Smile Designing

July 17th, 2008

Every individual desires to have a beautiful perfect smile with proper alignment of the teeth. With the help of conservative aesthetic procedures the desired results can be achieved. Few problems and the treatment modalities in this regard are discussed here:

  1. Alteration of shape of natural teeth (cosmetic contouring)

  2. Alteration of embrasures

  3. Correction of diastemas (spaces present between anterior teeth)

  • Reshaping and polishing the natural teeth : attrition of teeth ,abnormal wear from habits (eg. Biting fingernails, holding objects with the teeth) are the common aesthetic problems.

Cosmetic contouring is done to achieve youthful, feminine characteristics like rounding incisal angles, reducing facial line angles and opening incisal embrasures.Similarly the opposite result in masculine features. The reshaping procedure is limited to enamel only.

  • Anterior teeth can have embrasures that are too open as a result of the shape or position of the teeth in the arch. For eg.- Sometime the permanent lateral incisors are missing, the canines and posterior teeth may drift mesially or the space may be closed orthodontically. In many instances mesioincisal embrasures remain too open.

Composite can be added to establish an aesthetic contour and correct the open embrasures.

  • Diastemas are spaces occurring in between the anterior teeth , usually between the maxillary central incisors. There are numerous causative factors for a diastema to occur like prominent labial frenum, congenitally missing teeth, interarch tooth discrepancies etc. Diastemas are closed only after recognizing and treating the underlying cause.

After careful selection of the case, diastema can be corrected with use of acid etch and composite augmentation of proximal surfaces. In some cases, diastemas are simply too large and composite augmentation will result in excessively large central incisors. In such cases, a combination of orthodontic and esthetic procedures is applied. With orthodontic treatment, large spaces are redistributed symmetrically amongst the anterior teeth and then composite augmentation is done. The final result is improved proportionately among the anterior teeth.

Tags: , , ,
Posted in Cosmetic Dentistry | Comments (0)

Teeth Whitening

July 17th, 2008

A smile opens heart and initiates communication. A beautiful radiant smile is one of the greatest assets a person can have.When teeth are discolored, malformed, crooked or missing, people tend to avoid smiling or try to “cover up” the teeth.Children and teenagers are very particular about their appearance and are especially sensitive about unattractive teeth.

Restoration of a beautiful smile always have positive psychological effects on an individual resulting in imprived self image and enhanced self-esteem.

Conservative treatment for discolored teeth

Every individual desires to have “white teeth”. Discoloration of any type especially on the anterior teeth makes an individual seek dental care.

Discolorations are classified as extrinsic and intrinsic.

Extrinsic stains are located on the outer surfaces of the teeth , whereas Intrinsic stains are internal.

Extrinsic discoloration

  • Stains from tobacco smoking :present on teeth of smokers. Stains vary from yellowish -brown to black deposit as a result of collection of tobacco tars and resins.

  • Brown stain :present on surfaces of teeth adjacent to orifices of salivary gland ducts.

  • Black stain :present as a thin, black deposit on the tooth surface usually in a narrow line or band just abovr the free gingiva. This stain may be caused by chromogenic micro-organisms.

  • Green stain :present most often in children as a heavy gray green stain especially priminent on the gingival third of maxillary anterior teeth. This stain appears to be soft or “furry” and is difficult to remove, suggesting its association with enamel cuticle. It may be coloration of remnants of nasmyth’s membrane, possibly by blood pigment.

  • Orange stain :present as a thin layer on teeth surface. The stain varies from orange to brick red color and is due to pigment producing micro-organisms.

Stains due to existing restorations.

Intrinsic discoloration : caused by deeper internal stains or enamel defects.

Teeth with vital or non-vital pulps and root canal treated teeth can be affected.

Causes :

  • Hereditary disorders :

1) erythroblastosis foetalis – due to inheritance by the foetus of a blood factor from the father that acts as a foreign antigen to the mother. It is manifested in the teeth by the deposition of blood pigment in the enamel and dentin of the developing teeth, giving them a green, brown or blue hue. The stain does not involve teeth or portions of teeth developing after cessation of hemolysis shortly after birth.

2) congenital porphyria – The deciduous and permanent teeth may show a red or brown discoloration as porphyria gets deposited in developing teeth due to its physical affinity for calcium phosphate.

  • Medication : Tetracycline stains – generalized type of intrinsic discoloration. Discoloration of either deciduous or permanent teeth may occur as a result of tetracycline deposition during prophylactic or therapeutic regimens instituted either in pregnant female or postpartum in the infant. The severity of the staining depends on the dose , duration of exposure to the drug and type of tetracycline analog used. The stain varies from yellow orange to dark blue-gray.

  • Fluoride stains : Usually these stains are generalized and result due to the presence of excess fluoride in drinking water and other sources at the time of tooth formation.

  • High fevers associated with early childhood diseases : Localized areas of discoloration may occur on individual teeth because of enamel or dentin defects induced during tooth development.

  • Poor oral hygiene : results in decalcified white spots.

  • Non – vital teeth : The pulp may become infected or degenerate as a result of trauma , deep caries or irritation from restorative procedures. If the treatment is delayed the degenerative products from the pulp tissue will stain the dentin and will be readily apparent because of the translucency of enamel.

Many people have definite esthetic problems from intrinsic stains, whereas others worry needlessly about the overall color of their teeth. The dentist must decide if the color of the teeth can be improved enough to justify treatment. For eg., persons with light complexions may believe that their teeth are too dark, when actually they are normal in color.

One of the treatment for discolored teeth is Bleaching treatment.

The lightening of the color of a tooth through the application of a chemical agent to oxidize the organic pigmentation in the tooth is referred to as bleaching.

Bleaching technique may be classified as -

  • Non vital bleaching procedures

  • Vital bleaching procedures, as to whether the tooth is vital or non-vital.

Non-vital bleaching procedures–

Primary indication is to lighten teeth that have undergone root canal therapy.

  • In-office bleaching technique :

In this technique a sealing cement is placed over the exposed root canal filling and then a bleaching agent (35% hydrogen peroxide paste or gel) is applied.

  • “Walking bleach technique” or out of office technique :

In this technique , paste of sodium perborate is filled intracoronally. The bleaching mixture is changed every 3-5 days and usually one to three treatments are requtred to achieve optimal tooth lightening.After the treatment, the tooth is restored with a composite restoration byt it may susequently discolor. In such cases, the tooth is then bleached externally.

Vital bleaching procedures–

Indications for this procedure include intrinsically discolored teeth from aging, trauma or drug ingestion. Teeth exhibiting yellow or orange intrinsic discoloration appears to respond best to this treatment. Brownish fluorosis stains are often responsible to this treatment.

  • In-office technique (Power bleaching) :

It is under the dentist’s control. In this technique, after proper isolation of teeth with the help of rubber dam, the teeth are first etched with 37% phosphoric acid(not always necessary) and then 35% hydrogen peroxide paste or gel is placed on the teeth.

This treatment is generally rendered weekly for 2-6 treatments.

Treatment time in the clinic is 30-45 min.

  • Dentist prescribed – home applied technique :

Nightguard vital bleaching

In this technique, patient’s arch impressions are taken and nightguards are fabricated. 10% to 15% carbamide peroxide bleaching material is generally recommended. The patient is instructed in the application of the bleaching gel or paste into the nightguard.

Total treatment time using an overnight approach is usually 1 to 2 weeks.

Side effects : post treatment sensitivity which usually subsides within a week.

Duration : Vital bleaching results in tooth lightening for only 1-3 years.

Other conservative treatments for discolored teeth

Microabrasion and Macroabrasion

These are also conservative procedures for the reduction or elimination of superficial discolorations. These technique result in the physical removal of tooth structure are therefore indicated only for stains or enamel defects that do not extend beyond a few tenths of a millimeter in depth.

Veneers

A veneer is a layer of tooth colored material that is applied to a tooth to restore localised or generalised defects and intrinsic discolorations.

Types : partial veneers and full veneers

made of – composite, processed composite, porcelain or pressed ceramic materials.

Indications : teeth with facial surfaces that are malformed, discolored, abraded, eroded or have faulty restorations.

Tags: , ,
Posted in Cosmetic Dentistry | Comments (11)

Dentists in Bangalore

June 29th, 2008

Following is the list of all the websites offering dental treatment in Bangalore. The list is not exhaustive, please let me know if I have missed some one.

Tags: , , , ,
Posted in Dentists in Bangalore | Comments (33)