Dental enamel, the outer surface of our teeth is the hardest substance in the human body, stronger even than our bones. It is constantly assaulted by chewing force and grinding habits as well as the occasional knock from accidents. Over time, all these cumulative forces can result in a cracked tooth, putting our wellbeing and
We are happy to introduce the latest treatment solution provided by Align Technology. The introduction of Invisalign G6, which includes the launch of ClinCheck Pro with 3D Controls and the first premolar extraction solution make it possible for our team to take orthodontic teeth movement to an exciting new level of finesse and predictability. ClinCheck Pro with 3D Controls
Dr Wong has significant experience in the field of oral maxillofacial surgery and dental implants. Her friendly and approachable personality relaxes patients, enabling them to make better decisions on their personal care.
Dr Yong has been practising dentistry for two decades. He is well versed in the different types of braces systems available and have helped patient of all ages achieve predictable outcomes within a reasonable time and cost.
Dr Dovban has been practising dentistry for almost a decade. He completed his Masters training at the National University of Singapore and has a special interest in the treatment of acute and chronic gum disease.
Dr Chia qualified at the National University of Ireland. She is a vivacious, compassionate and friendly person. She enjoys treating patients of all ages and is also responsible for spearheading our social initiatives.
Dr Doig has been practising for a decade. He believes that smiles change lives, leading him to have a special interest in aesthetic dentistry. His affable personality provides a relaxing experience for patients of all ages.
Dr Nantham graduated from the University of Otago. She is competent in children preventive care, adult aesthetic and advanced restorative treatment. She builds good relationships with her patients to achieve excellent results with her calm and gentle nature.
Dr Tony Peng graduated from the University of Glasgow. He has a passion for restorative, aesthetic and preventive dentistry. Dr Peng is committed to providing gentle, quality dental care for both children and adults.
Dr Stohler has been practising dentistry with a special interest in root canal therapy for over a decade. She graduated from the UCLA School of Dentistry and completed a Certificate in Endodontics and a Masters degree from Marquette University.
People who have lost or about to lose all their teeth are often concerned about a myriad of issues, ranging from the ability to chew to self-esteem. The All-on-4® treatment concept is an innovative and novel treatment solution designed to help these individuals regain their normal oral function and appearance in the shortest amount of time.
The All-on-4® treatment concept uses four dental implants to support between ten and twelve artificial teeth. This treatment is possible thanks to dedicated implant placement protocols that are pre-planned to achieve a high degree of initial stability. Advancements in implant surface coating and groove designs also play an important role in maintaining implant stability throughout the critical healing phase. Precision engineered multi-link abutments enable the implants to be immediately loaded with a dental bridge on the same visit of the surgery.
1) Rapid improvement in quality of life.
The All-on-4® treatment concept provides patients who have loss or about to lose all their teeth with a permanent full arch dental bridge which is supported by four implants on the day of surgery. This quickly leads to an almost immediate improvement in chewing function, appearance, taste, speech, and self-esteem.
2) Shorter treatment time
Two key elements contributes to a significantly reduce treatment time in patients who do not have adequate bone volume at the back teeth region. Tilting of the implants located at both ends avoids the need for time-consuming bone grafting procedures, while immediate loading of the implants shortens the actual time to having teeth in the mouth.
The All-on-4® treatment concept also helps to reduce treatment cost when compared to conventional implant treatment as it is supported by less implants and in most instances avoid the need for bone grafting procedures.
4) Enhanced stability.
The stability of dental implants is influenced by the amount of bone-to-implant contact. By tilting the implants located on both ends, longer implants can be used without the need for bone grafting procedures. The tilting of the implants also enable them to be anchored in better quality bone that is present at the front of the jaw bone, reduce the risk of surgery and facilitate an optimal dental bridge design. In short, it makes treatment more predictable.
Anyone who is physically well enough to undergo a routine dental extraction will often be fit enough for dental implants surgery
People who are currently using loose fitting full dentures or about to lose all their remaining teeth (especially those that have lost their back teeth prematurely many years ago) stand to benefit the most from All-on-4 treatment.
Patients can expect minor bleeding, bruising and discomfort during initial healing. Some patients may also experience numbness of the lips post-surgery. Your surgeon will be able to explain to you more about the incidence of common complications and the likelihood of success as it may vary significantly between different individuals and surgery site.
Dental braces is used to reposition teeth, align the dentition and improve on a person’s bite.
Patients undergoing braces treatment can look forward to a more attractive smile, enhanced oral health, better chewing function, speech and self-esteem.
Active braces treatment takes between one and three years to complete. This treatment duration is dependent on the complexity of your condition, your age and motivation as well as the expertise of the orthodontist.
You can help reduce the treatment duration by being explicit about your desired treatment goals, keeping a high standard of oral hygiene, avoiding breakage or damage to the braces device, keeping appointments, complying with elastic wear and starting young. There is however no age limit for braces treatment.
It is recommended to have your 1st visit with an orthodontist when the dentition is changing over to the permanent set (between the age of 6 and 12 years). The most common reason for maligned teeth is due to inadequate spacing which disrupts the normal eruption of the permanent teeth. During this transition stage, the bite may also be affected by poorly positioned teeth or uneven jaw bone growth.
A consultation at this stage provides a valuable window of opportunity to detect and manage (or minimize) such disruptions in approximately 5% to 15% of the population. Fortunately, that also means that a large majority of children will not require treatment at this age.
The common age for braces treatment is during the early adolescent years (between the age of 12 and 16 years) when most of the permanent teeth have erupted. The adolescent patient often benefits from a faster and better treatment outcome due to the favourable growth spurt that coincides with puberty.
For a small minority of individuals (less than 5%), the orthodontist may recommend that treatment be delayed until late adolescence / early adulthood due to the presence of significant disharmony between the jaw bones (which support the dentition). Delaying treatment to allow for skeletal maturation in these individuals allow for treatment to be more predictable and efficient.
Your orthodontist may take x-rays, impressions and photos of your teeth (and face) to better assess and monitor your condition during the consultation process.
The treatment experience can be variable between patients and is highly dependent on your condition and system (or device) being used.
You should expect teeth movement to cause mild to moderate discomfort (often describe by patients as a dull ache or tenderness affecting the teeth when biting) for 2 to 3 days after each adjustment appointment. Patients who are prone to apthous ulcers may experience an increase in incidence during treatment. This can be managed using braces relief wax and topical steroid or analgesic ointments. Most patients adapt to the presence of braces within the first 3 to 4 weeks and will be able to eat, sing or play musical instruments as per usual.
Some patients prefer a less conspicuous appearance during treatment. You are encouraged to discuss the suitability of ceramic brackets or aligners with your orthodontist if you have similar concerns.
You should expect to wear your retainers full time (morning and night) during the 1st year after braces treatment. They often feel strange and cause speech difficulties initially. The retainers can be removed for eating, brushing, sports and the occasional important event. Wearing the retainers well will allow the supporting bone and gums to mature, rewarding you with longer term stability. From the second year onwards, your orthodontist will likely convert you to part time wear (i.e. approx. 8 to 10 hours nightly). He may continue to review your progress every 6 to 12 months.
Patients who have difficulty complying with removable retainers should highlight this issue early so that a fixed retainer can be placed. A fixed retainer consist of a fine wire that is bonded on the back surfaces of the front teeth. They tend to trap food and make it harder for you to floss in between teeth. Regular preventive dental visits with your favourite dentist is an absolute must for patients with fixed retainers.
For most people, orthodontic treatment is an elective procedure that involves much effort, time and cost. It is therefore a common expectation that the treatment be safe and the outcome be lasting.
Relapse, whereby teeth that have been previously aligned tend to return towards their original position, is one of the common difficulties encountered by patients. This phenomenon affects approximately two thirds of all treated patients to varying degrees. Relapse is not entirely preventable as the position of the teeth is determined by the tone of the lip and tongue muscles as well as the supporting gums throughout life. Your orthodontist would have prescribed you with a set of retainers to prevent relapse and protect your investment.
Braces treatment is possible because of the ability of bone to remodel. During treatment, bone cells actively release enzymes that facilitate bone removal and deposition around the roots of the teeth. This may affect the roots themselves, causing them to shorten in predisposed patients (e.g. patient who suffers from endocrine disorders or have experienced trauma to the teeth prior to braces treatment). The degree of shortening is often mild (less than 1mm) and does not affect the longevity or health of the teeth. Only in rare instances, it is severe enough to warrant a discontinuation of braces treatment.
Teeth with deep fillings or a history of traumatic injury are susceptible to pulpal devitalisation during treatment. Such teeth often have a compromised blood supply and is less tolerant of movement. Your orthodontist will recommend root canal treatment for these teeth should it be needed.
CEREC technology is a recent development in dentistry that aims to provide patients with precise and durable restorations made of either ceramic or metal. This is made possible by the miniaturization of high definition image capturing devices and precise milling machines as well as advances in designing software. That is why it is also commonly referred to as “CAD/CAM Dentistry”.
The main advantage of CAD/CAM dentistry is in its ability to fabricate high quality, customised restorations in a short period of time – in as little as 10 minutes. This means that patients are now able to receive their dental crowns, veneers, inlays, onlays or bridges in a single visit, eliminating the need for repeated visits, uncomfortable dental impressions and the use of temporary restorations in between.
While patients are grateful for its aesthetics, efficiency and comfort; dentists laud its ability to allow for more conservative tooth preparations, which preserves healthy natural teeth structure. Research suggests that today’s milled CAD/CAM restorations are stronger, has better margin adaptation and less likely to fracture when compared to traditional dental fillings.
The dentist starts by removing decayed areas of the teeth. He subsequently prepares the remaining tooth structure to ensure that it comply with strict guidelines. Once satisfied, your dentist will use a handheld scanning device to capture the prepared tooth, adjacent teeth and opposing teeth in three dimensions. The dentist then uses proprietary CAD software to design the restoration. The amount of time taken may vary depending on his skill, experience, and complexity of the restoration. Some cases would require only a few minutes, while others could require up to half an hour or more to ensure quality.
Once finalized, the design information is transmitted to a milling unit to mill the restoration from a block of ceramic or metal block in a milling chamber. Milled restorations can thereafter be polished, stained, glazed and fired in an oven to create the final restoration.
The materials used in CAD/CAM dentistry have evolved significantly over the last 3 decades, allowing for restorations that are highly aesthetic, strong or a combination of both. The choice of material will hinge on the location of the tooth and loading forces that the restoration will be subjected to as well as your expectations.
The use of CAD/CAM restorations is limited by the complexity of the restoration and shade of your natural dentition. Long span dental bridges involving multiple abutment teeth preparations, have multiple opposing teeth and require reinforcement are best designed and fabricated conventionally with the help of a dental laboratory technician.
Restorations that require extensive natural characterization or staining to match adjacent teeth are also best fabricated in a dental laboratory. Patients are strongly encouraged to discuss their particular situation and desires with their dentist, to facilitate shared decision making in determining the most appropriate method.
CAD/CAM technology is not a replacement for the skill and acumen provided by a dentist or dental laboratory technician. Dentists must be precise in creating the initial tooth preparation and accurate when scanning as well as designing the restoration. All this are critical stages needed in the fabrication of a well-fitting and functional restoration that is easy to maintain and care for.
It is important to note that not every tooth can be treated with a CAD/CAM restoration. Your dentist will be able to share with you the pros and cons of CAD/CAM restorations versus conventional laboratory made restorations prior to embarking on treatment.
The cost of CAD/CAM restorations are similar to conventional laboratory made restorations, both of which are more expensive when compared to traditional dental fillings. There is no additional fee to have a restoration placed in one visit as opposed to two. Insurance reimbursement is similar for both same day CAD/CAM restorations and laboratory fabricated restorations.
Children Dentistry refers to the provision of dental care to young children, whereby the delivery of care may present with the need for growth or behaviour management.
We provide the following services for children.
Our dentist will provide care in a child friendly environment, spending time to reduce the anxiety that a child may experience with the visit. The initial objective is to carry out simple preventive and restorative care. Tasks that are more challenging can be performed once a child gains confidence or as a day surgery procedure under general anaesthesia. Thereafter, your child will be placed on active recall (at least once a year) so that any disturbances in teeth eruption or aberrant facial growth can be detected early and appropriate intervention instituted.
You can expect most visits to last approximately 30 minutes as children respond best when care is ‘not rushed’ and kept within their tolerance. Consequently, treatment may involve multiple visits and would require significant understanding and support of the caregivers.
A measured approach to providing care to young children will increase the likelihood of treatment acceptance by the child and consequently treatment success. A growing child presents an opportunity for teeth eruption and facial growth disturbances to be corrected early. We hope that good experiences in early life will lead to better health awareness and ultimately a proactive behaviour towards their own health as adults.
ClearBow is an aesthetic material used in the fabrication of orthodontic retainers. It comprises of a clear plastic strap that is engineered to provide patients with superior aesthetics, optimum tooth support and unparalleled durability.
The ClearBow retainer is a virtually transparent, allowing patients to wear their orthodontic retainers without feeling self-conscious.
The material used to fabricate the clear bow is softer than conventional steel wires. It does not scratch natural tooth enamel or exisitng dental restorations, such as porcelain veneers and composite dental fillings.
The clear material used in the fabrication of ClearBow does not stain when exposed repeatedly to natural colour pigments found in food and beverages.
The health and safety of our orthodontic patient is of paramount importance to us. That is why ClearBow is manufactured using high quality food-grade materials free from Bisphenol A (BPA).
The ClearBow is designed with an optimal width of 2.75 mm (.11″) and a concave anatomic shape to provide optimum tooth contact for superior retention, safeguarding the results of braces treatment for the longer term.
ClearBow retainers are engineered to better withstand the stress associated with repeated insertion and removal, providing you with many years of reliable use.
ClearBow is proudly made in Canada with 2 food grade materials sourced only from the United States; polyethylene terephthalate and stainless steel grade 316. These materials are widely used for different applications in the dental, pharmaceutical, food and beverage industry.
Cleft lip and palate is a congenital deformity that affects approximately 1 in every 600 live births in Singapore. Affected individuals may present with an isolated cleft of the lip or palate alone, or a combination of both. When just one side of the lip is affected, it is called a unilateral cleft. A bilateral cleft affects both sides of the lips.
During pregnancy, the face of the developing foetus is formed by the fusion of protuberances that emanate from the embryonic spinal cord. Disturbances that interfere with this phenomenon may lead to incomplete fusion, presenting itself as a cleft (gap) in the oral and/or nasal area.
Cleft lip and palate can occur due to genetic inheritance or from environmental influence such as maternal smoking, alcohol consumption or folate deficiency.
Parents are often alarmed when they are initially informed of the condition. These feelings are even more acute when they see their baby for the first time, wondering if the disfigurement will be lifelong. It is good to know that modern surgical and dental care has been demonstrated to be very successful in the treatment of cleft patients. Conversely, untreated cleft patients may end up suffering from a lifetime of dental problems, recurrent ear infections (which may lead to hearing loss), feeding difficulties, speech problems and low self-esteem.
The treatment of cleft lip and palate hinges on timed interventions to restore appearance, normal feeding, speech and allow for the normal eruption of teeth and ultimately facial growth. Due to the complex nature of the condition, the patient is often cared for by a multidisciplinary team of specialists and therapists throughout his/her first two decades of life.
Nasoalveolar moulding, cleft lip and palate repair is usually performed during the first 2 years to restore the infant’s appearance, ability to feed normally and facilitate speech development.
During the toddler years, speech therapy and periodic visits with the ear, nose and throat surgeon may be needed to manage ear infections or facilitate the placement of grommets that help keep the Eustachian tubes open. The child should also be introduced to regular preventive dental care at this stage.
From the age of between 6 and 12 years, periodic visits with the orthodontist are needed to prepare the child for grafting of jaw bone defects in order to facilitate the normal eruption of the permanent dentition.
During late adolescence/early adulthood, jaw surgery, nasal surgery and lip revision (if required) may be performed to correct residual dentofacial deformities.
The dental team plays an essential and critical role throughout the patients lifetime due to the location of the defect. Access to comprehensive dental care has been proven to significantly improve treatment outcomes and the patient’s quality of life in the longer term. We provide the following services at Parkway Dental Practice.
Recent advances in ultrasound technology can diagnose oral and facial clefts while the foetus is still developing in the womb. Folate therapy in the presence of maternal folate deficiency and abstinence from alcohol consumption and smoking can reduce your baby’s risk.
A good bite is dependent on the presence of matching upper and lower jaw bones in terms of size, shape and orientation. Jaw deformity occurs when there is an imbalance between the growth rate and potential of the jaw bones. The underlying reasons for this imbalance can be due to inheritance (genetics), disease (developmental), or facial trauma (acquired).
Affected individuals may complain of teeth that do not meet or match when biting, chewing disabilities, speech deficiencies, snoring with episodes of breathlessness during sleep (Obstructive Sleep Apnoea), excessive upper gum show, recurrent gum pain or cheek biting, protruding lower jaw (witch-like appearance), small lower jaw or absent chin (“bird-like” appearance) or crooked jaw (one side being larger or longer than the other).
Corrective jaw surgery is performed to restore normal chewing, speech and appearance. The surgery may involve one or both jaws depending on the severity and type of the deformity.
Correction jaw surgery can restore normal chewing function, facial proportions, speech and reduce episodes of breathlessness in patients with Obstructive Sleep Apnoea (OSA). Ultimately, correction leads to a better sense of both physical and psychological sense of well-being as well as self-esteem.
The treatment often involves a multi-disciplinary team, consisting of a dentist, an orthodontist and an oral maxillofacial surgeon.
The attending specialists will carry out a detailed assessment of your bite, oral, facial and general health during the initial consultation. During the consultation, specialized investigations such as x-rays, moulds of your teeth and facial photographs may be taken with your consent. They will also spend time to understand your treatment expectations and provide you with information on the proposed treatment plan, including its benefits and risks. A joint consultation with other specialists and family members can be arranged should the need arise.
Your general dentist will be responsible for your general dental health throughout treatment. His role is to ensure that any existing dental or gum disease be brought under control and maintained during treatment.
Your orthodontist will prepare you for the surgery by aligning your teeth and matching the width of the dental arches. This phase usually takes between 9 months and 18 months. He is also responsible for putting the final touches to the way you bite post-surgery over a period of 6 months to 9 months.
Your oral maxillofacial surgeon will perform the corrective jaw surgery under general anaesthesia, usually in a hospital setting. The surgery can takes about half a day and may require a short hospital stay of between 2 days and 4 days to facilitate your recovery. Most patients will be encouraged to rest at home for the next 3 weeks to 4 weeks to complete their recovery. In complex cases, your surgeon may request for you to “store blood” if there is an anticipated need for blood transfusions during the surgery.
Like all patients undergoing braces treatment, you should expect initial soft tissue irritation and occasional tenderness affecting the teeth after initial placement and upon each activation appointment. Most patients adapt quickly to braces treatment within the first few weeks. The preparation phase will often make your condition to appear worse as the position of your teeth are normalized within their respective jawbones.
As the surgery will be performed under general anaesthesia, you will be asked to fast for at least 8 hours prior to the surgery. The incisions will be made inside your mouth and cannot be seen externally. The jawbones are subsequently repositioned to restore the bite and facial proportions. The bone segments are fixed in place using small titanium bone plates and screws. These bone plates and screws can be left in place for life as they are inert and biocompatible, although some patients may opt to remove them after complete healing has occurred.
Most patients will feel very sleepy post-surgery, experience a sore throat, nausea or nose bleeds due to the lingering effects of the general anaesthesia. You would also experience some degree of facial numbness and occasional bleeding from the surgical sites. Facial swelling and bruising becomes significant after 48 hours and ice packs can be used to reduce the swelling. The swelling may take 2 weeks or more to fully subside.
Your surgeon will prescribe analgesics to help manage discomfort and antibiotics to keep infection at bay. You can help keep the surgical sites clean by irrigating the wound area with antiseptic mouthwash using a syringe and brushing the outer surfaces of your teeth gently.
You will be on a liquid diet (e.g. milk, blended porridge, juices etc) for the first few weeks as your upper and lower teeth will be secured together tightly onto a bite plate using rubber bands. The rubber bands will be loosened gradually over the subsequent weeks, allowing you to gradually return to your normal diet. Due to these challenges, you should expect weight loss of between 2 and 5 kilogrammes during recovery.
Other challenges include the possibility of nose bleeds or stuffiness. Your surgeon may prescribe you nasal decongestants if you experience nasal symptoms. You can expect to resume work or school after about 3 weeks. It is however important that you abstain from heavy physical duty or exercises as a precaution.
Corrective jaw surgery is considered a major surgery with significant risks despite its benefits. It is usually performed in young adults who have completed facial growth. Some of the more common risks include:
The face, lip and mouth are richly innervated and surgery to this region carries a chance of nerve injury. This may present as numbness or a tingling sensation affecting the lips, chin, tongue, and gums. The incidence of permanent nerve injury is correlated to the difficulty of the procedure and varies between 10% and 15%. This also means that 85% to 90% of patients make an uneventful recovery.
The jaw bone contain the dentition and surgery to this area carries the risk of injury to the roots of the teeth, causing them to lose their blood supply. Follow up care such as root canal treatment may be required if this happens.
The surgical incision can become infected or open up to expose the underlying bone in the event of an infection. This is often managed using antibiotics, antiseptic mouthwashes and in some cases, a minor surgery to clean up or re-stitched the surgical wound.
Relapse is the term used to describe the unwanted movement of the jaw bone towards its original condition, prior to corrective jaw surgery. This may occur immediately post-surgery or gradually over many months. Immediate relapse is linked to displacement of the jaw joint during surgery whereas delayed relapse is often caused by continued, unfavourable growth of the jawbones.
The jaw joint between the lower jaw bone and the head is supported by a group of strong muscles and ligaments. Changes to the jaw position will require the patient to gradually adapt to their “new bite”. Patients who have a history of jaw joint dysfunction are advised to inform your attending specialists, as surgery may either relieve or aggravate the condition depending on the underlying cause of the dysfunction.
Severe bleeding post-surgery is an uncommon complication which may require blood transfusion or re-admission to the hospital.
Corrective jaw surgery have generated a lot of interest of late. The information provided above attempts to present the risk and benefits of surgery in a balanced and neutral manner. We recommend that you talk to a qualified specialist that you trust if you are considering surgery, as no one article can fully cover all the intricacies of such a complex treatment.
A dental bridge is a restoration that replaces missing teeth by using adjacent teeth or dental implants for support. It is also commonly known as a fixed denture.
A dental bridge is able to restore your smile, maintain lip support, allow you to chew and speak normally by literally bridging the gap where one or more teeth may have been loss. It is fixed and can often be fabricated in two visits, making it a lifestyle friendly and convenient option.
The dentist starts by examining the location, no of missing teeth, the way you bite and the condition of the supporting teeth. He may recommend for you to take small x-rays of the supporting teeth if he is concerned about their health. Your dentist will also try to find out more with regards to your expectations on the appropriate appearance and longevity of the dental bridge.
Treatment consist of shade selection followed by careful preparation of the supporting teeth to ensure that they have an optimal taper, well defined margins, adequate ferrule and clearance from adjacent and opposing teeth. An impression of the teeth preparation is taken and sent to the dental laboratory to facilitate fabrication. Temporary crowns are made and fitted over the prepared supporting teeth in between visits.
On the fitting appointment, the temporary crowns are removed and the dental bridge tried in. Your dentist will check to ensure that the bridge is able to seat well, have good margins and is in contact (or suitable relationship) with adjacent and opposing teeth. He will also invite you to help assess the colour and overall appearance of the dental bridge. The bridge is cemented in place once it is deemed to be satisfactory.
The procedure can often be completed within two visits. The first visit is for preparation of the supporting teeth (takes approximately 90 minutes on average) and the second visit is for bridge fitting (takes approximately 30 minutes on average).
Teeth preparation is usually done under local anaesthetic with the exception of root canal treated teeth. The procedure is painless albeit a little tiring for the patient, due to prolonged mouth opening, especially for back teeth. Dental bridge fitting is fairly straightforward whereby the temporary crowns are replaced by the permanent dental bridge.
Dental bridges can be made entirely metallic alloys, ceramic or in combination with an outer layer of porcelain to maximise strength and simulate the appearance of natural teeth. Commonly used varieties include:
Metal dental bridges can be fabricated from alloys of noble (e.g. gold, palladium, platinum and silver) and base metals (e.g. tin, copper, nickel, chromium). Full gold dental bridges are of a better quality when they are high in noble content (at least 60% noble metal, of which at least 40% must be gold). Metal bridges require less removal of supporting teeth structure, causes less opposing teeth wear and is able to withstand chewing forces well. The metallic colour is the main drawback, making them a good choice to replace out-of-sight molars, especially in patients with a strong bite or grinding habits.
These are hybrid dental bridges made of a metal core and an outer layer of porcelain. The metal core provides strength while the porcelain mimics the colour, translucence and fluorescence of natural teeth. Porcelain fused to metal dental bridges attempts to seek the best combination of durability and appearance. Sometimes the metal beneath the porcelain can show through as a dark line, especially at the gum margins of supporting teeth with receded gums.
Alumina reinforced dental bridges are made of a glass infiltrated alumina core and an outer layer of porcelain. It has very good aesthetic qualities, although it is not as strong as porcelain fused to metal dental bridges. It is more suitable across short spans or areas which are subjected to light chewing forces.
Yttria-stabilized zirconia oxide is the hardest material used in dentistry to restore teeth, making it a good choice for replacing missing molars. Monolithic zirconia dental bridges are made entirely of zirconia oxide and come in a variety of tooth-like shades. Zirconia cores can be layered with porcelain to further improve its colour, translucence and fluorescents although it does not form a very strong bond with porcelain, rendering it more susceptible to chip.
Patients should always weigh the pros and cons of a dental bridge carefully as your dentist will need to remove between 1.0mm and 1.5 mm of enamel from the supporting teeth to accommodate the dental bridge. Dental bridges need to be diligently maintained with a combination of good personal hygiene and professional care. Failure to do so may lead to premature failure due to decay or gum disease affecting the supporting teeth. Another common problem is porcelain fracture due to heavy biting, flexing of the dental bridge during function or grinding habits. This can be mitigated with the selection of full metal dental bridges, appropriate treatment planning or the use of a night guard when sleeping.
Modern dental bridge material is biologically compatible and can last many years if properly cared for. The average lifespan is between 5 and 10 years. The decision to replace dental bridges often hinges on the health and appearance of the supporting teeth as well as its neighbours.
A dental crown is a restoration that completely encircles (caps) a tooth and cemented in place.
Crowns are used to protect weakened teeth (e.g. due to tooth fracture or after root canal treatment), to replace missing tooth structure (e.g. due to decay or wear), as part of a dental bridge or dental implant, to improve tooth shape and colour as well as close gaps between teeth.
The dentist starts by examining the location, size of the defect, the way you bite and vitality of the affected tooth. If the defect is large or cannot be readily seen, he may recommend for you to take a small x-ray image to assess the situation better. Your dentist will also try to find out more regarding your expectations on the appropriate appearance and longevity of the crown.
Treatment consist of shade selection followed by careful removal of decayed and weakened areas of the tooth. Filling material may be used to fill in areas with large defects. The tooth is subsequently prepared to ensure that it has an optimal taper, well defined margins, adequate ferrule and clearance from adjacent and opposing teeth. An impression of the tooth preparation is taken and sent to the dental laboratory to facilitate crown fabrication. A temporary crown is made and fitted over the prepared tooth in between visits.
On the fitting appointment, the temporary crown is removed and the permanent crown tried in. Your dentist will check to ensure that the crown is able to seat well, have good margins and is in contact (or suitable relationship) with adjacent and opposing teeth. He will also invite you to help assess the colour and overall appearance of the permanent crown. The crown is cemented in place once it is deemed to be satisfactory.
The procedure can usually be completed within 2 visits. The first visit is for tooth preparation (takes approximately 60 minutes on average) and the 2nd visit is for crown fitting (takes approximately 15 minutes on average).
Tooth preparation is usually done under local anaesthetic with the exception of root canal treated teeth. The procedure is painless albeit a little tiring for the patient, due to prolonged mouth opening, especially for back teeth.
Crown fitting is fairly straightforward whereby the temporary crown is replaced by the permanent crown.
Crowns can be made from stainless steel, metallic alloys, porcelain, plastic or ceramics. A combination of metal and ceramic is also possible to maximise strength and simulate the appearance of natural teeth. Commonly used varieties include:
These are often prefabricated for the back teeth and has to be shaped by your dentist prior to fitting. It can be fitted within one visit, making it convenient and affordable. The crown shape is however generic, resulting in a less than ideal margin and contact with adjacent as well as opposing teeth. Stainless steel crowns are seldom used for front teeth due to their appearance. It is therefore more suitable as temporary restorations in the treatment of baby teeth in children.
Metal crowns are commonly fabricated from alloys of noble (e.g. gold, palladium, platinum and silver) and base metals (e.g. tin, copper, nickel, chromium). Full gold crowns are of a better quality when they are high in noble content (at least 60% noble metal, of which at least 40% must be gold). Metal crowns require less removal of tooth structure, cause less opposing tooth wear and is able to withstand chewing forces well. The metallic colour is the main drawback, making them a good choice for out-of-sight molars, especially in patients with a strong bite or grinding habits.
These are hybrid crowns made of a metal core and an outer layer of porcelain. The metal core provides strength while the porcelain mimics the colour, translucence and fluorescence of natural teeth. Porcelain fused to metal crowns attempts to seek the best combination of durability and appearance. Sometimes the metal beneath the porcelain can show through as a dark line, especially at the gum margins of teeth with receded gums.
Plastic crowns are fabricated using resin based acrylic. They are tooth coloured and can be made chair-side in a single visit, making it an affordable and convenient solution. They however tend to wear down faster, are prone to fractures and tend to discolour over time when compared to other tooth coloured crowns. Plastic crowns are more suitable as a temporary restoration.
Commonly referred to as an “Empress Crown”, leucite reinforced crowns consist of a core of pressure injected reinforced ceramics and an outer layer of porcelain. Leucite reinforced crowns have excellent tooth like characteristics and are more fracture resistant compared to traditional porcelain crowns.
Alumina reinforced crowns consist of an alumina core and an outer layer of porcelain. It has been in use for more than 25 years and is at present considered to be the aesthetic standard for tooth coloured crowns. Glass infiltrated alumina cores have recently been introduced to enhanced its bond strength to porcelain.
Yttria-stabilized zirconia oxide is a very hard ceramic material that has recently been introduced in dentistry. Monolithic zirconia crowns are made entirely of zirconia oxide. It comes in a variety of tooth-like shades and is suitable for back teeth due to its hardness. Zirconia cores can be layered with porcelain to further improve its colour, translucence and fluorescents although it does not form a very strong bond with porcelain, rendering it more susceptible to chip.
Patients should always weigh the pros and cons of crowning carefully as your dentist will need to remove between 1.0mm and 1.5 mm of enamel to accommodate the crown. Crowned teeth should be maintained with a combination of good personal hygiene and professional care. Failure to do so may lead to premature failure due to decay around the tooth margins or gum disease. Another common problem is porcelain fracture due to heavy biting or grinding habits. This can be mitigated with the selection of full metal crowns or the use of a night guard when sleeping.
Modern dental crown material is biologically compatible and can last many years if properly cared for. The average lifespan is between 5 and 15 years. The decision to replace crowns often hinges on the health and appearance of the crowned tooth as well as its neighbours.
Extraction of a permanent tooth is usually performed when it is deemed to be unsalvageable (e.g. due to large decay, deeply placed fracture or loss of gum support). It may also be performed as part of braces treatment or aesthetic procedures.
A dead tooth harbours bacteria and can cause localized infections within the tooth socket and surrounding bone. Dental extraction is done with the purpose to eliminate this potential threat and allow the patient to move on with its proper replacement.
The dentist starts by assessing the restorability of the affected tooth. He may take an x-ray to determine the extent of tooth damage and shape of the root/s. He is also likely check with you on your intentions to replace the tooth to be extracted.
Upon your consent, he will proceed to numb the adjacent gum using a fast acting, topical anaesthetic gel. This is followed by an injection of local anaesthetic to numb the tooth. The tooth is thereafter delivered by gently loosening it using either a pair of forceps or luxator.
The procedure takes approximately 10 minutes on average and is dependent on shape of the tooth root/s and length as well as the amount of tooth structure remaining.
The procedure itself is often painless as it is performed under local anaesthesia. It is quite normal to be able to feel a little pressure (or pulling sensation) during tooth loosening and delivery as you are fully conscious. Your dentist will ask you to bite gently on a sterile piece of gauze to apply pressure on the extraction wound after the tooth is out.
You can expect minor bleeding or oozing of the extraction wound during the first few hours. This can be stopped by placing a piece of sterile gauze onto the wound and biting gently onto it to apply pressure. You can help prevent bleeding problems by avoiding hard, hot or spicy food for the next 48 hours.
The local anaesthetic will usually start to wear off after 2 to 3 hours. Patients who are concerned about pain are encouraged to take painkillers right after the procedure before the local anaesthetic wears off. It is advisable not to eat while experiencing numbness as you may end up biting on yourself without knowing it.
Avoid strenuous physical activity or exercise immediately after the procedure. You can resume your normal routine after 24 hours. Smokers are advised to reduce or refrain from smoking, as there is strong body of evidence that shows that smoking interferes with the normal healing.
Avoid the urge to rinse repeatedly, spit or suck on a straw for the 24 hours. Doing so may cause dislodgement of the blood clot, increasing your risk of complications. You can brush the rest of your teeth gently, avoiding the wound site for the first 2 to 3 days. Most patients will be able to resume normal brushing by the end of the 1st week.
As with all surgical treatment, dental extractions can result in complications. Common complications include:
This is usually associated with severely damaged or root canal treated teeth. Such teeth will have to be surgically removed.
This is a painful condition that is characterized by loss of the initial blood clot from within the tooth socket. Treatment is aimed at preventing wound infection and managing pain. Fortunately it is not very common.
On rare occasions, healing is complicated by delayed bleeding. This is often associated with breakdown of the initial blood clot due to an infection. Treatment is directed at promoting blood clot stability and eliminating the infection.
Tooth loss is almost always accompanied by bone loss at the extraction site over time. We know that the bone loss is fastest during the 1st year post-extraction. This affects your future tooth replacement options (e.g. the use of dental implants or denture support).
The best way to manage this issue is for you to discuss tooth replacement options with your dentist prior to the extraction itself. Your dentist will be in the best position to advise you on the use of bone preservation techniques or the possibility of immediate dental implant placement to help you keep a healthy bone level.
Fillings are used to replace missing tooth structure due to decay or fracture. Fillings can be made of a wide variety of material such as composite resin, glass ionomer, amalgam, gold and even ceramic.
The main benefit is in its ability to protect the underlying dental pulp (nerve and blood vessels within a tooth) from injury. It also restores chewing function and appearance.
The dentist starts by examining the location, size of the defect and vitality of the affected tooth. If the defect is large or cannot be readily seen, he may recommend you to take a small x-ray image to assess the situation better. Your dentist will also try to find out more regarding your expectations on the appearance and longevity of the filling.
Treatment consist of careful removal of the decayed parts and weakened areas of the teeth. A medicated lining may be used protect the pulp tissues. The cavity then filled using the material of your choice and shaped to mimic a natural tooth.
The procedure time is dependent on the severity of the condition. Smaller cavities can be restored within 15 minutes whereas larger ones may take up to 45 minutes.
The procedure is painless when the cavity is small. It is possible for you to feel sensitivity if the cavity is deep as it will be nearer to the pulp. In such cases, your dentist will often offer you the choice of local anaesthesia so that you will feel more comfortable during the procedure.
In general, metallic fillings have the advantage of being more durable whereas non-metallic fillings have the advantage of being more tooth-like in appearance. Non-metal fillings are more technique sensitive and hence takes a longer time to fabricate. Ceramic fillings have good durability and appearance although they do cost more. It is advisable not to place different type of metal fillings side by side to avoid the phenomenon of Galvanism.
Some patients have been concerned about the health risk and environmental impact of amalgam since it contains mercury. It is true that amalgam is an alloy of silver, tin copper and mercury. The US FDA, after an extensive review of scientific evidence of its use for the last 100 years, did not find any health risk associated with its use. Dentists are also trained on the proper storage, handling and disposal of mercury. In fact, most modern dental practices use capsule systems whereby there is zero direct contact with the mercury used in amalgam.
Ultimately, the decision will hinge on your priorities in terms of durability, appearance, the amount of healthy tooth structure remaining, safety and cost. Do consider letting your dentist know what is important to you so that he can better guide you in this matter.
Fillings that are well done can potentially last many years with proper home care and regular professional care. The most common reasons for the need for retreatment is due to tooth decay adjacent to the filling, discolouration and fracture.
Modern dental fillings have a very good safety record. If you are uncomfortable with the use of amalgam in young children or during pregnancy, please let your dentist know so that he can advise you on the use of an alternative filling material.
Dental imaging refers to the use of x-ray images (radiographs) to visualize the dentition and its surrounding structures. Radiographic technology has evolve significantly over the years and most modern dental practices would now be equipped with digital units which require lower effective doses. Higher end equipment are often capable of producing both 2D as well as 3D images.
With the use of x-rays, your dentists will be able to locate hidden dental structures (e.g. roots of teeth, buried teeth), establish bone levels and detect disease (e.g. cavities, benign or malignant masses, bone loss) that are otherwise not visible to dentist.
An X-ray image is formed when a controlled release of X-ray radiation penetrates the oral structures before striking a film or sensor. Dense objects (e.g. teeth and bone) impedes x-ray radiation penetration appear lighter as less radiation will strike the film or sensor. Dental caries and soft tissues appear darker as they are less dense and are easily penetrated by the X-rays. Dental restorations (fillings, crowns) may appear lighter or darker, depending on the density of the material used in their fabrication.
The X-ray radiation dosage received by a dental patient is typically very small, equivalent to a few days’ worth of background environmental radiation, or an airplane flight between Singapore and Shanghai. The beam is concentrated into one short burst aimed at a small area and incidental exposure of other parts of the body is further reduced by the use of a lead apron.
Traditionally, exposed x-ray films is developed using a series of chemicals in a dark room. The adoption of electronic x-ray radiation sensors have made this process faster, more environmental friendly and reduce the effective radiation dosage, making it safer for patients and staff.
The x-ray view is dependent on the location, size and structure of the ‘area of interest’ to the dentist. Smaller images often require for the film/sensor to be placed in the mouth (collectively known as intra-oral views) while larger images require the film/sensor to be located outside the mouth (collectively known as extra-oral views).
The periapical view aims to capture the tip of the tooth root/s and its surrounding bone. This is especially useful in the investigation of pathology affecting a specific tooth and recording the progress of root canal treatment.
The bitewing view is taken to visualize the crowns of the back teeth and height of the alveolar bone. This allows your dentist to investigate for the presence of decay occurring between the back teeth, under existing restorations (e.g. fillings, crowns) and recording treatment progress during gum treatment.
The occlusal view is useful to visualize midline pathology (e.g. buried teeth, cysts etc.) that are located at the front part of the palate or floor of mouth.
A full mouth series comprises of up to 4 bitewings and 14 periapical views. It is used selectively in patients with multiple or generalized dental problems due to the high cumulative dosage.
A cephalogram is a standardized extra-oral view that is used to evaluate facial proportions and identify the skeletal contribution of a poor bite (malocclusion). It is called a Lateral Cephalogram when it is taken from the side and Antero-Posterior Cephalogram when it is taken with the patient facing forward.
A panoramic film is a very versatile, extra-oral view that provides a great overall view of the dentition, the upper and lower jaw bones, the heads and necks of the mandibular condyles, the coronoid processes of the mandible, the nasal cavity and the maxillary sinuses. It is very useful in the detection and localization of buried teeth, fractures and other pathologic entities involving the jaw bones.
CBCT scans have the ability to produce good quality 3D images of the jaw bones and teeth. This is especially useful in the placement of dental implants, planning jaw surgery, locating buried teeth and identifying tooth root canal morphology. CBCT scanners are specifically designed for use in the oro-facial region and exposes the patient to a much lower radiation dosage when compared to traditional CT scanners, albeit more than routine dental x-ray views.
It is possible for both tooth decay and periodontal disease to be missed during clinical examination. X-ray imaging of the dental and periodontal tissues is an essential element of comprehensive oral examination.
The principle of ALARA (As Low As Reasonably Achievable) is used by healthcare practitioners when recommending the use of dental x-rays. The frequency and type of x-ray investigations is dependent on the suspected presence of active disease and nature of treatment.
Dental implants are today the gold standard for permanent tooth replacement. It has the potential to offer patients a more natural, aesthetic, comfortable and lifestyle friendly solution when compared to removable or fixed dentures. Dental implants are very versatile and can be used to replace a single missing tooth, multiple missing teeth or function as an anchor to stabilize removable full dentures.
Dental implant treatment is possible because of the ability of bone to heal and grow around Titanium, providing stability and retention. This phenomenon is called Osseointegration and occurs over the first 6 months after implant placement. Besides being inert and biocompatible, Titanium is also strong, yet light in weight.
1) Keeps your remaining natural teeth free from dental restorations.
Dental implants eliminates the need for adjacent teeth preparation associated with the use of fixed or removable dentures.
2) Maintain our natural lip support and smile.
As dental implants are embedded in bone, the existing jaw bone height and thickness is maintained. This helps significantly in ensuring long term lip support for the face.
3) Simply more comfortable.
Dental implants are held in place, permanently by the jaw bone, eliminating the inconvenience and discomfort associated with removable dentures.
4) Last longer.
The long term survival rates of dental implants in the presence of adequate bone volume and good oral hygiene is very good. Many long term studies show that dental implants are simply the better option when compared to other forms of teeth replacement.
5) Restores normal function.
Dental implants mimics the natural teeth in daily function. The added stability allows us to chew and speak confidently. This has a direct impact on our professional and social wellbeing.
6) Excellent long term value.
Dental implants are very cost effective in the long term, especially when placed early after tooth loss by an experienced and competent surgeon. While the initial cost is higher than other forms of teeth replacement, the need for remakes in healthy mouths are more infrequent.
Anyone who is physically well enough to undergo a routine dental extraction will often be fit enough for dental implants. Dental implants are not suitable for the growing child as their jaw bone is still developing. There is however no upper age limit for dental implant treatment in healthy adults.
People with existing gum disease or chronic diseases will need to work with their dentist and physicians to achieve a good level of control prior to embarking on dental implant treatment. Studies show that smoking habits decreased the success rates of dental implant treatment. Smokers may therefore want to consider making a change to their lifestyle to improve the predictability of their care.
Firstly, the attending surgeon will carry out a pre-treatment assessment by doing a visual examination, taking x-ray, CT scans or photos, and making impressions of your teeth and gums. Once the initial assessment is completed, the surgeon will discuss the treatment options, process, risks and cost with you. Treatment often involves 2 stages, a Surgical and Restorative stage.
During the surgical stage, the surgeon will embed the titanium implant into the jaw bone, after careful preparation under local anaesthesia. The incision on the gum is subsequently stitched and allowed to heal. Patients who are anxious can opt to carry out treatment under sedation or general anaesthesia. On average, it takes about 30 minutes per implant.
On some occasions, the surgical stage is carried out on the same visit as the extraction of a tooth. This is possible if there is no active infection affecting the tooth to be extracted. This approach have the benefit of being convenient for the patient as well as reduce treatment time. The cost for immediate placement may be slightly higher due to the need for minor bone grafting.
The restorative stage is conventionally carried out between 3 and 6 months after the surgical stage. The attending dentist will expose the top part of the implant and take an impression of it to facilitate the the fabrication of the dental crown.
The surgery itself is pain free as it is done under local anaesthesia. During the preparation of the bone, you may be able to feel some vibration or mild sensitivity.
The impression and fitting of the crown during the restorative stage is also pain free. Your dentist may enlist your help when choosing the colour of the crown. Patients who have high expectations about the colour or shape of their crown may need additional visits and incur additional cost due to the need for additional lab work. The crown is fitted in place once the dentist is satisfied with the way it touches the adjacent and opposing teeth.
You should expect some minor bleeding, bruising, swelling and discomfort during the initial healing period. You are encouraged to rest at home during the first day after surgery and to avoid physical exercise or very hot food/beverages over the next 48 hours. Painkillers and antibiotics will be prescribed as needed to reduce discomfort and and avoid infection of the surgery site. It is recommended to avoid the consumption of alcoholic beverages whenever you are on prescribed medication.
The attending surgeon will guide you on how to keep the surgery site clean using antiseptic mouthwashes. Normal brushing of other teeth is important. Your surgeon will often review the healing of the implant site after one week.
The attending dentist will guide you on proper implant care after the final crown has been placed. A follow-up visit with the dentist is usually scheduled three months later to check on the function of your newly restored implant and that you are able to keep it clean.
Like all other surgeries, the placement of dental implants carries some risks. Common complications include the failure of osseointegration due to infection, injury to adjacent teeth or nearby vital structures that lie within the jaw bone (e.g. blood vessels and nerves).
Your surgeon will explain to you the incidence of such complications and the likelihood of success as it may vary significantly between different individuals and implant site.
Like natural teeth, the longevity of dental implants is dependent on good personal and professional care. The evidence over the last three decades tell us that dental implants is a very predictable treatment option in patients who are conscientious of their long term oral health.
Dental sealants refers to the bonding a thin layer of plastic onto the grooves of the chewing surface of a tooth as a way of preventing tooth decay.
Dental sealants reduce the depth of the grooves on the tooth surface, making it easier for children to keep their teeth clean by brushing. Since plaque removal is more effective, there is much less likelihood for tooth decay to take a grip and fester.
The placement of dental sealants is fairly straightforward and often takes just one visit. The tooth is cleaned, etched, conditioned and dried. Liquid plastic is then flowed onto the grooves of the tooth surface and hardened using an intense blue light. The bite is subsequently checked and the hardened sealant is buffed to a smooth finish. Your child can resume normal activities immediately after the appointment.
Molar and premolar teeth are the most common teeth on which dental sealants are placed. Having said that, any tooth that exhibits characteristics that increases the risk of tooth decay should be sealed. The recommendation for dental sealants will also take into account your child’s oral hygiene habits, diet and predisposition to teeth decay.
Dental sealants last between 3 and 5 years on average. It is however not uncommon to see sealants placed during childhood still intact on the teeth of young adults. Your dentist will check your child’s sealants during routine dental visits and will recommend repair or reapplication when necessary.
Dental sealants are very safe as it is made from the same materials as tooth coloured fillings. Dental sealants in combination with regular brushing and flossing, forms an affordable, yet formidable defensive strategy against tooth decay.
A dental veneer is a thin layer of tooth-like laminate that is placed over a tooth, either to improve its shape, size or colour or to protect a tooth’s surface from further damage.
Dental veneers are often used to attain the perfect smile. Some of us have small teeth, resulting in spaces that cannot be easily closed using braces or discoloured teeth that resist whitening. Others may have worn away the edges of their teeth or suffer from conditions that cause erosion of the enamel of their teeth, resulting in a prematurely aged appearance.
Multiple veneers can mask these spaces, restore teeth height that have been shortened by wear, protect teeth from further erosion, fill small black triangles between teeth caused by gum recession, improve color, shape, and symmetry, and make the teeth appear straight.
Communication with your dentist about your concerns and exploring alternate solutions is essential for a successful outcome. Each smile is different and veneers need to be carefully prescribed. Your dentist will start with a smile analysis to determine the steps that are necessary to achieve the smile that you desire. Thereafter, he may carry out a diagnostic mock-up or show you a simulation of your new smile.
Porcelain veneers consist of a thin ceramic shell (which replace tooth enamel), and an adhesive layer that bonds it to natural tooth. A small amount of the original tooth enamel must be removed, usually less than a millimetre, to create room for the porcelain veneer. An impression of the preparation is taken and sent to the dental laboratory for veneer fabrication. Once ready, the veneer is fitted in place using light-sensitive resin based adhesives.
The procedure for composite veneers is slightly different as the veneer material is applied directly onto the prepared tooth surface, sculpted to its desired shape and hardened using a curing light.
The procedure can often be completed within two visits. The time taken for teeth preparation and fitting is dependent on the number of teeth being treated.
Teeth preparation is usually done under local anaesthetic to minimize discomfort. You should expect transient sensitivity to hot and cold temperature in between visits and immediately after the fitting appointment. This is due to the removal of that thin layer of enamel and typically resolves within a few days.
Dental veneers are strong enough to withstand normal chewing forces and you can expect to use them like your own teeth. Like glass, they are also brittle and you will do well to avoid the same excessive stresses you would avoid with natural teeth (e.g. don’t bite your fingernails, chew ice, or use them to open beer bottles!)
Dental veneers can be made from composite, ceramic or porcelain. A composite veneer can be built-up in the mouth or indirectly fabricated in a dental laboratory. In contrast, a ceramic or porcelain veneer may only be indirectly fabricated.
Porcelain veneers are more durable, have excellent aesthetics and stain resistance compared to composites. It has a glass like property and can be sculpted, making it very difficult to tell the difference between a porcelain veneer and a natural tooth.
Composite veneers can be fabricated in a single visit and are generally more affordable. It is however more prone to staining and leakage compared to porcelain veneers.
Some dental laboratories/manufacturers are able to fabricate very thin ceramic veneers that reduce the amount of tooth structure removal. These types of veneers are more conservative and reduce the incidence of teeth sensitivity, albeit more expensive. They have their own disadvantages and may not be suitable for everyone.
You should always weigh the advantages and disadvantages of dental veneers carefully as your dentist may need to remove between 0.3mm and 0.8 mm of enamel to accommodate the thickness of the dental veneers.
Dental veneers need to be diligently maintained with good personal oral hygiene and professional oral care. Failure to do so may lead to premature failure due to decay or gum disease affecting the margins of the veneers. Another common problem is veneer fracture due to normal function, grinding habits or mishaps. This can be mitigated to a certain extent with the use of a night guard when sleeping.
Today, with improved resin based adhesives, dental veneers can last an average of between 5 and 10 years. Some studies suggest that approximately 50% of dental veneers will have to be replaced at the tenth year anniversary due to porcelain fracture, leakage, discolouration, decay or shrinkage of the gum line.
The use of dental veneers to simulate straight teeth, commonly referred to as ‘instant orthodontics’, in young patients with healthy teeth is not recommended. The long term maintenance needed and potential need for irreversible teeth preparation is simply not worth the time saved from undergoing routine braces treatment.
Dentures, commonly referred to as “false teeth” are made to replace missing natural teeth. It can be made of plastic or a combination of metal and plastic. A partial denture is used to replace a few missing teeth within the same arch whereas a full (or complete) denture is used to replace all teeth within the same arch (meaning, all natural teeth are missing).
Comfortable and well-made dentures helps you to chew, speak and maintain your facial appearance.
The dentist starts by examining your existing oral condition and dentures (if any). He will also evaluate your expectations of how the replacement teeth should feel and look. If necessary, he will recommend an action plan to restore back the health of your gums or existing teeth prior to the fabrication of the dentures.
Thereafter, he will take a mould of your teeth and gums, match the size as well as colour of the replacement teeth to your existing teeth. Depending on the number of missing teeth, bite registration and a trial denture may be fabricated, whereby you will be invited back to assess its suitability. This process facilitates any adjustments that may be desired by the patient or dentist. A new denture is subsequently made using the trial denture as a template.
Simple partial dentures can often be fabricated within a few working days whereas full dentures may need up to a month. The treatment duration and number of visits often vary depending on your expectations and experience with the use of dentures. Each visit on average is about 30 minutes.
Patients often experience an initial awkwardness when using new dentures. The time needed to get used to them will depend significantly on the patient’s perseverance and experience using dentures. Most patients will take an average of 3 weeks to 4 weeks to get used to them.
When eating, start out with soft and bite sized food (e.g. cutting food into smaller pieces). Chewing gently using both sides of your mouth at the same time will help stabilize the dentures. Over the next few weeks, include other foods until you return to your normal diet.
It is normal to salivate a little more than usual during the first few days when using new dentures. These increased stimulation affecting the salivary glands will cease once you get used to them.
Your speech is dependent on the position of teeth. New dentures are likely to affect your speech initially. Practice your speech by reading out loud and repeating troublesome words until you resume normal speech.
New dentures can cause sore spots on denture supporting areas of the gums and teeth. Please help the dentist identify these areas so that proper adjustments to the dentures can be made. You can stop wearing the dentures if you experience significant irritation.
You are encouraged to wear them most of the time except when sleeping. Removing them when sleeping allows your gum and teeth to rest. Soaking the dentures in water when not using them is recommended to maintain its shape.
Use a soft toothbrush and toothpaste to brush your teeth, gums and dentures after every meal if possible. Avoid using hot water, abrasive or bleaching agents to clean your dentures. Doing so will either deform or discolour them. Brushing your dentures over a basin of water will often prevent accidental breakage should they slip out of your hands. Soak the dentures in denture cleaning solutions once or twice a week to loosened hardened deposits. Remember to rinse them thoroughly before use.
Your dentures may become loose over time. This is due to the fact that prolonged tooth loss often causes our jaw bones and gums to shrink. Poorly fitting dentures can cause soreness, infections, inability to cut food and loss of lip support. It is recommended that you visit your favourite dentist for routine dental care and have the fit of your dentures assessed at least once a year.
Dentures are safe for everyday use when they are properly fabricated and cared for. Avoid using broken dentures, excessively small or loose dentures as there is a risk of choking on them. Poor oral hygiene when using dentures can lead to bad breath, fungal infections affecting the gums or decay of the remaining teeth.
Professional fluoride therapy involves the application of fluoride gel or varnishes onto the teeth surface to make it more resistant to dental decay (cavities) or treat teeth sensitivity.
Fluoride helps prevent dental decay by making the tooth surface more resistant to acid attacks from sugar fermenting bacteria found in dental plaque. Fluoride also has the ability to reverse early decay by disrupting acid production of plaque bacteria and promote the tooth remineralisation.
Studies show that topical fluoride is very useful in fighting tooth decay in children and adults. This is especially true in people with conditions that predisposes them to an increased risk of decay, such as:
The tooth surface is constantly undergoing the process of demineralisation and remineralisation from daily activity. Minerals are lost when acids (formed by sugar fermenting bacteria or acidic drinks) attack the enamel layer. Once the acidic environment has been neutralized by our saliva, minerals such as fluoride, calcium, and phosphate (from food, drinks or dental care products) are redeposited onto the enamel surface. Cavities form when the demineralisation activity is not repaired by adequate remineralisation. Fluoride reduces this risk by the formation of fluorapatite, which contain fluoride ions that reduce the rate of tooth enamel demineralization and increase the rate of remineralisation during the early stages dental decay.
Professionally applied topical fluoride comes in 2 common varieties:
Fluoride gels are delivered with the use of trays, which contain a groove to hold the product. The tray is held in the mouth by asking the patient to bite lightly on it for about four minutes. The tray and excess gel is subsequently removed and the patient is instructed not to rinse, eat, smoke, or drink for at least 30 minutes after application. This method is suitable for whole mouth fluoride therapy in most patients, except for very young children who are unable to spit or follow instructions.
Fluoride varnish is painted on as a thin layer with a small brush. It sets within seconds, easier to apply and more precise for small areas. It also has the advantage of a sustained release of fluoride ions as long as it remains in place.
Professionally applied topical fluoride has a very good safety record. There is at present no evidence that its professional use causes fluorosis of teeth.
Gum surgery is recommended to correct moderate to severe forms of gum disease. The objective is to allow your dentist to gain direct access to hardened tartar deposits around the roots of your teeth that lies deep below the gum line, reshape the supporting bone and reduce the depth of gum pockets. The treatment is usually performed by a gum specialist (Periodontist).
The benefits of surgery is to enhance healing of the supporting gum and bone around the affected teeth so that patients can continue to keep and use them. The reduction of gum pockets also facilitates home care, making it easier for you to maintain a healthy and functional dentition.
Your periodontist will initially numb the gums using a local anaesthetic so that you remain comfortable during the procedure. A small incision is made along the gum margin to enable the periodontist to fold back the gums and expose the roots of the affected teeth. Identified areas of hardened deposits that harbour bacteria removed from the root surface using a combination of hand instruments, ultrasonic devices and in some cases using lasers. The periodontist will subsequently proceed to smoothen and recontour the irregular surface of the damaged bony areas. The gums are finally repositioned and held in place using stiches.
The procedure time varies depending on the number and location of the affected teeth. The average procedure time is approximately 45 minutes.
The procedure is fairly painless as it is performed under local anaesthetic and feels a little bit like scaling & polishing. Some patients may opt for sedation if they feel particularly anxious about the surgery.
Following surgery, the surgical site may feel slightly tender, sore and swollen for up to week. Some patients may also experience more sensitivity to hot and cold during the initial healing period. You may be prescribed strong painkillers to relieve the discomfort, antibiotics to prevent infection and an antibacterial mouthwash to keep the mouth clean.
While most patients are able to resume their normal routines the day after the surgery, It is best to avoid chewing on hard food (e.g. ice and nuts), especially at the surgical site for the next few days. Smoking have been proven to interfere with healing. You are advised to work out a plan with your periodontist on how best to manage this habit to facilitate your quick recovery.
Your periodontist will review your progress, clean the surgical site and remove the stitches 7-10 days later.
The procedure may cause an initial increase sensitivity to temperature (hot or cold) and pH changes. Your periodontist may apply topical fluoride gels or employ the use of a hard tissue laser to help manage this complication.
Some patients may also feel that their teeth appear to be longer or observe larger gaps between the teeth after the surgery. The impact will be dependent on the location of the affected teath and severity of the gum disease. You are encouraged to discuss your aesthetic expectations with your periodontist prior to the surgery.
The health of your gums may also be affected by certain chronic diseases (e.g. diabetes) and consequently its ability to heal after surgery. Do make it a point to inform your periodontist about any conditions that you may have as well as any medication that you are taking for these conditions.
While most patients will experience improvements after the surgery, the long term success of the surgery is dependent on patient’s ability to maintain optimal home dental care and attend regular preventive dental care visits with his/her favourite dentist. Gum disease can recur if the patient is not motivated to do so. Retreatment may be needed in refractory cases.
Invisalign takes a novel approach to straightening teeth, by using a series of custom-made removable trays to help you achieve a confident smile without the use of traditional brackets and wires. The aligner trays are made of smooth, comfortable and virtually invisible plastic. Wearing these aligners over your teeth full time, will gradually and gently shift your teeth into place, based on the exact movements prescribed by your orthodontist.
Invisalign offers many great advantages for adults and teens who require orthodontic care.
Many adult patients seek orthodontic care because they didn’t have it as a teen or experienced relapse from their previous orthodontic treatment. With Invisalign®, adults can now straighten their teeth without drawing attention and function confidently at work. It can also be safely used with existing dental work such as veneers, crowns, bridges, and dental implants.
Invisalign Teen is designed especially for teenagers. It’s a great fit for their lifestyles because the aligners can be removed before eating, playing an instrument, during contact sports, for brushing or when making an important presentation. Invisalign Teen also comes with six replacement aligners in case they are misplaced or damaged.
On your first visit, your orthodontist will review your dental and medical history, listen to your concerns and conduct an oral examination. Rest assured that he will spend time to answer all of your questions about orthodontic treatment and the financial considerations involved. He will commence to take the records only if you consent to proceed with treatment.
You will be invited back for fitting of your aligners once they are ready. During this appointment, your orthodontist will check the fit of your 1st pair of aligners and bond small tooth coloured attachments to your teeth to enable your aligners to work more efficiently.
You’ll be scheduled for future visits every six weeks for checkups and adjustments. Our practice assistants will do their best to ensure that future appointments are convenient for you. Our general dentist will also attend to you twice a year to ensure that your teeth and gums remain healthy throughout treatment.
Your orthodontist will be responsible for taking pictures, impressions and x-rays of your current teeth and smile. Using this information, a 3D digital model of your teeth is created and used to fabricate a series of customized aligners that will gently shift your teeth into position. ClinCheck, a proprietary software by Align Technologies allows you and your orthodontist to review the treatment plan and make adjustments to ensure the best possible outcome.
Invisalign is completely removable so you will be able to eat, drink, brush and floss as normal. Every two weeks, you’ll start using a new pair of aligners, and eventually, your teeth will be in the position prescribed by your orthodontist. You will need to wear the aligners for at least 22 hours a day to stay on target.
There are no diet restrictions with Invisalign because you remove them before you eat. You don’t have to worry about breaking off a bracket or having a wire bother your gums because you ate the wrong thing. When you’re done eating, simply reinsert your aligners back onto your teeth.
The aligners are comfortable and clear so no one will know you’re wearing them. You can still take part in all of your extracurricular activities and continue your active lifestyle. There are no metal brackets to attach and no wires to tighten. You just pop in a new set of aligners approximately every two weeks, until your treatment is complete. You’ll achieve a great smile with little interference in your daily life. The best part about the whole process is that most people won’t even know you’re straightening your teeth.
The cost of Invisalign’s treatment depends on the complexity of your teeth movements, treatment duration and treatment sequence that has been designed for you by your orthodontist. No two treatment plans are exactly alike, because no two mouths are exactly alike.
Like traditional braces, Invisalign is offered with different payment options. We are accredited providers for most medical and dental insurers and accept credit card and NETS payment. Our interest free instalment plan provides you with absolute peace of mind.
Invisalign repositions teeth as safely and effectively as traditional braces and are approved by the US FDA as medical devices. Treatment success is dependent on your ability and willingness to wear them for at least 22 hours a day. Invisalign has been used by more than 1.5 million adults and teens worldwide and has enjoyed a very high satisfaction rate.
Laser Dentistry refers to the use of a very narrow, intense beam of light energy in dental procedures. The light energy produced by modern dental lasers can be used to remove or shape both hard and soft tissues.
Hard tissue lasers are used to replace the dental drill and reduce the need for local anaesthesia in simple procedures. Patients who are anxious about the sound of the dental drill or the thought of injections can now look forward to a more pleasant experience.
The use of soft tissue lasers to make incisions during surgery have the added ability to control bleeding and disinfect the wound. Proponents of its use have also reported quicker healing times and less eventful recoveries post-surgery.
Dental lasers are used as cutting instruments or to deliver heat to a very precise area. It is safe alternative and is effective for a wide range of dental procedures, especially when used in conjunction with conventional dental instruments.
Dental lasers can be used to:
Dental lasers are safe when it is used by trained practitioners who adhere to the manufacturer’s safety guidelines. These safety guidelines include the need for you to wear special safety glasses that serves to protect your eyes during the procedure. The assistant will also be using a high powered suction device to evacuate the smoke that forms during tissue ablation.
Mini dental implants were first introduced as a temporary implant during full mouth rehabilitation. While there is no rule on how long it can be used as a temporary implant, it is implied that the mini dental implants were ultimately removed once the final denture was ready to be fitted.
The pursuit for cost efficiency and a less invasive form of implant treatment has led to the use of mini dental implants as a semi-permanent solution to stabilize loose dentures in individuals who lack adequate bone volume or not physically fit enough for conventional dental implant surgery.
1) Smaller may be better in the presence of limited bone or health
Mini dental implants are dental implants with a diameter of less than 3mm. It can therefore fit into narrow areas with limited bone volume due to their smaller diameter. This reduces the need for bone grafting procedures which increase the complexity and cost of implant care.
Mini dental implants have less number of connecting parts, are relatively easier to place and often have simple treatment objectives. All of these factors make mini dental implant treatment more affordable, compared to conventional dental implant treatment.
3) Minimally invasive surgery
Individuals who have severe chronic ailments, very elderly or overly anxious may have a preference for a treatment plan that involves minimal surgery.
4) Temporary anchorage
Mini dental implants smaller than 1.8mm, also known as micro dental implants, are routinely used as temporary “anchors” to assist in tooth movement during dental braces treatment. The micro implants are removed upon completion of braces treatment and heal without any visible scarring.
Mini dental implants are limited by its main advantage, its size. The smaller diameter reduces its physical strength and the amount of implant to bone contact. While it provides an adequate degree of stability to full dentures, it does not do so well as a single tooth replacement solution. Using it to replace a single tooth or multiple mini dental implants to support a permanent fixed dental bridge subjects the mini dental implants directly to heavy biting forces which will ultimately cause it to bend, break or loosen.
The successful use of dental implants has been well documented over the last four decades. Today, potential implant patients and dentists alike have numerous different types of dental implants to choose from, ranging from size, surface coating technology and restorative options. While we celebrate our options, it also makes the decision making process harder.
One good way of making things easier is to adopt a Restorative Driven Treatment Approach. This approach can help unlock the most suitable treatment option by closely examining and understanding the functional and aesthetic improvements expected by the patient.
Narrow dental implants are engineered for areas with limited space, such as missing upper lateral incisors or lower front teeth. These implants are narrower than conventional dental implants and have a diameter of between 3mm and 3.5mm.
1) Safe placement in areas with limited space.
Narrow dental implants allows for safe and predictable treatment in situations where conventional implants are too wide to fit, such as the replacement of small sized teeth, areas with reduce bone thickness or adjacent to teeth with abnormal root angulations. The clinical performance of narrow implants has been validated in several studies that show an overall survival rate of 97.3% after five years, validating its safe use and predictability.
2) Good combination of form and strength.
Dental implants should ideally be able to withstand the heavy biting forces associated with chewing function. The strength of a dental implant however diminishes with its size and diameter. Narrow dental implants provide a good balance between size and toughness in small spaces for most people.
3) Good combination between size and aesthetics.
The diameter of a dental implant affects the appearance of the final dental crown. A smaller than usual implant diameter gives the appearance that the tooth is very narrow at the gums, resulting in a triangular looking tooth. Clinical studies show that narrow implants are “wide enough” to provide good aesthetics for the smaller members of our dentition.
No. Mini implants have a diameter less than 3mm. More than size difference is the fact that narrow dental implants are engineered to be restored just like conventional dental implants. It is simply just a “thinner” version that is manufactured with added emphasis on toughness.
Root canal treatment involves the removal of dead or diseased pulp tissue from within a tooth as well as the cleaning and shaping of the root canal thereafter to receive a filling. The common causes of pulpal injury are decay, trauma and excessive wear.
Root canal treatment saves natural teeth that have sustained irreversible pulpal injury. It prevents (or delays in some cases) the need for teeth extraction and the accompanied need for their replacement. It is also used to as an option of last resort to treat hypersensitive teeth that do not respond to conventional treatment. Occasionally it is used as part of a treatment plan to restore teeth that are maligned.
The dentist will initially numb the tooth to be treated using local anaesthetic and isolate the treatment area using a rubber dam. The rubber dam prevents saliva contamination and accidental ingestion of root canal instruments and materials used during the procedure. The dentist will thereafter proceed to remove decayed areas and gain access to the pulp chamber using the dental drill. Infected (or dead) pulp tissue is subsequently removed using hand instruments and the root canal system is cleaned using a mild disinfectant solution. The root canal is shaped using small files before being sealed with an inert material called gutta-percha. Your dentist may use various devices, such as x-ray imaging equipment, apex locator, loupes or a dental microscope to aid him during the procedure.
Root canal visits takes about 60 minutes on average and may require multiple visits, depending on the shape and number of canals present as well as the nature of your condition. Front teeth have the advantage of being in a more convenient location and usually have a single large ovoid canal whereas back teeth usually have multiple fine canals which are harder to access. Patients who present with chronic infection, resulting in damage to the surrounding tissues (e.g. sinus tract, cystic changes etc.) should expect a longer follow-up period with their attending dentist.
The experience is variable depending on the nature of the pulpal injury. Existing inflammation and infection can reduce the effectiveness of local anaesthetic agents, resulting in a “hot tooth”. In such an event, medication are often prescribed by your dentist to calm the tooth down prior to root canal treatment.
Fortunately, such situations are uncommon and most patients will experience little or no pain during the procedure. Your dentist may use root canal medicaments and place a temporary filling in between visits.
The tooth and its surrounding gum may feel slightly tender over the next few days due to inflammation. Your dentist may prescribe you analgesics to help you manage the discomfort. After a short observation interval, your dentist will likely recommend that the root canal treated tooth be protected from the potential risk of fracture with either a crown or an onlay. A root canal treated tooth functions like any other normal tooth and can potentially last a life time with good personal oral hygiene and professional care.
Root canal treatment is a common and safe procedure with high success rates (>90% for first treatments). Failures are often associated with the presence of complicated canal systems, recalcitrant infections or tooth fracture. Root canal treatment when carried out in vertically cracked teeth have a guarded prognosis as it is hard to predict or prevent crack propagation from occurring during and after the completion of treatment.
Other potential risks include the possibility of root canal wall perforations, fractured instruments, apical irritation from instruments and disinfectant solutions. The prevalence of these complications have reduced with the adoption of modern materials, technique and equipment. A very small number of patients have also been reported to have swallowed small root canal instruments or experienced soft tissue irritation from the disinfectant solution used during the procedure when it was not possible to use a rubber dam.
Conventional dental implant treatment often requires a bit of waiting time between the placement of the dental implant and issuance of the dental crown. This treatment protocol has indeed served many dental implant patients very well over the last 4 decades and its success has led to an increasing number people asking for shorter treatment times so that they can resume their usual lifestyle as soon as possible.
The good news is that Same Day Dental Implant treatment is already a reality for selected individuals. People who possess a good degree of bone volume and quality, in good health and free from an existing dental infection can now look forward to having literally new teeth in a day!
Same Day Dental Implant treatment is possible because dentists today have access to more than four decades of dental implant experience and research data. The criteria for predictable care and success are definitely better understood compared to when we first started. Dental implant design, surface treatment technology and the manufacture process of dental implants have also evolved to enhance the integration of dental implants to bone (osseointegration).
In a nutshell, Same Day Dental Implant treatment is a natural progression of what we have learnt and done over many, many years.
The main advantage of Same Day Dental Implant treatment is that patients can resume their normal appearance and function almost immediately. Patients feel more confident about themselves and is able to return to their normal lifestyle much faster.
Another benefit is that Same Day Dental Implant treatment eliminates the need for temporary dentures that are often needed in conventional dental implant treatment. When a person loses his or her teeth, one automatically feels embarrassed and it pushes the individual psychologically backwards when one has to wear a removable denture, even temporarily. That is why having the ability to regain new teeth in a day sounds so appealing to many individuals.
Same day dental implant treatment is more technique sensitive compared to conventional dental implant treatment. The success rates of same day dental implants are comparable to conventional dental implants in the hands of a qualified, well trained and skilled practitioner.
In conventional dental implant treatment, the dental implant is provided with a healing time of between 3 and 6 months after placement. This allows the bone to heal and mature around the dental implant before it is crowned.
Same Day Dental Implant treatment is based on the precept that bony healing around a dental implant can proceed as normal even if the implant is crowned on the same visit. The key to success lies in ensuring that the dental implant has a high degree of initial stability, is fully encased in good quality bone and free from infection immediately after placement. Great care is also taken to ensure that the implant crown is not exposed to excessive and heavy biting forces from normal function during the healing phase.
To provide you with greater peace of mind, our team of dentists and specialists will do a comprehensive visual and dental CT scan of the treatment area to help determine your suitability for Same Day Dental Implant treatment.
Scaling and polishing is the most common dental procedure requested by patients.
The main benefits of the treatment is in its ability to
The procedure will usually entail the initial use of an electronic scaler to remove hardened deposits on the tooth surface known as calculus or tartar. This is followed by the application of a rotating rubber cup with a slurry mix of fine grit powder or paste on the surface of the teeth to remove soft deposits (known as plague) and external stains. Recalcitrant stains (commonly found in heavy smokers) can be gently removed using a high pressure water jet that is mixed with fine grit salt particles.
The average treatment time is approximately 30 minutes.
You should expect the process to be fairly “wet” as water is used to cool down the vibrating scaler tip, carry away debris and vehicle to carry the polishing powder. The dental assistant helps you to stay “dry” by using the suction tip to evacuate water and debris during the procedure. You may experience mild sensitivity (especially if you suffer from receding gums) and bleeding from inflamed areas of the gum (caused by the tartar deposits).
It is a very safe, low stress procedure for most people.
Sedation dentistry helps patients to relax by reducing their perception of environmental stimuli such as noise, smell or discomfort. You will still be aware of your surroundings and able to answer questions.
Studies suggest that 1 in every 5 patients are anxious about their dental visits. For these individuals, sedation dentistry can make their visits more comfortable and enable their dentist to deliver care more efficiently. The increased patient tolerance may also increase the number of procedures possible within a single visit, without sacrificing either patient safety or clinical quality. Our experience is that many anxious or busy patients would prefer to receive their care in as few visits as possible.
Sedatives can be given to patients using a variety of methods, including by mouth, under the tongue, inhaled through the nose or through the veins. The type of sedation that the dentist prescribes will depend on the procedure being performed, the patient’s overall health and any other medication they are taking.
Oral sedation is a convenient method for some patients as the sedative can be swallowed whole or placed under the tongue (after crushing) to be absorbed into the bloodstream. It does not require any special equipment and cost very little. Benzodiazepines are the most common class of sedatives used today. They have been used for almost half a century and have a relatively low incidence of side effects or adverse reaction with other medications. The main disadvantage of the technique is that it is not very precise, as the sedative effect can be variable between patients.
Inhalational sedation is one of the mildest forms of sedation available. It is administered by the patient breathing a mixture of nitrous oxide and oxygen. The gas mixture is commonly referred to as ‘laughing gas’ in many parts of the world because some patients feel so giddy and ecstatic that they often giggled. This technique is used to calm millions of anxious patients each year because of its safety record, rapid onset and quick reversal time.
Intravenous sedation is a very precise form of sedation as the sedative medicine is delivered directly into the bloodstream. This allows your anaesthetist to control the depth of the sedation by making small adjustments to the dosage being delivered. Modern intravenous sedatives also have better analgesic and amnesic effects which is often helpful to anxious patients requiring oral surgery.
In addition to a feeling of deep relaxation, sedative medication may create a feeling that time passes very quickly or make a patient remember very little of their time in the dental office. Analgesic properties help reduce any sensation of pain or discomfort.
You will need to arrange for a companion to accompany you to and fro the practice on the day of your sedation appointment. You should not eat or drink six hours prior to your appointment unless otherwise directed by your dentist.
Consider taking the remainder of the day off, stay hydrated and avoid operating heavy machinery or driving for the next 24 hours.
All medication, prescribed or available over the counter, carries potential risks. Unpleasant side effects can occur depending on the sedative used, dosage, type and duration of sedation. Patient’s reaction and tolerance of the different type of sedation techniques may also be quite different. For this reason the attending dentist or anaesthetist will ask a series of questions about your health and lifestyle. It is important to answer these questions as accurately as possible to ensure a safe outcome. Patients with a complex medical history may have their existing physicians co-opted into their care.
The replacement of back teeth can be complicated by loss of alveolar bone height which often accompanies tooth loss. This is made more challenging by the proximity of the back teeth to anatomic structures and the heavy chewing forces during normal function.
Bone grafting procedures to compensate for the lack of bone height have proved to be successful in providing sufficient bone quantity and quality for dental implant placement. Some individuals may however be unsuitable or unwilling to proceed with bone grafting due to the increased cost, risks or additional surgery and healing time. Short dental implants is a viable alternative for such individuals.
1) Lower risk of injury to adjacent anatomic structures.
Short dental implants are dental implants with a length of between 5mm and 8mm. It can therefore fit into areas with limited bone height and decrease the risk of encroachment into the maxillary sinus in the upper arch or injury to the inferior dental nerve in the lower arch.
2) Simplified implant surgery.
The elimination of bone grafting procedures shortens the overall treatment time and keep the number of surgeries needed to a minimum.
3) Faster healing time
A straightforward surgery in the absence of the need for bone grafting often heals faster and less eventfully when compared to simultaneous implant placement and bone grafting surgeries.
4) More affordable
The elimination of bone grafting procedures also reduces the total cost of dental implant treatment.
Short dental implants are limited by its main advantage, its size. The shorter implant height reduces the amount of implant to bone contact and reduces the crown to root ratio. One way to overcome these shortcomings is to use an implant that is as wide as reasonably possible and to adopt a one-for-one replacement strategy, meaning one implant for each missing tooth to be replaced.
The successful use of dental implants has been well documented over the last four decades. Today, potential implant patients and dentists alike have numerous different types of dental implants to choose from, ranging from size, surface coating technology and restorative options. While we celebrate our options, it also makes the decision making process harder.
One good way of making things easier is to adopt a Restorative Driven Treatment Approach. This approach can help unlock the most suitable treatment option by closely examining and understanding the functional and aesthetic improvements expected by the patient.
Teeth desensitisation is carried out to manage repeated episodes of transient, sharp pain when eating sweet, sour or acidic food; drinking hot or cold drinks; or sucking air through the teeth. The most common causes of teeth sensitivity include loss of the enamel shell (due to decay, trauma or wear), exposure of the tooth root (due to gum disease or overzealous brushing), and cracked teeth. Patients who are afflicted with grinding habits, have received head and neck radiotherapy, suffering from bulimia or gastro-oesophageal reflux are at a higher risk of experiencing teeth sensitivity.
Treatment allows you to resume normal function, minus the sensitivity.
The dentist will do an oral examination, conduct special investigations or take x-rays of your teeth to determine the underlying cause of the sensitivity. Once the underlying cause is determined, treatment may consist of one or more of the following: personal use of desensitising toothpastes, fluoride gel application, fillings, crowning, gum grafting or root canal treatment.
The procedure time is dependent on the treatment plan. Fluoride gel application and fillings are relatively simple and can be completed within a single visit whereas more complex procedures may require multiple visits or even require the attention of a specialist.
The experience may vary depending on the treatment plan. Fluoride gel application is painless and only requires an hour of abstinence from eating and drinking after the procedure. Other treatment may require the use of local anaesthetics and involve tooth preparation.
Recurrence of teeth sensitivity hinges on the management of the underlying cause and chosen treatment. Your dentist will often recommend a conservative treatment approach, supported by an action plan to manage the underlying cause at the start. Example, a person who is experiencing teeth sensitivity due to overzealous brushing may be treated with fluoride gel application and modification of existing brushing technique or frequency. Another example, a person who suffers from excessive enamel wear due to teeth grinding when sleeping may be treated with a combination of crowning and use of a night guard.
Treatment risk is dependent on the chosen treatment. Fluoride gel application and fillings are safe, with little or no risk. The potential risk for complications increases with more advanced treatment options such as gum grafting or root canal treatment although it is still considered to be relatively low.
Teeth whitening is carried out to improve the colour of the teeth. There is more than one way of doing so and the most suitable method is often dictated by the underlying cause of discolouration, your tooth structure and expectations.
Most people feel that whiter teeth projects a more youthful and attractive smile, enhancing their self-confidence both at work as well as their social lives.
The dentist starts by investigating the nature of your teeth discolouration and colour of your existing restorations (e.g. tooth fillings, veneers, crowns, etc.). He will also check the health of your teeth and gums to ensure that it is safe to proceed. Your dentist is likely to record your initial tooth shade and may take photos and impressions of your teeth.
The procedure time is dependent on the method employed. In-office bleaching can be completed within an hour whereas home bleaching may take between two and three weeks.
This will also depend on the method used.
Home whitening is most suitable for individuals who wish to lighten their teeth colour gradually in the comfort of their own home and time. This method requires an impression to be taken for the fabrication of customized bleaching trays. The customized trays ensures that the gel is evenly distributed and covers all the targeted teeth sufficiently. It also prevent direct contact of the gel with the soft tissues of the mouth and reduce gel leakage.
Home whitening kits work by having the bleaching ingredients in whitening gels to diffuse into the tooth structure and break down the stain particles present over a period of two to three weeks. These kits typically contain between 10% and 35% of Carbamide Peroxide (active ingredient). The duration of usage varies significantly (ranges from a few hours to overnight) depending on the brand. Your dentist will provide you with detailed instructions on the usage regime and care.
Since these kits consist of bleaching agents that can potentially cause harm to your teeth and gums if misused, they have to be prescribed by a dentist. Unused bleaching gels can be kept up to their expiry dates if stored in a cool, dry and dark area. These can be used to maintain the whiteness of your teeth by repeating the procedure a few months later.
In-office whitening is most suitable for individuals who want fast results. It works in a similar way to home whitening kits, producing equally satisfactory outcomes. It is faster because of the use of a higher concentration or different formulation of the bleaching agent. Chemical activators, light and heat sources are commonly used to catalyse (hasten) the process.
Internal tooth bleaching is most suitable for root canal treated teeth. The source of discolouration in root canal treated teeth is often from within the tooth (e.g. root canal filling materials, residual blood cell deposits).
Internal tooth bleaching as its name suggest, literally works by whitening your teeth from inside-out. Bleaching agent is placed inside your tooth and left in place for two weeks to work its magic, before being removed and the affected tooth restored. As the bleaching agent is placed internally within the tooth, your dentist has to ensure that the existing root canal filling is sufficiently robust.
Teeth whitening last between 18 and 24 months on average, depending on your lifestyle habits, oral hygiene and access to routine dental care.
Common complications associated with teeth whitening are transient teeth sensitivity, soft tissue irritation or a less than expected change in tooth colour.
The incidence of teeth sensitivity and soft tissue irritation is relatively higher with in-office teeth whitening. These symptoms will resolve spontaneously once active treatment is stopped.
The teeth colour at the end of treatment often varies a little between different individuals. It is affected by the underlying cause of teeth discolouration, your inherent tooth structure and compliance with the treatment regime. Do share your expectations with your dentist so that he can better understand your needs.
All professional teeth whitening products have to be registered with the Health Sciences Authority of Singapore. It is a safe procedure when carried out using reputable products under the supervision of a dentist.
Wisdom teeth start its development during adolescence and erupts into the oral cavity during early adulthood. Most of us unfortunately do not have enough jaw space to accommodate these teeth. As a result, these teeth are unable to erupt fully and starts to jam itself against the tooth in front of it. Dentists often refer to this condition as an “impacted wisdom tooth”.
This include the ability to eliminate areas of food trap that often leads to recurrent gum infections (which manifest as episodes of pain or discomfort), prevent decay of the adjacent tooth that lies in front of it, and prevent premature loss of gum or alveolar bone due to chronic gum infection.
The surgeon will start by administering local anaesthetic to numb the affected wisdom tooth and its immediate surroundings. Patients who are especially anxious may also choose to do the surgery under sedation or general anaesthesia. The surgeon will thereafter proceed to make an incision along the gum line and expose the impacted wisdom tooth by removing some bone around it. Delivery of the tooth is often accomplished by dividing the tooth into 2 or more pieces to minimize the risk of nerve injury during removal. Finally, the surgeon will proceed to clean the socket and close the incision using stitches.
The average procedure time is 15 minutes.
The recommended age to remove wisdom teeth that are impacted is during early adulthood when healing is often swift and uneventful. The experience will also be more predictable as the roots of the wisdom teeth may not have fully formed yet and the jaw bone still relatively elastic.
The surgery itself is fairly painless as this will be managed using fast acting local anaesthetic agents. Patients often find the noise and vibration associated with bone removal and sectioning of the tooth to be slightly uncomfortable (as sound conduction through bone is more efficient than air). You will also be able to sense some pressure during the delivery of the tooth.
You should expect mild bleeding, swelling and discomfort over the surgery site for two to three days after the surgery. A small percentage of patients may experience bruising along the jawline and neck.
You are encouraged to rest at home during the first 24 hours after the surgery. This will allow for the formation of a proper blood clot and minimise the risk of prolonged bleeding. Avoid smoking, exercising and using a straw for the first 48 hours. It is recommended that you do not consume alcoholic beverages whenever you are on prescribed medication.
A soft or liquid diet is recommended for the first 3 days before slowly resuming to your normal diet thereafter. Your surgeon may advise the use ice packs and prescribe analgesics to help relieve the swelling and discomfort. You can keep the wound site clean by rinsing with an antiseptic mouthwash. You can brush the other teeth as per usual.
A follow-up visit with the surgeon is often scheduled about 1 week after the surgery to ensure that you are making good progress towards a full recovery.
A potentially, serious complication associated with wisdom tooth surgery is nerve injury. This is due to the close proximity of the wisdom tooth to the Inferior Dental nerve. Injury to the nerve will result in a persistent feeling of numbness or a tingling sensation affecting the lower lip, gums, chin or tongue after the surgery. Fortunately, these symptoms will often resolve over time in most cases of mild nerve injury. Only on rare occasions does the injury become permanent. The experience of the surgeon and the patient’s ability to cooperate during the surgery may play a significant role in risk reduction.
A more common complication is the occurrence of a painful condition, three to five days after the surgery, known as a “dry socket”. It occurs when there is an inexplicable failure to form a proper blood clot within the tooth socket. Your surgeon may suggest for you to abstain from using a straw, smoking and spitting (or do any other type of sucking action) immediately after the surgery to mitigate this risk. The complication will usually resolve by itself and immediate emergency management is directed at pain control for patient comfort.
The All-on-4® treatment concept is designed to help patients with total teeth lost to regain their normal oral function & appearance in a short amount of time.
Patients undergoing braces treatment can look forward to an attractive smile, enhanced oral health, better chewing function, speech and self-esteem.
Advanced CAD/CAM technology is used to provide patients with precise and durable restorations made of either ceramic or metal on the same visit.
Children Dentistry refers to the provision of dental care to young children, whereby care may present the need for growth and behaviour management.
ClearBow retainers are engineered to provide patients with superior aesthetics, optimum tooth support and unparalleled durability.
The treatment of cleft lip and palate aims to restore appearance, normal feeding, speech and allow for the normal eruption of teeth and facial growth.
Jaw surgery restores normal facial proportions, chewing, speech and reduce episodes of breathlessness in patients with sleep apnoea.
A dental bridge replaces missing teeth by using adjacent teeth or dental implants for support. It is also commonly known as a fixed denture.
A dental crown is used to protect a weakened tooth, replace missing tooth structure, as part of a dental bridge or implant and to improve tooth shape.
Dental extraction is performed to remove teeth that are no longer salvageable, as part of braces treatment or other aesthetic procedures.
Dental fillings protect the underlying dental pulp and replace missing teeth structure, restoring function and appearance.
Dental imaging enables dentists to locate hidden teeth, establish alveolar bone levels and detect oral diseases that are otherwise not visible to dentist.
Dental implants offers a natural, aesthetic, comfortable and lifestyle friendly way to replace missing teeth in adults.
Dental sealants refers to the bonding a thin layer of plastic onto the grooves of the chewing surface of a tooth as a way of preventing tooth decay.
A dental veneer is a thin, tooth-like laminate that is placed over a tooth to improve its appearance or to protect a tooth’s surface from further damage.
Comfortable and well-made dentures helps to restore normal chewing , speech, smile aesthetics and maintain your facial appearance.
Fluoride therapy involves the application of fluoride gel/varnish to make teeth more resistant to dental decay.
Gum surgery restores gum health by removing deeply located, hardened tartar deposits on the roots of teeth and the reduction of pocket depth.
Invisalign® straightens teeth by using a series of custom-made removable trays, making treatment more comfortable and discreet.
Laser Dentistry can be used to treat conditions affecting the soft tissue of the mouth and hard tissue of the teeth or bone.
Mini dental implants can be used as a semi-permanent way to stabilize loose dentures in the absence of adequate bone volume.
Narrow dental implants are engineered for areas with limited space, such as missing upper lateral incisors or lower front teeth.
Root canal treatment saves natural teeth that have sustained irreversible pulpal injury, avoiding the need for dental extractions.
Same Day Dental Implant treatment allow patients to resume their normal appearance, function, confidence and lifestyle almost immediately.
Scaling and polishing prevents the onset of gum disease in healthy mouths, eliminates bad breath and removes surface stains caused by our diet.
Sedation dentistry helps patients to relax by reducing their perception of environmental stimuli such as noise, smell or discomfort.
Short dental implants is a viable alternative for people who are unsuitable for conventional dental implant treatment.
Teeth desensitisation eliminates episodes of sensitive teeth associated with eating, drinking, brushing or when sucking air through teeth.
Teeth whitening is carried out to rejuvenate and create a more attractive smile by improving the natural colour of your teeth.
Wisdom tooth surgery eliminates recurrent gum infections, episodes of pain and prevents adjacent tooth decay caused by an impacted wisdom tooth.