Restorative Dentistry

Restorative Consultation Appointment

The appointment time is usually 1 hour. During this time a thorough examination of the mouth will be undertaken along with digital full mouth x-rays, full mouth and facial photographs.

The information gathered will be analysed and an inital treatment plan formulated. Estimated costings associated with this initial plan will be furnished. Any advisable referrals to other dental disiplines will be suggested and subsequently organised as needed.

A CBCT scan may be suggested. This can be undertaken on the day of consultation or at a later date. A second appointment after the CBCT scan has been analysed may be arranged to discuss the scan results.

Implant Dentistry

There are basically three parts to an implant restoration

1. The titanium ‘root’ piece which gets placed in the bone. Over time, bone grows up to and around the implant ‘root’. This process is called ‘osseointegration’ and provides a biologic fixation with the bone.
2. The abutment is the component which is connected to the implant ‘root’ once the implant root has integrated.
3. The definitive porcelain implant crown/tooth, which is made in a laboratory and fitted to the implant abutment.

Sometimes it is possible to connect a temporary or transitional crown to the implant ‘root’, at the implant insertion appointment. This can only be done if a number of important ‘clinical checkpoints’ are passed at this insertion appointment. It is not possible to accurately assess these conditions beforehand, only at the time of the implant ‘root’ placement appointment.

The time required for osseointegration can vary from patient to patient, but a guideline of eight to twelve weeks would be reasonably common.

Dental Hygiene and Maintenance

After treatment care

Once you have completed your treatment and your restorations are successfully in place, they will need to be maintained. Restorations are only as good as their foundations and the foundations, like your own natural teeth, can become compromised by bacteria. We have a dedicated hygienist who will assist you in the correct home maintenance of your restoration(s) and general oral hygiene.

We understand and value that you, as a patient, have made considerable investment of both time and expense in the health and function of your mouth. We will encourage and help you maintain your new oral status. You will be taught the skills, tools and techniques to maintain in health, every surface of every tooth every day.

At a hygiene appointment:

• Your medical status will be reviewed to see if there is any general medical condition which could have an impact on your oral health.
• An oral cancer screen will be performed as well as screening for oral signs of other serious medical illnesses.
• Any necessary digital xrays will be taken.
• Hard and soft deposits of calculus and plaque which contain damaging bacteria will be removed.
• Your Implants/Restorations will be reviewed.
• If surface tooth staining is present, this will be addressed by means of prophy jet technology.
• Your teeth will be polished.
• Instruction on the maintenance of your implants/restorations will be reinforced and demonstrated.
• Oral hygiene instruction will be given.
• Desensitising medicaments will be applied to any sensitive teeth.

We usually advise that you alternate your hygiene appointments between our hygienist and you own dentist to ensure maximum oral health as it is now known that poor oral health can have serious implications for your general health and well being.

Protection of Restorations

After your restorations have been placed, it may be suggested that a customised Michigan upper night splint is constructed for you to wear at night. This will help protect the new restorations and your own natural teeth from the effects of clenching and grinding. This is of particular importance for those patients who require restorations to replace tooth structure lost through excessive tooth wear.

A Michigan night splint may even be required in some patients to wear before any restorative treatment is undertaken so that muscle tension in the jaws can be relieved and a reliable treatment position established.

Tooth Borne Crowns & Bridges

Crowns are used to protect and rebuild broken teeth that are beyond filling. They can also be used to reshape teeth.

Crowns are custom made in a dental laboratory and are composed of high strength ceramics or porcelain reinforced with metal. They are cemented on the natural tooth which must be prepared first to accept the crown. At the preparation appointment, the tooth and surrounding gum is anaesthetised and made comfortable with local anaesthetic. The tooth is then prepared and shaped in such a way that the crown will fit precisely, giving a smooth transition against the gum margins. This is important as if a crown is poorly fitting, it will not lie harmoniously against the gum and the health of the gum will be compromised. Every endeavour is made at SEDS to ensure the fit is excellent, from the attention to detail and particular techniques used at the preparation stage to the construction stages undertaken in the laboratory. The quality of different dental restorations vary widely. Quality depends on attention to detail at all stages of construction and this cannot be emphasised enough. The life span of a restoration depends heavily on these factors.

When the support teeth either side of the gap are heavily filled and would benefit from protection,  a conventional bridge may be suggested. In this case, the support teeth are crowned and joined to the crown replacing the missing tooth.

When the support teeth either side of the gap do not themselves require restoration or protection, an adhesive bridge may be suggested rather than a conventional bridge, as these bridges require less intervention to the abutment support teeth. The missing tooth is replaced by a crown that has metal ‘wings’ on either side that are bonded to the back of the abutment teeth in such a way that the ‘wings’ are not visible from the front of the teeth.

Veneers

In some cases it is advantageous to alter the shape, shade or alignment of a tooth and this is often achieved using a porcelain veneer. Veneers are a very thin porcelain shell of tooth coloured ceramic material that is bonded to the front surface of the tooth. While the natural tooth is prepared to a certain extent to accept the veneer, the preparation is minimal when compared to that needed for a conventional crown. As a general rule, crowns tend to be used to restore more broken down teeth while veneers are used to improve:

• Discoloured teeth
• Cracked or chipped teeth
• Unevenly spaced teeth
• Misaligned teeth
• Worn teeth

Tooth Whitening

This technique can be used on its own, or can be used as an adjunctive therapy to other restorative measures. For example, before crown or veneer preparation, it is sometimes advantageous to pre-lighten the underlying tooth structure so that the finished crown or veneer can reflect more light from it’s surface and therefore look more vibrant.

Tooth whitening is also used extensively to restore vitality and youthful appearance to natural teeth and in some cases is the only treatment required for a dental cosmetic upgrade. There are different types of bleaching techniques:

• Home whitening with 10% carbamide peroxide
• In-office whitening
• Deep whitening
• Non-vital tooth whitening (to lighten the colour of a previously root treated tooth)
• Combination therapies

You will be advised which technique is most suitable for you.

Many unregulated products often contain acidic components in their formulation which can be very damaging to teeth. These types of products, although freely available, are to be avoided. The safest and most predictable results are obtained under the guidance of dentists familiar and successful with the procedure, using regulated products with proven documented efficacy and safety data.

Full Mouth Reconstruction

In some cases, teeth are so broken down that oral function is at a minimum and reconstruction of the whole mouth is required to establish a functioning bite. This requires a high level of expertise and is accomplished using an extensive variety of dental techniques.

Sinus Grafting

The maxillary sinus is an air cavity lying over and above the upper back teeth. There are many air cavities in the skull and their function is to allow air to circulate and humidify. The maxillary sinus has no major important biologic function and can increase in size and volume over time.  If any of the maxillary teeth are lost, the sinus increases in size to occupy the area of the lost teeth. This means that bone volume is decreased and there may not be enough bone to place implants without intervention. Bone volume increase in this situation is achieved by grafting which lifts the sinus. Success rate for implants placed in the grafted maxillary sinus area is approximately 92%. Antibiotics and anti-inflammatory medication is prescribed before and after the procedure which is carried out under local anaesthetic. There are two methods by which the sinus is lifted.

Osteotome sinus lift

In this procedure, the area to be lifted is relatively small and the sinus anatomy favourable. The graft material is advanced into the sinus by an instrument called an osteotome through a small opening made in the gum at the site of the missing tooth. The implant is often placed at the same time as the grafting procedure or may be done after a period of healing.

Lateral window sinus lift

This technique is used when larger areas require lift. “A window” is made through the bone on the side of the sinus in the area above the missing teeth and graft material is placed directly into the sinus space. After several months of healing, the grafted bone integrates with the surrounding bone so that there is sufficient volume for implant placement.

Implant Supported Over Dentures

The jaws are composed of two types of bone called basal bone and alveolar bone. Most of the major vessels and nerves are in the basal bone and the teeth are housed in the alveolar bone.  When teeth are lost, the alveolar bone no longer has a function and resorbs over time. If all the teeth are lost as is the case in full denture wearers, there is considerable bone loss over time. This is more noticeable on the lower jaw as there is less bone here to start.

This brevity of bone can make wearing dentures, especially lower dentures, very difficult due to movement. It can also be painful as the lower denture will eventually lie on basal bone and therefore on nerves and blood vessels housed in this bone.

If dental implants are placed in the jaw,  they can support an implant assisted over denture. Implants are placed that have snap-like anchors. These snap into corresponding anchors on the denture giving security and confidence to the patient. The denture can be removed by the patient.

This relatively simple technique can truly revolutionise people’s lives as it allows more comfortable nourishment and confidence when speaking.