The Treatments

Aesthetic • Modest • Optimal

Aesthetic. Modest. Optimal - These are the prime features of the treatments offered by Excellence Total Dental Healthcare Center. We keep pace with all the latest advancements in Dentistry in order to make our treatments more effective and beneficial. Our main aim is to provide treatment which suits a patient, according to his/her aesthetic and dental issues as well as budget.

Excellence Total Dental Healthcare Center offers a wide range of routine and specialized dental healthcare services such as -

The Treatments:

  • General Dentistry
    Regular Dental Checkup

    Our dentist runs a thorough check up in order to verify the condition of your teeth. Proper treatment will be given if there is an issue. In case of children, the growth and development of teeth will be assessed.

    Tooth Fillings

    Tooth fillings are used to fill holes (cavities) that have formed, usually as a result of tooth decay or wear. There are many types of filling, each suitable for different cavities.

    Scale and Polish (Prophy)

    Scale and Polish treatment is done in order to prevent formation of bacteria that can damage gums. Our dentist will use a special tool to remove the tartar (Calculus) and then perform thorough polish on your teeth that prevent bacteria from sticking to them.

  • Orthodontics

    The branch of dentistry that specializes in aligning teeth is called orthodontics. Orthodontic treatment usually involves wearing a brace (appliance). The brace applies gentle pressure on specific teeth to move them into the right place.

    Orthodontic treatment usually takes between one and two years, depending on the severity of the problem. There are different kinds of braces. Some can be removed while others are fixed in place.

    Removable braces are made of plastic and usually have wire clips and springs to move specific teeth. In most cases, they are used to move upper teeth. A removable brace must be taken out to be cleaned, but it should be worn at all other times, including mealtimes and at night. A relatively new type of orthodontic treatment makes teeth straightened using removable, see-through, plastic aligners (ex: Invisalign).

    Fixed braces cannot be removed. They are made of small brackets that are glued to the teeth and joined together with a wire. Fixed braces can be used on upper and lower teeth. Once the treatment is finished, the brackets and glue are removed from the teeth.

  • Root Canal Treatment

    Endodontics is a branch of dentistry that deals with the diseases of tooth's pulp. The pulp is found in the center of the tooth and in canals (called root canals) inside the root of each tooth. Pulp includes connective tissue, nerves and blood vessels. Pulp nourishes the tooth when it first emerges through the gum. Once the tooth matures, the pulp can be removed without destroying the tooth.

    Even though removing pulp in a tooth is called Endodontic Treatment, it is often referred as Root Canal Treatment or Root Canal Therapy. Root canal treatments are quite common. The goal of root canal treatment is to save the tooth by removing the infected or damaged pulp.

    Why Would You Need Root Canal Treatment?

    Root canal treatment is needed for two main reasons. The first reason is infection. An untreated cavity is a common cause of pulp infection. The decay erodes the enamel and dentin of the tooth until it reaches a root canal. This allows bacteria to infect the pulp. Antibiotics cannot cure the infection inside teeth. The inflammation caused by the infection reduces the blood supply to the tooth. The reduced blood supply also prevents the pulp from getting healed.

    The second reason for a root canal therapy is the damage to the pulp that cannot be fixed. Trauma or a fractured tooth can damage the pulp; so can a lot of restorations, such as several fillings placed in the same tooth over a period of time. Sometimes, common dental procedures such as preparing a tooth for a crown can hurt the pulp. Then the tooth might need a root canal therapy.

    When the pulp is just inflamed, it may heal on its own. Your dentist may want see if this will happen before doing root canal treatment. If the pulp remains inflamed, it can be painful and may lead to infection.

    An infection in the pulp can affect the bone around the tooth. This can cause an abscess to form. Hence the tooth has to be saved by removing the infected or damaged pulp, treating any infection, and filling the empty root canals with a material called Gutta Percha.

    If root canal treatment is not done, an infected tooth may have to be extracted. It is better to keep your natural teeth if you can. If a tooth is missing, neighboring teeth can drift out of line. They also can be overstressed from chewing. Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges. Also, if you ignore an infected or injured tooth the infection can spread to other parts of your body.

    Having root canal treatment on a tooth does not mean that the tooth will need to be pulled out in a few years. Once a tooth is treated, it will last for the rest of your life.

    Signs and Symptoms

    If you have an infection in your tooth, you may not feel any pain at first. But if it is not treated, the infection will cause pain and swelling. In some cases, an abscess will form.

    Your tooth might need a root canal if:

    • It hurts when you bite down on it, touch it or push on it
    • It is sensitive to heat
    • It is sensitive to cold for more than a couple of seconds
    • There is swelling near the tooth
    • It is discolored (whether it hurts or not)
    • It is broken

    Root canal treatment can be done in one or more visits. It depends on the condition. An uncomplicated root canal treatment often can be completed in one visit. Some teeth may be more difficult to treat based on their location in the mouth. Some teeth have more roots than other teeth. Treating a tooth with many roots takes longer time. Some teeth have curved root canals that are difficult to find.

    Once the root canal treatment is finished, you will need to see your dentist to have a crown or filling for the tooth. You are likely to receive a crown if the tooth is discolored or if it is used for chewing. The purpose of the crown is to prevent the tooth from breaking in the future.

  • Dental Implants

    A dental implant is an artificial tooth root that an implantologist places into your jaw to hold a replacement tooth or bridge. Dental implant is an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason. While most advanced in nature, dental implants are actually more tooth-saving than traditional bridgework, since implants do not rely on neighboring teeth for support. Under proper conditions and maintenance, implants can last a lifetime.


    What Dental Implants Can Do?
    • Replace one or more teeth without affecting bordering teeth.
    • Support a bridge and eliminate the need for a removable partial denture.
    • Provide support for a denture, making it more secure and comfortable.

    Advantages of Dental Implants Over Dentures or a Bridge
    • Dental implants are the best solution to the problem of missing teeth.
    • Dental implants look and feel like your own teeth. Since dental implants integrate into the structure of your bone, they prevent the bone loss and gum recession that often accompany bridgework and dentures. No one will ever know that you have a replacement tooth.
    • Dental implants do not sacrifice the quality of your adjacent teeth like a bridge does because neighboring teeth are not altered to support the implant.
    • Dental implants will allow you once again to speak and eat with comfort and confidence. They are secure and offer freedom from the irksome clicks and wobbles of dentures. They do not cause misplaced dentures and messy pastes and glues.
    • The success rate of dental implants is very high. They are considered an excellent option for tooth replacement.

    Are You a Candidate for Dental Implants?

    The ideal candidate for a dental implant is the one having good general and oral health. Adequate bone in your jaw is needed to support the implant, and also healthy gum tissues free of periodontal disease are a must.


    What is Treatment Like?

    This procedure requires a team effort between you and your dentist to be successful. Your dentist will consult with you to determine where and how your implant should be placed. Depending on your specific condition and the type of implant chosen, your dentist will create a treatment plan tailored to meet your needs.

    • Replacing a single tooth: If you are missing a single tooth, one implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root.
    • Replacing several teeth: If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots.
    • Replacing all of your teeth: If you are missing entire teeth, an implant-supported full bridge or full denture can replace them. Dental implants will replace both your lost natural teeth and some of the roots.

    What Can I Expect After Treatment?

    As you know, natural teeth require a careful at-home oral care and regular dental visits. Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing are still required. After treatment, your dentist will work closely with you to develop the best care plan for you. Periodic follow-up visits will be scheduled to monitor your implant, teeth and gums to make sure they are healthy.


    Implant Supported Detures

    The maxillary denture (the top denture) is usually relatively straightforward to manufacture so that it is stable without slippage. A lower full denture should or must be supported by 2-4 implants placed in the lower jaw for support. A lower denture supported by 2-4 implants is a far superior product than a lower denture without implants, because -

    • It is much more difficult to get adequate suction on the lower jaw.
    • The functioning of the tongue tends to break that suction
    • Without teeth the ridge tends to resorb and provides the denture less and less stability over time. It is routine to be able to bite into an apple or corn-on-the-cob with a lower denture anchored by implants. Without implants, it is quite difficult or even impossible to do so.

    In any case, implant supported dentures provide several advantages over conventional dentures. They offer improved comfort due to less irritation of the gums, confidence due to less risk of slipping out, and appearance due to less plastic required for retention purposes. Patients with implant supported dentures have increased chewing efficacy and can speak more clearly.

  • Cosmetic Dentistry

    Cosmetic dentistry may involve:

    • The addition of a dental material to teeth or gums - examples: bonding, porcelain veneers (laminates), crowns (caps), gum grafts.
    • The removal of tooth structure or gums - examples: Enameloplasty, Gingivectomy etc.,
    • Neither adding nor removing dental materials, tooth structure or gums - examples: teeth whitening (bleaching).
    • Straightening of teeth accompanied by improvement in appearance of face orthodontics

    Whitening or Tooth Bleaching is the most common cosmetic dental procedure. While many whitening options are now available, including over the counter products, dentist-supervised treatments remain the recommended procedures for lightening discolored teeth.

    Teeth reshaping (sculpting) removes parts of the enamel to improve the appearance of the tooth. It may be used to correct a small chip, or to alter the length, shape or position of teeth. It can also be used to correct crooked or excessively long teeth. The removed enamel is irreplaceable, and may sometimes expose dentin. It is also known as Enameloplasty, Odontoplasty, contouring, recontouring, slenderizing, stripping or sculpting.This procedure offers fast results and can even be a substitute for braces under certain circumstances.

    Bonding is a process in which an enamel-like dental composite material is applied to a tooth's surface, sculpted into shape, hardened and then polished.

    Dental Bridges are false teeth, known as a pontics, which are fused between two porcelain crowns to fill in the area left by a missing tooth. The two crowns holding it in place that are attached onto your teeth on each side of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth. Fixed bridges cannot be taken out of your mouth as you might do with removable partial dentures. In areas of your mouth that are under less stress, such as your front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space. Bridges can reduce your risk of gum disease, help correct some bite issues and even improve your speech. Bridges require your commitment to serious oral hygiene, but will last as many as ten years or more.

    Veneers are ultra-thin, custom-made porcelain laminates that are bonded directly to the teeth. They are an option for closing gaps or disguising discolored teeth that do not respond well to whitening procedures. Depending on the procedure, tooth reduction may be necessary.

    Gum lift is a cosmetic dental procedure that raises and sculpts the gum line. The procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or more symmetrical teeth.

    Bite Reclamation is for those patients who have had years of excessive wear to their teeth due to grinding or acid reflux can alter their vertical dimension. This gives them a closed or shorter look to their face and smile. By opening up their bite, a qualified professional can reclaim their vertical dimension and sometimes even remove unwanted wrinkles as well.

  • Tooth Whitening
    Choose a Tooth Whitening System at Our Practice - Beyond® power Whitening and Tray Whitening

    There are several factors that can contribute to the staining or yellowing of teeth. Smoking and consuming beverages such as coffee, tea and red wine are known to cause discolorations, but even people who avoid these products sometimes develop yellowish teeth. Teeth also accumulate stains deep in the tubes that make up tooth enamel as a normal part of aging. The older you get, the yellower your teeth. Undergoing treatment with a tooth whitening system at Excellence Total Dental Healthcare Center, such as beyond ® tooth whitening, is a simple way to turn an ordinary smile into a dazzling one.

    The Right Tooth Whitening System for You

    There are numerous tooth whitening products in the market, including whitening toothpastes, over-the-counter treatments, in-office products and at-home systems that are available only through dental practices. We do not recommend using any over-the-counter bleaching products; without a dentist’s supervision, the bleaching solutions cannot be strong enough to reach deep into the tooth structure to make teeth much whiter, but could be strong enough to cause irritation to the gums. Our patients can choose in-office tooth whitening system at our dental center (Beyond® tooth whitening) or the tray Whitening (two-visit procedure) for the absolute whitest teeth. Dr Karthik will discuss the benefits of each option during your consultation.

    Beyond® Tooth Whitening

    The popular Beyond® tooth whitening system uses a special gel that is designed to be applied to the patient’s teeth by an experienced dentist. The active ingredient in the whitening gel is hydrogen peroxide, which is activated by a specialized lamp. During the tooth whitening process, the patient can lie down comfortably and listen to music or simply relax. The procedure only takes 30 mins to complete. (http://www.beyonddent.com)

    Tray Whitening

    Unlike the Beyond® tooth whitening system, tray Whitening is a 3-step system. The first step is nearly identical to that of Beyond® and takes approximately the same amount of time. During this visit, however, molds are taken of your teeth so that a set of custom-fabricated trays can be made. These trays are the key to the success of the system. You simply sleep with them for 2 weeks, after which time you return to the office for another session just like the first.

    Tooth Whitening Alternatives

    Some people may have certain kinds of tooth discoloration, such as tetracycline stains that do not respond well to whitening treatments. These patients may want to consider alternatives to tooth whitening, such as porcelain veneers or dental bonding.

    After the Treatment, How Do I Care for My Whiter Smile?

    For the first 24 hours after the beyond treatment avoid smoking, having coffee, tea, cola or red wine and other dark –colored drinks or food. Also avoid using colored mouthwash or toothpaste.

    How Safe is Beyond®?

    The Beyond® cold whitening Technique is absolutely safe. Because Beyond® uses cold light at a low temperature, it cannot irritate the nerves of your teeth. Also, the whitening fluid is water Based and does not come into contact with your gums and will not damage your teeth or tooth enamel.

    How Long Does Treatment Take with Beyond®?

    In only 30 to 40 minutes, discoloration which has built up over the years will magically disappear. It takes no longer than the time it would for you to have a haircut or a manicure, or have a cup of coffee – it’s that simple!

    What is the Difference Between Beyond® and Other Methods of Whitening?

    This technique whitens your teeth right away and has no side effects. It does not damage your teeth and gives the best possible results.

    Are My Teeth Suitable for Cold-light Whitening?

    In fact, Beyond® gives magical results for anyone who wants to whiten their teeth. This includes people with teeth which have stained by smoking or by substances like coffee or tea. It also whitens teeth stained by Tetracycline, speckled by fluoride or yellowed by medicines or hereditary discoloration.

    How White Could My Teeth be?

    Test proves that after whitening with Beyond®, the teeth score from 5 to 14 points higher on the VITA scale. The results depend on how discolored the teeth were originally but the end result will be white, shiny teeth.

    How Long Will the Whitening Last?

    This varies from a person to person and depends on your diet, but the effect should usually last for two years.

  • Dental Veneers

    Dental veneer is a type of cosmetic alteration that employs thin, semi-transparent coverings made from porcelain and are permanently bonded to your teeth. Veneering is an amazing procedure that improves your teeth’s appearance.

    Porcelain veneers are a form of dental treatment that cosmetic dental surgeons use to dramatically change the color and contours of a tooth. They are so versatile that they can be used in various situations from repairing a chipped tooth to a complete smile make-over. A smile make-over can cover various procedures such as straightening crooked teeth, restoring broken teeth, filling the gaps between teeth, and treating stained and discolored teeth.

    Dental veneers are made from durable, ultra thin ceramic casings that are bonded to the front of a patient's tooth to hide discoloring, chipping and cracking or to cover unsightly spaces between adjoining teeth. They are designed to seamlessly blend in with surrounding teeth and should last quite a while if taken care of properly.


    Veneers are routinely used to fix -
    • Teeth that are discolored because of root canal treatment or stains from tetracycline or other drugs, excessive fluoride or other causes, or the presence of large resin fillings that have discolored the tooth
    • Teeth that are worn down
    • Teeth that are chipped or broken
    • Teeth that are misaligned, uneven, or irregularly shaped (for example, having craters or bulges in them)
    • Teeth with gaps between them (to close the space between those teeth)

    What is the Procedure for Getting a Dental Veneer?

    Getting a dental veneer usually requires three visits to a dentist – one for a consultation and two to make and apply the veneers. One tooth or many teeth can simultaneously undergo the veneering process as described below.

    Diagnosis and Treatment Planning - This first step involves active participation between you and your dentist. Explain the result that you are trying to achieve to your dentist. During this appointment your dentist will examine your teeth to make sure dental veneers are appropriate for you and discuss what the procedure will involve and some of its limitations. He/she also may take X-rays and possibly make impressions of your mouth and teeth.

    Preparation - To prepare a tooth for a veneer, your dentist will remove about 1/2 millimeter of enamel from the tooth surface, which is an amount nearly equal to the thickness of the veneer to be added to the tooth surface. Before trimming off the enamel, you and your dentist will decide the need for a local anesthetic to numb the area. Next, your dentist will make a model or impression of your tooth. This model is sent out to a dental laboratory, which constructs your veneer. It usually takes 1-2 weeks for your dentist to receive the veneers back from the laboratory. For very unsightly teeth, temporary dental veneers can be placed at an additional cost.

    Bonding - Before the dental veneer is permanently cemented to your tooth, your dentist will temporarily place it on your tooth to examine the fitting and color. He/she will repeatedly remove and trim the veneer as needed to achieve the proper fit. The veneer color can be adjusted with the shade of cement to be used. Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished, and etched which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and the veneer is then placed on your tooth. Once properly positioned on the tooth, your dentist will apply a special light beam to the dental veneer, which activates chemicals in the cement causing it to harden or cure very quickly. The final steps involve removing any excess cement, evaluating your bite and making any final adjustments in the veneer as necessary. Your dentist may ask you to return for a follow-up visit in a couple of weeks to check how your gums are responding to the presence of your veneer and to once again examine the veneer's placement.


    What Are the Advantages of Dental Veneers?
    • They provide a natural tooth appearance.
    • Gum tissue tolerates porcelain well.
    • Porcelain veneers are stain resistant.
    • The color of a porcelain veneer can be selected such that it makes dark teeth appear whiter.

    Veneers offer a conservative approach to changing a tooth's color and shape. Veneers generally do not require the extensive shaping prior to the procedure that crowns do, yet offer a stronger, more aesthetic alternative.


    What Are the Disadvantages of Dental Veneers?
    • The process is not reversible.
    • Veneers are more costly than composite resin bonding.
    • Veneers are usually not repairable should they chip or crack.
    • Because enamel has been removed, your tooth may become more sensitive to hot and cold foods and beverages.
    • Veneers may not exactly match the color of your other teeth. Also, the veneer's color cannot be altered once in place. If you plan on whitening your teeth, you need to do so before getting veneers.
    • Though not likely, veneers may get dislodged and fall off. To minimize the chance of this occurring, do not bite your nails, chew on pencils, ice or other hard objects, or put excessive pressure on your teeth.

    Teeth with veneers can still experience decay, possibly necessitating full coverage of the tooth with a crown. Veneers are not a good choice for individuals with unhealthy teeth (for example, those with decay or active gum disease), weakened teeth (as a result of decay, fracture, large dental fillings), or for those who have an inadequate amount of existing enamel on the tooth surface. Individuals who clench and grind their teeth are poor candidates for porcelain veneers, as these activities can cause the veneers to crack or chip.


    How Long Do Dental Veneers Last?

    Veneers generally last for 5-10 years. After that period, the veneers would need to be replaced.


    Do Dental Veneers Require Special Care?

    Dental veneers do not require any special care. Continue to follow good oral hygiene practices including brushing and flossing as you normally would. Even though porcelain veneers resist stains, your dentist may recommend that you avoid stain-causing foods and beverages (for example, coffee, tea or red wine).


    Are There Alternatives to Dental Veneers?

    Yes, alternatives to veneers include bondings and crowns. Veneers offer a nice intermediate option. Veneers may be best suited for individuals who want to change the shape of their teeth more than just a little bit - as is done with bonding - but not enough to require a crown.

  • Prosthodontics

    Complete dentures prosthesis is designed for people who have lost all their teeth or have very damaged teeth and want to get them removed and have replacements. Each patient may require only a single denture (upper or lower) or a complete denture set (both upper and lower dentures).

    At Excellence Total Dental Healthcare Center, you will find a high-quality, well-fitting denture that -

    • Restores your youthful appearance
    • Allows you to eat most of the foods you love
    • Helps you feel better about yourself
    • Eliminates embarrassment
    • Enables you to speak more clearly
    • May even improve digestion!

    The Modern Denture

    Advanced dental materials create dentures that are more comfortable, more durable and fit better than your parents and grandparents ever imagined. But perhaps the greatest advancement in modern denture science is the ability to recreate much more natural-looking smiles.

    Artificial denture teeth are designed to have the look and feel of natural teeth. Each tooth can be positioned individually and “naturally” to give dentures a more realistic appearance. The 21st century offers a much more natural choice of colors for artificial gums and teeth. New processing methods ensure the best possible fit, function and comfort.


    Facts
    • Dentures do not last forever.
    • Even if your dentures fit perfectly, you should still see a dental professional regularly.
    • No one will know you are wearing dentures.
    • Denture wearers can eat more normally.
    • Denture wearers can speak more clearly.
    • Adhesives can play a role in your denture's fit and comfort.
    • Over-the-counter and prescription medications can affect dentures.
    • Regular denture care is affordable.
    • Repairing denture on your own cause damages.
    • With planning, denture corrections can often be made in one day.
    • Do not avoid replacing your denture just because you do not want to go through another long adjustment period.
    • All dentures are not created equal since the quality varies depending on the price range.

    Implant-Supported Denture
    What Is It?

    An implant-supported denture is a type of overdenture that is supported by and attached to implants. A regular denture rests on the gums, and is not supported by implants. An implant-supported denture is used when a person does not have any teeth in the jaw, but has enough bone in the jaw to support implants. An implant-supported denture has special attachments that snap onto attachments on the implants.

    Implant-supported dentures usually are made for the lower jaw because regular dentures tend to be less stable there. Usually, a regular denture made to fit an upper jaw is quite stable on its own and does not need the extra support offered by implants. However, you can receive an implant-supported denture in either the upper or lower jaw.

    You should remove an implant-supported denture daily to clean the denture and gum area. Just as with regular dentures, you should not sleep with the implant-supported dentures at night. Some people prefer to have fixed (permanent) crown and bridgework in their mouths that cannot be removed. Your dentist will consider your particular needs and preferences when suggesting fixed or removable options.

    How Does It Work?

    There are two types of implant-supported dentures; bar-retained and ball-retained. In both cases, the denture will be made of an acrylic base that will look like gums. Porcelain or acrylic teeth that look like natural teeth are attached to the base. Both types of dentures need at least two implants for support.

    Bar-retained dentures — A thin metal bar that follows the curve of your jaw is attached to 2-5 implants that have been placed in your jawbone. Clips or other types of attachments are fitted to the bar or the denture or both. The denture fits over the bar and is securely clipped into place by the attachments.

    Ball-retained dentures (stud-attachment dentures) — Each implant in the jawbone holds a metal attachment that fits into another attachment on the denture. In most cases, the attachments on the implants are ball-shaped ("male" attachments), and they fit into sockets ("female" attachments) on the denture. In some cases, the denture holds the male attachments and the implants hold the female ones.

    The Implant Process

    The implants usually are placed in the jawbone at the front of your mouth because there tends to be more bone in the front of the jaw than in the back. This usually is true even if teeth have been missing for some time. Once you lose teeth, you begin to lose bone in the area. Also, the front jaw doesn't have many nerves or other structures that could interfere with the placement of implants.

    The time frame to complete the implant depends on many factors. The shortest time frame is about five months in the lower jaw and seven months in the upper jaw. This includes surgeries and the placement of the denture. However, the process can last a year or more, especially if you need bone grafting or other preliminary procedures.

    Two surgeries usually are needed. The first one places the implants in the jawbone under your gums. The second surgery exposes the tops of the implants. The second procedure comes three to six months after the first.

    A one-stage procedure is now used sometimes. In this procedure, your dentist can place the implants and the supporting bar in one step. The success rate of this procedure is high.

    • Initial consultation

      Before any work is done, you will visit either a dental specialist called as Prosthodontist or a general dentist who has advanced training in the placement and restoration of implants.

      During the examination, the dentist will review your medical and dental histories, take X-rays and create impressions of your teeth and gums so that models can be made. In some cases, the dentist may order a computed tomography (CT) scan of your mouth. This shows where your sinuses (located above your upper teeth) and nerves are. It allows the dentist to make sure they will not be affected by the implant placement. A CT scan also may be done to see how much bone is available and to determine the best locations for the implants.

      If you are not already wearing a complete denture to replace your missing teeth, your dentist will make you one. You will use this temporary denture until the implant-supported denture is placed. It will take about four visits, spanning several weeks, to complete this denture. By making this temporary denture, your dentist is able to determine the best position for the teeth in the final denture. The temporary denture also can be used as a backup if something happens to the final implant-supported denture. The temporary denture can also be used as the final denture to reduce overall costs. Attachments will need to be added so it can fit securely to the implants.

      Once the temporary denture is finished, the surgeon will use a copy of it as a guide to help place the implants in the proper positions. Holes will be drilled in the copy of the denture so that the surgeon can see where the implants should be placed.

    • First surgery
      • Month 1 (if no denture needs to be made)
      • Month 2 (if denture needs to be made)

      The first surgery involves placing the implants in the jawbone. During the first surgery, an incision is made in the gum where the implant will be placed. A hole is drilled in the bone, the implant is placed into the hole, and the incision is stitched closed.

      After this surgery, you should avoid putting pressure on the implants. The temporary denture can be made so that direct pressure is placed on other areas, not on the implants. It may also be given a soft reline (new lining next to your gums) to help to reduce the pressure on your gums.

      After the first surgery, the dentist will wait three or four months if implants were placed in the lower jaw, and five or six months if they were placed in the upper jaw, before scheduling the second surgery. During this time, the bone and the implants integrate (attach and fuse).

    • Second surgery
      • Month 4 or 5 (no denture needed to be made)
      • Month 5 or 6 (denture needed to be made)

      Standard abutments connected to the tops of the implants

      Once the implants have become fused with the bone, the second surgery can be scheduled. Your dentist will confirm whether the implant is ready for the second surgery by taking an X-ray. This surgery is simpler than the first. A small incision is made in your gum to expose the tops (heads) of the implants.

      A healing cap (collar) is placed on the head of each implant after it is exposed. This guides the gum tissue to heal correctly. The collar is a round piece of metal that holds the gums away from the head of the implant. The collar will be in place for 10 to 14 days. The dentists will adjust your temporary denture again and it may be given another soft reline. The reline material will secure the denture to the healing abutments.

      About two weeks after the second surgery, the healing caps will be replaced with regular abutments. Your gums should now be healed enough for your dentist to make an impression of your gum tissue and abutments. The impression is used to make a working model of your abutments and jaw. This model is used to make the denture framework and teeth.


    Denture Try-In and Insertion
    • Month 5 or 6 (no denture needed to be made)
    • Month 6 or 7 (denture needed to be made)

    At this point, the metal bar is placed on the abutments. You will have the first try-in of your new denture framework to see if it fits properly.

    • Bar secured to abutment with screws
    • Fitting side (inside) of the denture showing the attachments (clips)
    • The denture is being seated on the implants and bar

    Once the metal bar and the denture framework have been fitted together properly, the teeth are temporarily placed on the framework in wax. The whole denture is then tried in your mouth. If everything works well, the teeth are secured in the denture framework permanently. The bar or ball attachments also will be secured.

    You will have to return to your dentist for another visit to have the completed denture inserted. When the denture is inserted, the denture is clipped onto the bar or snapped onto the ball attachments.

    At this point, your temporary denture will be given a new reline. This will allow it to be used as a backup denture in case you lose or break your new overdenture. If you are using the "temporary" denture as a permanent denture, the bar or ball attachments are placed in that denture.

    Caring for Your Implant-Supported Denture

    If you are wearing final upper and lower dentures, you need to remove the denture at night and for cleaning. You also should carefully clean around the attachments.

    Your dentist will test all the parts of your new denture to see if they are secure. Even though your denture is stable, it still can move slightly when you chew. This slight movement can cause the denture to rub against your gums, which can cause sore spots. Your dentist will check your gums and also will check the way your top and bottom teeth come together (your bite) after insertion of the denture.

    The clip or other attachments on the bar-retained denture usually will need to be replaced every 6 to 12 months. They are made of a plastic material (nylon) and will wear after continued use.

    What Will X-Rays Show?

    An X-ray will show the implants in the jaw and any attachments to them. Your dentist will take X-rays a few times during the procedure. They help the dentist to see that the implants, abutments and attachments are in the right places.

    Possible Complications

    In addition to the risks of surgery and of the implants failing, a bar-retained denture carries certain risks of its own. A bar-retained denture needs space on the denture framework for the special attachments that are fitted to the bar. This means that there is less space available on the denture framework for the teeth to be fitted. Because of this, the teeth sometimes can come loose from the base. This problem is easily fixed.

    Also, when the bar is attached to the implants it is important that the bar is evenly balanced on each implant. Dentists call this a "passive fit." If the fit is not passive, the extra strain on the bar can cause the screws to loosen. If you grind or clench your teeth, it's more likely that parts of the denture will break or that your implants will come loose.

    What Can You Expect From Your Implant-Supported Denture?

    Your implant-supported denture will be more stable than a regular denture. You will find it easier to speak and you will not have to worry about the denture becoming loose or falling out of your mouth. You generally will be able to eat foods you could not eat before. However, you will not be able to chew hard or sticky foods because they can damage the denture.

    If you have an implant-supported denture in your upper jaw, it can be made to cover less of your palate (roof of your mouth) than a regular denture. That's because the implants are holding it in place instead of the suction created between the full denture and your palate.

  • Periodontics

    Periodontology or Periodontics is the specialty of dentistry that studies supporting structures of teeth, diseases, and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva(gums), alveolarbone, cementum, and the periodontal ligament. A professional who practises this discipline of dentistry is known as a periodontist.

    Periodontal diseases are infectious diseases caused by bacteria present in mouth. The main cause is dental plaque which is a soft deposit present on teeth due to the lack of proper cleaning of teeth. Many other factors contribute such as food lodgment, improper brushing habits, improper shape and size of teeth, faulty dental restorations and treatment procedures. Abnormal habits such as thumb sucking, lounge thrusting and mouth breathing, faulty nutrition and food habits as well as few debilitating diseases ex: diabetes, hypertension, mental retardation, blood disorder, and conditions such as pregnancy, menopause, puberty etc.

    Periodontal disease can affect any individual of any age, sex, race and community at any time in life. But there are some risk factors or behaviors which increase the susceptibility of an individual to get this disease and can modify the status of disease to a more aggressive and rapidly deteriorating form. They are smoking, diabetes, old age, pregnancy, family history of similar problem, hypertension. The worst fact about the periodontal disease is that the disease are very slow in onset, progression and hardly cause any symptoms or problems in the initial stages

    Patient is usually unaware of the presence of disease, though some may report bleeding gums, loose teeth, spreading of the teeth with appearance of spaces where numb feeling in gums, relieved by digging with a tooth pick. There may also be pain of varied types and durations, including constant, dull, gunning pain, dull pain after eating, deep vibrating pain in jaws, acute throbbing pain, sensitivity when cleaning gums, sensitivity of heat and cold, burning sensation in gums, and extreme sensitivity to unheated air. Usually what happens is that these symptoms appear at a very later stage of the disease and till then the poor patient, even being very keen about the health of his teeth, does not even get to know that this silent disease has already gone to its worse phase.

    The problem which appears is that the disease, which could have been reverted with just a bit of enhanced care and effort, is so much spread in the mouth, that patient is left with only fewer, more complicated, more extensive and expensive treatment options to save his teeth. Treatment for periodontal diseases do exist and have miraculous results but intervention vary according to the stage of disease at which the patient presents to the doctor.

    Initial Stage

    Therapy is simple, non-surgical and less extensive and the disease too is totally reversible mostly at this stage professional oral proplytaxis i.e. scaling and polishing will suffice, along with enhanced maintenance and hygiene care on the part of patient.

    Moderate Stage

    A little more extensive procedure generally known as gingeral curellage or deep scaling can be helpful and these are good chances of healing of tissues.

    Advanced Stage

    At this stage, treatment has to be surgical along with basic phase of scaling, polishing and maintenance. Many periodontal surgical procedures are available depending on the type of disease.

    • Ginginectomy - A minor surgery done under local anesthesia for enlarged and malformed gums to enchance health and beauty of smile.
    • Flap Surgery - A minor surgical procedure where tooth root is cleaned of all the infectious material and diseased tissues after raising a small part of overlying gums.
    • Periodontal Bone Grafting Procedures - Flap Surgery combined with the placement of various natural and artificial bone, where the tooth has been severely weakened by bone loss by periodontal disease.
    • Guided Tissue Regenerations - Wherein some artificial barrier materials are used with the purpose of stimulating bone growth in a guided manner.
    • Mucogingival Surgery (Perso Plastic Procedure) - This surgical procedure is aimed at either enhancing the esthetics of mouth by enlarging tooth root coverage etc., or to enhance the successful outcome of rest of periodontal surgical procedure.
    Terminal Stage

    It is the stage where tooth is diseased beyond the limits and support has weakened to such an extent that it can no longer survive in the existing bone. Here comes the last resort - extraction of the tooth, which will be replaced by a dental implant, a synthetic substitute anchored to the jaw bone to replace the tooth and preserve the surrounding bone.

  • Child Dentistry

    Parents often have questions about taking care of their children's teeth such as "When should they start brushing?", "What kind of toothpaste is best?" "When should you them to the dentist?". Knowing the answers to these questions can help you to keep your kids' teeth healthy and cavity free.

    However, an early visit to the dentist is a good way to learn proper oral hygiene at an early age, including avoiding nighttime bottles or cups of formula or juice, proper tooth brushing, and a diet that promotes good dental health.

    First Dental Check Up: It is very important for your child to have his/her first dental checkup before their first birthday. Baby teeth serve important purposes such as helping the child to speak normal and clear, and to chew naturally. Baby teeth also hold a place for permanent teeth to come in properly. The best way to keep your child's teeth healthy are regular dental checkups.

    You should also talk with your dentist about using sealants in your school-age child. A sealant is a plastic material that is applied to the teeth which hardens and provides a barrier against plaque and other harmful substances. Sealants can be applied to the 1st and 2nd permanent molars to help protect the grooves and pits of these teeth that can be hard to clean and are prone to developing cavities, and appropriate premolars as soon as possible after they erupt (usually after 6 years of age).

    What should I use to clean my baby's teeth?

    A toothbrush will remove plaque bacteria that can lead to decay. Any soft-bristled toothbrush with a small head, preferably one designed specifically for infants, should be used at least once a day at bedtime.

    When should I take my child to the dentist for the first check-up?

    In order to prevent dental problems, your child should see a pediatric dentist when the first tooth appears or no later than his/her first birthday.

    Are baby teeth really that important to my child?

    Primary or "baby" teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also aid in forming a path that permanent teeth can follow when they are ready to erupt.

    What should I do if my child has a toothache?

    First, rinse the irritated area with warm salt water and place a cold compress on the face if it is swollen. Give the child Acetaminophen for any pain rather than placing aspirin on the teeth or gums. Finally, see a dentist as soon as possible.

    Are thumbsucking and pacifier habits harmful for a child's teeth?

    Thumb and pacifier sucking habits will generally only become a problem if they go on for a very long period of time. Most children stop these habits on their own, but if they are still sucking their thumbs or fingers past the age of three, a mouth appliance may be recommended by your pediatric dentist.

    How can I prevent decay caused by nursing?

    Avoid nursing children to sleep or putting anything other than water in their bed-time bottle. Also, learn the proper way to brush and floss your child's teeth. Take your child to a pediatric dentist regularly to have his/her teeth and gums checked. The first dental visit should be scheduled by your child's first birthday.

    How often does my child need to see the pediatric dentist?

    A check-up every six months is recommended in order prevent cavities and other dental problems. However, your pediatric dentist can tell you when and how often your child should visit based on their personal oral health.

    When should we begin using toothpaste and how much should we use?

    The sooner the better! Starting at birth, clean your child’s gums with a soft infant toothbrush or cloth and water. As soon as the teeth begin to appear, start brushing twice daily using fluoridated toothpaste and a soft, age-appropriate sized toothbrush. Use a "smear" of toothpaste to brush the teeth of a child less than 2 years of age. For the 2-5 year old, dispense a "pea-size" amount of toothpaste and perform or assist your child’s toothbrushing. Remember that young children do not have the ability to brush their teeth effectively.Children should spit out and not swallow excess toothpaste after brushing.

    How do I make my child's diet safe for his teeth?

    Make sure your child has a balanced diet, including one serving each of - fruits and vegetables, breads and cereals, milk and dairy products, meat, fish and eggs. Limiting the servings of sugars and starches will also aid in protecting your child's teeth from decay. You can also ask your pediatric dentist to help you select foods that protect your children's teeth.

    How do dental sealants work?

    Sealants work by filling in the crevasses on the chewing surfaces of the teeth. This shuts out food particles that could get caught in the teeth, causing cavities. The application is fast and comfortable and can effectively protect teeth for many years.

    How do I know if my child is getting enough fluoride?

    Have your pediatric dentist evaluate the fluoride level of your child's primary source of drinking water. If your child is not getting enough fluoride internally through water (especially if the fluoride level is deficient or if your child drinks bottled water without fluoride), then your pediatric dentist may prescribe fluoride supplements.

    What can I do to protect my child's teeth during sporting events?

    Soft plastic mouthguards can be used to protect a child's teeth, lips, cheeks and gums from sport related injuries. A custom-fitted mouthguard developed by a pediatric dentist will protect your child from injuries to the teeth, face and even provide protection from severe injuries to the head.

    What should I do if my child falls and knocks out a permanent tooth?

    The most important thing to do is to remain calm. Then find the tooth. Hold it by the crown rather than the root and try to reinsert it in the socket. If that is not possible, put the tooth in a glass of milk and take your child and the glass immediately to the pediatric dentist.

    How safe are dental X-rays?

    There is very little risk in dental X-rays. Pediatric dentists are especially careful to limit the amount of radiation to which children are exposed. Lead aprons and high-speed film are used to ensure safety and minimize the amount of radiation.

    How can parents help prevent tooth decay?

    Parents should take their children to the dentist regularly, beginning with the eruption of the first tooth. Then, the dentist can recommend a specific program of brushing, flossing, and other treatments for parents to supervise and teach to their children. These home treatments, when added to regular dental visits and a balanced diet, will help give your child a lifetime of healthy habits.

  • Minor Oral Surgery
    Third molar or wisdom tooth removal

    Which teeth are the wisdom teeth?

    "Wisdom teeth" are a type of molar. Molars are the chewing teeth found furthest in the back of the mouth. Most humans have 1st, 2nd and 3rd molars. A person's third molars are their wisdom teeth. A person's third molars will erupt (come into place) right behind their second molars (if there is room for them and they are aligned properly). With most people, this eruption process takes place during their late teens or early twenties (ages 18 to 24 years, although eruption outside of this range is not uncommon).
    People usually have four wisdom teeth: upper left, upper right, lower left, and lower right. If they do not have, it is due to their genetic makeup. It has been estimated that about 25% of all people are lacking one or more of their third molars.

    What are "impacted" wisdom teeth?

    In dental terminology, an "impacted" tooth refers to a tooth that has failed to emerge fully into its expected position. This failure to erupt properly might occur because there is not enough room in the person's jaw to accommodate the tooth, the tooth's eruption path is obstructed by other teeth or because the angulation of the impacted tooth is improper.
    Studies evaluating relative younger age groups (ages 17 to 30 years, a population relatively less likely to already have had their wisdom teeth removed) have suggested that the incidence of having at least one impacted third molar runs on the order of 65 to 72%.

    What are the classifications of impacted wisdom teeth?

    Dentists use a number of terms, in combination, to describe the positioning of impacted wisdom teeth. They are mesial, distal, horizontal, vertical, soft-tissue and bony. The terms mesial, distal, horizontal and vertical refer to the general angulation (positioning) of the impacted tooth. The most common type of impacted wisdom tooth is the "mesial impaction." The term "mesial" means that the tooth is angled forward, toward the front of the mouth.
    The other types of impactions, in order of frequency of occurrence, are the vertical, horizontal, and distal types. The term "distal" means that the tooth's angulation is directed towards the rear of the mouth. Vertically and horizontally positioned impacted wisdom teeth are, respectively, oriented either upright or lying on their side.
    In addition to mesially, vertically, horizontally, and distally impacted, wisdom teeth are also be classified as soft-tissue or bony impactions. A "soft tissue" impaction is one where the upper portion of a wisdom tooth (the tooth's crown) has penetrated through the bone, but has not yet erupted fully through the gums. The term "bony" impaction indicates that the wisdom tooth is still encased in the jaw's bone.

    Why might a wisdom tooth be impacted?

    The reason why some wisdom teeth are impacted is not an easy question to answer. A primary cause of wisdom tooth impaction is simply that there is inadequate jawbone space behind the person's second molar. Why this lack of space exists is not fully understood. However there does seem to be a correlation between large tooth size, the presence of generalized tooth crowding, and having impacted wisdom teeth.

    Does modern man's diet play a role in third molar impaction?

    It has been theorized that the coarse nature of Stone Age man's diet had the effect of producing extensive tooth wear (not only on the chewing surface of the teeth but also on the sides of the teeth where neighboring teeth rest against each other). The net effect of this wear would be a reduction in the collective "length" of the teeth as a set, thus allowing enough jawbone space to accommodate the wisdom teeth by the time they erupted. In comparison the diet of modern man does not usually cause a significant amount of this type of tooth wear.
    It has also been argued that the coarse nature of Stone Age man's diet, as compared to modern man's relatively soft diet, probably required more activity of the "chewing" muscles. This activity could have stimulated greater jawbone growth, thus providing more space for wisdom teeth.
    The harsh and threatening world of the caveman no doubt often lead to the occurrence of broken teeth and even tooth loss. Once a tooth (or a portion of it) is missing the teeth behind it have a tendency to move forward. This shifting would make more jawbone space available for the wisdom teeth. In comparison with the advent of modern dentistry there are relatively few reasons why a tooth should be lost or remain in a state of disrepair.

    Neccesity of the Wisdom Teeth Removal

    Should all wisdom teeth be extracted?

    Clearly not all wisdom teeth need to be removed. There is nothing inherently bad, lacking or undesirable about wisdom teeth. In fact, these teeth, just like any other type of tooth, can be valuable members of a person's dentition.
    It is also important to state that all types of surgery, including oral surgery, contain some inherent risk. And for this reason, wisdom teeth should only be extracted in those cases where a suitable case for their removal can be made.

    Do all impacted wisdom teeth need to be extracted?

    It might come as a surprise to you but no, not all impacted wisdom teeth necessarily need to be removed. It certainly can be possible that a person with an impacted wisdom tooth could live their entire life without ever experiencing any problem with it. Of course, the difficulty associated with evaluating wisdom teeth is being able to determine which ones are likely to place the person at risk. This is where your dentist's experience and judgement come into play.

    What type of impacted wisdom tooth is most likely to place a person at risk for experiencing problems?

    One of the primary factors that a dentist will take into consideration when evaluating an impacted wisdom tooth is its impaction type. And in regards to this matter, the following guidelines typically hold true. Overall, full bony impactions (a situation where the tooth is fully encased in the jawbone) are the type of impaction least likely to be associated with problems. The anticipated problems would fall along the line of cyst or tumor formation or else the cause of root resorption of a neighboring tooth, all of which are comparatively lower frequency events.
    Partially erupted third molars (wisdom teeth where just a portion of the tooth's crown projects through the gum tissue) are the type most likely to become problematic. Their communication with the oral cavity (and associated exposure to the bacteria that it harbors) is what places these teeth at greater risk for complications, especially pericoronitis, periodontal disease and tooth decay.

    Should any retained wisdom tooth be monitored?

    Over time a wisdom tooth's status may change. This includes both the potential for the formation of pathology or a change in the tooth's positioning (i.e. a full bony impaction becomes a less predictable partially erupted tooth). For this reason, any wisdom tooth, but especially an impacted one, should be routinely evaluated both visually and radiographically (with x-rays) on a schedule suggested by the person's dentist.

    Should some "impacted" wisdom teeth probably not be considered true impactions?

    It is important to keep a wisdom tooth's normal eruption process in mind when passing judgement on it. A typical time frame for third molars to erupt is between the ages of 16 and 25 years. For people in this age range, in some situations, a case might be made that it is debatable that the term "impacted" really applies to their tooth. After all, it is quite possible that the tooth is still erupting and has not yet arrived at its final positioning.
    That is not to imply that it is not sometimes clearly obvious even at a young age that a wisdom tooth will never be able to erupt successfully. But in those cases where available jaw space and the tooth's alignment appear to be somewhat within normal limits then quite possibly the tooth should be given some leeway, in the sense that it is given more time to progress with its eruption.
    Then at an age lying closer to the end of the normal eruption time frame, if it appears that the tooth will be incapable of erupting appropriately, it can still be extracted within that time window typically considered best for extracting wisdom teeth (the upper boundary of which is on the order of age 24 years).

    What is the evidence in support of a wait-and-see approach for wisdom teeth?

    Age is an important variable to consider when making a decision about what to do about an impacted wisdom tooth. As a rule of thumb, there is no question that comparatively younger patients tend to experience fewer complications with third molar surgery. Because of this, for those 35 years of age and beyond, if an impacted wisdom tooth exists (especially a full bony impaction) and it shows no evidence of associated pathology, it is frequently left alone.