay that extends to one or more of the cusps. Onlays are placed in much the same way as inlays. First, an impression of the decayed tooth is taken, and a temporary onlay is placed over the tooth. The impression is then used to create the onlay according to the tooth’s dimension in our lab. Like dental inlays, onlays can be created from tooth-colored porcelain, which makes them virtually undetectable to the naked eye or from metals like gold. Onlays also help to conserve more tooth structure because their use requires minimal removal a tooth’s surface. Perhaps their most important benefit, however, is that, in saving damaged teeth, onlays help patients avoid the eventual need for more extensive treatment with dental crowns, dental bridges, or dental implants.

Bridges

Dental bridges literally bridge the gap created by one or more missing teeth. For example, a typical 3 unit conventional bridge is made up of two crowns for the teeth on either side of the gap; these two anchoring teeth are called abutment teeth – and false tooth/teeth in between. These false teeth are called pontics and can be made from gold, alloys, porcelain, or a combination of these materials.
Some of the things that bridges can achieve:
– Restore your smile
– Restore your ability to properly chew and speak
– Maintain the shape of your face
– Distribute the forces in your bite properly by replacing missing teeth
– Prevent remaining teeth from drifting out of position
– Replace a removable prosthesis e.g. acrylic denture

Teeth Whitening

Bleaching is a whitening procedure that does not require any removal, cutting or etching of your teeth. Products like tea, coffee, red wine, tobacco, and the natural aging process make teeth darker or stain them over time.
Professional dental whitening is performed with the aid of active oxygen, which decolorizes the distracting color pigments present in the tooth. We use Zoom (discus dental) whitening system in our practice. 

There are dental aids and products, which allow for tooth whitening treatment from the comfort of your own home in custom made trays that the dentist will construct. In only a day or two, your custom bleach trays will be ready for you. We will provide a special bleaching agent that you put into the clear, nearly invisible trays. With only a few hours of use per day, the bleaching agent removes stains from your enamel in a very short time without altering tooth structure or existing dental work in any way. When you are satisfied with the resultant color than only occasional treatment will be required to maintain the results.Teeth Whitening

Dentures

A denture is a removable replacement for missing teeth and surrounding tissues. Two types of dentures are available: complete and partial dentures. Complete dentures are used when all the teeth are missing, while partial dentures are used when some natural teeth remain.

Dentures are created in our own lab in a few general steps:
– A series of impressions of your jaw will be taken together with measurements of how your jaws relate to one another and how much space is between them.
– Models, wax forms, and/or plastic patterns in the exact shape and position of the denture to be made will be created. You will “try in” this model several times and the denture will be assessed for color, shape, and fit before the final denture is cast.
– Cast a final denture
– Adjustments will be made as necessary

Some of the different types of dentures that we construct in our clinic/ lab are:
Full Dentures – Full dentures are given to the patient who has lost all the teeth. Normally after the extractions, the patient is advised to wait for one to two months. However, if patient cannot wait even for a day then the immediate dentures are given.

Immediate dentures – not only restores the facial profile immediately but also helps in the healing of the extraction socket.. Usually a later relining of the fitting surface becomes necessary when the gums heal.

Partial Dentures: dentures are given when the tooth loss is not complete. Few teeth are extracted and few are left in the mouth. The partial dentures are given to replace the few lost teeth. 

Cast Metal Partial Dentures: they are usually superior partial dentures. They are stronger, less bulky and offer best fit compared to acrylic dentures. In this, there is cast metal frame on which the acrylic teeth are attached. 

Acrylic Partial Dentures: in this type of dentureIn this type of denture, the base is acrylic on which the acrylic teeth are attached. They get retention from the adjacent teeth with small metal clasps. They may be more bulker, but are easier to repair should any mishaps happen.

Implant Supported Dentures: a dental implant supported denture is also referred to as an “overdenture” that is attached directly to dental implants. Regular dentures simply rest on your gums. A dental implant supported denture is attached to implants and as a result fits more firmly in the mouth and permitting little movements, giving patients more confidence in their smile.