Dentistry implants are not new to dentistry; in fact the Mayans and the Chinese were already trying to replace lost teeth in 3000 BC by hammering foreign objects into the jawbone. It was in 1980 that titanium emerged in dentistry.
Today, the implantology success rate is very high provided that the quality and quantity of residual bone are adequate. If a tooth is extracted, an implant should be placed immediately for the front teeth and after 4 months for a posterior tooth. A long waiting time before the replacement surgery will most probably lead to bone loss requiring bone grafting prior to the placement of an implant.
The implant surgery is done under simple local anesthesia like any other dental treatment and takes usually less than one hour. Aside from mild discomfort and a little inflammation, there are usually no serious complications and the patient can return to their everyday life but must avoid vigorous exercises for 24 hours.
While implants are the ideal solution for toothless spaces, they remain foreign bodies in the dental system. They do not move like natural teeth and are at risk of infections. Their crowns may become loose or even break and finally, implants are not as good as natural teeth that can continually adapt to changes in the system. That's why we try to save natural teeth as much as possible by giving prevention advice, restorations, crowns or root canal treatments. We should only opt for an implant when the prognosis of preservation of the natural tooth is low.
In more complicated cases of aesthetic treatments or major tooth structure destruction, such as after a root canal, we install a crown on the tooth to restore its integrity and its initial strength. The preparation of the tooth is more important than in the case of a veneer, but we can correct much more complex cases. Traditionally, crowns were made of yellow gold, then came the crowns covered with acrylic and later porcelain. Nowadays, we try to use all-porcelain crowns to get an exceptionally cosmetic result with the strength and consistency of gold crowns.
A bridge is a structure cemented onto the remaining teeth to replace missing teeth. The supporting teeth, called pillars, are reduced in size to receive the structure. We use a gold frame for support and the outer layer is made of porcelain for aesthetic purposes. Complete porcelain bridges made without any metal can be made but they tend to fracture in extensive cases. A typical example of the use of bridges would be that of a young patient wearing partial dentures for several years but is not comfortable with them (often due to the fact that they must be removed at night).
Bridges allow a stationary structure to replace the missing teeth. The major problem with bridges is their longevity, since the function of the missing tooth is distributed on the two pillars, the load-bearing teeth may developsome complications. These complications can be benign, such as gingivitis caused by the difficulty of cleaning around the pillars, the need for a root canal because of the work done on the tooth; or the complications can become more serious such as a root fracture due to an excessive load. If two teeth have to be replaced, the longer bridge structure will have more complications and its longevity will decrease. Nowadays, since there are other more conservative options available, we increasingly use implants to replace missing teeth without damaging the adjacent teeth.
Any missing tooth should be replaced as soon as possible to:
- better share the stress of mastication
- avoid tooth migration
- help with diction.
When the number of missing teeth becomes more significant, we can use different types of prostheses (fixed or removable, partial or complete) to restore function.
A complete denture is used in a toothless mouth and therefore is supported by the gums and underlying bone. Its retention is done through a suction allowed by a perfect adaptation of the contour of the device. This perfect adaptation cannot be maintained for a long period of time because of the changes in the gums and bone, which is why it is important to change prostheses every 5 to 7 years.
Another option is the prosthesis on implant which allows greater stability since the retention is provided by fixed structures. The prosthesis can be fixed, removable, on retention balls, on a screwed or clipped bar, teeth can be made of acrylic or porcelain. The comfort level desired by the patient and their budget will lead us to the appropriate options.
There are two kinds of removable partial dentures: with or without metal support. The prosthesis with a metal skeleton is supported and retained by the remaining teeth to provide better stability. The prosthesis without a metal skeleton is supported by the gum, which offers less stability and greater gingival irritation. To resist the forces of mastication, the denture that does not have a metal support will be much thicker and may compromise the patient’s comfort. Of course, the prosthesis with a metal skeleton is more expensive.
Beginning of bone destruction
Advanced stage of bone destruction, tooth mobility, destruction of the ligaments.
There are several phases of gum disease, the first is called gingivitis. Normally, healthy gums do not bleed. You probably know what plaque is and you know that we should not keep it on the teeth too long. This transparent film of bacteria that forms on your teeth is the main cause of gum problems. When these bacteria are in contact with your gums for an extended period of time, toxins are released that cause inflammation. This is the beginning of gingivitis. The gums will become red, swollen, tender to the touch and bleed more easily. Gingivitis can be cured by strict hygiene (brushing and flossing) and regular visits to the dentist. If you have gingivitis without knowing or without worrying about consequences, the disease can progress into the next stage: periodontitis.
If plaque is not removed well, it will calcify into tartar. Gradually, as the tartar forms, it will irritate the gums which will detach from the tooth, leaving enough space for the formation of more tartar.
If the patient does not seak treatment, the tartar will cause bone decay and the destruction of the ligaments that hold the teeth in place and will eventually cause tooth mobility, abscesses and pus formation. Depending on the stage at which the periodontal problem is diagnosed, treatment will be different.
If the problem can be treated before bone destruction begins, the treatment required will only consist of tartar-removal and the use of medicated mouthwashes. If bone decay has begun or is very advanced, the treatment will depend on the severity of the problem. Tartar removal and gingival curettage may be accompanied by a minor surgery of the gums to first remove all the tartar and then remove all infected unattached tissue to reduce the depth of the pockets of tartar. Only then we will evaluate the need for bone grafts to strengthen the teeth, or bonding to help healing process.
Why do we remove wisdom teeth?
There are many elements that come into play when evaluating the need for the extraction of wisdom teeth. Among the most important are:
- Lack of space
- Pressure on the surrounding teeth and displacement of teeth
- Infections or recurrent inflammations
- Cysts or tumors
- The patient’s age
- The position of the tooth
- The patient’s health
In some cases, the extraction of wisdom teeth is not always required. We look at each case individually to assess whether the tooth or teeth will not cause problems (infection, inflammation, pain, etc).
The ideal age of extractions is between 16 and 21 years because we do not want to remove wisdom teeth before the roots are fully formed (to avoid damage to the mandibular nerve that lies in the bone) and also because a half-formed root will be less anchored in the bone. Any young person should be examined to assess the need to extract them, but as we stated previously, we do not do extract systematically. If we believe that the wisdom tooth will remain in the bone without causing complications or that it will come out normally, we let it be.
We very often see wisdom teeth growing in the wrong direction and remain stuck, either by the jaw bone or by the neighboring tooth. In that case, because the teeth are not completely out of the gum, food lodges itself between the gum and the tooth and can cause painful infections. In other cases, the antagonist (the maxilla) continues to grow as the tooth of the mandible is stuck, forcing the patient to bite his cheeks continuously.
We must first explain what a root canal treatment is. It’s simply removing the nerve of the tooth, the disinfection and sealing of canals. All this can be done in one or two sessions without feeling any pain. Normally, root canals are not painful. The patient has an emergency appointment when he or she is in pain and a root canal treatment is performed to remove sensitivity. When the nerve of the tooth is in a state of inflammation, the pain becomes unbearable and the best option is to calm the tooth with medication prior to treatment.
When a tooth is damaged, either due to cavities or a fracture, or if it required a big restoration that put the healthy structure of the tooth at risk, we try to save it since we always consider a natural tooth to be better than any artificial one. To save such a tooth, we are forced to devitalize it, which means that we remove its pulp (which is often already dead, infected or inflamed). The pulp contains nerves and blood vessels that nourish the tooth. In some cases, radiological examination allows us to know if a tooth is alive or not by finding an abscess in the bone (the patient may not feel any pain and the tooth may not show signs of destruction). Other times, the tooth will change color or the patient will have a significant inflammation in the nerve.
If there is an abscess (this means that the pulp is dead and that the infection has penetrated the bone that supports the teeth), the infection must be removed before sealing the tooth: we’ll then have to use antibiotics.
After administrating local anesthesia and isolating the tooth using a dental dam to prevent further bacteria from entering the canal, we remove the cavity that might be on the tooth or any previous restoration. We then make an opening into the pulp cavity to access the canals. To properly clean the canals, we use sterile solutions to disinfect while we remove the infected tissue of the root. After thoroughly drying the canals, we seal the tooth with a biocompatible sealant called gutta-percha. The root canal treatment is completed, but since some patients may experience inflammation and / or mild tenderness (which disappears after a few days), we let the tooth rest with a temporary filling, but the tooth is not functional yet. Then we will decide on the type of final restoration, which depends on the degree of yellowing or decay of the tooth in question (in most cases, we will cover the teeth that have blackened using a crown).
A root canal treatment and the installation of a crown do not stop the formation of other cavities or gum infections.
Although an endodontic treatment offers a high success rate, sometimes it does not succeed. In most cases, we can still save the tooth. We will then proceed to a minor oral surgery. Unfortunately, it happens in very rare cases that all attempts fail: the complete extraction the tooth will be required and it will be replaced with an implant.
Orthodontic treatments can be divided into three distinct phases:
Interception and treatment of decompensation: this step is to correct oral habits, maintain space for permanent teeth and make a palatal expansion to correct the lack of space or to extract teeth. These treatments are not necessary for all patients; we begin this phase at the age of 7-8 years old, only in patients who require correction of the dento-alveolar relation which could lessen the need of skeletal correction.
Orthopedic treatments: for the alteration of the skeletal environment, it is the phase of the devices that allow us to control bone growth in adolescents. In most cases, this phase starts before puberty (11 years of age for girls and 14 years of age for boys).
Comprehensive treatment: the last phase is when we put the 'braces' or any other system of invisible orthodontics to align all the teeth.
These phases are often continuous in time, with a phase leading immediately to the next one. Some cases are much more complex and may require surgery, but we do not want to go into details, since our goal is to inform you of treatment options.
The best time to begin orthodontic treatments always depends on the patient. Between the ages of 6 to 8, we can begin to predict the pattern of the dento-skeletal growth of the patient. This is when we plan the future steps. If the patient has an obvious lack of space, we try to correct the problem immediately so that the next steps are easier or even unnecessary.
For example: an 8 year old child who still sucks his/her thumb may prevent the normal development of the palate due to the pressure of the finger and create a deep palate, a lack of space and overlapping adult teeth in the future. To counter this, we can make a device that will firstly fix the bad habit while expanding the palate.
In a matter of 6 to 9 months, this treatment will bring the patient to the ideal position for him to growth as he should without needing braces or surgery in the future. In other cases, the patient may not need treatment until the age of 12-13 or even later if we determine that the he or she would respond better to a treatment when his or her oral hygiene habits improve.
There are so many variations between patients that we cannot predict the best time to start treatment without seeing the patients. We recommend an orthodontic evaluation of the around the age or 7, to discuss the facial growth and the different treatment plans. We review our patients every 6 months and reassess the situation after each visit in order to begin treatment at the optimal time.
Nowadays adults are beginning to reconsider the possibility of straightening their teeth. Therefore, as the demand increased, the market adjusted. There are now a multitude of dental realignment systems that are almost invisible. These systems are first and foremost brackets of porcelain or plastic (the color may change a little during treatment).
There are also lingual braces that are less used because the treatment is very complicated for the dentist and we can have more aesthetically pleasing and functional results with other systems.
Recently, a new system of housing has been made available on the market: the Damon-type brackets (Damon 2, 3, Mx, Q). Currently, only the brackets on the front teeth are transparent. The reason we classify them as invisible orthodontics is that treatment time is reduced by about 30% to 50%. So the treatment is slightly compromised on the aesthetic side by the little wire between the boxes, but the patient completes the treatment in 9 to 16 months. The system does not use elastics to hold the boxes to the wire but rather a small door, it takes away the resistance and also reduces the number of appointments required to complete the treatment.
Since early 2011, we use the Insignia system which allows us to accelerate the treatment time by using individualized orthodontic brackets and wires. Imagine a 3D virtual model of your teeth where the dentist can move each tooth individually in three-dimensions to get the optimal result. It is a system that allows precise control of the orthodontic treatments from the beginning until the end to maximize the effectiveness of the treatment.
The ideal occlusion of each patient is modeled in a 3D virtual program which then makes it possible to manufacture brackets and wires tailored to the planned final position of the teeth determined by the dentist. With its computer-aided bracket placement system, this new revolutionary process allows a more beautiful finish and requires fewer adjustments (and therefore fewer visits) during the treatment.
Lastly, there’s the gamut of transparent-shelled devices, best known as Invisalign, which consist of a series of retainers made from semi-rigid plastic replaced every two weeks that allow small-scaled movements. Other systems such as MTM, Red-White-Blue, etc... are also available. These barely visible retainers allow patients to have an excellent oral hygiene and can be removed during meals. Unfortunately these treatments are limited to small movements compared to ordinary brackets but they are perfect for minor corrections in adults.
Porcelain veneers are a thin layer of porcelain bonded to the outer surface of the teeth, much like an artificial nail. Made from extremely hard porcelain, after bonding they become very tough and can mask most imperfections of the teeth so the patient can obtain a radiant smile. Whether they are used to change the color of the teeth, to close spaces, to hide overlapping teeth, to cover broken bones or even to extend the shape of the teeth, veneers allow us to give you the smile of a star in just two visits.
Several advantages come with the installation veneers. They provide highly esthetic and predictable results with minimal preparation of the teeth and appointments are rather short.
In today's society, general appearance and especially a great smile have become the starting point of all meetings, whether professional or personal. The high demand for a healthy looking smile has brought new techniques and improvements to create new aesthetic solutions to help modify and improve the smile.
What is “cosmetic dentistry”? It is the entire branch of dentistry that deals with improving the appearance of teeth which includes:
- Restorative Dentistry (improving the chewing function, veneers or crowns)
- Orthodontics (repositioning of the teeth)
Some patients are tired of having amalgam fillings (also known as “silver fillings”). In this case, the patient may request to change the old filling with a composite filling (“white filling”) or a porcelain inlay to brighten the tooth.
When the front teeth turn yellow, are stained, broken, chipped or if spacing occurs, it is possible to restore them and make them as beautiful as they once were with composite restorations in no time. For more complex cases, we recommend porcelain veneers or crowns.
Who doesn’t want to have brighter teeth and a beautiful smile? Nowadays, it only takes two 15-minute long appointments to have whiter teeth. You will have customized retainers containing Rembrandt bleaching gel that you will use for 15 minutes every day for 2 weeks in the comfort of your home.
You can also sleep with these retainers to avoid interrupting your daily activities. You will see a difference within just a few days after starting the treatment!
For people who do not have the patience or the time to wait two weeks to dazzle their family and friends with whiter teeth, we offer the option of laser whitening. During lunch time, before an important appointment, it's easy! Sixty minutes and you're done.
Unfortunately, not everyone’s teeth whiten properly. Stained and yellow teeth whiten very well but gray teeth or teeth with intrinsic stains do not whiten as beautifully. It is for this reason that during your first consultation, we will tell you if this treatment is for you or if perhaps you might benefit more from custom porcelain veneers or crowns.