Wednesday 29 January 2014

Recent case to share with you all


Cosmetic case to share with you

I started this case seven months ago and it involves different aspects of dentistry that I want to tell you about. The patient came to see me as she was unhappy with the appearance of her teeth. 
As you can see from the pre operative photo there is a median diastema ( gap in between upper central incisors ) and the upper lateral incisors are small for the rest of the mouth.












We had a consultation about what she was not happy about and formulated a treatment plan. As it was only the anteriors that required movement, I decided to use Insignia, which is a clear brace system from America, which specifically moves upper first premolar to upper first premolar.

Impressions, a bite and full mouth photographs were taken and aligners were made to close the diastema. Each aligner is worn for three weeks, then we would review the progress and move onto the next one. After six months of wearing aligners the gap closed. 

Aligners are made of clear plastic and fit only on the teeth, they are very comfortable and speech and general day to day activities are not affected. They must be worn all the time to complete movement, especially during the night.

Once the gap was closed, the patient had in surgery bleaching, which lightened her teeth by about 8 shades from A3 vita to 0.5M vita. She then topped this up with one week of home bleaching, as you would have read in my previous blog on bleaching, this involves wearing bleaching trays for about two hours per day with 6% hydrogen peroxide gel within them.

Then the fun appointment came! At this appointment, both the upper right and left lateral incisors were prepped on the surface by 0.3-0.5mm to create enough space for the porcelain veneers. Dental impressions were taken of both arches, shade was taken and all of this was sent to the dental lab. The porcelain veneers were made and returned after one week.

The veneers were then fitted with a special cement called nexsus. The teeth are still fragile and prone to moving back to their original position and the gap re-opening, so I fitted a wire to the backs of the upper teeth and made a night time essex retainer.

An essex retainer looks like a hard plastic mouth guard and will help to keep the teeth in the new positiom until the bone has fixed. This could take up to a few years, retention is very, very important.

This is the end result











The patient is delighted, I will review her in a weeks time and it is very important for six monthly check up and cleans as part of her maintenance program.

Monday 13 January 2014

Few facts about Whitening

Firstly may I wish you all a very Happy new year! Now back to teeth ..
More and more people are wanting whiter teeth. Does teeth whitening work and is it safe? 

What is teeth whitening?

Teeth whitening involves bleaching your teeth to make them lighter. Teeth whitening can’t make your teeth brilliant white, but it can lighten the existing colour by several shades.

Who can perform teeth whitening?

Teeth whitening is a form of dentistry and should only be performed by a dentist or another regulated dental professional, such as a dental hygienist or dental therapist, on the prescription of a dentist.
Some beauty salons offer teeth whitening, but this is illegal, so please stay away from these places! 
You can also buy DIY home teeth whitening kits but these may also carry risks. So do be watchful of these products.

What are the different types of teeth whitening available? 

Most dental practices offer two types of whitening:
  • Laser / in-surgery Teeth Whitening
  • Professional home whitening kits
Both procedures are based on a bleaching process that uses a peroxide-based bleaching gel of varying strength (3%-6% peroxide). 

Laser Tooth Whitening

Laser tooth whitening or in-surgery whitening is a procedure that takes place at the dental practice and uses a light-activated bleaching gel to whiten your teeth. The procedure usually takes approx 1 -2 hours and produces instant whitening results.  I would recommend that laser whitening should be followed up by professional home whitening.

The Laser Tooth Whitening procedure

Prior to carrying out the procedure you would have a consultation with your dentist to make sure that you are suitable for teeth whitening and to explain possible risks and side effects of the procedure. Most dental practices will ask you to sign a teeth whitening consent form to confirm that you have fully understood the procedure and all risks. These days, because the product is heavily regulated, the side effects of sensitivity doesn’t exist anymore. The only real risk is that the gums can become irritate if they are not sufficiently protected during the bleaching procedure.
Before the teeth whitening process is started a dentist or a hygienist will thoroughly clean the teeth, removing any surface stains and tartar. 
The next step will be to make a record of the shade/colour of the teeth before the procedure. This is either recorded using a tooth coloured shade guide/chart or by taking a digital photograph of your teeth. 
The area is then prepared for the procedure.  The dentist will usually place some form of protection around the gums so that only the teeth are exposed to the bleaching gel. This involves covering the gums with cotton wool rolls and a protective gel material that hardens once applied to the gums. A cheek retractor is used to keep the lips and cheeks away from the teeth.
It is very important that your dentist isolates your gums and lips with a protective material in order to avoid any potential damage or burning. 
Eye protection (goggles) is also provided to prevent any damage to the eyes from the laser used or any accidental splashes of the peroxide. 
The whitening gel is then applied to the surface of the teeth and exposed to a light or laser, which activates it. Some systems do not use an activating laser and many dentists argue that the laser doesn’t make any difference to the end result.  During this process if you feel that your lips or gums start to burn then you should let your dentist know immediately. After approximately 15 minutes the gel is removed and the process repeated another 3 times. 
Finally wash off the whitening gel and remove all the lip and gum protection, then a post operative shade/colour is taken. The results are usually quite dramatic and can often be up to 10 shades lighter. Ideally a kit for home whitening should be provided with custom trays and professional whitening gel. 
There is no sensitivity now, due to the fact that the new bleaching gels have a lower percentage of hydrogen peroxige gel and this is combined with calcium. 
Professional home whitening kits provide more permanent results over a longer time scale, whereas laser tooth whitening offers immediate results. A combination of the two provides the perfect solution to both immediate and long-term whitening needs.

Professional home whitening kits

To make a professional home whitening kit, impressions (moulds) of your teeth are taken and bleaching trays are made. Depending on the teeth whitening system, some trays need to be worn overnight while others for only 1-2 hours a day for between 2-3 weeks.

Suitability for whitening

Many people are not suitable for teeth whitening and a dentist will assess your suitability during a consultation. If you have gum disease or other dental health problems, you may not be suitable. The teeth whitening process does not change the colour of crowns, veneers or fillings so it is important to understand that you may need to change these to match the colour of your whitened teeth. This procedure is not suitable for pregnant women or women breast feeding.

Does it hurt? What are the side effects of teeth whitening?

No sensitivity is recorded these days, due to the new bleaching gels on offer. As mentioned before, this is at a lower percentage mixed in with calcium.

Which teeth-whitening brand or system is the best?

There are many different brands of professional teeth-whitening systems, each claiming to provide the best results. The most popular systems are Zoom!®

How much does teeth whitening cost?

This depends on which system is used. Home bleaching is less expensive, as the patient is carrying this out at home compared to in house bleaching. An approximate figure of £250 for home bleaching and £375-550 for in house bleaching I would suggest.
Pre whitening


Post whitening