Dental Procedures

Fillings and Root Canal Tratment

Fillings
A dental filling is a type of restorative dentistry treatment used to cure minimal tooth fractures, tooth decay or otherwise damaged surfaces of the teeth. Filling materials, which include composite, porcelain and silver amalgam, may be used to polish the tooth surfaces for better biting or chewing. Depending on the extent of tooth decay or damage, the affected tooth may require additional procedureslike:

● Dental Crowns
● Dental Implants and Dental Bridges.
● Root Canals

Consultation: The dentist will examine the suspected teeth using a dental probe and caries detecting liquid, as well as take an X-ray to determine the exact location of the cavity and decay. Once it is determined then a filling is needed, you will be givenadvicefor filling and sealing the cavity to prevent further decay and damage to the tooth. Based on your medical history, location of the cavity, aesthetic needs, biting force, durability, cost, number of visits and your preference, the dentist will find out the best filling option for you.

Procedure: The procedure commences with the preparation of the tooth and necessary surrounding areas in order to restore the decay or damage. The decay or damage is removed with a dental hand-piece or laser, and the area is cleansed to remove bacteria or debris before the restoration is completed.Tooth isolation is critical in a composite restoration because it prevents moisture from interfering with the bonding process. This requires the placement of various adhesives followed by the composite material, which is then hardened with a special bonding light. The completed composite restoration is both functional and natural looking.

Recovery & Aftercare: After the cavity has been filled, the dentist will discuss steps you can take to prevent decay from forming under or around the filling, or in other teeth.

It is advised to brush twice a day with fluoride toothpaste and flossing with dental floss or an interdental cleaner once a day. Keep appointments with the dentist and hygienist for routine check-ups and teeth cleanings. Depending on your risk for caries, the dentist also may suggest sealants that can be placed over your molars to prevent the build-up of plaque and decay, as well as the use of fluoride mouth rinses as an additional preventive measure.

Also, since diet and nutrition affect oral health, it will be important to maintain a balanced diet and limit your intake of sugary foods and drinks, and between meal snacks.

Cost: The cost of dental fillings depends on a variety of factors, including:
● The dentist who performs the procedure.
● The location where it is performed.
● The type of dental insurance you have. As mentioned above, dental insurance typically does not cover the additional costs associated with composite.
● The number of tooth surfaces that need filling. For example, one tooth may have only one surface affected by decay or damage, while another tooth may have one or all surfaces affected by decay or damage.

Composite fillings are usually more expensive than traditional amalgam fillings because they require
a more sophisticated process, more expensive materials and additional office equipment. On
average, amalgam fillings are expected to last approximately 12 years, while composite fillings are
expected to last five to seven years.

Porcelain or Composite?: There are a number of pros and cons associated with both composite and
porcelain, and amalgam.
● Safety and Appearance
● Durable
● Shaped Tooth
● Well Technique and Less Time
● More Skilled doctors for composite fillings

Root Canal Treatment
For your teeth to function properly inside your mouth, the damaged tissues and infection needs to be removed. Root canal treatment serves this purpose and is known to be one of the oldest forms of endodontic treatments. With the help of this treatment you can restore good health of your teeth. As years the success rates had increased and treatment time has been optimized with time as well. Signs of infection: The signs which indicate you for having a root canal treatment are as below,
● Minimal to severe pain.
● Tooth discoloration.
● Swelling and irritation in the surrounding gum tissue.
Root canal procedure: The first step in root canal procedure is to provide anaesthesia for preventing the tooth from severe pain during the procedure. Before the root canal procedure is
performed, you may be put under treatment with some antibiotic for a smooth root canal.

This process is performed under due attention and care to minimize the damages or danger to any
surrounding ligament or bone. All the traces of infection or debris is completely removed by delicately cleaning the canals and tip of the root by using nickel titanium pin-like material. Tools like digital X-rays captured during cleaning phase, an apex locator to locate the tip of the root and a
microscope which can magnify 32-times may be used by the dentist as additional tools for
measuring the root.
Now, for the healing purpose a temporary filling is being placed in the hole which is used to access
the root canals. Once the healing is done properly and the root canal turned out to be successful,
permanent restoration like dental filling or crown is placed. If you feel any discomfort or soreness in
the mouth resulted out of root canal procedure post procedure medications are available to make
you feel better.
Finding the right dentist: Simple root canals can be performed by a general or family dentist. But
for a complex and difficult procedure, you may require an endodontists for carrying out your
treatment. Endodontists are specialist’s dentists who focus on disorders of the dental pulp and
specialized in root canals. An Endodontist for teeth with more than one canal is also known as
molars.

Crowns, Bridges and Dentures

CROWNS
These also Known as “caps,” which preserves the functionality of damaged teeth. This common
dental restoration is used to protect a cracked tooth, restore functionality of a tooth with excessive
decay or replace a pre-existing crown.
Consultation & treatment planning: Crowns are suggested by your dentist – if you have undergone root canal treatment or tooth decay or damage is so extensive that veneers, direct composite bonding aren’t viable treatment options. Crowns can be easily customized in dental laboratories or at dentist’s clinic depending on the material whether it will be used to restore a damaged tooth or create an artificial tooth replacement for an implant.
As a part of your consultation, impressions of your existing teeth will be taken as a reference to
create the same shape and size of your restoration. These impressions will be used to make models
for designing the new length, shape and alignment of your teeth and you can have a trial of your
new smile before proceeding to the treatment.
Procedure: A molded impression of your teeth is prepared and sends it to a dental laboratory for
performing the crown procedure. Since the time final restoration is made ready in the dental laboratory a temporary crown is placed in order to protect the damaged teeth. Dentists are using
recent technologies like CAD/CAM technology (Computer aided design/manufacturing) to display a
3-D picture of the teeth. The restoration is cemented through milling of a ceramic block. But if this
technology is there within the dental office, the need for a temporary crown can be reduced.
Recovery & Aftercare: Once your permanent crown is placed, you will be provided with all the
information regarding Do’s and Dont’s and about caring for your new restoration. These includes
basic measures like brushing twice daily and flossing with dental floss or interdental cleaners once a
day in order to maintain proper oral hygiene. As a result these practices will help you to remove
plaque from the area where crown meets gum and prevent dental decay and gum disease.
Some tips goes like this, Biting your fingernails & grinding your teeth should be completely avoided as these would significantly shorten it’s life-span. Also avoid chewing hard foods, ice or other hard objects as they will damage the crown. If still you can’t avoid your habit of grinding your teeth your dentist will suggest you to wear a night-time mouth guard to offer protection while sleeping.
Cost: The cost of the dental crown procedure will be depending upon various factors which may be
technical demands of the treatment, expertise and location of the dentist or the equipment used.
Crown materials: There are three basic options of restorative materials used for building a crown.
They are:
1. Porcelain fused to metal
2. All ceramic
3. Gold
The material is selected is determined by the clinical demands, aesthetic demands, strength
requirements, durability and restorative space available.

Choosing the right dentist: To decide the best possible design with proper anatomical features,
arts and science are important factors. The dentist and the laboratory technologist play a crucial role in the treatment procedure.

The material choices and technologies for today’s crowns are new and it is important for the dentist
to know how much experience he has with the equipment used in the procedure. The level of
expertise may vary dentist to dentist as per their experience of treatment done.

Bridges
A Bridge is a type of fixed dental restoration which is used to replace one or more missing tooth by
joining an artificial tooth to adjacent teeth. It will cover the area where a tooth is missing.There are
several types of fixed dental bridges and they are conventional fixed, cantilever and resin bonded
bridges. Conventional and cantilever bridges shapes the teeth covering the missing teeth. And then
crowns are being placed on to the shaped teeth which are attached to an artificial tooth also known
as pontic.
Consultation & treatment planning: Once it is determined by your dentist that bridge is the best replacement for your missing teeth or tooth, different materials will be advised to you which can be used in the dental laboratory to make your restoration. Depending upon the place in the mouth where the bridge will be placed the availability of material depends. The material availability also depends upon other factors like your grinding and clenching of your teeth, dental insurance
coverage and others factors outlined by your dentist. The various bridge combination used while
fabricating can be porcelain and metal, porcelain and gold or some high-strength metal-free
materials like zirconia or alumina.
As a part of process, X-rays and impressions of the treatment area will be taken by your dentist with
preoperative photographs which will be used for planning an ideal restoration for you. The
preparation of the bridges depends upon the number of consecutive teeth you are missing which
can be two or more units. Two crowns are cemented to the teeth on both sides of the space called
as abutments with one or more false teeth to fill the space. After the filling the spaces additional
impressions are being taken by your dentist.
Are you a candidate?:To know whether you are the right candidate or not, the health of your gums and other teeth needs to be evaluated by your dentist during your first visit to clinic. The dentist then prepares teeth which can support the bridge with the help of local anaesthesia. The problem arises when the support teeth are decayed or badly damaged and the dentist has to build them back up before they can be used as supporting teeth.

Recovery & aftercare: Special caring tips will be given to you by your dentist after the bridge has
been cemented into the place to maintain the performance and longevity of your restoration along
with the health of your teeth and gums. Proper brushing with fluoride toothpaste should be done
twice each day in order to protect the build-up of plaque and bacteria. The areas surrounding your
bridge between the pontic and underlying gum tissue should be properly and thoroughly flossed
with a special floss threader.

Bridge Cost: The cost of the dental bridge depends upon the several factors like mentioned below:
● The potential need for additional procedures (fillings or root canals) in one or two of the
adjoining teeth.

● Dentist’s technique and Laboratory equipments
● Location of the dentist.
● Your dental insurance coverage.
● Type of material used in building bridge
● Preparation of artificial teeth

Dentures
Dentures is the material constructed to replace the missing teeth and they are supported by the
surrounding soft and hard tissues of the oral cavity. These are also known as false teeth. There are
many denture designs out of which some rely on bonding or clasping or dental implants. This can be used to replace missing teeth for people with no remaining teeth or for the people who have lost
several teeth only. The appliance in this case may be called as either partial or overdenture. These
dentures are designed so well that they are comfortable and functional to improve your smile and
facial appearance. The appearance is very similar to the natural teeth.
Preparation & placement: Your dentist will examine your gums and supporting bone structure to identify the appropriate treatment plan and evaluate the need for dentures during your first dental visit.
In order to correct the bony ridges that may interfere with the stability of the denture oral surgery is
performed in some cases. Once it is fixed that dentures are right for you, the dentist will take an
impression of the gums to identify every ridge to make out the best possible fit to your teeth. In
some other cases the remaining teeth may need to be extracted.
A denture is placed to enable proper healing of the extraction sites where the teeth needs to be
removed and serve as an aesthetic replacement for your natural teeth. Untill final dentures can be
made the immediate dentures can be easily modified for changing ridge contours. While
constructing the immediate dentures, dentists use a shade and mold chart to choose replacement
teeth which closely matches with your natural teeth, thus minimizing the changes in appearance.

Final dentures: The conditions for forming complete dentures are when the gums are restored to a healthy condition and sufficient time has passed for healing. All the teeth in the upper or lower jaws of the mouth are being replaced by these complete dentures. From six to 12 months, the gums will naturally shrink through the healing process of tooth loss.During this period the immediate dentures may require changes to adjust the gums and underlying bone structure changes. This may require soft and hard relining procedures.
These dentures should be removed at night while sleeping no matter whether they are complete
dentures, overdentures and partial dentures. This helps the gums to get wet completely by saliva
which has important properties of naturally occurring flora in the oral cavity. Saliva is very useful for maintaining a healthy mouth.

Dentures care: The healing depends upon practicing healthy dental hygiene while wearing
dentures. There is a risk which can develop a serious medical condition of oral irritation resulting
from improper dental hygiene. These include conditions like periodontal disease, leukoplakia (thickened white, potentially harmful patches on mucus membranes, also called smoker’s tongue)
and fungal infections (denture stomatitis).

It will take some time with practice learning to adjust to the feel of new dentures to chew with
them. It should begin by slowly chewing on very small pieces of soft food, using both sides of the
mouth simultaneously. Once the comfort and confidence increases you can later progress towards
larger pieces of soft food and then proceed towards harder foods.

Cost: Several factors which decide the cost of your denture procedure are as below:
● The possible requirement of an additional procedure such as extractions of remaining teeth
or oral surgery to refine bony ridges.
● A prosthodontist specializes in making dentures may charge more for his services.
● Location of the dentist
● Type of dental insurance coverage
● The complexity
● Dental materials selected by the patient and the dentist. For Example, highly cross-linked
polymer denture teeth are more aesthetic and do not wear as much as conventional plastic
teeth and are more expensive. There are different metals which can be used in removable
partial dentures that may also increase the cost.
● The type of warranty offered. Some warranties may be for one to two years, while others
may run up to 10 years.
Choosing a Dentist: While investigating the denture procedure it is important to enquire about the dentist’s training and experience. Many general dentists offer the treatment; prosthodontists
receive three years of advanced training in restorative dentistry. This makes them to be a better or
more experienced option for you to choose the best when it comes to denture or an alternative like
implants or bridges. The American college of prosthodontists offers additional resource information
about the training of prosthodontists in the U.S.

Braces and Aligners
Braces
Dental braces are the devices that are used in orthodontic treatment that corrects and straighten
the teeth which are crowded, crooked, non-aligned or irregular spacing. Braces help to create a
more attractive and healthy smile for both children and adults by moving the teeth into its ideal
position. This also helps in aiming improving the dental health.
Procedure: The dental braces procedure begins after the cheek retractor is used to keep the teeth
visible and dry. The teeth are polished first to ensure that the brackets bond properly after which
they are air-dried.
Further for preparing them for bonding the brackets a conditioner is used on the front surfaces of
the teeth for 30 seconds. Proceeding further to enhance the bonding process, the brackets are
cleaned off, the teeth are dried, and an adhesive primer is placed on the teeth.
Cement is applied to the predetermined positions on the teeth after placing it on the back of the
brackets. The excess cement is removed after the brackets are placed in their position and gets
hardened into place with high-intensity light. Now the dental arch wires are put into place and the
retractor is removed.

Adjustments: After the braces are placed inside your mouth, appointments for regular adjustments are necessary. This is because the elastic ties holding the wires in proper place stretch and weaken over time. These wires would be incapable of creating the proper pressure to correct the dental issues requiring treatment without proper adjustments.
Your movement of teeth and progress made are being evaluated by your orthodontist during your
adjustment appointments. This may help dentists for further recommendation to improve the final
outcome of the treatment plan.
You can get to feel some tightness, typically progressing to soreness which will last for approximately four to six hours after the adjustment procedure of post fitting of braces into your
mouth. This soreness is the direct result of the replacement wires tightening the teeth into position.
You will undergo a pain same like when your dental braces were placed initially which can be
relieved by using OTC pain relievers.

Living with Braces: Proper oral hygiene should be maintained and some certain types of food
need to be avoided for braces wearers. Also it is very important to brush at least three times a day
because inadequate brushing may lead to damage of the enamel. It highly suggested carrying a
tooth brush by many orthodontists so that you may brush your teeth after lunch while at work or
school. Sticky foods diet should be avoided as they can get stuck under your braces and possibly
causing detachment. The bond between the brackets and enamel can be break by hard foods and
candy; hence they should also be avoided.
Braces removal: Your braces will be removed with a simple and relatively painless process once it is confirmed by your orthodontist that your treatment is complete. The bond between the brackets
and your teeth is safely and gently broken. The brackets can be removed when the adhesive bond
releases and when the bases of the brackets are removed. The adhesive is left on the teeth to
prevent the damage to the enamel and tooth structure during the process.
A dental hand piece is used to remove the remaining bonding cement after all the brackets are
removed. The pain will be minimal because no tooth structure is being removed as the hand piece
used is typically the same tool that would be used for repairing a cavity. Your gums may be slightly
inflamed after all bonding cement has been removed, but this will usually deplete in a few days by
brushing regularly and proper flossing.
Recovery and Aftercare: After one or two weeks of your dental braces removal an appointment is made for retainer replacement. Retainers are however can be prepared and placed inside the mouth at braces removal appointment.
Retainers are one of the key devices which is necessary during the “retention period” of orthodontic
treatment. These retainers are very much helpful in providing a proper completion of treatment by
making the teeth relatively stable and retain to its proper shape after the braces removal. You
should meet your regular dentist for a teeth cleaning once your braces are being removed. It is very
much important to go through a thorough oral cleaning of your teeth after removal of braces so that
your orthodontist can clean any leftover adhesive from the area where braces were there.

Aligners
Aligners are attractive alternatives to traditional braces and they are designed to guide the teeth
into their proper position. Unlike metal braces, aligners are minimally invasive and they do not trap
food particles or plaque between the teeth. Aligners are easily removable while eating, brushing and
flossing, or any other important events. These are recommended frequently for adults with mild
spacing problem and are not recommended to children and adolescents with non-permanent teeth.

Aligners use a gradual force to control the teeth movement but without using metal wires or brackets. These are made of strong plastic material and are customized accordingly to fit into
everyone’s mouth. The latest computerized technology is being used to fabricate these devices in a
laboratory. The aligners come in sets and the number depends on the orthodontic condition. In
order to reach the desired maximum effectiveness the aligners should be worn for at least 20 hours
a day. These aligners should also be removed infrequently depending upon various other factors like type and severity of alignment, and the type of aligner (Invisalign, ClearCorrect) used. The treatment time generally ranges from 9 to 24 months and the costs for clear aligners are comparably higher than traditional braces.

GUM DISEASE
A Gum disease is a serious gum infection that can damage the gums and can destroy the jawbone. It
is also known as periodontal disease and periodontitis which is an inflammatory condition that
affects the tissues surrounding a tooth which is the main reason for tooth loss. It starts with the
toxins produced by the bacteria growth inside the mouth which can damage the teeth’s connective
tissue and bone. If not treated properly may lead to destruction of the tissue and fostering tooth
loss.
Signs of Gum Disease: While progressing painlessly the gum disease may produce few signs at the last stages of the disease. Sometimes the root of the tooth becomes exposed causing tooth
sensitivity. Also pus may be produced and pockets may form between the gum and tooth. Below are
some common signs of gum diseases which you and your dentist can look for:
● Bleeding gums during and after brushing
● Red, Swollen or Sensitive gums
● Bad breath or bad taste in mouth
● Receding gums
● Loose or teeth that are appearing to be shifted

Common Causes:
Improper Dental Hygiene: Plaque is the primary cause of Gum disease. If it is not removed
through daily dental hygiene practices and regular professional dental cleanings, bacteria may get
evolved i and cause gingivitis that will result in gum disease.
Organic Changes in the Mouth: Hormonal changes that occur in metabolism and hormone
during pregnancy, puberty, menopause, and monthly menstruation makes gum more sensitive,
which may affect the organic balance in the mouth.
Medical Conditions: The body’s ability to produce sugar gets affected in serious conditions
(such as diabetes or kidney disease) which may result to periodontal disease. Illness may also affect
the condition of your gums and has been found and proved by the Center for Disease Control. The
medications used to address these types of issues may be responsible for overgrowth of gums.
These overgrown gums are more bacteria prone and hence the disease.
Saliva Flow Inhibitors: Some medications may affect the oral health due to which the flow of
saliva gets reduced resulting in dry mouth syndrome (Xerostomia). Seniors may be more susceptible to dry mouth syndrome because of the natural reduction of salivary flow associated with age.
Poor Functional Habits: Bad habits such as smoking make it harder for gum tissue to repair
itself. Other bad oral hygiene habits such as not brushing daily and flossing may cause gum disease.

Treatments: There is various numbers of treatments available to those who are suffering from gum disease which depends upon the severity of the condition.
Your dentist will evaluate the extent of the damage in order to develop a conservative initial plan.
This evaluation will help to determine if plaque is being removed on a daily basis or not.
Tissue Regeneration
Tissue Regeneration is the new technique which involves grafting the bone to offer a better chance
of bone re-growth. This technique is applied when your bone has been destroyed and to strengthen
thin gums, soft tissues grafts may also be used.
There is another advance technology called Guided tissue regeneration which involves the insertion of a membrane to help in bone regeneration process. This is sometimes useful during periodontal surgery.

Pocket Elimination Surgery
Surgery may be part of the treatment plan to help prevent tooth loss resulting from gum disease. Below given are some surgical options:
● The pocket gap is reduced between the teeth and gums by performing Periodontal flap surgery.
● In case if the jaw bone is cratered by bacteria, the bone can be reshaped through a bone surgery which helps to eliminate the craters and prevent the future bacteria growth.

Laser Therapy
● Laser therapy is used to reduce the pocket size but has not been tried out practically yet. There is noexistence of any evidence to support the idea of Laser therapy to restore damaged connective tissue.
Cost of Treatment: The cost of Gum treatment depends on several factors. For Example, additional routine tooth cleaning or scaling or root planning procedure at the gingivitis stage may get required in order to prevent the effect of disease. In this case, the cost of treatment will be affected further.

Other factors affecting costs include:
● Technology used in the procedure
● Location of your dentist
● Type of Dental insurance you have
● Type of treatment plan required.

Braces and Aligners