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Implant and Ceramic Dental Studios 2018
If you have any questions please write them in the left-hand margin of the page and bring them to our attention. Please sign the bottom of each page to show that you have read it. Please date each page as well. Thank you.
To ensure the best quality and services to new clients and to existing patients at all stages of treatment. There is an emphasis on patient journey being kind, caring, honest and educational. We protect the team always, who in turn protect patients in a calm, pain-free and enjoyable environment that is considerate during treatments and that encourages patient feedback. You participate directly with the technicians as regards the manufacture and type of material directly.
Our Philosophy of Care
The intention of this document is to inform you of the myriad of possibilities that exist as potential problems when undergoing implant, root canal restoration and prosthetic treatment. Many of the problems or conditions mentioned occur only occasionally or rarely. There may be other inherent risks not discussed in this document. You should be aware of the problems that can occur, and that every effort will be made to treat the conditions that develop or we will refer you to the appropriate healthcare professional.
The practice of dentistry is not an exact science and, therefore, reputable practitioners cannot guarantee results. Please understand that no one can promise that any treatment or dental procedure will be successful or that any risk, complication or injury will not occur. You should understand that unforeseen conditions or circumstances might arise during the course of the treatment. The following information is routine for everyone considering restorative and prosthodontics treatment using our team.
While recognising the benefits of a pleasing smile and well-functioning teeth, you should always be aware that dental treatment, like any treatment of the body, has some inherent risks and limitations. These are seldom enough to contraindicate treatment, but should be considered in making a decision. As in all other healing arts, results cannot be guaranteed.
We at the Implant and Ceramics Dental Studios do endeavour to predict and show you every stage, leading you on your journey to your desired goal. We aim to treat all our patients according to the philosophy of care. Our purpose is to provide excellent dental services that give a patient comfort, function, and beauty, as well as confidence within GDC (General Dental Council) Regulations. We do this by having the whole team present during treatments.
Our dental services include General and Preventative Dental, Dental Implants and Cosmetic Dental care including Facial Aesthetics and Orthodontics. Having the confidence in the appearance of your smile can result in a healthier approach to the general care of your teeth. By taking pride in your smiles we can keep up-to-date for life. We take a systematic approach to our detection and prevention of decay and gum disease and, equally, a systemic approach to the creation and delivery of a dental plan.
We provide patients with diagnostic options following examination of their mouth. The diagnostic opinion is a result of an assessment of all the diagnostic procedures that have been taken. From time to time your Diagnostician will be unable to identify and assess areas of concerns for different reasons. Such instances often occur when information is not supplied, full assessments are not undertaken, or simply that a developing problem is not yet apparent. There can be no guarantee that all dental problems are diagnosed at an examination.
Consultations are a time where a dentist will consult with the patient regarding a specific dental concern. The consultation appointment is not in the examination appointment and will identify additional diagnosis other than the specified concern for the consultation appointment.
1. Initial Diagnostic Procedures
In order to help formulate treatment recommendations, the following diagnostic provides procedures that may be performed.
2. A Medical and Dental History
1. Discussion of your dental problems, concerns and desires
3. Plaster cast of the mouth and teeth
4. Examination of the mouth and associated structures
6. Conference with previous or current trading health professionals. If additional diagnostic procedures or consultations are indicated, they will be discussed
3. Treatment Recommendations
These are based on information gained from initial diagnostic procedures and previous experience and may vary for similar situations. Therefore, second opinions are often appropriate. The ultimate goal of treatment is to assist you in obtaining optimum dental health and appearance. We will discuss with you the most appropriate and ideal treatment plan, as well as reasonable alternative plans, in those instances where supporting structures are compromised. Recommendations can be made only after consultation with the specialist.
We will also inform you of the likely dental prognosis for each of these treatment plans and a dental prognosis of no treatment will be initiated at this time.
4. Cosmetic (Aesthetic) Considerations
It is our intent to contribute all technical and artistic capabilities to help you achieve your aesthetic expectations and to incorporate these factors in your final dental restorations. You are asked to provide your input during treatment, and an effort will be made to incorporate your wishes in harmony with the functional and physiological requirements of the restorations. You are certainly encouraged to bring with you any friend or relative during the final list of the consultations and any previous dental records that can help in achieving your desired dental goals.
After your approval, restorations will be finalised, after which only very minor changes can be made. After the restorations are finalised, any moderate or major changes will require a review of the major component of your care and will be at your expense. Some changes in appearance may be beyond the capabilities of restorative and prosthetic dentistry and may require orthodontics, oral maxilla-facial surgery, plastic surgery, or other adjunctive measures
5. Referral to Other Specialists
Dental restorative and prosthodontics treatment often requires concurrent treatment with other dental specialists such as:
• Periodontics: This is the treatment of gum tissue and implant placement
• Endodontics: Root canal treatment
• Anaesthesiology: Conscious sedation and vital medical monitoring in our office
• Orthodontics: Straightening of teeth
• Oral surgery: Extractions, jaw surgery, bone grafting, implant placement.
Fixed Prosthodontics, Veneers, Crowns and Fixed Bridges on Natural Teeth and Implants
Dental crowns are restorations that cover up or cap teeth, restoring them to their natural size, shape or colour. The crown not only improves the function and appearance, but can also strengthen a tooth that might otherwise be lost.
In some instances a crown covering the entire tooth may not be needed and an inlay, onlay or porcelain veneer is recommended.
We have an array of materials that you can participate in choosing to maximise the benefits of colour and longevity depending on the individual situation presented and treatment chosen. We endeavour to educate you these materials and give you a clear explanation as to what will give you the best result. You and the team will help take it forward so that you are also given a temporary stage or an opportunity to visualise to some degree the way this prosthetic may look in your mouth within the oral environment.
If there is any soft tissue compromise predicted, we can give you avenues with a new treatment plan; a thorough conversation will occur to deliver your best desired result. There may be some degree of compromise that we debate through function, aesthetics and a psychological compromise.
Generally, an inlay restores a chewing part (functional biting surface) of the tooth without covering the cusp tips. An onlay restores the chewing part of the tooth, including the cusps. A porcelain veneer covers the front part of the tooth. For discussion in this document the term crown would include inlays, onlays and porcelain veneers. A fixed bridge is designed to replace teeth that have been lost. Aside from the obvious effects of missing teeth on personal appearance and mastication, there are other concerns. The normal pressure of chewing and stress can cause the remaining teeth to shift out of alignment, resulting in malocclusion and periodontal problems, meaning gum problems.
Dental crowns and fixed bridges are made of porcelain for optimum appearance, and traditionally containing an inner layer of gold alloy for strength. We have an array of materials to choose from that may be a more practical and functional solution. They also improve aesthetic solutions that may enhance the strength of your remaining tooth structure. They are bonded directly and become more an integral part of your remaining tooth structure. If the remaining tooth is discoloured and cannot be changed in colour using whitening or internal whitening, the only alternative may be to cut away natural tooth structure. At this point we will consult you about that as an option so that you have a choice. This compromise can only be assessed at the time during the appointment.
Our crowns can be made of porcelain, gold, titanium, cobalt chrome, ceramics, hybrid ceramics, composites and acrylics. All having advantages and disadvantages in various situations within the oral environment. This will depend on the functional limitations presented to us by the number of teeth you have left at the time and the overall tooth structure condition, as well as the soft tissue conditions.
The amount of soft tissue interfering or influencing the look of the tooth and gums needs to be assessed. Our aim is to try and match the layers of the replacement tooth to that of natural teeth in transparency and wear resistance. (This is so they can wear at the same rate). This will be dependent on the amount of remaining tooth structure. For a comprehensive treatment, sometimes additional strength may be needed from within the tooth to carry a restoration on the outside of the tooth. This kind of procedure may only be presented to us once we have uncovered remaining historic dental treatments when the treatment begins.
All-ceramic restorations give the same light qualities as the natural enamel layer of natural teeth; these aesthetics are delivered on the correct colour underlying where the enamel layers are to be placed. To achieve the best results, additional treatments may be needed to adjust the colour underneath these restorations, which we may only know at the time. We have the luxury of technicians onsite who will be present chairside at the time of cementation; they customise cements, making unique mixes to help overcome aesthetic compromises in situations like these.
Potential Problems with Fixed Prosthodontics
Fixed prosthodontics meaning crowns and bridges are used to treat problems of decay, fractured teeth and malocclusion to protect teeth which have had root canal treatment. However, the restorations are a replacement of natural teeth and, as such, potential problems do exist.
1. Root Canal Treatment
Restoration of a damaged tooth with a dental crown can be used to protect the tooth and prevent root canal treatment. However, the need for a root canal filling may not become apparent until after the old crown has been removed. A root canal filling replaces the dental pulp, the innermost part of the tooth. This treatment becomes necessary when the pulp is irreversibly injured or infected from the cumulative effect of cavities, fillings or cracks in the teeth and occur approximately six percent of the time. It normally can be performed without re-making the dental crown if the crown was a new one.
We can do this by carefully selecting the right material that is repairable for the future so we can reduce the risk potential. However, in some instances, the longevity of the bridgework may be compromised and the replacement of the dental crown or fixed bridge will be necessary.
It is sometimes better to have a missing section of a root and crown stump replaced by a yellow gold insert. We call this a ‘Post and Core’, this is made of yellow gold to protect the tooth, as it is softer and has proved to protect the remaining root as it bends more readily. This can also make a very solid stump onto which a crown can be cemented. The longest lasting root canal crowns and treatments are usually done in this way. Patients may shy from having this treatment because of the additional cost but, if you really want to save a tooth, this is often the best way to do it. However, it does require an additional surgery appointment and a laboratory bill. Please ask at reception.
Periodontal Gum Disease
Periodontal disease can occur at any age, with or without crowns or fixed bridges. Well-designed crowns and bridges aid in its prevention, as does good oral hygiene, regular cleaning and dental examinations. So too is a healthy diet and good general health.
2. Tooth Preparation
This is preparing teeth for dental crowns and fixed bridges. It requires removal of old filling material, tooth decay and any damage to the original tooth structure and old repairs. In addition, the removal of undamaged tooth structure is often required to make room for the porcelain or metal. This metal is under the porcelain. We avoid using metalwork, this means our restorations are reliant completely on the underlying strength of the remaining tooth structure. For the best results, you have to make sure that the underlying tooth structure is as strong — and the best colour — as possible, resulting in a metal-free oral environment. This not only has holistic benefits, enabling future maintenance of the remaining tooth structure to be examined under an X-Ray. (Metal fillings are radio opaque and cause light sparks, hiding future assessment and maintenance of the remaining tooth structure in their entirety of a restored tooth).
Ordinarily, a reduction of approximately 1 to 2mm is needed to accommodate the thickness of the space for making porcelain-bonded crowns. (This is today considered to be incredibly invasive as it takes away the strongest part of your tooth — the enamel layer). With a veneer, we only aim to add onto old teeth and stay in the enamel layer itself. Hybrid ceramic materials (latest materials).We use these in every day practice as they are known to be much more conservative and protective of the remaining tooth structure in all intra-oral situations and environments. In certain cases, allergy tests will be relevant. They can also be readily repaired and do not chip like porcelain crowns do, as well as being shock absorbing.
3. Provisional Temporary Restorations
Provisional crowns and fixed bridges are used to protect the teeth and provide a satisfactory appearance while the new crown and fixed bridges are being made. Provisional restorations are usually made of the material that compliments the colour and the shape of any future restorations. They are designed to be aesthetically pleasing and smooth but may have tiny pits where they may discolour more readily. Temporary restorations are sometimes joined together so flossing may not be possible. Careful brushing may be required, as well as avoiding certain foods like curry or anything hard. They are designed to be a prototype that gives us a very good idea as to the future crowns to ensure they will function correctly.
Provisionals or temporaries will never be as strong as the final crowns. They are not strong enough for every eventuality. They are made so we can remove them easily without disrupting or trimming underlying tooth structure. They are attached to the underlying teeth with a relatively weak cement to help facilitate their removal. (As and when your appointments may dictate). You may find that through the cementation the colour may adjust from one area to the other. This will not happen in the final restorations. It will therefore be important to minimise the chewing pressure on provisional or temporary restorations since they can be easily be broken and dislodged. If this does happen, call our surgery and we will repair or re-cement.
4. Porcelain Fractures
Porcelain is the most suitable material for aesthetic replacement of tooth enamel. (Because porcelain is a glass like structure and it can break). However, the strength of the dental porcelain is in line with dental enamel, and the force needed to break dental porcelain would usually fracture natural tooth enamel, as well. Small porcelain fractures can be repaired, whilst larger fractures often require a complete new crown, veneer or fixed bridge. This is the reason why it is important to establish why the natural teeth have broken or failed in the first place. A maintenance program of night-time appliances may be required to ensure that future tooth fractures do not happen, especially on your new teeth. With multiple units, we will always be responsible and recommend a full occlusal evaluation with our in-house restorative and occlusal expert Guru, Vasile Pana.
5. Dark Lines at Gum Tissue Level
Sometimes, dark lines appear at the gum line of porcelain crowns and fix bridges. Dark lines may also appear at the top of implant crowns as they meet the implant at the gum line. The dark line is the metal edge of the crown or an implant that may now be exposed as the soft tissue has moved away. This can happen due to a reaction from the metal from under the porcelain in the case of crowns, or occlusal overloading and natural bone shrinking away from the implant. This can be prevented by using porcelain edges on dental crowns and fixed bridges. If the root is dark of colour, and darker than the crown, a dark area at the gum line will appear. This can be minimised by the use of tooth-coloured filling materials or placement of the new crowns and fixed bridges that will compensate for the new position of the gum tissue in the future.
In some instances, a periodontal skin graft operation can be done to cover this area of recession. At the Implant and Ceramic Dental Studios, due to our onsite laboratory team, we have very good techniques to help cover such unsightly areas that may develop with very thin contact lens type soft tissue discs that match your soft tissue really well. These will have to be made and charged as and when if this does develop. Every effort is made to avoid situations like this by carefully selecting material types and, in certain instances, with nervous patients who are sure that the same has happened before on previous implants. We may even consider ceramic implants to prevent this from happening in the future.
6. Stains and Colour Changes
All dental restorative materials can stain. The amount of stain generally depends on oral hygiene as well as consumption of coffee, tea and tobacco. A large amount of staining is caused by Corsodyl mouthwash and certain medications. Dental porcelain usually stains less than natural tooth enamel and the stain can be removed at a dental hygiene cleaning appointment. Natural teeth darken with time more than dental porcelain crowns. Therefore, at the time a new dental porcelain crown or fixed bridge is placed, it may have a good colour match with the teeth around it but less of the match as your natural teeth age. For this reason, please read tooth whitening carefully.
7. Tooth Whitening
Whitening provides many people with a conservative method of lightening their teeth. There is, however, no way to predict to what extent a tooth will lighten. At this practice, we do take a photograph of the colour, using a shade-matching tab in the photograph to give you a good idea what the colour was before we started. In a few instances, teeth may be resistant to the whitening process. Frequently, side-effects may be experienced, such as tooth hypersensitivity and soft tissue irritation. Crowns and dental treatments will not change colour over time. It is therefore recommended to whiten your teeth before any cosmetic work to ensure the work does not require replacement in the future if you were to then decide to whiten your teeth.
We call this process Colour Management of Your Dentition. What it means is if you whiten your teeth before you start your treatment, and we then make your crowns in the future, your colour can be brought back into line by what we call “topping up”, using a whitening agent to restore your teeth to the way they were when we first placed your restorations.
8. Tooth Decay
Tooth decay may occur on areas of the tooth or roots not covered by a dental crown. If the cement seal at the edge of the crown is lost due to oral fluids leeching it out, decay may form at the juncture of the crown and tooth. If the decay is discovered at an early-stage, it can often be filled without remaking the crown or fixed bridge. Tooth decay around the margins of the crown is usually a key component requiring the replacement of the crown.
9. Loose Crowns or Fixed Bridge, or a Loosening Implant
A dental crown or fixed bridge may separate from the underlying tooth structure. For this reason we may recommend to redo what is underneath the new crown on exposing or taking off an old crown. This will incur new charges that may not be foretold at the time. This can also be due to excessive forces on this tooth.
Some continually loosening crowns will require a new crown or a new fixed bridge or a root canal or even the removal of the tooth. In some cases we may recommend a dental crown or fixed bridge may be separated from the tooth if the cement is lost or the tooth fractures. For this reason we may recommend to redo what is underneath the new crown on exposing or taking off an old crown. This will incur new charges that may not be foretold at the time and it may even result in the loss of the root.
A laboratory- made post and core may be made to protect the remaining roots and create a platform onto which a new crown can be made more solidly.
Implants loosening may be caused by the screw loosening and doing so over of a period of time. An implant may also start to loosen as the Osseo-integration between the implant itself and the bone may decrease over a period of time; this can be due to excessive forces, or bad oral hygiene.
10. Tooth Root Mobility
Tooth roots may become mobile if they are not strong enough to withstand the forces of natural teeth or on crowns and fixed bridges. This occurs when gum tissue and bone around the roots have severely receded and the bite forces are excessive. This is why at the Implant and Ceramic Dental Studios we endeavour to explore all risk potentials prior to the beginning of treatment.
Tooth roots may become mobile if they are not strong enough to withstand the forces against natural teeth or on crowns and fix bridges. This can be noticed when gum tissue and bone around the roots have severely receded and all the bite forces are excessive. This is why at the Implant and Ceramic Dental Studios we endeavour to explore all risk potentials prior to the beginning of treatment due to occlusal loading and so we talk of TMJ dysfunction, or otherwise known as TMD.
11. Food Impaction
As with natural teeth, food may become lodged between dental crowns and under fixed bridges. Dental crowns and fixed bridges are often connected — in other words, splinted together — creating the need for specialised hygiene techniques. Also, gum recession may make food impaction unavoidable, even with the most ideal construction of dental crowns and fixed bridges. When having implants, you might find that the soft tissue in and around the implant may pull away within a year or two; this can happen due to not enough bone support, especially in cases with long-term tooth loss before the implant is placed. This is why it is best to put an implant straight into any existing socket. We recommend the same day dental treatment for all implant placement, if possible. This also ensures maximum blood supply, as the trauma to the tissue is reduced threefold by the same day technique and you have far less scar tissue around the implant site.
12. Excessive Wear
Sometimes crowns, fixed bridges and implants are used to restore barely worn teeth and roots. If natural teeth were worn from clenching and grinding (Also known as bruxism), the new crowns and fixed bridges may be subjected to the same wear or even fracture like the original teeth did. In general, dental porcelain and metal alloys wear at a slower rate than tooth enamel. We therefore recommend that a hybrid ceramic will be a much better material solution for the restoration in the oral environment. If excessive wear has been noted on review, we may recommend an occlusal splint for protection while sleeping after the treatment during a review appointment.
13. Temporomandibular Dysfunction TMD
Placement of dental crowns and fixed bridges, as well as implants, inevitably change the occlusion or the bite. In very rare occasions, the change may precipitate TMD symptoms, even if we have technically improved the occlusion. TMD is known to be triggered by stress, ergonomics, family loss, marital stress, financial stress and incorrect tooth movement and growth or even chipping or fractures of teeth. These all have clear links with increased TMD. Pain or clicking in the region of the jaw joint may occur at any time during one’s life. Usually, multiple factors cause the condition. In many instances, your muscle spasms cause the pain.
Sometimes, actual joint pathology, such as arthritis, maybe present, in addition to problems with the joints themselves. Bad habits of holding a pen in your mouth in between your teeth, chewing on a pen and grinding your teeth, otherwise known as bruxism, can occur even if the bite is 100% right, with normal joints and proper musculature. It can be affected by anything, from the number of pillows you have when you sleep, to falling asleep sitting upright in front of the television. In general, anything that interrupts the harmony of the jaw joint, be it conscious or subconscious, in habit and behaviour.
14. Tooth Cracks
When replacing old dentistry and, when on investigating cracks in the teeth, it becomes apparent that below surface cracks may require further treatment, or sensitivity and toothache may occur It is almost impossible to always diagnose these areas before your treatment commences. Treatment may require crowning, root canal or even removal of the tooth in severe cases of tooth cracking.
Sensitivity will occur in treated teeth. The sensitivity is usually transitional and settles within the period of a few days to a month. Prolonged sensitivity may occur for a number of reasons, and one treatment to alleviate severe sensitivity may be root canal treatment. The measure for sensitivity can be comprehended by rating your sensitivity out of 10 on its worst day and decreasing the number as you note an improvement or change. By plotting this on a diary we can work out at the practice at your next review whether this is a healing process or a worsening of your tooth or treatment. This may require further interventions or further treatment.
16. Leakage and Decay
One of the most likely failures of fixed prosthodontics is the eventual breakdown of the cement holding the crown. You may have decay around the gum line of the tooth underneath the crown or bridge. This breakdown is often hard to diagnose but it is very important to treat if it commences. This is why we do recommend all ceramic restorations, as it will be clearer through the x-rays in the future to see if this may or may not be happening. This breakdown can be seen more readily as metal is radio opaque. This will occur after a decade or two of functioning, but may occur sooner, particularly when oral hygiene is not optimal. Leakage or decay often requires replacement of the crown or bridge for the removal of the decay, possible root canal treatments or even extraction of the tooth entirely may be needed.
Removable prosthodontics is the replacement of missing teeth with dentures that can be removed from the mouth. There are several types of removable dentures. They include:
1. Complete dentures supported by gum tissue
2. Partial dentures supported by gum tissue and remaining teeth
3. Overdentures supported by roots of natural teeth or implants
1. Mastication, Stability and Retention
Removable dentures, under the best of circumstances, do not have the same chewing efficiency as natural teeth. The ability to masticate food depends on the stability and retention of the dentures. Stability and retention are affected by many factors, including the attachment of the dentures to natural teeth or implants, if any; the amount and type of bone, gum tissue and saliva; and the patient’s dexterity effect the fit of dentures.
Properly fitting dentures will support the lips and facial contours in a manner similar to natural teeth. Dentures can often be contoured to provide additional facial support. However, excessive lip and facial support from dentures may result in a “swollen” appearance and irreversible tissue damage.
Removable dentures cover areas of the teeth and palate that are not normally covered. The presence of acrylic resin, metal or porcelain in these areas requires adaptation of the tongue and lips for proper speech, which may require a period of time. During a period of prolonged spaces in your mouth, the tongue will spread and reshape into those zones; this is called “tongue spreading”. When a new prosthetic device is put into your mouth, there will be a period of time for your tongue to re-adjust to the new confines of the oral environment. This can cause speech hindrance and will take a long while to adjust but a continual improvement shows adaption to the new situation, and a full recovery and adaptation is to be expected.
4. Denture Clicking
Denture clicks occur when the upper and lower denture teeth inadvertently contact during speech or mastication. To minimise this problem, denture teeth have to be repositioned to create more space between the upper and lower teeth. However, this repositioning will decrease the amount of lip and facial tissue support afforded by the dentures. Sometimes, a compromise is needed between full facial support and potential denture clicking.
Taste buds are located on the tongue, which is not covered by removable dentures. Contrary to popular belief, there are no taste buds on the palate. However, the acrylic resin and metal of removable dentures may affect the taste of food, especially if the dentures are not properly cleaned.
6. Staining and Cleaning
The amount of stain on dentures generally depends on oral hygiene, as well as the consumption of agents such as tobacco, coffee and tea. Bleach should not be used to clean removable dentures, as bleach can stain the metal portions of the dentures and severely fade the pink acrylic resin in time. Calculus will build up on dentures if they are not kept clean.
7. Denture Odour
The pink acrylic portion of the denture or implant bridge is a plastic material with a microscopic amount of porosity which can collect debris and odour. This can be reduced by not using acrylic, and resin and glass-filled composites instead. Also, dental plaque with its associated odour may accumulate on dentures in the same manner as it accumulates on natural teeth. It is therefore imperative to thoroughly clean your dentures.
8. Chipping and Tooth Wear
Porcelain denture teeth have the slowest rate of wear and the highest stain resistance, but they do have a tendency to chip. Slight chips can be polished, but larger chips usually require replacement of the porcelain tooth on the denture. Acrylic resin density have more resistance to chipping, but they have a tendency to wear down faster than porcelain. If wear adversely affects the appearance or occlusion, the acrylic resin teeth can be replaced. Chips and cracks of the pink acrylic resin portion can usually be repaired without remaking the denture. Newer materials cost much more but can overcome these issues and are usually only offered on request. They are called composites, these are pre-milled resin and glass blocks using 3D technology, and can be adjusted much more readily. They are favoured by clinicians due to the similar wear characteristics to natural teeth and its shock absorbing nature.
The shape and size of the gum tissue, as well as the bone underneath, can change with time. A reline procedure readapts the pink acrylic resin portion of the denture to the new shape and size of the gum tissue. Typically, a reline is needed every 3 to 5 years. However, this would vary depending on many individual factors.
10. Number Lip (Paraesthesia)
The nerve to the lower lip traverses throughout the lower jaw bone. If the bone covering the nerve is lost, the nerve will lie directly under the gum tissue. Pressure from a removable denture on this area may cause a numbness left in a manner similar to pressure on your elbow causing numb fingers. This problem requires selective adjustment of the denture base. In very rare and extreme situations, the nerves would have to be surgically repositioned.
11. Food Impaction
Removable dentures always have some space between the pink acrylic resin portion and the gum tissue. In addition, there is always some movement of the removable denture during mastication. These factors create a situation where food may accumulate between the denture and the gum tissue. Therefore, it is essential to remove the denture for cleaning on a periodic, daily basis. Removable partial dentures with metallic clasps may have additional food retention problems. It is for this reason recommended not to sleep with your denture in your mouth, giving your soft tissues a chance to rest and irrigate naturally to stay healthy.
12. Dry Mouth
The quantity of saliva may be adversely affected by some systemic problems, medication and/or radiation therapy around the head and neck. Lack of saliva may increase the irritation of a removable denture against the gum, as well as severely increasing the incidence of tooth decay. Anyone with symptoms of dry mouth must bring this to our attention as it can affect the type of prosthetic that we will be putting into your mouth. There are treatments and procedures available during the treatment day to reduce the effects of dry mouth. Please consult the office about these.
It should be understood that some dental implant systems or specific applications are still considered experimental. Implant longevity depends on many factors, the patient’s health, the use of tobacco, alcohol, drugs and sugar being the most important to control oral hygiene.
1. The amount of quality bone and surgical compromises with regard to existing root infections
2. The amount of time the teeth have been missing
3. The degree of biting force
4. The number of missing teeth
5. Missing gum
6. Number of teeth left
7. Closeness of remaining teeth that are infected to the new implant site
8. General health
9. Influence of nicotine on the healing wound
10. Diabetes and its complications
As with any restorative procedure, the potential exists for the fracture of an implant component or loss of implant from the bone. Alternatives to implants and treatment plan variations will be discussed with you after consultation. After implant placement surgery, it is possible that the gum tissue that has been stitched together at the time of the surgery may fail to heal immediately and the line of repair may open slightly. (For this reason, we favour minimal surgery and offer our Same Day Extraction and Implant Service). To help prevent this, you should temporarily adhere to a soft diet and avoid pressure to the tissues by leaving the dentures out until initial healing is well advanced, usually 7 to 14 days.
At that time your denture may be modified before resuming its wear. This modification will occur after each phase of your surgeries. The estimated time between Phase One surgery, when the implant itself is placed, and Phase Two surgery, when the parts project through the tissue into your mouth is about three months in the lower jaw and six months in the upper jaw.
If you are having a Same-Day surgery, the tissue trauma is reduced to one session and the second phase is avoided. A Stage One surgery gives a much better blood supply in the long-term to the existing tissues. This gives a much healthier long-term stable potential with the soft tissues. By having a Same-Day surgery you will also find that by gentle micro-movement of the implant against the Class Four bone, cell growth of the bone will be stimulated, giving a much stronger, long-term potential in bone integration to the implant itself.
You may need frequent soft lining placed into your denture prior to the construction of the permanent prosthesis. If you choose to have a Soft Tissue forming denture that maintains the socket on extraction, you will need to ask the practice about this. It is a very good technique developed by a Periodontist called Robert Lamb to help grow the bone within an infected socket by maintaining the blood clot in that socket, and the blood clot becoming the new bone. This would not be available on the Same Day service.
To promote good healing, you should inform us of any sores or ulcers that persist for 3 to 4 days, or any uncovering of the fixtures after the first surgery. Stitches are removed if needed one week after surgery. With regard to discomfort, you should note that 10 being the highest, you should notice a decrease from 10 down to 1 over a period of time and plot the results in a diary. Failing this you need to notify us.
You may possibly experience some of the following complications with implant treatment:
Occasionally, the individual fixtures may fail to integrate; in other words, they might not become firmly anchored into the bone. You will notice this by movement. This is usually discovered at the time of the second surgery or in a review appointment. Often it is the result of not strictly maintaining a soft diet during the interim between the first and second surgeries, or not returning for adjustments and additional soft linings should soreness or ulcerations occur. Any fixture that fails to integrate will be removed. At that time, either a new fixture will be placed, followed by another 3 to 6 months healing time, or the prosthesis will be constructed on the remaining fixtures that remain.
Fracture of the abutment fixtures, screws and associated parts are rare but can happen. This can lead to the removal of the fixture, in which case you may need to have a different prosthesis constructed. It may be necessary to switch from a fixed to a removable prosthetic design.
Your appearance may be changed in terms of the tooth contour, position and lip support. Appearance and speech changes are more likely with upper implants since it is necessary to leave the implant post exposed for proper oral hygiene. If this creates an undesirable appearance, an aesthetic veneer can be made
Eating excessively hard food can lead to increased soreness under the conventional denture and possible fracture of teeth or fixture parts.
If the jaw joints or facial muscles are overloaded from excessively hard foods, or you grind or clench your teeth, you may experience some jaw joint and facial muscular discomfort.
Cleaning the teeth and posts of the implant will be much different from cleaning a conventional denture. Although rare, abnormal tissue reactions and/or infections can occur around the implant parts if they are not kept clean. Like other dentures and bridges, the teeth may stain in with excessive coffee, tea or smoking and Corsydol mouthwash.
If your denture is of the removable type, the teeth or denture may be damaged if dropped.
There may be some initial discomfort around the implant post immediately after the denture is placed, which should eventually disappear.
The screws attaching the prosthesis to the fixture may loosen with time. This is under no circumstances to be left alone. You should come back to the practice. The screws will need to be tightened if this occurs sometimes requiring re-making your crown at your expense. All replacement screws and parts are charged for.
When the replacement teeth have been worn down, they will need to be replaced. This means your denture will be removed for a few days or you can use the same day service. This would be at your expense.
The Alternative to Implant Treatments are:
1. To not have treatment
2. To have a new conventional removable denture
3. Other surgical procedures to improve the left over ridge (with attendant risks and problems)
For Long-Term Success of Implant Treatments
You have to take on the following responsibilities:-
1. Follow all instructions regarding soft diet and denture use during healing after each phase of surgery
2. Clean the implant posts and dentures thoroughly as instructed
3. Attend periodic examinations as advised by your dentist. There is an additional fee for this service
4. Exercise care in not abusing the prosthesis
5. Advise your dentist immediately if any problems persist or start
6. Take out a practice membership plan to make your yearly program sustainable
Q&A: Further Points and Questions about Implants to Raise
1. What is an implant?
And Implant is a man-made replacement for the natural missing root which allows a technician to make a crown, which then fits on top of the new root. At the Implant and Ceramic Dental Studios we make this with you chairside to match every need at the time. Implants can be made from ceramic or titanium, and they need to be a certain distance apart and cannot be attached to existing teeth. They allow each tooth to act independently and to be treated separately and not rely on one another for additional support. They are particularly useful if there are no further teeth to attach any prosthetics, and we just rely on the bone for support. This enables the patient to return to a relatively normal mastication and a much-improved aesthetic result, as well as a more confident lifestyle. Depending on how long the soft tissue has been missing, there may be a need for its replacement. (Either this is artificial or it is a graft by a Specialist Periodontist). An Implant is not a transplant but an artificial replacement.
2. How is an implant inserted?
By trying not to disturb the tissue and bone on a Same Day Service, we can carefully remove the tooth and replace the whole space immediately.
If the site is not strong enough, we cannot proceed with a Same Day service, so we then prepare the site and wait for healing, after which the site can then receive the future implant.
Using a Same Day technique, we can place the implant and the missing tooth with a crown attached to the implant in the same day while you wait. This can only happen on the day if the implant can be sufficiently tightened to 35nm of torque using our measuring device. You then wait for us to make the final restoration on the same day. If we cannot load it with a final crown, we will then create a situation where you will still only need one surgery and we aim to minimise the tissue trauma so no second surgery is needed. This is done by custom-making a healing cap to the same dimensions of the future crown and fitting it onto the newly-fitted implant. This mimics the full final crown in the future, as it would leave the soft tissues at the implant site amongst the existing teeth and means we will not need to revisit the site surgically at the second visit 3 months later. (It will not be strong enough to be used against biting forces).
A conventional approach at most practices will justify a Two or even Three Stage Surgery, only being concerned about the tissue at the end of the implant healing phase. We do offer this service as well.
3. What is the procedure?
We begin the implant placement by making a pilot hole after a good assessment as to where the bone is under the soft tissue. The length and width of the implant is predetermined, using all the information gathered. A stock implant of premeasured dimensions is then selected and carefully screwed into a pre-made pilot hole. If proper fixation is not achieved in a Same Day Service, the original placement can be withdrawn straight away and replaced with a tighter fitting one; this is in fact good practice.
The tightness must achieve a resistance of 35 Newton Metres of torque, using a torque wrench to measure its stability on first placement. If this is achieved, we are confident at our practice that we can give you a Same-Day treatment, for which we need the whole team available for you on the day. This of course has cost implications.
Our aim is to minimise bone and soft tissue trauma and replace missing bone on extractions on the day of extraction. The more surgical stages required, the more the trauma for the tissues and so long-term healing may be compromised as tiny blood capillaries do not regenerate readily over time.
Implant treatment is designed to restore up to 80 percent of your previous tooth loss function. It will never be as good as what you had before. Your own natural teeth in a healthy well-maintained condition are the best natural implants which you can possibly have. It is, therefore, in the best interest of your health and well-being to do anything you can to keep your teeth in the best condition for the longest possible period of time.
With good care on your part, and good frequent dental check-ups, you will be able to accomplish this goal. When a tooth is lost, it is best to replace the tooth with a non-removable replacement as promptly as possible. You are probably familiar with the traditional bridgework, which uses natural teeth as supports for bridges that join the space with the teeth that are still there. This does not have the increased support which was present when the natural teeth were there. What does continue to occur is that unstimulated bone continues to disappear, and underneath the bridge in time.
The teeth are supporting not only the missing tooth, but they now have to contend with bone loss around their foundations as the bone shrinks away from the missing tooth and roots. An implant is the only thing that can stop this. This is because a bridge does not go into the bone in the place of the missing root. To use the analogy of a fence post, you will also find with the extra load that the remaining teeth are taking side forces of the missing teeth which hastens the loss of them as well. A tooth becomes a lever left on its own and they begin to move side to side over a period of time.
Some people, instead of bridges, replace missing teeth with partial dentures; this is a series of replacement teeth with clasps on a metal framework. At best, this can be successful if shared amongst natural teeth holding just one or two teeth that are missing but, by taking it out and putting it in, and it being a foreign body in your mouth, it can present the same characteristics — to a degree — as an orthodontic appliance. This will also need continual relining, maintenance and renewing from time to time. The rule of thumb to protect your teeth is a partial denture should be remade every five years. A partial denture will not maintain, nurture or stimulate bone growth. Any removable appliance will fit it best at the beginning and the oral environment is ever-changing and so can never remain completely stable. Overloaded teeth, whether it is a bridge or partial denture causes high rates of bone loss. Another important point to remember about a removable appliance is that it is susceptible to being lost or broken outside of your mouth; this is the most common cause of failure.
When teeth are lost, the supporting bone structure sinks away from the history of where the tooth was. This root socket more often than not has two walls in common with existing teeth so, by losing one tooth, you potentially can lose three in total. The shared wall of the old bone sockets sinks away from the existing roots and the soft tissue drops down, like a domino effect, and the teeth begin to fail. Shrinking gums result in ill-fitting dentures. The soft tissue becomes thicker as the bone disappears and begins to move much more on the bone, so you will have to resort to dental adhesives or other sort of adhesives to continually maintain your dentures in you oral environment. This will be because relines will not be as effective as the bone disappears in the long-term. Indeed, bottom ridges do completely disappear in the end.
On the up-side, where implants have been placed and properly maintained, the tendency is to preserve the bone because the bone is being used somewhat in the same way it was when the natural teeth were present with its roots.
Your chewing efficiency, for the purposes of comparison, assuming that patients with all of their own natural teeth in a healthy, well maintained, functionally accurate conditions, chew at 100% efficiency. However, with every tooth lost, efficiency decreases. The amount of decrease is dependent on whether or not your teeth are replaced and how. Ultimately, if a person reaches the point with no teeth, and are using properly fitted dentures on an adequate but bony ridge, achieving efficiency of perhaps 15 to 18 percent may be achieved. If the ridges are not adequate, and the amount of tissue over the bone becomes mobile, the percentage decreases even more.
Implants and non-removable bridgework are best documented of all replacement methods. A person may get to as high as 85 percent efficiency compared to what they had with their natural teeth, depending on the number of natural teeth present and their condition along with oral maintenance through hygienist and dental treatments. Bridges do not last as long as implants, they do not support the bone, in fact they overload the bone as they sway side to side in micro-millimetres. They accelerate bone loss.
4. What is my “Medical Examination”?
The most important part of your treatment — and the most time-consuming, not to mention what goes on behind the scenes. For every hour you spend in the surgery, five hours maybe spent in creating and researching the right solutions for your treatment. An average treatment letter can take up to 2 hours and will include a comprehensive report on your outcome and variance of outcomes. This often goes unnoticed; in the current market, complimentary and free appointments are offered all the time.
You will have to question the validity on this basis alone. At the Implant and Ceramic Dental Studios we take pride in communication and transparency. We feel patient education is essential in a good treatment, as well as team-bonding.
Fixing and filling one tooth essentially involves very little responsibility for the practitioner. Treatments more than one tooth has a much more comprehensive, serious impact on your long-term oral health and comfort. We endeavour to assure you from the beginning that you have full participation with all team members to deliver exactly what you want knowing any compromises prior to the completion of the definitive restoration. On the day of cementation, you also have the team, who make the teeth, alongside you, to make any quick professional adjustments using the right equipment at the right time to ensure your comfort starts on the day of cementation.
5. What is my homecare?
After ensuring that we have been informed of any diseases, medications and allergies, your home care has to be provided by yourself and must be first rate. Homecare involves communicating with us any concerns and any feedback to improve on future or present issues. You must keep your teeth and implants cleaner than you have ever done previously. You must be able to use a toothbrush, dental floss, and whatever other devices we recommend keeping both your natural teeth and the implants healthy. If this is not done, there is a good possibility that the implants will not succeed, and we may have to remove them. Furthermore, smoking and/or excessive alcohol consumption are a deterrent to excellent dental healthcare. An ongoing program of hygienist/therapist appointments are essential to maintain any warranty offered.
6. Do you need X-rays?
These are necessary for proper diagnosis during treatment and for follow-up treatment when it is complete. We take minimal dosage images and need consent for CT Scans.
7. What are opposing teeth?
The teeth or denture which are opposite to the implanted area are a very important consideration to the success of the implants or crowns and bridges we provide. There must not be any grinding of the teeth at night against the implants; if there is, you need to bring this to our attention. Early signs can be seen by early forms of bone loss in one or the other direction around the implant. Care must be taken not to overload the implants by chewing on hard object such as ice, which could damage even your natural teeth. The patient should not engage in anything which may cause damage to the implant or the underlying bone, such as full contact sports, especially if not wearing some sort of shield. This must be brought to our attention prior to any treatment commencement as we will have to make provision for one of these appliances to be made for you at the end of your treatment.
8. Is there loss of nerve sensation?
There are cases reported in dental literature in which there is temporary loss of nerve sensation following certain surgical procedures. This does happen sometimes, but is usually temporary. Motor nerves are never affected. Unfortunately, there have been instances where complete nerve sensation has not returned even after many years. There have been such occurrences following removal of deeply-impacted wisdom teeth. It is possible that such a thing could happen with the placement of an implant in the bone. It is usually temporary, and is a loss of nerve sensation only, not causing a dropping or sagging of the face.
9. Are all implants successful?
The answer is, no. There are many variables to be considered in placing the implant.
The patient must be healthy and there must be adequate healing powers present in the patient if, for example, if the patient is a controlled diabetic. Inconsistent healing could complicate the procedure. If such a condition developed at a later date after the implants this, too, may complicate the future of the implants.
A proper diagnosis must be made and the proper implant placement and procedure must be selected for the individual patient.
The implants must be treated properly by the patient. If the patient is neglectful, there could be complications.
10. Will implants last a lifetime?
Very few things to do last a lifetime. There are some implants that would have been in the mouth for a very long time — as much as 30 to 40 years. This is not average. The average expectancy is less, and is based upon a number of variables, such as the patient’s health and proper maintenance and so forth.
In the final analysis, whether they last a lifetime depends on how long you live which is, of course, an important factor. This is why it is worth trying to keep your teeth as long as you possibly can.
11. How old can you be to have implants?
Many people of 70 and 80 years of age are a better surgical risk than someone year younger who has physical complications. Older individuals are more likely to need implants because they have lost more teeth, and have lost more supporting bridges. The prospect of going into a home and having removable dentures puts fear into most people, the idea of a fixed prosthetic would appeal. As long as you live and breathe and are important to someone, including yourself, you owe it to the people around you to take the best care of yourself and to be as comfortable as you can in the last years. Incidentally, what is a good age to have a hip replacement or a coronary bypass?
Implants are made of biologically-compatible materials which have undergone extensive testing over a period of several years. Since these materials are largely metals, such as titanium and Surgical Vitallium, and have never been a living tissue, there is no likelihood of causing an antigen response which could cause rejection.
12. Can you get cancer from implants?
There are no incidents reported in the dental medical literature of Dental Implant Clinic cancer.
13. Are implants chosen for cosmetic reasons?
Are implants inserted for cosmetic reasons? Not usually. (All-on-4, can be). The primary object of a dental implant is to give additional support to the teeth and should be viewed as functional. We enhance and maximise the comfort and healing potential by having a technical team on site so they can participate and help during the treatment and surgery. Technicians can concentrate on making sure that aesthetics are at its best for the given situation using the latest materials with an emphasis on avoiding metals. The nursing and surgical team concentrate on your comfort.
14. Are they under Warranty?
There is no way that we can guarantee anything which goes into the mouth and which is under the control of the individual patient. Physicians do you not tell you that the transplanted heart, kidney, or coronary bypass will be keeping you alive for any specific time. We can only tell you that we strive to place the implants properly, provide you with information you need to help care for your implants at home, and we will be available for regular periodic follow-up appointments to evaluate your continued dental health.
We will do everything we can to make the implant succeed. You will have to make that same commitment. If you do not keep your end of the bargain, the implants will fail. Also, you must return to set regular intervals for examination and service according to our recommendations. If you do not do this, difficulties may arise, resulting in the loss of the implants in the complex nature of oral Implantology. It is important that all post-operative examinations and all treatment should be handled by us.
Referrals will be made only to those doctors with experience and training in implant dentistry.
It is Expensive!
As the implant procedure will vary in complexity and extent, depending on the patient’s dental condition and requirements, it they can involve a significant investment. A survey of 350 consecutive patients after completion of their implant treatment reveal that not only was it worth the investment, but that they would happily do it again.
It is a new way of Life!
15. Will insurance pay for implants?
Some dental procedures, implant surgeries and portions of implants are covered by dental and medical insurance policies. Talk to reception and they will assist you to obtain these benefits.
16. Will there be any discomfort?
There should be no pain with a careful, close relationship with the team.
This will vary in complexity and extent depending on the patient’s dental condition and requirements, so some pain can be involved. However, anaesthetics and sedation virtually eliminates this. Post-surgical discomfort can be controlled by anti-inflammatories and is no different to having your teeth removed.
17. How much time will it take?
It depends on your condition and needs, and the extent of the work involved. Individual operations may take one half hour to several hours. If you feel you cannot endure such a prolonged period of time in the chair, please bring this to the attention of the dentist. We will make sure that we can time your treatments in periods that allow us to manage that element of your treatment. This includes toilet stops and beverages. It is the responsibility of the patient to ensure that they have all the information communicated to them and the steps are followed clearly prior to treatment, including when sedation is your preference and that transportation has been is arranged.
18. How long will you be off work?
This can vary according to your stamina and your general health. We would expect you to take the rest of the day off and, with the right medication, we have patients who do work the next day but, generally, we recommend a day or two off for a full recovery. You can expect to have some swelling, some pain or discomfort, and possibly some bruising. The time taken off work is really an individual decision.
If you have decided that you want to be considered as an implant candidate, you can be encouraged by the fact that there are many thousands in this country and around the world who have dental implant treatment, and other medical procedures with excellent results.
Occlusal Diagnostic Splint Therapy
Initial treatment with dental occlusal and muscle therapy is considered an appropriate conservative and reversible approach and can eliminate headaches altogether, which is one of the biggest symptoms of TMD (Temporomandibular Dysfunction)
It is rarely diagnosed easily until it is too late, as it takes a lot of time, leading to a lot of dentistry and huge expense to the patient and the employer alike.
An occlusal diagnostics splint, also known as a bite splint, is used to determine if improvement of the occlusion or a repositioning of the jaw would improve any TMD symptoms of a patient.
The symptoms can include headaches, clicking, discomfort around the face and even eye ache. It is often caused by long-term general dentistry where crowns and restorations including fillings have been done at different times creating a domino effect of occlusal trauma. Orthodontic treatment can also be a huge contributing factor.
The cumulative effects of all these components come home to roost on the longevity of future dental treatments. This can clearly be seen by having a full appraisal evaluation to check if your hinge joints are sitting in the right place in your skull. Anything that contradicts the position the jaw wants to be in leads to what we call an occlusal disease. It manifests itself by continual fractures of dentistry and teeth, and no longevity of any restorations made historically; also, extensive bone loss around the teeth and repeated infections, with concentration around key teeth in your mouth. The process of this diagnosis can be lengthy and time-consuming and we do keep the fee fixed for us to try and cover all eventualities at all stages.
It involves four sets of study models, plus comprehensive paperwork to support our findings for medical legal reasons. This is the report that you will be able to take away with you from our practice, as very few practices offer the service.
A headache for years can go in minutes by finally occlusal grinding. Equilibrations adjustments should be made after orthodontics to ensure harmony.
Your treatment may require long-term night-time appliances that will insure an already traumatised joint may be permanently changed by the trauma. In severe cases a referral to an occlusal specialist may be needed. Additional treatments to the musculature associated with this disorder include exercises, massage, medication, physical therapy, acupuncture, nutritional counselling, ice packs, immobilisation and, at times, Botox.
Most procedures are performed with a local anaesthetic, commonly referred to as Articaine, Lignocaine, Prilocaine etc. You need to bring this allergies to local anaesthetic to our attention. In addition, sedative and pain medications can be used to help minimise anxiety and discomfort. In rare instances, allergic reactions may occur, so you are requested to inform the team of any known allergies you may have. Local anaesthetics, reportedly on extremely rare occasions can cause permanent damage to neurosensory perception associated mainly with the lower jaw. This may result in permanent or temporary nerve paralysis. Some sedative or pain medications may cause drowsiness. Therefore, when these medications are used, you would need to make arrangements for transportation to and from the practice and for someone to care for you after your appointment. We do use intravenous sedation, also known as Twilight sedation. A qualified anaesthetist will provide the services at an additional cost to your dental care. The drugs used will have an amnesiac effect and you will require someone to accompany you home; you may lose your perceived sense of the length of the procedure. You may even need someone to look after you for the rest of the day. Complications do occur, though rarely, and any concerns should be discussed in your pre-treatment consultation with the anaesthetist.
Prosthodontics Treatment during Pregnancy
Elective procedures or procedures that can easily be postponed should generally wait until after childbirth. Treatment of dental pain and urgent procedures can be performed with relative safety to the foetus by minimizing the use of medications and avoiding the use of nitrous oxide and other medications with known foetal effects.
Therefore, it is essential that you inform the practice of a confirmed or suspected pregnancy.
A Treatment Guarantee
Any dental care performed is subject to extreme environments inside your mouth and, as such, any type of dental care has risks. It is by managing these risks, using appropriate technological materials, and taking the best care possible, that your dental work will last best possible. Sometimes things happen, whilst driving a car, one might get a nail through the tyre, or a windscreen may be hit by a stone … For our mouth, a cup of coffee can bang against your new teeth and have a traumatic consequence. We cannot be protected against such things; however, through proper planning and by applying proper science and mechanical principles to your teeth, a long-lasting result can be expected. We wouldn’t expect anything we have to last if bites are not even and well-maintained; there are service contracts for every manmade device, which they need checking at regular intervals.
We have In-House Dental Plans
It is our philosophy of care to provide early intervention of dental care which results in treatment of small problems and it is our aim to prevent major treatments in the future.
Maintenance Packages for Ongoing Protection
We have designed certain packages to help spread the cost in maintenance programs. Please ask at reception.
These packages are to help spread the cost in maintenance programs. They come in 3 levels, depending on the treatments and maintenance needed.
Dental implant fixtures have a greater than 90% survival rate at 20 years in non-smokers. Non-smokers will be guaranteed for a period of five years from the dental implant surgery date to withstand normal chewing and biting forces. Smokers have an increased risk of dental implant disease which could result in the loss of dental implants. Due to the increased risk of failure of dental implants in smokers, no guarantee is given where a patient is smoking during the first six months following the dental implant surgery, or where we diagnose a bone loss or gum disease around an implant.
Depending on severity, can be predictable but may require more than one stage of surgery; and there are techniques that can avoid this procedure. The further the bone is being grown from the original ridge, the more likely that more than one procedure may be needed.
Removable Dental Implant Dentures
Require a reline on an annual basis due to the extra forces generated on fixed dental implants and resin teeth and they will require a reset of new teeth every 3 to 8 years. The patient is responsible for the reset cost, as this is normal wear.
Major Dental Treatments and their Life Expectancy
Whilst this can never be guaranteed, or even predicted, international research suggests that the average life expectancy of cosmetic reconstructive procedures should be 8 to 15 years. This can only occur if a regular maintenance and review of the foundation health is carried out on a 3 to 6 monthly basis.
Crowns, veneers, inlays, and bridges will be guaranteed for a period of five years from the seat or insertion date, and be able to withstand normal chewing and biting forces. Should a restoration break during this five-year period, we will replace it for the fabrication costs. After the five-year period, the patient will assume the full current cost for any restorations needing to be replaced. To prevent the risk of porcelain fracture in un-cosmetic areas of your mouth, gold materials or metal may be recommended in patients who grind their teeth with extended wear patterns, and have an unprotected biting scheme. It is an essential condition of this warranty that at least six-monthly maintenance appointments are carried out and a prospective splint is worn nightly when recommended
Invisalign and Orthodontics
These treatments do depend highly on patient compliance and on the wearing of the aligners 22 hours per day. In the instance that they are not warn enough, treatment will fall behind and may need to be started again. New impressions have an additional cost if treatment needs to be restarted. One set of retainers is included in the treatment cost for Invisilign.
This is mainly used for minor to medium movement of the teeth.
With tooth movement in adults you can never be sure if the tooth or the bone will resorb or shrink, this is the risk. In young children the best time to move the teeth is for this reason, so a good treatment would move the bone first (using arch expanders before Invisilign) and then only consider extractions. Always be aware that veneers or tooth shape may be altered and may need addressing after the treatment is complete by making or remaking.
After the treatment is finished, you can either continue to wear your retainer to keep the teeth in place or consider an “Occlusal Equilibration’ treatment, and so completing the treatment to give much more tooth stability in the long term, ask at reception.
This is a gentle procedure that allows your lower teeth to contact your upper teeth very evenly all the way around your mouth. The goal of this treatment is to create a “Solid bite” that prevents stress on individual teeth and reduces stress on the jaw muscles and jaw joint.
Dentures and dental implant bridges will be guaranteed for a period of three years from the seat or insertion date to withstand normal chewing and biting forces. Should a breakage occur during the three-year time-period at our practice, we will replace it with a fabrication cost only. Normal wear of denture teeth themselves can increase due to the extra force generated with dental implants. Normal wear is not covered in this warranty. After the three-year period, the patient would assume the full current cost for any damages that need to be replaced. Dental implant bridges will require relines on a 6 to 12 monthly basis due to increased comfort and biting forces. The cost of relines will be the responsibility of the patient. We can make these start to finish in one day.
Our practice uses exclusively white resin based fillings. Our fillings are guaranteed for one year. This excludes breakages of the filling when the filling is moderate to large in size. In these instances, it is often recommended to have porcelain crown or porcelain onlays or porcelain inlays which are both stronger and longer-lasting. With hybrid ceramics as an alternative, we can increase the strength of your remaining teeth by using this latest material. Please ask the dentist, as it does fall into the cost category of crowns and bridges — not fillings — due to the costs involved.
Anyone wanting their existing amalgam removed for fear of mercury poisoning, it is pointed out that the removal of fillings is likely to cause a greater exposure to mercury than leaving the fillings in place. We do follow a very strict Holistic Protocol with our in-house Holistic Dentists. Ask at reception.
Our bite and occlusion in our mouths are continually changing. We need to see you routinely every six months to ensure that your bite and teeth move in a way that do not damage your new restorations. Any work carried out in and around teeth we have made, including fillings, can create excessive force on the treatment provided by us, resulting in a null and void warranty unless reviewed and approved by us after the treatment. Please let us know of any emergency work needed so we can assure you of its potential effect on any of our work done.
In the event of regular 4 or 6 monthly maintenance visits not being attended, and a protective night-time splint not worn consistently when recommended, this guarantee will be null and void. We require you be given certain information and that we obtain your consent prior to the beginning of any treatment. What you are being asked to sign is a confirmation of what we have discussed, the nature and purpose of the treatment, the known risks associated with the treatment, and the feasible treatment alternatives; also, that you have been given an opportunity to ask questions and that all your questions have been answered in a satisfactory manner.
Informed Consent and Authorization
I certify that I have read and understand all the pages of the Informed Consent which outlines the general treatment considerations, as well as the potential problems and complications of restorative/prosthodontic treatment. I understand that potential complications and problems may include, but are not limited to, those described in this document. I understand that during and following the contemplated procedure, conditions may become apparent that warrant additional or alternative treatment pertinent to the success of comprehensive treatment. Recognising the potential problems and risks of the restorative/prosthodontic treatment, authorisation is given for the dental treatment to be rendered by the dentist and office staff. I also approve any modification in design, materials or care if it is felt this is for my best interest. In addition, I consent that photographs and/or videos of the procedures may be shown for teaching or advertising purposes.
Any Invasive or Surgical Procedure has Risks
Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. Individual results can vary. Read more in Our Informed Consent Document (/general-dentistry/risks-and-complications)
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Posted by: The Probe 7th August 2019
One of the UK’s top cosmetic dentists is warning people against travelling abroad in the hope of a cheap fix after seeing a huge rise in ‘Turkey teeth.’
Dr Ken Harris, who runs the multi-award winning Riveredge Cosmetic Dentist in Sunderland, has seen a massive rise in people needing remedial treatment after travelling to Turkey for cosmetic dentistry. He is urging people to think twice before agreeing to bargain price veneers, which can cause a huge amount of damage to teeth.
“We have seen a number of people who have gone to Turkey and then decided to have their teeth done, or booked a travel package which includes some kind of cosmetic treatment,” said Dr Harris.
“The results in some cases have been horrendous. The teeth are ground down to virtually nothing and then in some cases it is crowns, not veneers, which are being fitted and then the patient comes home and realises how many problems they now have.”
Dr Harris is also concerned at the “assembly line” approach of some clinics, where people are literally in and out in a few hours.
“To get this kind of treatment done takes time if it is done right,” he said. “It’s impossible for veneers to be fitted in a few hours and this is why people find they need a huge amount of work done to have them corrected, although in some cases their teeth are completely ruined.”
He advises anyone thinking about travelling for this kind of treatment to get proper advice and do their research before making the decision.
“While it may seem a very good deal, in the long run it can set people up for problems that they might never recover from,” said Dr Harris.
Riveredge Cosmetic Dentistry has a world-wide reputation, with Dr Harris (BDS, MFGDP, FFGDP RCS (Eng), MSc Restorative and Aesthetic dentistry) one of only two Fellows of the British Academy of Aesthetic Dentistry (BACD) and a regular lecturer to dentists around the globe.
He is recognised as one of the leaders in the field of cosmetic dentistry, often being brought in by other practices to handle complex cases.
The strong team at Riveredge includes Dr Richard Coates BDS (UNcle) Pg Dip CID, who chairs The North East Private Dentists group, is a long standing member of The American Academy of Cosmetic Dentistry and holds a diploma in implantology from Newcastle University.