Specialist Dentistry

Orthodontics

Orthodontics is a branch of dentistry that specializes in treating patients with improper positioning of teeth when the mouth is closed (malocclusion), which results in an improper bite. Orthodontics also includes treating and controlling various aspects of facial growth (dentofacial orthopedics) and the shape and development of the jaw. An orthodontics specialist is called an orthodontist.

Orthodontics used to be called orthodontia - the word comes from the Greek orthos, meaning "straight, perfect or proper", anddontos, which means "teeth".

Orthodontics also includes cosmetic dentistry; when the patient's aim is to improve his/her appearance.

An orthodontist uses a range of medical dental devices, including headgears, plates, braces, etc. to help in:

  • Closing wide gaps between the teeth
  • Making sure the tips of the teeth are aligned
  • Straightening crooked teeth
  • To improve speech or eating (oral function)
  • To improve the long-term health of gums and teeth
  • To prevent long-term excessive wear or trauma (of the teeth)
  • Treating an improper bite

What is malocclusion?

Malocclusion literally means bad bite. Some children's jaws and teeth do not develop properly. Malocclusion refers to crooked, misaligned teeth and a fault in the relation between the bottom and top set of teeth (the two dental arches). This may develop because of injury to the teeth or facial bones, frequent thumb sucking, or for reasons unknown.

Thumb sucking (or finger sucking) can result in localized deformation of the teeth and supporting bone. In order to restore a natural improvement, the thumb sucking habit has to be stopped.

Generally, malocclusions do not affect physical health, malocclusion is not a disease, it is a variation in the normal position of teeth. However, it may impact on the shape of the person's face and the appearance of their teeth, which can lead to embarrassment, a lack of self-confidence, and even depression.

Severe malocclusion may affect eating, speech and keeping the teeth clean.

UK health authorities say that approximately one third of all 12 year-olds in the country probably need orthodontic treatment. People may require orthodontic treatment for different problems:

  • The front teeth protrude - treatment not only improves the patient's appearance, but also protects the teeth from damage; people with protruding front teeth are more likely to injure them in sports, falling down, etc.
  • Crowding - if the patient's jaw is narrow, there may not be enough space for all the teeth. In such cases the orthodontist may have to remove one or more teeth to make room for the others.
  • Impacted teeth - as the adult teeth come through, they are not in the right position.
  • Asymmetrical teeth - the upper and lower teeth do not match, especially when the mouth is closed but the teeth are showing.
  • Deep bite (overbite) - when the teeth are clenched, the upper ones come down over the lower ones too much.
  • Reverse bite - when the teeth are clenched, the upper teeth bite inside the lower ones.
  • Open bite - when the teeth are clenched, there is an opening between the upper and lower teeth.
  • Underbite - the upper teeth are too far back, or the lower teeth a too far forward ("bulldog" appearance)
  • Crossbite - at least one of the upper teeth does not come down slightly in from of the lower teeth when the teeth are clenched; they are too near the cheek or the tongue
  • Spacing - there are gaps or spaces between the teeth, either because a tooth is missing, or the teeth simply do not fill-up the mouth (opposite of crowding)

When can orthodontic treatment start?

Treatment will not usually commence until the child is about 12 or 13 years old; when the adult teeth have come through and developed fully. In some cases treatment may start a couple of years later if teeth problems had not become noticeable beforehand.

Children with a cleft lip and palate may require orthodontic treatment before their adult teeth have developed completely.

Good oral hygiene is essential before any orthodontic work can begin. When devices are placed on the teeth, bits of food are much more likely to become stuck; the patient will need to brush much more carefully and more often to prevent tooth decay while treatment is ongoing.

Patients who have not reached good oral hygiene standards beforehand are much more likely to suffer from tooth decay after treatment begins.

Diagnosing dental problems and recommending treatment options

Assessment - the orthodontist will assess the state of the patient's teeth and make a prediction on how they are likely to develop without treatment. The following diagnostic procedures will be performed:

  • A full medical and dental health history
  • A clinical examination
  • X-rays of the teeth and jaw
  • Plaster models of the teeth

After the assessment is done, the orthodontist will decide on a treatment plan.

Examples of orthodontic appliances

There are two types of orthodontic appliances: fixed and removable ones.

Fixed appliances - the most common devices used in orthodontics. They are used when precision is important. Although the patient can eat normally with fixed appliances, some foods and drinks need to be avoided, such as carbonated drinks, hard sweets, or toffee. People who participate in contact sports need to tell their orthodontist, so that special gum shields can be made.

Examples of fixed appliances include:

  • Braces - consisting of brackets and/or wires and bands. Bands are fixed firmly around the teeth and serve as anchors for the appliance, while brackets are usually connected to the front of the teeth.

    Wires in the shape of an arch pass through the brackets and are fixed to the bands. As the arch wire is tightened, tension is applied to the teeth, which over time moves them into proper position.

    A patient sees the orthodontist once a month so that the braces can be adjusted. The treatment course may last from several months to a number of years.

    Children tend to prefer the colored braces, while adults usually go for the clear styles.

  • Fixed space maintainers - if the child loses a milk tooth, a space maintainer will stop the two teeth at either side of the spaces from moving into it until the adult tooth comes through. A band is fixed to one of the teeth next to the space, and a wire goes from the band to the other tooth.
  • Special fixed appliances - these may be recommended to control tongue thrusting or thumb sucking. Patients may find them uncomfortable, especially when they are eating. Experts say they should only be used if they are really necessary .

Removable appliances - these are typically used for treating minor problems, such as preventing thumb sucking or correcting slightly crooked teeth. They should only be taken out when cleaning, eating or flossing. Sometimes, the orthodontist may advice the patient to remove them during certain activities, such as playing a wind instrument or cycling.

Examples of removable appliances include:

  • Aligners - an option instead of traditional braces for adult patients. They are virtually unnoticeable by other people and can be taken out when patients brush their teeth, floss, or eat.
  • Headgear - there is a strap around the back of the head, which is attached to a metal wire in the front, or face bow. The aim is to slow down upper jaw growth, and keeping the back teeth in position while the front ones are pulled back.
  • Lip and cheek bumpers - specially made to relieve the pressure of cheeks or lips on the teeth.
  • Palatal expander - an appliance designed to make the arch of the upper jaw wider. The device consists of a plastic plate that is placed in the palate (the roof of the mouth). The plate has screws which exert pressure on the joints in the bones, forcing them outward, thus expanding the size of the palatal area (roof of mouth area).
  • Removable retainers - these are placed on the roof of the mouth. They are designed to stop the teeth from moving back to their original positions. If modified, they may also be used to stop children from sucking their thumbs.
  • Removable space maintainers - an alternative to fixed space maintainers.
  • Splints (jaw repositioning appliances) - they are placed either in the top or lower jaw and help the jaw close properly. Splints are commonly used for TMJ (temporomandibular joint disorder) syndrome.

Oral & Maxillofacial Surgery

Oral-Maxillofacial Surgery is a surgical specialty which involves the diagnosis, surgery and adjunctive treatment of diseases, injuries and defects involving both the functional and aesthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

Oral and maxillofacial surgeons are well-prepared to:

  • Manage diseases of the teeth and their supporting soft and hard tissues.
  • Surgically reconstruct inadequate bone structure in the jaw area.
  • Lip and cheek bumpers - specially made to relieve the pressure of cheeks or lips on the teeth.
  • Evaluate, plan a course of treatment and place dental implants to replace one, two or a mouthful of missing teeth.
  • Expertly treat head and neck trauma and injuries to the face, jaws, mouth and teeth.
  • Diagnose and treat facial pain.
  • Diagnose and treat oral cancer and other diseases in the maxillofacial region.
  • Perform corrective jaw surgery to improve the function and appearance of patients with such conditions as cleft lip and palate and other congenital defects.
  • Diagnose and surgically treat obstructive sleep apnea.
  • Perform facial cosmetic procedures to enhance facial appearance and function.

Implant Dentistry

people lose teeth all the time, either through trauma (when teeth are knocked out) or due to decay, gum disease or old age. Whatever the reason for losing your teeth, they need to be replaced, both for aesthetic and functional reasons. The most common treatments for missing teeth are either a denture or a fixed bridge. However, dental implants are now becoming a more popular treatment to replace missing teeth, as they provide a longer-term solution, slow down bone loss and preserve nearby healthy tooth tissue.

What is a dental implant?

A dental implant is an artificial substitute/replacement for the root portion of your natural tooth and is anchored into a pre-drilled socket in your jaw-bone to support a crown, bridge or secure a denture firmly in place. Implants are made from titanium, a material that is well tolerated by bone and integrates easily with bone tissue. During the placement of a dental implant, the goal is to achieve a close contact between the outer surface of the implant and the surrounding bone tissue so they can "fuse" together (osseointegration), creating a stable support for the new teeth.

How is a dental implant placed?

Before any implants are placed, it is important for your dentist to assess the health of your teeth and gums. If there are any signs of gum disease or decay, these must first be treated. Thereafter, your treatment will be planned following several x-rays and, in some cases, a CT scan to assess that bone quality and check for nearby anatomical structures to avoid before any drilling. The procedure is usually carried out under local anaesthesia; IV sedation is sometimes used if it is a long procedure or the patient is very anxious.

The gum where the implant is to be placed is cut and lifted and a small hole is drilled in the jawbone at the precise location of the intended implant. The titanium implant is tightly fitted into this socket and the gum is stitched back over the implant. If there is insufficient bone material to accommodate the implant, a bone graft may be required, or the dentist may use smaller-sized mini implants if suitable.

Once the implant has been placed, it is left to heal and integrate with the jawbone for between six weeks to six months. The bone tissue will grow and anchor itself into the microscopic rough surface of the implant.

During this "healing period", patients are given temporary teeth (bridges) or continue to wear dentures. It is important that temporary teeth do not exert any force on the healing implant. After the healing period, the gum is again lifted and a post is attached to the implant with a temporary crown. Four to six weeks later, when the surrounding gum tissue has matured, the final permanent restoration can be fitted to the implant.

What are the advantages of dental implants over dentures and bridges?

  • Reduced bone loss
    Normally, the bone tissue surrounding the root of your tooth is maintained by your body's natural renewal process. However, if you loose a tooth, you will be left with a hole where your tooth root used to be and the bone around this area will slowly begin to disappear (atrophy) which may change the shape of your jaw. A dental implant placed in that area can actually stimulate bone growth and production, preventing loss of valuable bone structure. In some patients where bone loss is substantial, a bone graft may be required before placing a dental implant. Bone loss is a problem for people who have dentures, and as the shape of the jaw slowly changes, the dentures need to be adjusted or re-made to fit the new shape of the jaw. Bone loss can also make a person look older, since the area around the mouth can sag as bone is lost
  • Improved function
    Once dental implants are fully integrated into your jaw, they function just as well as your own natural teeth: you can eat the foods you want and speak with complete confidence. With dentures, eating hard foods such as an apple can be a problem: either the dentures come loose or patients cannot withstand the hard biting forces as they cause pain in the gums. Irritation and inflammation of the gums is a common problem amongst denture patients. Dentures can be supported by implants or mini-implants, which will greatly improve function, enabling patients to eat the foods they want with complete confidence and not having to worry about bone loss and loose dentures falling out.
  • Improved dental hygiene
    Unlike bridges and dentures, which require special cleaning instructions and extra attention, dental implants just need regular brushing, flossing and dental hygiene appointments, just like your natural teeth.
  • No need to drill or remove any healthy tooth structure
    When replacing missing teeth with dental bridges, the teeth adjacent to the gap need to be prepared and healthy tooth structure is removed to accommodate a crown or bridge abutment to fit over the top of the tooth. In the future, if one of the supporting teeth is damaged, the entire bridge restoration will also be compromised, whereas with an implant, the restoration is independent of any of your other teeth. By replacing lost teeth with an implant, no support is required of the adjacent teeth, and your natural teeth do not need to be prepared or altered in any way
  • Better aesthetics
    If done correctly, a dental implant should be indistinguishable from your surrounding natural teeth. Dentures can come loose and look unnatural if they do not blend with your gums, and some bridges and dentures have unsightly metal clasps to hold them in place. Dental implants provide a much better cosmetic and functional end result.

How many teeth can a dental implant support?

Traditionally, an implant placed into your bone supports a single crown and this is know as a "single tooth implant". However, if you have several missing teeth, you do not necessarily need an implant for every missing tooth: one implant can support several teeth via a bridge or denture. The number of implants required depends on the volume and density of bone tissue available at each implant site. Often, smaller-sized "mini implants" are used to secure dentures in place.

In the case of full-mouth reconstructions, where an arch of several teeth (10+) needs to be supported in either the upper or lower jaw, a minimum of five to six implants in each jaw would be required. The exact number of implants needed would depend on the individual case and your implant surgeon would be able to advise you on the best solution after a thorough examination and assessment.

Am I a suitable candidate for dental implants?

Dental implants can be placed in patients of any age (with fully developed jawbones), provided that they have a sufficient quantity and quality of bone tissue available. Most healthy individuals that maintain a good oral hygiene program are suitable candidates for dental implants. Circumstances where implants may not be suitable, or situations that have an increased risk of implant failure, include:

  • Heavy smoking – this slows down and hinders the healing process.
  • Excessive alcohol intake – disrupts healing of the gums.
  • Periodontal gum disease – all active gum disease must be treated prior to any implant procedure to ensure the long-term success of any treatment. Periodontal disease is a major cause of bone loss, which would hinder the success of any implant procedure.
  • Immuno-compromised individuals (steroids, auto-immune disease, patients undergoing radiation treatment).
  • Teeth grinders (bruxism) – a night-time splint can be given to treat this

How will I know if I have enough bone for implants?

Using a combination of dental X-rays and a CT scan, your bone density and volume can be assessed, and information about nearby anatomical structures to avoid (such as nerves) can also be gathered.

What if I don't have enough bone for dental implants?

The alternatives for replacing missing teeth include dentures and bridges. However, there are various bone-grafting and tissue-regeneration procedures that can be carried out to enable treatment with dental implants:

  • Sinus augmentation – if you need to replace missing teeth at the back of the upper jaw, a sinus augmentation, whereby new bone in the sinus is created, can increase the height of the bone available for the placement of implants in this area.
  • Onlay grafting – this is where a piece of bone is taken from somewhere else and secured over an area that is deficient in bone; over time, the newly placed bone will fuse with the underlying bone creating a better environment for an implant to be placed.

Where can bone be taken from for the graft?

The best source of bone for your graft is your own bone tissue from elsewhere in your body. Bone can be grafted from the chin, the back of the lower jaw, the hip and the tibia. Bone taken from your own body is the most viable and has faster healing times when compared to alternatives. In many cases, a combination of artificial bone substitutes and your natural bone is used. In any bone grafting procedure, the grafted bone provides an anchor and stimulus for the existing bone to grow onto, eventually providing an environment suitable for the placement of implants.

How long do dental implants last?

Dental implants have been used for over 30 years to replace missing teeth and they can last a lifetime depending on how well you look after them. Like any other restoration, your implant-supported teeth can still be damaged by trauma and affected by gum disease and poor oral hygiene

Tooth Extraction

If your tooth needs to be extracted, consult with us, we perform painless extractions with the latest techniques. People usually say that having a tooth extracted is a dreadful and uncomfortable experience but with our extensive skill and care it can be easy and pain-free.

There are several reasons when a tooth can not be saved:

  • Severe infection, diseased tooth
  • Tooth bad damaged
  • Extensive decay
  • Broken tooth
  • Abscessed teeth
  • Fractured root
  • Extremely overcrowded teeth
  • Loss of bone, loose teeth
  • Root canals are not accessible
  • Baby tooth when it is in the way of permanent tooth
  • Impacted tooth
  • Supernumary teeth

These are the most common circumstances when a tooth needs to be taken out

There are two ways of performing it: simple extraction and surgical extraction. During the check-up the dentist will take an X-ray to see the condition of the tooth and will find out which procedure is suitable for you.

Simple (non surgical) tooth extraction

Simple (non surgical) tooth extraction requires only a local anesthetic to numb your mouth and it is performed on teeth that can be seen and easily accessed in the mouth. This is a relatively quick treatment

Sometimes it happens that during the removal of the tooth, the tooth breaks or can not be moved. In these cases a surgical extraction needs to be performed.

Surgical tooth extraction

A surgical extraction is a complex procedure but it can be done using local anesthetic or we can provide IV sedation (general anasthesia) for anxious patients to relieve pain.

Surgical extractions are performed on teeth that can not be easily accessed, have broken or become impacted off the gum line.

This procedure requires an incision. The oral surgeon cuts and pull back the gum and often a portion of bone also has to be removed to reveal the tooth. Sometimes the tooth needs to be cut into parts. After the extraction the dentist will close the gums together with stitches.

Specialists Dental and implant center team experienced in both types of extractions. Our general dentists and oral surgeon (who specializes in surgeries, in complicated and risky procedures) can assure you to make the whole procedure as easy and smooth as possible.

Root Canal Treatment

To understand a root canal procedure, it helps to know about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissue, and helps to grow the root of your tooth during development. In a fully developed tooth, the tooth can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it.

Endodontic treatment treats the inside of the tooth. Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, faulty crowns, or a crack or chip in the tooth. In addition, trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

How does endodontic treatment save the tooth?

During root canal treatment, the inflamed or infected pulp is removed and the inside of the tooth is carefully cleaned and disinfected, then filled and sealed with a rubber-like material called gutta-percha. Afterwards, the tooth is restored with a crown or filling for protection. After restoration, the tooth continues to function like any other tooth.

Contrary to jokes about the matter, modern root canal treatment is very similar to having a routine filling and usually can be completed in one or two appointments, depending on the condition of your tooth and your personal circumstances. You can expect a comfortable experience during and after your appointment.

Saving the natural tooth with root canal treatment has many advantages:

  • Efficient chewing
  • Normal biting force and sensation
  • Natural appearance
  • Protects other teeth from excessive wear or strain

Endodontic treatment helps you maintain your natural smile, continue eating the foods you love and limits the need for ongoing dental work. With proper care, most teeth that have had root canal treatment can last as long as other natural teeth and often for a lifetime.

In specialists dental and implant center our doctors are specialised in single sitting Root canal treatment where it is finished in single sitting .