Oral Health Guide 2013 Esthetic Dentistry

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DENTAL LAMINATES Dr. Bhavna Rai Prosthodontist, Al Jahra Dental Center

The face is the most esthetically prominent part of the human body. An important component of the face is the mouth and teeth.

What are porcelain veneers?

Porcelain veneers (sometimes called dental veneers or porcelain laminates) are thin, usually custom-made shells of tooth-colored materials designed to cover the front surface of teeth to improve appearance. These shells are bonded to the front of the teeth altering their color, shape, size, or length. Veneers can be made from porcelain or from resin composite materials. Porcelain veneers resist stain better than resin veneers and better mimic the light reflecting properties of natural teeth.

An attractive smile An attractive smile plays a key role in a person’s sense of wellbeing, their acceptance by others, success at work, in relationships, and emotional stability. A successful person will invariably be confident, and have an attractive smile. If on smiling and conversing, the dental problems are visible; this would create a different impression.

Some individuals try to hide dental problems by holding their hands over the lips to show as little of the teeth as possible.

Well aligned teeth are an important part of an attractive smile. A person’s smile is determined by the shape, color, size and arrangement of the teeth in the mouth. ‘Keep a smile on your face and let

your personality be your autograph’ is a famous saying, and thus a compromised smile from the irregularity of the teeth structure would jeopardize the individual’s self-esteem and confidence. An impaired self-image may be more disabling than pertinent physical defect. On improving their appearance, the person goes through life with a positive self-image. The science of improving the appearance of the dental arch is termed as Esthetic Dentistry or Cosmetic Dentistry.

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Dental Laminates

Porcelain Laminates The objective of Cosmetic Dentistry is to provide the maximum improvements in esthetics with minimum trauma to the dentition. Earlier full crown replacements were the rule of thumb to reshape and modify teeth. Full crown replacements required extensive removal of tooth structure. It alters the incisal guidance, the contact points, morphology, food flow patterns and phonetics which, then have to be re-established. Psychologically, it feels like an invasive procedure.

The porcelain laminate veneers are recent, minimally invasive and a very exciting development in the dental armamentarium. The dental surgeon can change the appearance, size, color, spacing, shape and to a minor extent even the positions of teeth. Many laminate veneering procedures can be accomplished with little or no preparation of the natural teeth and in some cases do not require anesthesia.

Types of Laminate Materials Currently there are 3 types of laminate materials available 1. Porcelain 2. Resin 3. Ultra thin laminates

When do I need laminates?

Porcelain Laminate Veneers are mostly indicated in the following clinical conditions (see pictures): v Stained or darkened teeth, v Hypo calcification (white spots or patches of discoloration on the teeth) v Diastemas (Spacing between the teeth- commonly seen between the two front teeth) v Peg Laterals (abnormal conically shaped teeth that are small in size, usually seen in lateral incisor teeth) v Chipped Teeth (edges of the teeth are broken in sports and fights or due to oral habits like nail biting, grinding, eating of melon seeds) v Mildly rotated teeth v Teeth positioned out of the arch (moderately lingually or labially placed) v Stained old restorations (old fillings with tooth colored plastic materials) v Worn-out teeth(from habits like clenching and grinding at night) v Midline which has shifted v Toothbrush abrasions (teeth damaged by faulty brushing) v Worn Acrylic Veneers (Old Plastic Restorations) v Bonding to existing bridges (restored missing teeth by bridges where tooth colored facing is lost) v Missing Lateral Incisors (Canine is modified to look like laterals)

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When should I avoid laminates?

Porcelain Laminate Veneers cannot be used in cases of: v Root canal treated teeth v Excessive spacing between the teeth. v Very poor oral hygiene. v Certain contact sports.

Indications For Porcelain Laminate Veneers

Stained or Darkened Teeth

Stained Composite Restoration

Hypocalcified white Discoloration

Failed Acrylic Veneer

Toothbrush Abrasion

Worn Acrylic Veneers

Chipped Acrylic Veneers over the Bridge v v v

Acrylic Veneers Failures bonded to Dentin

Extreme clenching and bruxing habit Extreme or major midline deviation Protruding teeth

How are Laminates made?

Traditionally, laminates used to be made in the laboratory by a layering and baking process. Currently laminates are increasingly being made in CAD CAM machines. These machines create the laminates by grinding a block of porcelain.

How many appointments do I need?

A minimum of 2 to 3 appointments are usually needed. The first appointment is usually a consultation appointment. It involves your active participation. Explain to your dentist the result that you are trying to achieve. During this appointment, your dentist will examine your teeth to make sure dental veneers are appropriate for you and discuss the procedure and its limitations. He or she also may take X-rays and possibly make impressions of your teeth. At the second appointment your dentist will perform 31 doctors book.indd 31

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Dental Laminates

Treatment with Porcelain Laminate Veneers

Correction of Stained or Darkened Teeth

Correction of Spacing

Correction of Old Failed Plastic Fillings

Correction of Peg (Small) Laterals

Disadvantages of porcelain veneers v Veneers are more costly than composite resin bonding. v Porcelain veneers are usually not repairable should they chip or crack. v Because enamel has been removed, the tooth may become more sensitive.

the actual procedure and make the necessary impressions to give you temporaries. During the third appointment the laminates are usually tried in the mouth. If everything is satisfactory, it can be bonded onto the teeth the same day.

Are laminates painful?

Usually a small amount of tooth material needs to be removed from your tooth to make space for the laminate. This is usually best done with an anesthetic to reduce your discomfort. After the procedure, a temporary laminate may be placed.

If the bonding has been performed carefully and without a gap, usually there is no pain nor sensitivity. However, a slight gap or leakage can cause a slight sensitivity. In case of severe sensitivity, it is best to go for a root canal treatment.

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How are laminates glued on?

Before the dental veneer is permanently cemented to your tooth, your dentist will temporarily place it on your tooth to examine its fit and color. He or she will repeatedly remove and trim the veneer as needed to achieve the proper fit; the veneer color can be adjusted with the shade of cement to be used.

Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished, and etched -- which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and it is then placed on your tooth. Once properly positioned on the tooth, your dentist will apply a special light beam to the dental veneer, which activates chemicals in the cement, causing it to harden or cure very quickly.

Ultra-Thin Laminates As an alternative to conventional porcelain veneers/laminates which requires tooth preparation of 0.5 mm, there are newer materials available that don’t require any tooth reduction. They are crafted out of dental porcelain called Cerinate®. Owing to its exceptional strength, these veneers can be made extremely thin.

Some of the commercially available products are Lumineers, Vivaneers and Durathin. Of which Lumineers are the most widely used.

How thin are they?

Lumineers® can be as little as 0.2 to 0.3 millimeters thick. That is less than 1/64th of an inch, and similar to the thickness of a contact lens. In comparison, conventional porcelain veneers typically require a minimal thickness of at least 0.5mm.

What`s the advantage of no-prep placement?

The main advantage of the ultra thin veneer lies in the technique used for its preparation.

A)

B)

Conventional Veneer placement.

When regular porcelain veneers are placed, the dentist will first grind away some of the front side of the tooth.

Usually they trim an amount that is about the same thickness as the porcelain veneer they plan to place. And although that is just a very slight amount, the patient will have to sit through this drilling process, and an anesthetic may be required. For some people, that is more than what they want to endure.

Lumineers placement.

Since Lumineers® can be made ultra-thin; they offer the option that they can be bonded directly onto a tooth surface, without trimming it back first. This avoids the need for any tooth grinding and anesthesia. Since there is no tooth reduction, the patient does not require temporary veneers.

Not all dentists think the use of this technique is such a good idea. And, in fact, there is a fair amount of debate in the dental community about if and when veneer placement using a no-prep approach makes a reasonable choice.

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Dental Laminates

CASE SELECTION For a successful treatment with Lumineers proper case selection is a must. Here are the guidelines: 1.

Teeth that require just minor cosmetic or colour improvement.

2.

Teeth that are already fairly straight.

3.

Patients who have relatively small teeth, especially those that have gaps between them, often make ideal candidates for no-tooth preparation veneers.

4.

The same goes for people whose teeth are slightly lingually inclined (tip inward somewhat as opposed to being bucked). In these cases, the added thickness of the veneer helps to create the change that is required.

LUMINEERS Technique

TRADITIONAL VENEERS Technique

BEFORE Teeth are stained, slightly misshapen with spaces in-between.

An impression is made and the mold is sent to the Laboratory where only Lumineers are crafted.

AFTER Teeth appear stained and slightly misshapen. An impression is made and sent to a lab.

Lumineers Veneers No Painful Tooth Preparation On next dental visit, the dentist tries in Lumineers to ensure a good fit. Teeth are moderately etched to prepare for placement but there is no removal of sensitive tooth structure, unlike the painful part of traditional veneer techniques. The Lumineers are bonded to natural teeth and set in place with a curing light.

Traditional Veneer Tooth Preparation Anesthetic shots are given to numb the area and teeth are severely shaved away with a drill to accommodate the veneers.

Pain Free After In only 2 easy dental visits, your patient will have a permanently whiter and beautiful smile without shots, drilling, or pain.

Potentially Painful After A better, but still flawed smile, as the procedure is not reversible like Lumineers since, the original teeth have been shaved down the patient may suffer pain and discomfort immediately after the procedure.

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ADVANTAGES AND DISADVANTAGES No-drill, no-shots veneering technique is not better than conventional placement, it is simply different.

The disadvantages are 1.

Ultra thin veneers are often very opaque. Poor light handling characteristics of these opaque veneers make it difficult to duplicate the life like appearance of natural teeth.

2.

May appear bulky or over contoured since there is no preparation. But dental research shows over contoured restorations by as little as 0.5 mm can cause adverse effects like gingival inflammation.

“Root canal? You have charged me for the Suez canal!�

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OWARDS A BRIGHTER SMILE BLEACHING SIMPLIFIED Dr. George P Alex, MDS, Endodontist,Farwaniya Specialized Dental Centre.

A dazzling smile is an asset to one’s personality.

Over the years, neatly aligned white teeth have come to signify an attractive smile.With the constant urge of mankind to look good, especially among peers, more and more people are turning up for medical help to attain a brighter smile.

Bleaching is one of the techniques available to achieve a brighter smile, provided the teeth are all in perfect condition.

Why Do Teeth Discolour ?

Before we go in to the treatment options available for whitening the teeth, let us examine why they tend to discolour. Although the tooth colour varies from person to person, it is a known fact that it tends to get darker with age. The discolouration of teeth or staining of teeth can be of two types.

1) Extrinsic Stains – These are stains which occur on the surface of the teeth due to various external factors like smoking, excessive use of tea/ coffee/coloured beverages or poor brushing habits. These stains can be easily removed by thorough cleaning by a dentist, teeth bleaching in some cases and proper maintenance thereafter.

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2) Intrinsic Stains – They are caused due to changes within the tooth structure, during its development. It may be caused by intake of some medications, excessive fluoridation or due to any trauma to the teeth.

Treatment options differ based on which type of stains the patient presents with.

Teeth Bleaching Vs Teeth Whitening Although these two terms are used interchangeably, in the strict medical sense they differ. According to the FDA, which is a regulatory agency, the term “bleaching” is permitted to be used only when the teeth can be whitened beyond their natural colour and this applies strictly to products that contain bleaching agents like Hydrogen Peroxide or Carbamide Peroxide. The term “whitening“ refers to restoring a tooth’s surface colour by removing the dirt and debris and any product that cleans, such as a tooth paste can be considered a whitener.

Teeth Bleaching Let us discuss in detail the different types of bleaching techniques practised in modern dentistry. Any kind of bleaching procedure of

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Bleaching

teeth should be done only after consulting your dentist. Depending upon the severity of the darkness or the amount of whiteness desired, the dentist may recommend two kinds of bleaching treatment.

He/She will then use a shade card guide to determine the natural color of the teeth and discuss with the patient the amount of brightness that is desired.

Based on where the treatment is done, it is broadly divided as 1) In Office Bleaching - which is done in a dental clinic by the dentist; 2)

3)

Professionally Supervised Home Bleaching - which is done by the patient at home after the dentist decides the bleaching agent and fabricates the tray for the patient ;

Hydrogen Peroxide is the most preferred bleaching agent and various methods like heat, light, laser are employed to get the desired result.

Over the Counter Whitening or Bleaching treatment - which is done at home without the supervision of a dentist.

All the above treatment options use some kind of bleaching agent like Hydrogen Peroxide or Carbamide Peroxide but in varying concentrations In Office Bleaching : As the name suggests it is done in the dental clinic and is the most effective and safest option available. The dentist will consider the overall dental and medical health of the patient and decide on the treatment plan. The dentist will first clean and polish the teeth.

Most of the time, significant results can be obtained within one or two sessions of one hour each

In some cases the dentist will fabricate trays for the patient and dispense low concentrate bleaching agent to be used at home. The dentist may also employ anti sensitivity treatment to avoid sensitivity of teeth after bleaching. In all respects ‘In Office bleaching’ is the best option available despite the higher cost associated.

Another type of bleaching treatment done in the dental clinic is ‘Walking Bleach’. This technique is used to bleach a single or multiple front teeth which has discoloured after trauma or Root Canal Treatment ( RCT ). Here the bleaching 38 doctors book.indd 38

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agent is placed inside the tooth structure after completion of RCT and is followed up until the desired colour is achieved.

Over the Counter Whitening or Bleaching treatment: They are the cheapest and most easily available method for teeth bleaching. The bleaching gel in this system has a lower concentration and a ‘one size fits all tray’, whitening strips or paint on applicators. In many cases this may only partially whiten some teeth .

Professionally Supervised Home Bleaching: This is done at home but as the name suggests, under the doctor’s supervision. The dentist will complete all the necessary preparatory treatment and prepare a tray according to the patient’s teeth and decide on the bleaching agent, its concentration, time and period of the treatment.

Carbamide Peroxide is the preferred bleaching agent. It will be applied to the custom made trays and these trays will be worn by the patient for a fixed number of hours or minutes for a specific time period. They can give excellent results as the bleaching agent is in constant contact with the tooth surface for a longer period of time.

Risks associated with Teeth Whitening: Although teeth whitening treatments are generally safe when it is executed properly, some risks can be associated to it: 1) Sensitivity – Bleaching can cause a temporary increase in sensitivity to temperature, pressure and touch. Patients with gum recession, cracks in teeth and faulty restorations are more prone to it, which may last for couple of days or even more.

2)

Gum Irritation – Many patients experience gum irritation which may last up to several days especially in ‘over the counter bleaching treatment’ as the trays do not fit properly as in other two treatment options.

3) Technicolour Teeth – Tooth coloured restorations, crowns or veneers are not affected by the bleaching agent and may retain their original colour, which may lead to the technicolour effect as the adjacent teeth get bleached and look more white.

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Bleaching

Maintenance of Bleached teeth Maintenance of bleached teeth is important to retain the results. The patient has to pay special attention to his brushing habits as well as control / regulate his intake of hot/cold/coloured beverages.Regular maintenance visit to the dentist is a must as the bleaching regimen may need to be repeated.

Conclusion: To conclude, teeth whitening or bleaching is a commonly used procedure to make an individual’s smile look brighter and more attractive. The results may vary from person to person and if the expectations are realistic, teeth bleaching can boost the personality immensely. Unrealistic expectations and improper procedures can lead to patient discomfort and other teeth related problems. With proper maintenance a whiter, brighter smile can be yours for life.

HOW LONG HAS MR. DANVERS HAD THE SALIVA SUCTION IN HIS MOUTH?

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COSMETIC PERIODONTAL THERAPY Dr. J. David Gnanasekhar Al-Zahra Health Center, Al-Zahra, Kuwait

Dentistry is a science that combines human biology, engineering and art. Periodontology is a dental specialty that deals with the study and management of conditions and diseases that affect the periodontal tissues [(perio = around, dont = teeth) together is referred to as periodontal]. The primary responsibility of any periodontist is to take care of the health of periodontal tissue which includes that part of the jaw bone into which the roots of the teeth are embedded and the overlying gum tissue, so that the teeth can remain firm and functional.

In this modern age, appropriate facial expression and smile have great impact on the individual’s success, prestige and position, both professionally and personally. A good smile requires not just shapely lips and properly aligned teeth, but also requires the gum tissue to have the ideal color and contour and with its margin appropriately positioned on the teeth in relation to the lip line.

There are several conditions and diseases that negatively affect the ideal esthetic characteristics of the periodontal tissue and modify the much needed perfect smile. This article briefly explains

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four of several periodontal conditions that are primarily responsible for causing esthetic problems and how these conditions can be corrected by simple cosmetic periodontal surgery.

Swollen Gum: This is the most common gum condition for which patients seek cosmetic gum treatment. Gum tissue can become swollen due to inflammation caused by poor oral hygiene, habitual mouth breathing, as a side-effect of certain medications or it may be caused by an uncommon hereditary condition. The treatment includes excising the swollen gum tissue, and provide ideal gum contour to help patient maintain good oral hygiene.

1A) Gum swelling caused by a certain medication taken for hypertension.

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Periodontal

1B) Gum swollen due to an uncommon hereditary condition. This condition produces unacceptable appearance, and prevents the person from maintaining adequate oral hygiene.

2A) Gummy smile caused by protruding and large upper jaw.

2B) Gummy smile with short upper front teeth.

1C) The swollen gum tissue was excised, and the resultant good gum contour allows the person to perform normal oral hygiene procedure and maintain periodontal health.

Gummy Smile: When a person smiles and if more than 3mm of the gum is visible below the upper lip line, then this individual is considered to have a gummy smile. Some persons with gummy smile in order to conceal the excessively displayed gum give a restricted smile. Gummy smile may become apparent in persons with short upper lip (incompetent lip), large upper jaw (vertical excess of maxilla) or in individuals with excessive gum tissue covering the teeth that make the upper front teeth appear short. The gummy smile due to the first two causes will not be discussed in this article. However, gummy smile with short teeth can be corrected by periodontal surgery in which the excessive gum tissue is excised and if needed some of the bone just below the gum tissue may also be reduced.

2C) Normal smile 2 months after surgical correction of gummy smile.

Gum Recession: Aggressive tooth-brushing technique, long-standing gum inflammation due to poor oral hygiene are the most common causes for the gum margin to recede and expose the roots of teeth. Mild recession may not cause any symptoms, but as the recession gradually increases the affected teeth can become sensitive to hot and cold food and make the teeth to appear long. Treatment of this esthetically unacceptable gum condition involves correcting the faulty tooth-brushing technique and elimination of the cause of the gum inflammation. This is followed by surgical correction of the receded gum.

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are stripped off. After complete healing, some of the pigmentation in the gums may return in some patients. However, the new gum is almost always much lighter in color and remains so for almost all patients who undergo such treatment.

3A) Very clean teeth with receded gum, exposing the roots of the teeth and making the teeth appear long. This gum recession was caused by aggressive tooth-brushing.

3B) One tooth appears long due to the receded gum.

4A)

A fair complexioned person with dark pigmented gum.

4B)

3C) Two months after treatment with gum grafted from the palate. Notice the gum covering the previously exposed root.

Dark Pigmented Gums: The color of the gum varies from light coral pink to brownish black.

The gum of fair-skinned persons can have varying shades of pink, and darker-skinned people have darker shades of gum. The colors are determined by color pigments produced by special cells present in the deeper layer of gum.

These cells can become abnormally active during the puberty stage of the individual and make the gum darker than usual, and this dark color may persist to make its appearance unacceptable.

However, this condition can be easily corrected by a simple periodontal surgery by which the upper layers of the gum along with pigment cells

A person’s good facial appearance not only depends upon ideally positioned, sized and shaped nose, eyes and lips, but also on good dental esthetics. And good dental esthetics not only involves properly aligned teeth, without any discoloration or discrepancies in their shape, but

4C) This fair skinned person with dark gum tissue (Fig. 4B and 4C). Depigmentation treatment was provided only for the gum tissue around the upper front teeth. The lower gum tissue is left untreated for baseline color comparison. When the patient is satisfied with new color of the upper gum tissue, the same depigmentation treatment will be provided for the lower gum tissue.

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Periodontal

also in the proper position of gum margin on the anterior teeth. However, it must be stressed that esthetically driven periodontal surgery should in most cases be done only in the presence of periodontal health.

Today’s dentistry is also an art, in which

the elements of color, balance, proportion, composition, texture and harmony blend to create a picture of health and beauty of the face, mouth in particular. Cosmetic periodontal surgery contributes greatly to this concept of dentistry.

“What will it be, Novocaine or Yanni?�

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IMPLANTS IN ESTHETICDENTISTRY Dr. Dolly Chopra Prosthodontist, Farwaniya Specialized Dental Center

Having missing teeth can be damaging to your self-esteem and the functionality of your smile. Dental implants have increasingly become a viable treatment option for achieving natural looking restorations. Before the arrival of implants, bridges were used to replace teeth. This often meant that the dentist had to grind away and prepare healthy and good looking teeth to receive the bridge. Using implants we can replace a single tooth or even a full set of adult teeth without the need for interfering with other healthy remaining teeth.

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Implants

What are Dental Implants?

Dental implants are the closest artificial replacement for natural tooth roots (Figure1). They are made up of titanium and have a screw shape which allows them to be placed into the jaw bone at the time of surgery. Over the next few months,the bone of the jaw forms an intimate bond with the implant which secures the implant in place. This is called osseointegration. Once integrated, the implant can then form a stable and long-lasting foundation for restoration of the missing teeth in a variety of ways

Advantages of Dental Implants 1.

Implants avoid the preparation and damage to adjacent teeth that is needed for conventional crowns or bridges.

2.

Bone Maintenance-When teeth are removed there is a tendency for the bone at that site in the jaw to recede. A dental implant reloads the bone with chewing forces and continues to maintain the bone in a similar way to the natural tooth root.

3.

Increased Confidence-Many patients who have lost front teeth lose confidence with the day to day activities like eating with friends, smiling, talking etc. This may be due to discomfort when chewing or because of embarrassing experiences with false teeth.Dental implants address these problems by providing a replacement for missing teeth which are completely fixed like natural teeth.

4.

5.

Improved Aesthetics and Facial Contour-Tooth and bone loss leads to changes in support for the lips and face causing premature aging.

Dental implants can provide a foundation for new crowns, bridges or prosthesis that can restore the balance of the lips and face and reverse this premature aging.

BEFORE

AFTER

Long term success-Dental implants have long term success rate of over a 95%. They should, if cared for correctly, last as long as natural teeth.

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What can Dental Implants do?

Single Tooth Replacement Some patients may have lost only a single tooth.

A single dental implant and crown can replace these teeth without the need to cut into adjacent healthy teeth to prepare conventional crowns or bridges.

Multiple Tooth Replacement For larger gaps in the dental arch, a number of implants are placed and these are linked together by means of a fixed dental bridge. Each missing tooth doesn’t need to be replaced with an implant.

Implants Avoid ‌ Implants avoid the need for preparation and damage to adjacent teeth that is needed for conventional crowns or bridges.

Full Arch Restoration Some patients may have lost all or nearly all of their natural teeth. In this situation there are two main options.

Firstly, the missing teeth can be replaced by a number of dental implants and a fixed bridge.

This provides a fixed replacement for the lost natural teeth and allows the same level of function as the lost natural dentition.

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Implants

The second option is to provide a special type of denture (called Overdenture) which locks onto the implants but is removable by the patient.

Immediate Replacement As its name suggests, this involves placing the implant in a tooth socket at the same time as the natural tooth is removed. This has some obvious appeal but not all patients are suitable for this technique.

Orthodontic Implants Some patients receiving orthodontic treatment need to use devices called ‘headgear’ which can be very uncomfortable. Dental implants can provide an alternative to this by placing implants at the back of the mouth or palate. This can make the treatment quicker, is less cumbersome and improves patient compliance and hence orthodontic success.

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General Considerations Am I suitable for dental implants?

There are few absolute reasons why patients would be unsuitable for dental implants and there are no higher age limitations on placement of implants.

1.

In the young adult implant placement is avoided until growth has stopped because the ankylosed implant would not follow the growth progression.

2.

Some medical conditions that would make a patient unsuitable for dental implants include :

P

Uncontrolled Diabetes

P

Heavy smoking

P

Patients taking bisphosphonates(a drug used to treat osteoporosis, multiple myelomas and breast cancer)

P

Immunosuppressant therapy

P

Head and neck radiotherapy

P

Bleeding disorders

Will it Hurt?

Implants can be placed under a variety of different anesthetics to ensure you are comfortable during your surgery. This may be local anesthetic, sedation or even general anesthetic.After your surgery the area may be slightly painful and swollen depending on what treatment you have had. You will normally be prescribed both antibiotics and simple painkillers after your surgery to relieve your symptoms. Ice packs on the face can also reduce swelling. Your dentist will normally advice you on routine aftercare to keep your mouth healthy while your implants heal.

3.

Deficient bone volume, active gum disease or dental infection would compromise the long-term success of implant treatment.

These conditions need to be corrected before the implant related treatment can begin.

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Implants

How long will my treatment take?

On an average , implant treatment from placement to finish can be from as little as 4 weeks for a single implant and up to 6 months or more in complicated multiple implants with additional procedures such as bone grafting.

What does the surgery involve?

The surgery involves making an incision in the gum. The bone is prepared by slowly drilling a hole to accept the titanium implant. The implant(s) are then gently screwed into place.

The gum is stitched back in place with dissolving sutures.

Sometimes the healing caps of the implants are visible through the gum and sometimes it is better to leave the implants buried beneath the gum. If this is the case, once healing is complete,the implant can easily be exposed in a few minutes under local anesthesia.

What is a bone graft and why would I need one?

Sometimes patients may have insufficient bone to ensure implants are placed successfully and with the best aesthetic results. The bone may be deficient either in a vertical or horizontal direction and this means that bone has to be bought in to make up this deficiency. This is called a bone graft.

What happens after my implant surgery?

The next stage after implant placement is the restorative phase. This is when the restorative dentist takes impressions in the mouth to allow crowns, bridges or new style dentures to be constructed accurately to fit your new dental implants.

Will I have to go without my denture or bridge before I have my new teeth?

Usually this is not necessary and the dentist can provide you with either a temporary bridge or denture to wear whilst your implants are healing.

After Care What do I need to do to maintain my implants?

Implants require the same care to maintain them as healthy natural teeth. It involves simple everyday tooth brushing and cleaning routine. If dental implants are not cared for correctly, deposits of plaque and calculus can develop around the implants which can produce inflammation and infection and can lead to loss of the implants.

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ESTHETIC TRENDS IN CLINICAL ORTHODONTICS Dr. Rino Roy Orthodontist, Al-Jahra Dental Center

Esthetic dentistry, can be defined as the skills and techniques used to improve the art and symmetry of the teeth and face to enhance the appearance as well as the function of the teeth, oral cavity, and face.

Esthetic innovations in the dental field attract a good deal of attention among both professionals and patients equally. New technological advances have helped the orthodontic profession progress from traditional techniques to more modern innovative aesthetictechniques. The profession has seen transitions from conventional metal braces to ceramic brackets, lingual braces, removable aligners, mini-screws (TAD), and more advanced technology in materials, thereby providing better aesthetic treatment. A desire for more aesthetic materials has resulted in both smaller and `tooth-coloured` appliances. Presently, there are many hi-tech advances that help progressive orthodontists provide better, faster, and more stable orthodontic therapy for you and your family.

Tooth Coloured Braces New improved clear or tooth coloured braces are one of the greatest hi-tech orthodontic advances

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Self-Ligating Ceramic Brackets

New improved clear or tooth coloured ceramic braces are one of the greatest hi-tech orthodontic advances. Originally designed for adults who desired braces that were less noticeable, patients of all ages are now enjoying the esthetic benefits of these clear braces. Because they are nearly invisible, people notice your smile, not your braces.

Features of the Esthetic Ceramic Brackets Z The new clear braces are smoother with rounded contours for outstanding patient comfort, less pain and irritation.

Z They are more durable (lasts the entire treatment), and functionally equal to their metal brace counterparts. Completely esthetic passive self-ligation brackets with unparalleled design are stronger and safer than ever before.

Z They newer generation brackets resist staining from coffee, mustard, red wine and other agents and discoloration throughout treatment.

Z They eliminate the need for elastomeric, which stain, attract plaque and collect bacteria during treatment.

Z Advanced passive self-ligation technology with low ligation force minimizes frictional resistance for more efficient tooth movement.

Z They are effective at treating mild to severe crowding while delivering arch development and aligned teeth, bite and smile arc.

Z In addition to the esthetic looks, ceramic passive self-ligation bracket can mean fewer appointments / office visits.

Clear Aligners Clear Aligners are removable medical grade plastic appliances which the patient wears instead of brackets and wires to correct malocclusion. These innovative dental aligners are a modern alternative to braces, for teeth that are in need of straightening. It is a clear change to the concept of cosmetic and adult orthodontic treatment without using conventional methods of wires and brackets. The Clear Aligner system offers various application possibilities for correction of the malocclusion such as diastema, mild to moderate crowding, rotations and tipping of teeth. Adults couldn`t have asked for a better choice to correct their malocclusion.

The clear aligner splints are fabricated specially for each individual patient.Using advanced computer technology, a series of cus52 doctors book.indd 52

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tomized clear appliances called `aligners` are precisely and individually fabricated in the laboratory.

Each aligner is worn sequentially by the patient to produce extensive tooth movements in both upper and lower arches. During the wearing period, the dentist/specialist will control the treatment results regularly and will take new duplications from time to time for reaching an optimum result.

How are Clear Aligners different from Regular Orthodontics?

Z Clear aligners are removable. The patient can eat normally and brush / floss easily after removing it out.

Z Due to its clear and transparent nature, most people won’t even notice it.

Z The aligners are comfortable. No metal wires or bands to irritate your gums and no metal or wires means you spend less time in the doctor›s chair getting adjustments.

Z Periodic change to new set of aligners as prescribed by the dentist/specialist.(usually every 2-3 weeks) Z The time of completion varies from 6 months to a year.

Z Clear aligner patients also report that it is much more comfortable to speak, laugh and socialise than its metal counterparts.

Lingual Braces Lingual braces, also known as Concealed and/or Invisible braces are the best, and only, non-visible form of fixed orthodontic therapy. Concealed braces are placed behind the teeth where they are not seen. The patient enjoys an unobstructed smile during treatment.

This means that the lingual braces realign teeth without any aesthetic worries. These appliances are custom-made to each patient and the techniques used require special instrumentation, equipment, doctor and staff training.

If you are self-conscious of your appearance and do not feel confident wearing traditional braces, lingual braces are an excellent choice.

What are the advantages of Lingual Orthodontics?

Z The main advantage is cosmetic as lingual braces are not visible from the front Z Lingual braces are more safer option for patients who play contact sports or certain wind instruments Z It is great alternative to patients sensitive to plastic Z It is a good choice for those who present frequently to audiences or clients and want to maintain aprofessional image Z During removal of regular orthodontics the front surfaces of the teeth can get damaged from

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debonding, and adhesive removal. In lingual orthodontics, the more important facial surface of the teeth is not damaged as the bonding is on the back side of the teeth Z Facial gingival tissues are not adversely affected Z Lip esthetics is better since the drape of the lips are not distorted by protruding labial appliances Incognito lingual Orthodontic Braces by 3Munitek are 100% customized to follow the contours of patient`s teeth for comfort and performance. Lingual Orthodontics is the appropriate choice for many adults and teenagers that need orthodontic treatment and promotes a combination of a perfect esthetics during the therapy as well as excellent therapeutic results.

Orthodontic Mini-Implants The use of Orthodontic Mini-implants also known as Temporary anchorage devises (TAD) or is rapidly growing. During the last decades, the orthodontic mini implant has progressed to the point where it is now a part of the everyday armamentarium of an Orthodontist. It can be used for multiple purposes like uncrowding, orthodontic camouflage, molar distalization, mesialization, segmental intrusion, vertical control and the treatment of the canted occlusal plane. Molar intrusion or pushing the molar deeper into its socket, once considered to be an almost impossible tooth movement by conventional orthodontic means, is now easily possible with orthodontic mini implants. Placing orthodontic mini-implants allows clinicians to use simple and aesthetic appliances to retract anterior teeth.

They are inserted using topical or surface anesthesia applied to the gums rather that local anesthesia. The local anaesthesia of adjacent teeth is best avoided in order to allow the sensation of pain, if the implant touches the tooth roots or periodontal ligaments, instead of the interradicular alveolar bone.

What are the Advantages of Orthodontic Mini-Implants?

Z They can be used to move teeth with absolute preservation of anchorage.

Z Orthodontic implants are far cheaper than dental implants, predictable and reliable.

Z Another important advantage of the orthodontic implant is it a non-invasive placement procedure.

Not very time consuming for any professional.

Z They can be easily removed, even without any kind of anaesthesia Z Raising a flap is unnecessary and most of the implants are self-tapping (self-drilling) which eliminates the extensive surgical procedures and expensive implant kits.

Z The ugly extra-oral headgear is eliminated as the anchorage is within the mouth. This improves reliance on patient compliance.

Z Reduced treatment time.

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Z In many kinds of severe malocclusion cases it eliminates need for large and tedious appliances and thereby contributing to greater patient comfort Mini-implants provide absolute anchorage to allow greater skeletal, dental, and esthetic changes in patients requiring maximum anterior retraction, when compared with other conventional methods.

Designed by orthodontists specif ically for orthodontic use, TAD is a coordinated system of mini-screws, attachments and instruments that provide clinicians with all the benefits of facial and dental esthetic corrections.

Conclusion Orthodontic treatment with esthetic materials is always a change for the better, regardless of age.

Due to hi-tech advances in treatment, esthetics and comfort, the trend of more parents and children in treatment together will likely continue to increase. By combining the synergistic effects of these innovations, progressive Orthodontists can provide a more esthetic treatment and shorter treatment duration. Modern esthetic improvementsin materials and techniques have made treatment much more `patient friendly`. Because of the above mentioned innovations, orthodontic treatment today is more comfortable, quicker and more esthetic than ever before.

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, INDIAN DENTISTS ALLIANCE IN KUWAIT

WITH DR. NAMPOORY

WITH DR. AMIR AT THE EMBASSY GHABQA

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BEFORE

AFTER

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LUMINEERS Technique

TRADITIONAL VENEERS Technique

‫قبل‬ Teeth are stained, slightly misshapen with spaces in-between.

An impression is made and the mold is sent to the Laboratory where only Lumineers are crafted.

‫بعد‬ Teeth appear stained and slightly misshapen. An impression is made and sent to a lab.

‫ال تحتاج ايل اي اعداد‬ On next dental visit, the dentist tries in Lumineers to ensure a good fit. Teeth are moderately etched to prepare for placement but there is no removal of sensitive tooth structure, unlike the painful part of traditional veneer techniques. The Lumineers are bonded to natural teeth and set in place with a curing light.

‫شكل االعداد التقليدي لالسنان يف حاله الفنري‬ Anesthetic shots are given to numb the area and teeth are severely shaved away with a drill to accommodate the veneers.

‫ال يوجد شعور باالمل‬ In only 2 easy dental visits, your patient will have a permanently whiter and beautiful smile without shots, drilling, or pain.

‫يوجة شعور بسيط باالمل‬ A better, but still flawed smile, as the procedure is not reversible like Lumineers since, the original teeth have been shaved down the patient may suffer pain and discomfort immediately after the procedure.

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Indications For Porcelain Laminate Veneers

Stained or Darkened Teeth

Stained Composite Restoration

Hypocalcified white Discoloration

Failed Acrylic Veneers

Toothbrush Abrasion

Worn Acrylic Veneers

Chipped Acrylic Veneers over the Bridge

Acrylic Veneers Failures bonded to Dentin

Treatment with Porcelain Laminate Veneers

Correction of Stained or Darkened Teeth

Correction of Spacing

Correction of Old Failed Plastic Fillings

Correction of Peg (Small) Laterals

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