Over the past 15 years the practice of implant dentistry, the placement of artificial tooth anchors into the jawbones, has arguably evolved faster than any other facet of dentistry. An implant is basically a screw-like structure that is placed into the bone during a minor surgical procedure. The amazing thing about this is that these prostheses are covered with a special metal called titanium. Titanium has the fascinating property of being biologically compatible with the body. Therefore, as the bone heals, the implant is incorporated seamlessly into the jaw. This is called osseointegration. When healing is complete an implant is an extremely solid structure.
After the implant has been in the bone for a number of months, typically 6 to 8 months, enough time has passed for integration of the implant into bone. Now the implant is strong enough to support a new tooth (or teeth). The next step is to attach a barrel-shaped structure called a core that actually is screwed right on to the top of the implant. Next, a mold is taken of that core and this mold is sent to a dental laboratory where a custom tooth is fabricated. This tooth is made to match both the colour and shape of the rest of the teeth of the mouth. At the final appointment, the new tooth, which is called an implant-supported crown, is cemented or screwed onto the core. The final structure is very strong, allowing the wearer to use the implant tooth with the same confidence as a normal, healthy tooth.
New advances in implant technology are allowing dentists to immediately load the implant. This means that in some cases, it is possible to put the core and tooth on top of the implant immediately after the implant is placed. This is especially helpful for those who require implants in the front of their mouths. It avoids one having to wear a temporary denture for the 6- to 8-month period of osseointegration.
Another growing aspect of implant technology is the use of these structures to help dentures fit more snugly. The attachments are called locators. In this case, instead of placing a core and false tooth over the implant, a small metal ball is attached onto the top of the implant. This is called the “male” attachment. Next, the “female” component is added to the denture such that the denture fits precisely onto the metal ball. The denture will now “snap” into place. People usually have at least two of these implant locators in order to retain the denture. The more implants used, the stronger the attachment. This procedure makes dentures fit very snugly and greatly improves a person’s ability to function with them. It eliminates the problem of dentures falling out when people eat, yawn or sneeze.
Cosmetic dentistry has become the main focus of many dental practices. Dentists can change the colour, shape, and alignment of teeth with the end result looking whiter and straighter than before. Changing the alignment of teeth can be done orthodontically (by moving teeth with wires and braces) or by putting facings and coverings over teeth to give the illusion that they are straight. The facings are called veneers and the full coverings are called caps or crowns.
Veneers are made of porcelain. The procedure involves very slightly polishing the front surface of usually the six front teeth (removing approximately 0.5 - 1 millimeter) and then taking a mold of these polished surfaces. At a second appointment, custom made veneers are bonded onto these prepared surfaces. The colour and shape is chosen to maximally enhance the esthetics of that person's smile. If the teeth have large fillings in them already, are broken, or if extra stabilization is needed, crowns are excellent restorations to strengthen teeth.
Bleaching: The chemical agent used to bleach teeth in both store bought and professional formulations is called hydrogen peroxide. Both store bought and professional formulations will whiten teeth. The question is how well?
Agents purchased in a store contain varying amounts of hydrogen peroxide and therefore are variable in their effectiveness. Professional formulations contain standard amounts of hydrogen peroxide and their results are therefore more predictable. However, the effectiveness of all of these products is patient specific. There is no way to predict the end result except that with the professional formulations, some degree of whitening should always occur.
Bleaching done by a dentist can be carried out during a dental visit, can be done by the patient over successive nights, or can be done by the patient during four, 15 minute sessions, daily for one week. It is safe and with professional guidance, no damage should occur to the oral structures. The only side effect might be slightly sensitive teeth for a few days.
How long the bleaching lasts will depend on the habits of the patient. One should refrain from smoking, drinking tea, coffee, colas or red wine during the bleaching process. Proper dental hygiene will also lengthen the time between bleaching sessions.
Even though you diligently brush and floss you may still lose a tooth and if this happens you should replace it...not just for appearance! When you lose a tooth to decay, injury or gum disease, the neighbouring teeth have to work a lot harder chewing and biting to get the job done. If the missing tooth is not replaced, the teeth around the gap will start to stress and shift and move around. That puts them in danger and without treatment, there's a good chance you'll eventually find more gaps in your smile.
One of the best ways to bring back your smile is crown and bridge treatment. Broken down and heavily filled teeth require crowns for stability and for improved esthetics. These crowns, or caps as they are also called, serve to fully cover the teeth. They are fabricated from porcelain, and sometimes lined inside with gold.
For lost teeth, we build a special dental bridge that spans the spaces left by your missing teeth. Bridges can be made of gold, porcelain-faced gold, or all porcelain depending on where they'll show up in your smile.
Getting a crown or bridge takes more than one appointment, but it will last for years. First, we do a thorough examination and prepare the neighbouring teeth for the bridge. An impression or replica of your mouth is taken so a bridge can be custom designed by an expert lab technician. At your next appointment the bridge is trimmed and adjusted before it is fixed in place. We take care to match colour and appearance. The end result is a healthy happy smile for many years to come.
What is A Root Canal?
A tooth consists of a crown, which sits above the gumline and the root which is embedded in the jaw bone. Inside the root is an internal portion called the pulp chamber, where the nerve of the tooth lives. If the nerve (or pulp) gets damaged, root canal treatment is needed.
There are a number of factors that can lead to a damaged nerve: Infection from deep decay; severe gum disease; trauma, orthodontic movement (in rare cases) and even the normal wear and tear of chewing and of extensive dental work have been shown to cause the need for root canal therapy. Teeth usually have 1-3 roots. The front teeth usually have one root and the back molars have 2 or 3. Each separate root (if multiple roots are present) needs to be treated in root canal therapy.
The procedure itself is painless since local freezing is used. Our office also can employ sedative techniques to make the procedure even more comfortable. In very rare cases usually when the tooth is extremely infected, it may be difficult to obtain complete freezing. This is where sedation is of excellent advantage. We have root canal specialists (endodontists) who are available at our office to help us with certain cases while we provide the sedation services.
During a root canal procedure, the dentist makes a small opening in the top of the tooth and removes the nerve and infected tissue inside. The roots are then filled with a rubber-like material. A temporary filling plugs the hole in the top of the tooth. Once the tooth heals, a permanent restoration is needed. The type of final restoration depends on where the tooth is located in the mouth and the size of the filling that the tooth had before the root canal was done.
In general, any tooth with a previously large filling will need a crown (or cap) after root canal treatment. It may also require a stainless steel post to be placed into one or more of the canals. If you have a question regarding what type of restoration is best for a particular tooth, ask your dentist.
Many people tend to equate good dental health with strong healthy teeth. This is only half of the equation. In order for our mouths to get the "gold star" rating for overall hygiene, our gums and the anchoring bone must be healthy as well.
We all know that our teeth are anchored to the jaw bone This, along with some of our facial muscles, provides us with the strength to chew. If this anchorage were not sound, our teeth would move, break and be unable to chew food.
The gums (called gingivae) blanket the jaw bone and act as a protective skin. The edge of the gingivae overlap the bone and encircle the teeth forming an attachment with the teeth.
This attachment is crucial to the health of the underlying bone because it acts as a barrier between bone and the natural bacteria that live on our mouths. This attachment however does not come right up to the edge of the gingiva. In fact, there is an outer edge of unattached gum tissue such that a natural pocket or space occurs between the teeth and the gingiva. A healthy depth for this space is 2-3 millimeters.
Part of our job in maintaining good oral hygiene requires keeping these pockets free from food debris. The best way to do this is to use dental floss.
Flossing is important because our mouths naturally harbor bacteria. Food that is left around our teeth is initially called plaque when soft and if allowed to remain on our teeth it hardens and is then called tartar or calculus. This leftover food becomes an excellent growth medium for bacteria to grow and flourish. It is dark, wet and if our oral hygiene is not excellent, it provides a source of nutrition for the bacteria. This is akin to "a kid in a candy store". As the bacteria grow in number, they begin to invade the edges of the gum tissue. The gingivae become darker red and swollen. They bleed easier This is called gingivitis, which simply means, swollen gums. Most people have this problem if only to a slight degree in some areas of their mouths. With improved flossing and brushing and a visit to the dentist, this disease is easily reversed and the gums will return to health.
If this situation is not corrected, the bacteria will begin to encroach on the attachment between the teeth and gums and violate it. This will result in a deeper gum pocket and one that is harder to keep clean. As this negative cycle continues, the bacteria can completely penetrate the attachment between the gums and the teeth and invade the jaw bone.
This disease is no longer referred to as gingivitis, but is now called periodontitis. This indicates that the gums and the bone are infected with bacteria. The gum pockets might be 5-6 millimeters deep at this point. The gingiva may look more purple and have no sharp edges but instead swollen, rolled margins which bleed to only slight touch. Luckily, this syndrome is also treatable with improved home care and professional hygiene visits.
If this problem is still not corrected, the bacteria will continue to flourish and now the jaw bone will begin to melt away from the teeth. Now the pockets may have become 7 millimeters or more and at this point we are no longer able to floss or brush the full depths of these pockets. This means that at this stage of the disease, regardless of how well we improve our flossing and brushing techniques, we will never be able to clean out these pockets. Therefore, if we do not seek dental treatment, there will always be plaque, tartar and bacteria in these pockets and the disease will continue until there will be little if any bone around the teeth. The teeth will have lost anchorage and will have to be extracted.
The treatment that is usually rendered is done by periodontist and involves a minor surgical procedure to decrease the depths of the periodontal pockets so that we may be able to keep them clean at home. This treatment can be performed with sedation, if desired.
Over the years, an aging population, an improvement in the quality of dental care and better oral hygiene products mean that we are holding on to our teeth longer then ever before. Because of this, dentists are seeing an increase in the prevalence of gum disease. It has been estimated that approximately three quarters of adults have some form of periodontal disease. For this reason, much of the cutting edge in dental research centres around the treatment and prevention of periodontal disease. Other studies have shown that there is an increased risk for gum disease in smokers and in those who have a higher sugar diet. As well, periodontal disease has been linked with heart disease.
We have periodontists who come to our offfice and treat certain periodontal conditions while we provide the sedation services.
Our dental team is very familiar with sports dentistry. Each of the dentists have been involved with sports that see numerous injuries to the face.
Dr. Isen and Dr. Nkansah, are, or have been, avid hockey players. Dr.Isen used to play competitive water polo.
Dr. Nkansah is the team dentist for the University of Toronto basketball team and the Toronto Raptors of the National Basketball Association.
We strongly urge all participants in contact sports to wear a professionally made mouth guard. Professionally made appliances fit more precisely than store bought "boil and bite" products and have been shown to dramatically reduce the incidence of dental trauma.
Our treatment rooms contain state-of-the-art dental equipment. We are "gadget people" and enjoy using new equipment and learning about the newest advances in the field.
For those patients not under sedation, we have installed cable TV with remote earphones. This helps to take one's mind off the treatment at hand and to minimize the noises associated with dental work.
If you are interested in seeing what is going on, each treatement room is equiped with a fibre optic camera that can be projected onto the ceiling-mounted TV. This gives a great view of the patient's teeth and surrounding anatomy. This camera can also be used to more effectively explain why certain procedures are required.
