All posts by SD Team

Artificial tongue- we can make you eat again

General Dentistry, , ,

Tongue is the only movable muscular organ without bone which has an important role in tasting food and perception of hot and cold, pressure and touch.Tongue prosthesis also known as glossal prosthesis is given in patients where the floor of the mouth is resected. The extent of the resection and amount of tongue tissue removed decides the design of the glossal prosthesis.

The resection surgery results in the dysfunction of mastication, speech and swallowing as the tongue contributes important role in all of these processes. A glossal prosthesis is given in case of partial glossectomy with removal of more than 50% of the tongue to restore the function. Depending on the extent of resection, the tongue prosthesis is attached to the mandibular teeth or maxillary and mandibular prosthesis. Palatal augmentation may or may not be needed with lingual augmentation.

The impression of the patient is firstly recorded to cover the defect completely. Then a model is prepared on which an acrylic record base was fabricated covering the floor of the mouth in mandibular resection cases. The function of the residualtongue is also recorded with softened modeling compound. A wax pattern is then fabricated on the record base. It confirms the dimensions of the oral cavity and has rounded edges. The tongue is tipped at an angle creating a highest point at its anterior one third. The wax thickness is reduced 4-5 mm at the base and posterior two-thirds of the tongue.

The wax up is tried in patient’s mouth and needed adaptations are made. The patient is asked to produce linguo velar and linguo alveolar sounds for verification. For production of fricative sounds like ‘s’ and ‘t’ a narrow sharp groove is carved in the maxillary prosthesis to direct the air stream and allow the production of these sounds.

The tongue prosthesis can be fabricated for two purposes. The typical prosthetic tongue for speech is flat with a wider anterior elevation. It aids in the articulation of various sounds.

The prosthetic tongue for swallowing has a trough in its posterior slope. This guides the food bolus into the oropharynx. A speech pathologist and a dietician are needed to monitor the glossectomy patients. The fabrication of a tongue may be done using acrylic or silicone.

The coordination of muscle and nerve is impaired even after flap reconstruction. It is very important to get a dynamic palatography before starting the treatment to assess the linguopalatal contact visually. The tongue prosthesis may be a one or two-piece depending on the case.

The restoration of resected jaw and tongue is a cumbersome procedure requiring intricate detailing and assessment of the available situation before initiating the treatment. The choice of material, technique, and the type of prosthesis is very critical in such cases as there are chances to create discomfort to the patient and totally eliminate the purpose of efforts which are taken to improve the quality of life of the patient. The importance of making correct choices for the patient is critical in such cases. A prosthetist can help you regain the confidence in eating and speaking with the help of the speech pathologist and dietician. Consult a specialist to know the best possible solution to your problem.

Pain in the neck: Do not take it lightly

General Dentistry, , ,

The joint between the mandibular condyle and the glenoid fossa of the skull is known as the temporomandibular joint. It is responsible for the movement of the lower jaw. The stability if this joint is a part of the health of the stomatognathic system. A healthy stomatognathic system is the one in which the teeth, muscle and the joint are in harmony.

TMj Treatment

Patients who undergo full mouth rehabilitation or restoration of worn dentition have to maintain the harmony between the teeth, muscles and joint. Bite restoration is to be done following a series of complex steps which aim in maintaining the occlusion at a pre existing point known as the centric relation. It is important to confirm this relation at every step to ensure no complications after the completion of the treatment.

An long standing imbalance in the occlusion may manifest as head ache, neck pain or shoulder pain owing to the abnormal stress the muscles are being subjected to. When the occlusion is not in its balanced position it stresses the joint and does not allow it to return to its rest position. This as a result causes the muscles to be strained and produce symptoms as head, neck or shoulder pain.

It is very important to rule out the cause of the disbalance and treat it to relieve the symptoms and correct the position of the TMJ. This would again maintain the harmony and relieve of the signs and symptoms.

A stiff neck can be relieved by adjusting the occlusion of a new restoration. Selective grinding can be a treatment option in case of single tooth restoration. In complex full mouth rehabilitation cases, Tek scan or T Scan which is a digital occlusal analysis system helps to analyse the occlusion, occlusal stability and force on individual teeth. It helps to find out the reason behind occlusal imbalance. It is used in patients with TMJ problems. It helps to screen your bite position and occlusion  from the baseline.

Joint vibration analysis is another technique to relieve TMJ pain. It is based on the principles of motion and friction produced by surfaces. It is recorded by accelerometers. Utilizing these advanced techniques the cause of the pain can be ruled out and treated accordingly. Orthodontic treatment options may be chosen in case of correction of an altered bite due to tooth position or angulation. In case a single restoration occlusal adjustment should suffice.

Of untreated the TMJ pain may exaggerate and even lead to neuromuscular problems. Therefore correct assessment of the reason behind the pain needs to be ruled out. This should them be followed by relevant treatment. Any pain in head, neck and shoulder should be considered as a possibility of referred pain due to dental problems as well. Consult your dentists for a joint vibration analysis or Tek scan to rule out the etiology and perform required treatment to relieve of all signs and symptoms.

Lost an eye – Let us Recreate it for you

General Dentistry, , , ,

The loss of an eye due to trauma, infection, or congenital defect puts the patient through a psychological turmoil. It also leaves the patient visually and esthetically impaired. In case of a defect, partial or complete removal of the eye may be required. Not all cases are suitable for prosthetic replacement. Some may require artificial eye surgery while others need no treatment at all.

artificial eye clinic
Artificial Eye Treatment

A silicone or acrylic based prosthesis imparts the lost confidence to such patients and motivates them to lead a normal life.
A multidisciplinary approach including a prosthodontist, opthalmologist, surgeon, and oral maxillofacial prosthetist should be considered to deliver a successful and esthetic outcome. Other than esthetic and psychological reasons, the eye prosthesis also saves the eye socket from any possibility of future infection.

The ocular prosthesis may be prefabricated or customized. It comprises of sclera and iris. Before making an impression, the socket needs to examine for the presence or absence of sclera and iris. Any signs of infection or inflammation should be ruled out as well. A stock tray is adjusted according to the socket by removing overextensions and adapting to the shape and contour of the socket. Then an accurate alginate or light body impression of the socket is made using the same ocular tray by the prosthodontist. This impression is then used to make a silicone index. The index is cut to remove the impression and replaced by a wax to fabricate a wax pattern.

The wax pattern is then carved and smoothened. It is then tried to confirm the fit, bulkiness, and drape and mobility of the eyelids, and the desired changes are made. In the next step, the iris is attached to replicate the normal gaze position. The wax pattern is then flasked and replaced by scleral polymer followed by curing. The acrylic surface and the iris are modified and finished for more natural appearance of the prosthesis. The painting and curing of the iris followed by adding replicating blood vessels to the sclera is done to add character to the prosthesis.

Addition and trimming of clear resin and margins of the prosthesis are the final step. The prosthesis is delivered to the patient with instructions about how to place and remove it. He is also informed about the need to get the prosthesis polished after some time.

Prosthetic Eye, Ocular Prosthetics
Artificial Eye Implants

The ocular prosthesis delivers esthetic as well as psychological support and develops confidence in the patient. The only complication commonly seen in such prosthesis is the infection caused by the monomer used during the process. The use of medical-grade, highly biocompatible materials, and reverse curing technique eliminates the possibility of that as well. The iris and sclera are designed to match the patient’s natural eye to produce high esthetic results. It is important for the team of prosthodontist, opthalmologist, surgeons, and oral and maxillofacial prosthetist to collectively plan out the treatment and assess all aspects of the case to the best of their knowledge about the procedure, techniques, and material used.

Dental implants vs bridges

Implants dentistry, ,

Replacement of missing teeth is required to avoid complications in future. A lost tooth can be replaced by dental implants or bridges. Losing a tooth may not seem a big issue initially but it leads to complications like movement of adjacent and opposing tooth, change in bite, loss of bone, uncomfortable chewing, jaw pain, etc. Removal of a tooth should be followed by planning its replacement as soon as possible.

A dental implant may be placed at the time of extraction itself to avoid further loss of bone. The dentist can give the final crown at the time of surgery or after healing period, where a temporary crown is given in the surgical phase. An impression with abutment in place is recorded and sent to the lab for final prosthesis fabrication. The crown may be screw or cement-retained depending on the case. It does not affect the adjacent teeth and bone in the process. Instead, implants utilize the available bone and space. It resembles natural teeth where the implant behaves like the root and the abutment with crown functions like a natural crown.

Missing tooth can also be replaced with a dental bridge where the adjacent teeth are minimally prepared to act as support fir the bridge. Different dental materials require different amount of tooth reduction. In some cases where patient experiences sensitivity, endodontic treatment may be needed as well. The impression for the prepared teeth is then sent to the lab for fabrication of the final crowns. The crowns may then be placed with dental cement. The material of crown varies from metal to ceramics to zirconia depending on the patient’s esthetic and functional requirements. It is important to select the correct material for the prosthesis to last long.

Replacement of lost teeth maintains the chewing efficiency and bite of the patient in the long run. It is important to choose the correct shade so that the restoration appears as natural as possible, especially in esthetic or anterior zone. Digital impression helps in hassle free recording of the tooth and replication of the same by the technician to fabricate the prosthesis. It also makes the patient comfortable and complaint. The need of a trial depends on the case. Digital planning also helps you to see the final outcome even before starting the procedure. It helps in better treatment planning.

Your dentist may help you choose the suitable treatment option for you after clinically and radiographically assessing the condition. The selection of material is crucial as well since a front tooth replaced by a metal or metal ceramic option would be highly unaesthetic. Functionally strong zirconia crowns are given for posterior teeth in patients with high esthetic demand. In patient with parafunctional habit monolithic zirconia is the material of choice. The crowns or bridges should restore the occlusion to avoid temporomandibular issues later. A good clinician may help you to decide the best dental treatment for you without digging a hole in your pocket and delivering the best solution for your case.

Anti aging dentistry

General Dentistry, , , ,

Age is just a number and this number can be dodged for as long as you wish. Telling someone they look much younger than their actual age is the best compliment one can get. In this era of looks and impression, one wants to leave a mark, and smile is the best tool to achieve it. Anti aging dentistry includes the non-surgical procedures to make you look younger just by changing few things in your smile.

The lower third of your face has a remarkable role to play in the aging features. The teeth and jaw collectively support the soft tissues to prevent the formation of wrinkles. The wrinkles around the nose and mouth are signs of aging which develop due to the degradation of collagen and collapse of bite due to loss of tooth and structure. In some patients the loss of bite due to wear or parafunctional habits, discoloring (basically yellow) of teeth, shape, and size of the teeth which is not in their ideal proportion makes them look greater than their actual age.

The correction of the following concerns using veneers, crowns, and implants is part of the anti aging dentistry. Restoring the lost height of the teeth due to wear with crowns reduces the age of the patient by 5 to 10 years. This restoration needs to be in resonance with the muscles and joints to maintain the overall health of the stomatognathic system along with the esthetics. The need to get injected with substances to correct the wrinkles appearing around the nose and mouth is eliminated.

Dental veneers are placed to maintain the teeth proportion, correct the shape and shade of the teeth, and enhance the features of the teeth to result in better esthetics. The resultant smile is more vibrant and makes the patient look much younger than their age. The designing of the veneers also considers the amount of black area appearing in patient’s smile. This area needs to be maintained to provide a depth to the smile. It may be combined with orthodontic treatment as well depending on the case.

Dental Implants are used to replace missing teeth for the patient as they result in collapsed bite and producing signs of early aging. The implants are then loaded with crowns and bridges to restore the lost bite providing the support to the overlying soft tissues, thereby correcting the signs of aging.

A simple treatment method like teeth whitening can rejuvenate the smile of a patient. The lighter the shade of your teeth, the younger the appearance. Dark or yellow color of the tooth is a sign of aging indicating the loss of tooth structure due to wear and tear. It may be a result of habits as well. A whiter smile radiates a beam of confidence and youthfulness making the patient appear younger.

The anti aging dentistry focuses on the lower third of your face especially the smile and maintains it to prevent early signs of aging. The need to undergo surgeries for the correction of these esthetic issues is completely eliminated. The temporary masking of the aging features using the injections is omitted as well. Before taking a plunge for surgeries related to signs of aging, consult your cosmetologist for customized and personalized treatment plan as the anti-aging dentistry is not a template form of treatment for all patients. Every individual needs a different treatment.

Delaying dental treatment does not help you save money

General Dentistry, , , , ,

Dentist appointments scare some people to an extent where they don’t want to visit him unless they are left with no other option. A 6 monthly visit to dentist helps you to keep a check on your oral and overall health.

An early diagnosis saves you not only money but also helps you plan and conserve your dentition for a longer time. It also eliminates the need of a lot of complicated procedures in the future.

A regular dental check up and cleaning appointment ensures a healthy oral cavity. The most common concern is pain in tooth. Patient experiences pain only when the infection in tooth reaches the pulp and needs endodontic intervention in most cases. This can be avoided by detecting the caries in the initial stage and restoring the tooth with just a filling. The root canal treatment is an expensive procedure as compared to a tooth colored filling. The negligence to pain if continues leads to the loss of a lot of tooth structure which poses the need of another additional treatment of post and core. After the complete removal of decay followed by endodontic treatment,a post is used as a support to replace the lost structure and hold a restoration in place allowing full function of the tooth.

Various complicated periodontal surgeries can be avoided by early intervention.Bone and soft tissue loss are long term effects of poor oral hygiene or a detrimental habit which if intervened at an early stage may avoid the damage.Regular oral prophylaxis eliminates the possibility of deposits being accumulated on teeth which is a common factor for soft tissue and bone loss. It can also lead to the loss of teeth.

A prolonged tooth decay leads to the loss of tooth structure increasing the chances of tooth fracture. This may ultimately result in the loss of a tooth which could have been saved if presented to the dentist earlier.

Replacement of missing teeth is the ultimate option thatneed to be managed by the additional surgeries which could have otherwise been avoided by earlier intervention. Infact even the loss of tooth could have been avoided by saving the existing natural teeth using simpler treatment options.

A parafunctional habit may be diagnosed and corrected in the early phase which later results in the situation of a full mouth rehabilitation. Prevention is definitely better than cure. Therefore, timely visits to your dentist can avoid the need of most of the complicated and expensive procedures in future.

Dental treatment is not expensive, ignorance is. A tooth that can be initially saved by a restoration, needs a root canal treatment when not attended to for a long time. This if still not heed to, results in the situation where the teeth needs to be removed and replaced artificially. Further ignorance adds to the cost of complex surgeries in the treatment. It is very essential to notice any signs of dental problem and get them attended at an initial stage to not only save the money for complicated and advanced dental treatments but also to save your natural teeth for as long as possible. Your dentist may help you understand the reason for minor dental problems which otherwise seem unimportant to you. A thorough clinical as well as radiographic assessment helps to diagnose dental concerns which have yet not developed any signs in the patient.

Invisalign – The Next Gen Braces

cosmetic dentistry, , , , , , , , ,

Orthodontics is the word that brings the picture of a metallic smile with braces in mind. That is not the case anymore. The Invisalign is a set of clear aligners made from biocompatible material customized for your teeth to deliver the same result as metallic orthodontic braces. The forces applied are not as great as in case of brackets.

Mild to severe crowding, spacing, or alignment issues can be easily corrected with Invisalign treatment. Appreciable results are achieved in extraction cases as well. This treatment may be combined with a smile designing if the patient wants to change the shape, size, or color of your teeth.

To begin with, your dentist will examine your teeth and assess the discrepancies present with them. He also makes a note of teeth related habits and expectations from the treatment. A digital scan of your teeth and bite is sent to the laboratory along with facial photographs to get the first assessment done.

In this assessment, a digital evaluation combined with the photographic details are used by an orthodontist on a software to decide the process and duration of treatment. The treatment plan is mailed to your dentist. In the following visit, your consent for the treatment is taken after a consultation with your orthodontist. Once the approval is done, the lab begins to fabricate customized aligners on your model which are delivered in 2-3 weeks of time. Your orthodontist will schedule any extraction or additional treatment during this time if needed. Any attachments would be placed on your teeth if advised in the plan. Depending on the case, your orthodontist can perform procedures like interproximal slicing, addition of composite buttons, etc. You will be given a set of customized aligners to be changed every two weeks in the pre-mentioned sequence.

The first set of aligners is to be worn for a week just to make you acclimatized to the treatment. The aligners have to be worn throughout the day except when you are eating. This makes the Invisalign braces treatment removable, patient-friendly, and almost invisible. The oral hygiene maintenance with aligners is easy and hassle-free. Invisalign utilizes application of precise yet mild force on your teeth to produce desired movements in a smaller duration of time. The scan assesses the amount of force to be applied on individual tooth to get your teeth in proper alignment. The aligners are a technique sensitive procedure since calculated forces are applied on individual tooth to reposition it correctly.

The Invisalign treatment can be taken by working adults as well because of their unnoticeable aligners. Visit your nearest orthodontist in Delhi for a pretreatment assessment to clear your doubts. He can guide you for your treatment to your beautiful and confident smile. He might even ask for extra oral scans to assess the relationship of your upper and lower jaw. This will help him deliver a more predictable solution to your orthodontic problem.

Zygomatic Implants – The Saviour

Implants dentistry, ,

Dental implants are the preferred choice of treatment of every dentist because of its predictable results. Various researches have lead to the introduction of many advanced techniques to improve the prognosis of the implant treatment and make it a long term success. Variation in implant designs has also been seen owing to the wide application of the treatment.

zygoma implants

Zygomatic implants are the longest implants designed for use in cases where the anterior part of the maxilla is severely resorbed. Due to the unavailability of the bone in the front region the support for prosthesis is taken from the implant placed in the zygomatic bone. The implants may be loaded immediately or in the second stage of the classical two-stage loading protocol. The patients who have already undergone a sinus lift procedure which has failed are indicated cases for the zygomatic implants.

Zygomatic implants are indicated in the severely resorbed maxilla or partially edentulous situations. They are also the treatment of choice in patients who do not want to undergo an additional sinus augmentation surgery. The patients where previous conventional implants, grafting procedure and sinus augmentation procedure have failed are indicated for zygomatic implants. Rehabilitation cases after tumor removal or trauma also include this as a part of the treatment modality.

The zygomatic implants can be used in conjugation with anterior endosseous implants. The number of implants depends on the amount of bone resorption existing. 2 more quad zygoma implants may be placed in the case where anterior implants could not be placed.

The dentist needs to study the CBCT report to assess the anatomical structures surrounding the surgical site. In the conventional technique, the zygomatic implants are inserted through the alveolar bone and maxillary sinus into the zygomatic bone for support. A lateral access is made to the maxillary sinus to gain visual access to the lateral posterior aspect where the implant needs to be placed. Careful elevation of the Schneiderian membrane is required to avoid any perforation.

To avoid the possible complications of sinus perforation, an extra sinus placement approach is taken. Here the implant is placed at the inner aspect of the sinus wall without perforation.

An infection of the sinus is the most common complication associated with zygomatic implants. Other possible complications include infraorbital nerve paresthesia, oro antral fistula, and orbit perforation. Fracture and bone necrosis is possible too if the implants are torqued over 45 N cm.

For the immediate loading implants, a primary stability and torque of 35-40 N cm is needed for all bone densities. The placement of zygomatic implants utilizes a completely different armamentarium and technique. The procedure involving close approximation with the maxillary sinus renders it extremely technique sensitive and skill-based surgery. The possible complications are really tough to manage as well. Therefore this treatment modality requires the precise treatment planning and immensely skilled implantologist to carry out the treatment avoiding all possible complications.

Is teeth whitening safe?

cosmetic dentistry, , ,

The increasing esthetic concern of people has made them more aware and conscious. People with tea, coffee, tobacco or smoking habit tend to get their teeth discolored resulting in unaesthetic smile. Dark or discolored teeth are a contributing factor in the under-confident personality of an individual.

Teeth whitening can be done by a dentist using a bleaching agent. Teeth whitening canalso be done at home using over the counter products like strips, gels, toothpastes, etc. Protocol needs to be followed, else complications may occur. Customized tray may be fabricated to hold the gel in contact with teeth to lighten the tooth color.

Teeth whitening reviews
Teeth whitening reviews

The commonly used bleaching agent is hydrogen peroxide ranging from32-40%. It is available in powder liquid for to be readily mixed at the time of procedure. The syringe systems allow hassle-free application. Teeth whitening is a single visit procedure wherein the dentist first cleans the teeth to remove any deposits from the tooth surface like plaque, calculus or extrinsic stains to make it more receptive for the treatment. Following this, a protective layer of gel is applied on the soft tissues to avoid contact with bleach. The gums are also protected by gingival barrier to avoid percolation of bleach through the sulcus. The bleach is then readily mixed and a coat is applied on the tooth for a prescribed time depending on the system of bleach being used. Some systems need photo activationfor 8- 10 minutes as well to improve the outcome.

Teeth whitening is a quick fix to elevate confidence and esthetics of a conscious individual. The percolation of dental bleach may result in blanching or burning of the soft tissues. Therefore,cautious application of whitening agent and proper isolation is very essential. It is a precise procedure where under treatment may not produce desired results and prolonging the same may result in severe sensitivity.

Post treatment care includes avoiding colored foods and beverages for 48-72 hours. Desensitizing toothpastes are recommended in case of sensitivity. The longevity of the treatment depends on the post-treatment care taken by the patient. This being a temporary treatment may need a booster dose to prolong the result.

Instant teeth whitening treatment
Zoom Teeth Whitening

Case selection plays a crucial role since in patient with moderate to severe fluorosis are not preferred to treat with bleaching instead veneers is the treatment of choice. Bleaching in such cases may worsen the tooth condition. Patients already having sensitivity are also not indicated for the treatment.

Zoom Teeth whitening is a very precise, efficient, and safe procedure if done with proper care and technique. Therefore, it is important to find the best cosmetic dentist with precise knowledge of the various systems available and the ability to select the best option for the patient and deliver the desired results. The treatment can be repeated but a prior consultation with the dentist should be considered as too much excessive whitening might result in damage to the enamel layer.