DENTAL CROWNS: THINGS YOU SHOULD KNOW

Crowns are very important and common form of restoration which maintains our teeth appearance and functions.

People still have some questions in their mind when it comes to get a crown. We here are trying to answer most frequently asked questions about crowns.

  • What Is A Crown Actually? How It Makes A Tooth Strong?

A crown is actually an artificial replacement which restores the missing tooth by surrounding the left out/ remaining tooth structure or sometimes as a covering for dental implant.

The crown maintains the aesthetics and functions like a natural tooth. The crowns are cemented permanently on the remaining tooth or implant and only be removed by a dentist.

  • When A Tooth Needs Crowns?

 After root canal treatment. The crowns are highly recommended following a root canal treatment as after the treatment the tooth loses the resiliency to absorb the chewing forces and becomes brittle. The crown will help to regain the structure of the tooth as well as the function protecting the damaged tooth from fracture or splitting the roots.

  1. For closing spaces between the teeth like chipped, worn out, discolored or poorly shaped teeth crowns can be used.
  1. When the tooth decay involves all the surfaces of the tooth and it is not possible to restore the tooth just by filling, crowns are given.
  1. If a tooth is cracked, dental crowns are a treatment of choice.
  1. Few dental conditions where the thickness of enamel is very less or less mineralized, dental crowns can provide protection to the tooth maintaining the esthetics and function of the tooth.
  1. If a tooth has a large filling and is prone to fracture, dental crowns are given to protect the remaining tooth structure.
  1. Crowns are also used as to make a bridge where the two crowns provide support to a third crown in between them, in case of a missing tooth.
  1. An Implant also needs crowns. Implants inserted in the jaw which acts as a root and the crown is given to replicate the natural tooth. It maintains the esthetics and function in the jaw in case of missing teeth.
  • Crowns Are Made Of Which Material?

There are mainly three types of crowns used in dentistry.

  1. ALL METAL – This is the most basic crown which is used in dentistry but now its demand is reduced due to awareness of the tooth colored crowns. It looks black due to metal and gives an unpleasant look to the patient.
  1. PORCELAIN FUSED TO METAL – This is the most common used crowns nowadays. The crown is made of both metal and porcelain. The metal is on inside and porcelain is on the outside. They are generally used for the back teeth as it doesn’t fulfill criteria of esthetics for front teeth.
  1. ALL PORCELAIN – These crowns are made only of porcelain, due to the revolution in dental industry. They are also known as metal free crowns and have excellent biocompatibility with high strength and fantastic esthetics which ensures long term success.
  • How Many Visits Are Required To Get A Crown Fixed?

The time depends on the tooth which needs the crown. If the tooth is decayed or at risk of fracture or caries reaching to the pulp, then the condition should be treated first before opting for crown.

Otherwise crowns generally requires two steps

  1. Crown preparation where the tooth is prepared and impression is taken of the tooth and is sent to the lab where it will be made. For meanwhile a temporary crown is given.
  1. Second session is when the actual crown is cemented and adjusted.
  • Is The Crown Preparation Is A Painful Procedure? How One Should Prepare Himself For The Treatment?

The procedure of crown preparation is painless. After placing the porcelain crowns, few people experience sensitivity to hot and cold. Therefore it is advisable to consult your dentist to get all information about your teeth structure.

  • Does The Crown Blends With The Natural Teeth Or Stand Out?

Crowns are made after taking the shade from the shade guide to give the crown a very natural look to blend with the natural teeth of an individual. They are given to replicate the natural tooth with its functions intact, therefore not just crown look like your natural teeth, it functions like your natural teeth as well.

  • How Are The Crown Fixed To The Teeth?

Crowns are fixed with dental cement and technique of the cementation is very specific for each type of crown on what quality the crown is made of.

  • How We Should Take Care Of The Crown? How Long Does It Last?
  • There is no time limit for a crown to last. They can last a lifetime and sometime they choose to fall out or become loose.
  • The oral hygiene is very important for a long life of the crown. By keeping the gums healthy and visiting the dentist regularly for cleaning and checkups will keep the gum infections at a distance.
  • Patient with bad habits such as grinding the teeth or forcefully clenching will need to their habits in control by using the other dental appliances to save the crown as well as their natural teeth from excessive pressure.

 

IS THE BRACES TREATMENT POSSIBLE WITH CROWNS AND BRIDGES?

  • Ortho treatment or braces treatment are mainly known as corrective cosmetic treatment to align and maintain the teeth in a correct position in order to give an ideal smile and ideal occlusion of the teeth.
  • As now a majority of people are suffering from dental caries and decay so it is possible that they must have gone through treatment to get crowns to protect their teeth.
  • If you have irregular teeth and you want a corrective treatment for this situation (ortho treatment/ braces) then you must consult your dentist to know about the treatment so that the presence of crown does not hinder the ortho treatment.
  • Although every patient is different and their demands are unique therefore causing the ortho treatment a bit challenging, it’s advisable to consult the specialist to get the best solution for the individual treatment so that you get the best smile for your face.
  • Applying braces to the artificial crowns is difficult than placing braces on natural teeth. It is always advisable to consult the specialist for ortho treatment if someone wants to go for braces.

There are few questions for people going for braces;

  • The Movement Of The Tooth Is Limited When Fixed Braces Are Put On The Implant Crowns Or Crowns

As the implants are fused very solidly into the jaw, it’s impossible to move them using orthodontic treatment. People with existing bridge are given slight forces to not to cause damage to the crowns and bridges. If the crown has history of root canal treatment, the force applied to move the tooth is minimum and the restorations/crowns are monitored during the course of the orthodontic treatment.

  • There Are Chances Of Damage To The Artificial Crowns During Orthodontic Treatment.

The damage is purely esthetic in nature and there is no need to do anything about the crowns especially if they are in the back of the mouth. If the damage to the crown is in front position, the dentist may fix the restoration once the ortho treatment is done and braces removed.

  • Other Cosmetic Restorations Have To Wait Till The Orthodontic Treatment Is Finished

If a person wants to replace the crown for esthetic reasons, it is recommended to go for it after the orthodontic treatment is finished and the braces are removed.

In case if the crown is loose you may ask the dentist or the orthodontist to replace the tooth with a temporary crown before the placement of the braces.

The new crown can always be fixed after the finishing of orthodontic treatment.

Dry Socket

After Teeth Extractions

ALVEOLAR OSTEITIS or Dry socket is a complication where wound healing is altered that may occur following extraction of teeth if the initial blood clot is not formed or lost.

dry-socket

An improper wound healing results in exposed bone in the socket which is devoid of normal healing tissues (Clot), hence the name “dry socket.”It occurs three to five days after an extraction and is characterized by an increase in severe and throbbing pain.

Dry socket is treated by temporarily packing the site with eugenol, antibiotics and oral rinses. As the socket forms a new layer of the healing tissue the pain will gradually subside and the socket slowly fills in over the next 2-3 months.

  • In patients the risk for dry socket increases who smoke after extractions, too early vigorous rinses, forceful spitting, or use a straw to drink within the first 24 hour, which can disturb the initial blood clot formation.
  • Another major risk factor for dry socket is traumatic surgical procedures such as tearing the gum tissue, excessive manipulation of the extraction socket and aggressive drilling of the bone which ultimately will result in devitalized tissue with poor blood supply.

While the possible incidence of dry socket is between 1-3% data shows that no dry sockets were recorded after performing more than 150,000 extractions over the past 20 years.

THE SECRETS TO AVOID DRY SOCKET AFTER TEETH EXTRACTIONS:

  • Non-traumatic surgical techniques and procedures: This means no or minimal gum tissue flap, no or minimal removal of bone, use of irrigation, gentle handling of the tissues and atraumatic removal of teeth with ease.
  • Avoid rinsing or brushing: Any forceful rinsing or brushing immediately following a tooth extraction can cause dislodging of the blood clot leading to a dry socket. Do not rinse or brush within 24 hours of extraction then rinse gently for the next 1-2 days and more vigorously in the following days.
  • Do not use a straw: The use of a straw in the first 24 hours can also cause suction and dislodge the blood clot. Use a glass following liquid consumption.
  • Avoid smoking: Smoking creates suction in the mouth that can dislodge the blood clot. It also directly inhibits the normal healing physiology.
  • Do not spit: With blood and saliva accumulating in the mouth following an extraction you may be urging to spit that out. This action can disrupt the formation of blood clot and dislodge it. Instead of spitting let the accumulated blood and saliva drool down and wipe it gently with a gauze or tissue.
  • Keep firm pressure on the extraction site: The gauze should remain in place for at least 30-45 minutes after extraction. Constant and firm pressure helps to slow down the bleeding and stabilizes the formed blood clot.

HOW TO PREVENT DRY SOCKET

Dry socket (alveolar osteitis) is a wound healing complication that can occur following teeth extractions if the initial blood clot is lost. This results in exposed bone in the socket devoid of normal healing tissues, hence the name “dry socket.” It usually occurs three to five days after an extraction and is characterized by a sudden increase in severe and throbbing pain. Dry socket is treated by temporarily packing the site with eugenol, antibiotics, and oral rinses. As the socket forms a new layer of healing tissue the pain gradually subsides and finally the socket slowly fills in over the next 2-3 months.

The risk for dry socket increases in patients who smoke after teeth extractions, vigorously rinsing too early, spitting, or using a straw to drink within the first 24 hours—all of which can disturb the initial blood clot.

While the possible incidence of dry socket is between 1.5-2%, here at   Dr. Sachdeva’s Dental Implant Institute, Delhi, we have experienced no dry sockets after performing more than 6500 extractions over the past 13 years.

Platelet Rich Fibrin (PRF) as healing aid in extraction socket:

Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors, and cells are trapped and may be released after a certain time and that can serve as a resorbable membrane, regulate inflammation and increase the speed of healing process.

It is a simple, natural and inexpensive technique for the production of leukocyte- and PRF (L-PRF) concentrates. It includes collection of whole venous blood (around 5 ml) in each of the two sterile vacutainer tubes (6 ml) without anticoagulant and the vacutainer tubes are then placed in a centrifugal machine at 3,000 rpm for 10 min, after which it settles into the following three layers: Upper straw-colored acellular plasma, red-colored lower fraction containing red blood cells (RBCs), and the middle fraction containing the fibrin clot. The upper straw-colored layer is then removed and middle fraction is collected, 2 mm below to the lower dividing line, which is the PRF. The mechanism involved in this is; the fibrinogen concentrated in upper part of the tube, combines with circulating thrombin due to centrifugation to form fibrin. A fibrin clot is then formed in the middle between the red corpuscles at bottom and acellular plasma at the top. The middle part is platelets trapped massively in fibrin meshes. The success of this technique entirely depends on time gap between the blood collection and its transfer to the centrifuge and it should be done in less time.

Tips: How To Get Your Child To Brush Teeth

Here we present you with few tricks to encourage your children to enjoy brushing:

  1. Let your child pick his toothbrush. They may be attracted by Color, cartoon theme or with those toothbrushes that light up when squeezed, so there are plenty of choices available in the market.
  2. Practice makes them perfect. Let your child enjoy the brushing of teeth of his favorite animated toothbrush. When he’s done with brushing, give him a chance to brush his teeth by himself. Make sure his teeth and gums are thoroughly cleaned.
  3. Show your child the brushing technique. You should show them how you brush your teeth if they refuse to brush. Children enjoy copying what their parents do and they can get engaged in taking care of his oral health.
  4. Add spice to the brushing routine. While they try to brush their teeth, sing and dance along!
  5. Give your kids chewable tablets that turn plaque into pink color, and playfully convince them to brush away the color with their toothbrush.
  6. Make him understand that each tooth of his pearls is important. Let your child give a nickname to each tooth and remind not to leave any tooth alone without brushing.
  7. Don’t forget to praise your child after he learns slowly to brush properly and reward him for a well done job.
  8. Let them choose the flavor of the toothpaste that appeal to their taste and be sure to use toothpaste that is specially made for kids.

 For more information, you can book an appointment at Dr Sachdeva’s Dental Aesthetic & Implant  Center I 101 Ashok Vihar Phase 1, Delhi- 110052

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CHECKED BRUXISM

ARE YOU GRINDING TEETH?

Bruxism is involuntary habitual grinding of the teeth, typically during sleep.

Several commonly associated symptoms with bruxism are hypersensitivity of teeth, jaw muscles soreness, headaches, wearing off teeth, damage to dental fillings and crown and overall damage to teeth.

Teeth grinding or bruxism is very common in children as well as adults and people may not realize it initially until their dentist spots out the symptoms in their mouth.

There are two main types of bruxism: during sleep (sleep bruxism) and during wakefulness (awake bruxism). Bruxism may be mild or aggressive.

 

SIGNS

  • Attrition means flattening of the occlusal surface, and Abfraction is where notches/grooves are formed at the neck of the teeth near the gum-line.
  • Fracture of teeth and repetitive failure of dental restorations including crowns.
  • Teeth Hypersensitivity due to wearing away of the protective layer of dentin and enamel.
  • Loosening of the teeth due to inflammation of periodontium due to excessive pressure.
  • Cheek biting/linea alba, or lip biting.
  • Indentations on the tongue.
  • Tenderness, fatigue or pain of the muscles of mastication, mainly masseter.
  • Trismus(restricted mouth opening).
  • Pain and clicking of TMJ

SYMPTOMS

  • Tooth wear
  • Tooth mobility
  • Pain

TREATMENTS

  • First of all the patient needs reassurance that the condition is not that serious that may lead to anxiety.
  • Specially made night guard to wear while sleeping to avoid clenching.
  • Orthodontic correction of teeth if the misaligned teeth are the cause for clenching.
  • Avoiding smoking and alcohol and having a healthy lifestyle.
  • Other interventions include relaxation techniques, stress management, behavioural modification and habit reversal.

 

 

For more information, you can book an appointment at Dr Sachdeva’s  Dental Aesthetic & Implant Center I 101 Ashok Vihar Phase 1, Delhi- 110052

            Contact us at

What Are Dental Emergencies? How To Deal With Them

 

  • Are you suffering from severe pain?
  • Does your mouth bleed while brushing?
  • Are your teeth mobile/loose?
  • Do you have any swelling in your mouth inside or outside?

Dental emergencies are very common, but one should have the knowledge to handle the situation in case of stress or emergency. Proper maintenance of oral hygiene and regular visit to dentist can help to reduce the chances of experiencing a dental emergency.

The most common dental emergencies may include teeth that are –

Forced out of position causing loosening of tooth

  • Facial trauma
  • Fractured facial bones.
  • Chipped, Broken or fractured tooth
  • Infection indicating an abscess

Treatment will depend on the severity of the damage. For example a chipped tooth is slightly damaged; it can be corrected by smoothening, of maybe restoring the tooth by bond and composite filling material. If the damage is beyond dentin and pulp involvement with severe pain, then the tooth should be treated (RCT).

Here are few scenarios where you may prevent the symptoms before they get worse, or even you get an idea that the time is right to see a dentist now:

  1. Chipped Tooth Or Broken Tooth

If it fairly visible and you are afraid about your looks then call your dentist and explain the situation.

Try to find and retain the chipped particle or any pieces and place it in a moist cloth with a few drops of water or saliva (If kept in good condition, it may be possible to reattach it).

  1. What To Do When Tooth Is Knocked Out Of Socket?

If your tooth is knocked out due to a blunt force trauma causing severe facial injury, try first to find the lost tooth. If the appropriate emergency steps are followed immediately after the tooth has been knocked out, the chances are very good that the tooth can be reinserted and preserved by a dentist.

  • Handle the tooth only by the crown not by the root. If you try to touch the root, u may damage the fragile cells on the root necessary for its reattachment back into the bone.
  • If the tooth is dirty, very gently rinse it in water to ensure that the tooth is clean but do not scrub the tooth or remove any tissue attachment.
  • If you want to then try placing the clean tooth gently back in the socket without touching the root and make sure that the tooth is facing the right direction. Do not force it into the socket. If it is not possible to put the tooth back in position then wrap it in a clean cloth or gauze. Soak it in a container of cold milk or if milk is not available, put the tooth in water that contains a pinch of table salt.
  • It is important to see the dentist for an emergency appointment for the best chances of retaining the tooth.

 

  1. What To Do When Tooth Is Fractured Or Cracked?


  • Rinse your mouth immediately to clean the area with warm water.
  • Take medication prescribed by your physician or dentist.
  • Do not attempt to put any painkiller directly on the site of injury to avoid any burning sensation, it may worsen the situation.
  • Avoid chewing with the injured site and always avoid extreme temperatures that may affect the already traumatized area.
  • Immediately contact your dentist as only he can tell how bad the condition is. The dentist might need to do an X-ray for evaluation of the severity of the situation.
  • See your dentist as soon as possible. Not receiving the proper treatment may result in progression of infection or further decay or damage.

IN CASE OF:

 

Lost Filling

As a temporary measure, you stick a piece of softened sugarless chewing gum at the place where filling is missing.  You should be sure that the gum is truly sugarless, as sugar can cause pain when in contact with the tooth and can lead to bacterial infections in the area.
See your dentist as soon as possible for the proper treatment and care.

Lost Crown

If you dropped out a crown of the mouth, make sure to visit your dentist as soon as possible without waiting for extra days. The tooth portion now exposed that has lost its support could easily be damaged or break off or crumble.

Keep the crown in a cool, safe place because if the crown is not damaged your dentist can reinsert it.

If the crown is out of the mouth for a long period of time, the teeth may shift causing further damage and the old crown will not fit at this stage.

Broken or Loose Brackets, Wires Or Bands

If a wire breaks or sticks out of a bracket it may cause discomfort by poke in cheeks, tongue, or gum.

Try to cover the pointed end with something soft substance like orthodontic wax, sugarless gum, or piece of gauze to avoid discomfort until you visit your orthodontist.

You should never try to cut the wire as you could swallow it or breathe it into your lungs.

Abscess

 

Dental abscess or tooth abscess is an accumulation of pus inside the teeth or gums. It should not be ignored as the infection may spread into nearby spaces affecting other teeth as well.

You may try to gargle with pinch of table salt in lukewarm water for a brief time for some relief.

Contact your dentist for proper care and treatment for the dental abscess before the infection spreads.

Possible Broken Jaw

To control the swelling in the traumatized area apply cold compressions. Stabilize the jaw with bandage wrapped beneath the jaw and tied on top of the head.
A broken or dislocated jaw may cause breathing problems or significant bleeding. If it is not treated properly, a broken jaw can leave you with devastating effects on a person’s ability to eat and breathe.

Sip on ice water and hold for sometime in your mouth until you see your dentist.

 

For more information, you can book an appointment at Dr. Sachdeva’s Dental Aesthetic & Implant Center  I 101 Ashok Vihar Phase 1, Delhi- 110052

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Why Did My Dentist Recommend a Root Canal?

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.

A root canal is a procedure that is recommended by your dentist in order to repair & save a badly damaged or infected tooth. This procedure involves removal of inflamed or infected pulp, careful cleaning & disinfecting it & then filling & sealing it with a material called gutta percha. The causes that affect pulp are a deep cavity approaching pulp, repetitive trauma to the tooth, a cracked tooth, faulty restoration.

Root canal is essentially a term that refers to the natural cavity that occurs within the core of a tooth. The nerve i.e. the pulp which is removed in the root canal treatment has no role in health & function of a tooth. Its only core function is to provide sensitivity towards hot & cold.

Why root canal treatment is recommended?

Pain: A toothache is the most common symptom of needing a root canal. The tooth may start to hurt spontaneously, in the middle of the night, or sometimes when the patient isn’t even using the affected tooth to eat or drink. The pain can progress to a very severe generalized headache that may cause the person to even forget what initially caused the pain. If the tooth is dead and has become abscessed, the patient will feel pain when he or she chews food or puts pressure on the tooth.

An Abscess:  may or may not produce swelling or bleeding around the tooth, and sometimes it causes significant swelling of the cheek, jaw, or throat. If this swelling is noticed, treatment needs are urgent.

It is very important, when feeling some pain around a tooth, to get a thorough examination with pulp vitality testing by a licensed dentist for a proper diagnosis.

What to expect during a root canal procedure?

  1. X-ray: If a dentist suspects you may need a root canal, he will first take x-rays to be certain of decay location.
  2. Anesthesia: Procedure is initiated with the administration of local anesthesia to the affected tooth.
  3. Pulpectomy: an opening is made & the diseased tooth pulp is removed.
  4. Filling: The roots that have been opened to get rid of the diseased pulp are filled with gutta-percha material & sealed off with cement.

 

Why Root Canal??

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

  1. Efficient chewing
  2. Normal biting force and sensation
  3. Natural appearance
  4. Protects other teeth from excessive wear or strain

Modern endodontic 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 at Dr. Sachdeva’s Dental Institute.

ENVISION THE FATE OF DENTISTRY – FACTS/PREDICTIONS

THE FUTURE OF DENTISTRY IN 2020 AND BEYOND WRITTEN BY DR.RAJAT SACHDEVA

I thought I’d share a few interesting facts/predictions that I came across whilst researching.
The exposure towards treating diseased individual over a growing population – Over the next 20 years the population in India is predicted to grow by 1.252 billion to just over 1.454 billion. The number of Indians over the age of 60 years has hit an all-time high, accounting for 8.6 per cent of the country’s population. Based on statistics we would be treating an ageing population – Today almost 1 in 15 people over 60 years old and by 2020 it would be 1 in 5 people above 60 years with an overall grow in population. We will be treating an increasingly diverse population – By 2030, ethnic populations will make 30% of the population of India.There will be an increase in the number of dentists – India currently has 309 dental colleges, which churn out around 26,000 dentists every year as compared to only 8,000 dental students graduated annually in year 1970. It is now, however, estimated that there will be a surplus of more than 1 lakh dentists in India by 2020. The dentists: population ratio of India, on date is 1: 10,000. However, the reality is that; in rural India 1 dentist is serving over a population of 2,50,000. Thus, the real picture is not that simple as it seems. As, we are about step into the next decade, there lies an urgent need to analyze the dental work force for many underserved groups of the country that do not have any access to oral health care.We will be treating less caries or moderate periodontitis but more tooth wear and more peri-implant disease.We will be treating a population with increasing socio-economic inequalities – Men and women in the highest socio-economic class can, on average, expected to live just over 5-6 years longer than those in the low socio-economic state. There will be an obvious increase in focus on value and impact on quality of life with more expectation over results. Dental professionals will be working in multidisciplinary teams and promoting the importance of oral health for general health. With every passing year there has been surge in proportion of female dentists with about 5% in last 5 years, a trend which is expected to continue. In the recent years, female students outnumber male students in getting admitted in dental colleges( like 60- 70% of the seats are occupied by girls).Although only 30% are practically converted into private practitioners.A growing propoprtion of female dentists will work part-time according to the research.The use of virtual reality will be constitutive to dental practice. Google glass integrated with dental loupes can become next best tool for dentists. Technology such as CAD/CAM, lasers and perhaps even robotics may be routinely used in practice.The evolution of materials would continue with bioactive,bone regenerative materials reproducing some compelling results.The impact of smart phones and social media will continue to grow for both dental professionals and patients.

Post-Operative Complications of Implant Placement

With the increasing acceptance of dental implants as a viable tooth replacement therapy, complications & failure rates have also increased proportionately.

A range of possible post-operative complications & their prevention are described below:

  1. Infection: Implants are made of titanium, which is strong & biocompatible, which means that is not rejected by the body. So the chances of developing post-operative infection are extremely rare. At times when dentist do not follow effective & strict protocol of sterilization, patient might be vulnerable to post operative infection.

Post-operative infection causes pain & discomfort to the patient, reason being- bacterial contamination of implant or surgical site during the procedure.

If the infection is limited to the soft tissue, a small gum boil will be noticed over the implant site. It can be punctured using a sharp probe & irrigated with chlorhexidine solution or citric acid. It heals & the pain subsides within 24hrs.                                                                                        In case of continuous pus discharge & severe pain which is not relieved by analgesics, this depicts that the infection has reached to the bone-implant body interface.

Prevention: one should follow strict protocol of sterilization in the operatory in order to avoid any bacterial contamination. Also, in such cases, the implant should be removed immediately & prescribe good antibiotic like tab Augmentin 1000mg twice a day for 5-7 days. A new implant can be inserted when the site gets healed in 6 weeks.

  1. Post-operative Edema: Post-operative edema develops in cases of traumatic implant placement. High speed drilling & no constant stream of chilled saline causes bone to overheat & this leads to accumulation of fluids in tissue spaces i.e. edema.

 

Prevention: Unnecessary trauma to the bone must be avoided during osteotomy preparation. Drilling speed must be set according to the density of bone along with a pumping motion of the drill should be employed during drilling to allow the saline to cool down the bone. This prevents overheating & necrosis of the bone.

Patient must be advised to apply an ice pack over the facial   skin of the surgical site intermittently for 45 min to cool down the bone in order to suppress heat generation & inflammatory oedema.

        prevention

  1. Pressure necrosis: results in cases where implant has been inserted & screwed at a very high torque, it may lead to pressure necrosis of the surrounding bone & the patient will complain of continuous pain not relieved by analgesics, for weeks after the surgery.

 

Prevention: Drilling at higher speed with maximum amount of chilled saline irrigation flow to cool down the bone. Use of final drill with the diameter only 0.2mm less than the implant diameter along with the use of bone tap to prepare threads in the bone to accommodate implant threads. Following these instructions help in reduction of post-operative pressure necrosis.

  1. Suture line opening: leads to exposure of implant threads in the oral environment & may cause the collection of plaque over the exposed rough surface of the implant, which may further cause peri-implantitis & loss of hard & soft tissue around the implant.

 

Causes of implant thread exposure

  • Suture line opening & loss of graft in cases where simultaneous bone grafting has been performed with implant placement also leads to implant exposure.
  • More superficial implant placement.
  • Thin mobile soft tissue recedes with muscle pull.

        Management:

  • Tension free sutures should be used to avoid the suture line opening because of the tension in the flap.
  • The open suture line should not be re-sutured but the patient should be instructed to keep it clean, as it heals by secondary intention in 2-3 weeks.
  • If soft tissue healing has not covered the exposed threads, either cover the threads using soft tissue grafting with or without simultaneous bone grafting, or adequate grinding & polishing should be done to make the surface smooth & prevent accumulation of plaque.

  1. Bone resorption: one of the most common complication in dental implantology. When occlusal forces are not distributed equally i.e. is off-axis to the implant prosthesis leads to resorption. Also, when implant with a wider platform is placed into the narrow crestal bone causes crestal bone resorption.

 

Prevention: Implant must be placed along the axis of the future prosthesis. For large mesio-distal diameter two implants should be placed with narrow occlusal table of prosthesis. Along with the maintenance of oral hygiene, soft tissue grafting for compromised soft tissue around the implant must be addressed.

  1. Peri-implantitis: is an inflammatory reaction with the loss of supporting bone in the tissues surrounding a functioning implant. Peri-implantitis is characterized by bleeding/suppuration on probing, together with loss of supporting bone.

The peri-implantitis lesion exhibits histopathological features that similar, but not identical, to those in periodontitis. Similar to periodontitis, the treatment of peri-implantitis must be based on infection control. Under these conditions, progression of the disease may be arrested & subsequent, lost peri-implant tissues may be generated by bone augmentation & soft tissue grafting procedures.

peri-implantitis

With this increasing trend of replacing the lost tooth with an implant, at Dr. Sachdeva’s Dental Institute, we incorporate several associated procedures like bone augmentation to provide this therapy to the maximum number of patients. We follow strict protocol for sterilization & restore implants to minimize postoperative or post loading complications.

TMJ: THE PAIN AND THE SOLUTION

The temporomandibular joint (TMJ) is the joint that connects the jaw to the skull. Temporomandibular joint disorder, or TMD, occurs when there is loss of harmony between the muscles and jaws in the face.

TMJ/TMD is a disorder which causes improper alignment of the jaw joint causing pain.  This pain leads to severe pressure on the nerves present around the joint.

Onset of Pain

Most people make some adjustment to accommodate the fit of their teeth to their jaw joint which is a physiological and normal process that is not painful in general. A painful situation can arise when a person experience some change to the teeth, like trauma or may be long term wear to the teeth such as abrasion, improper fillings or emotional stress causing unnecessary clenching and grinding of teeth.

Treating facial pain and jaw problems

  • Pain In Or Around The Ear
  • Tenderness Of The Jaw
  • Clicking Or Popping Noises When Opening The Mouth Or Even Head
  • Neck Aches.
  • Swelling Of The Face

The Preventive Measures:

  1. Stretching the jaw
  • Press the tip of the tongue to the roof of your mouth, then slowly opening mouth as much as you can without it becoming painful. If you feel pain, stop performing the exercise; it may need more time before you can engage it.
  • Close your mouth and your jaw is now as relaxed as possible. With teeth slightly apart, slowly open your mouth as wide as you can while looking up. Hold your mouth open for a few seconds, and then slowly close it.
  • Once your mouth is closed again, move your jaw to the left side while looking to your right with your eyes without turning your head or neck. Hold this position for a few seconds, the move back to the center.

 

  1. Strengthening the muscles
  • For a resisted opening exercise, put your thumbs under your chin and gently push downward against it, slowly open your mouth, keeping it open for a few seconds before slowly closing it.
  • For resisted closing exercise, keep your thumb under your chin and place your index finger from the same hand on the ridge between your chin and lower lip. Push gently as you close your mouth.

  1. Relaxation techniques

If you feel tense, try inhaling, then slowly exhaling for a count of five or 10. Although it is not a form of exercise, but learning how to reduce the stress in your life can go a long way toward easing any TMJ-related discomfort that develops as a result.

  1. Caring for Your Mouth
  • While brushing and flossing, be careful not to open the mouth too wide, mostly when reaching the second and third molars.
  • Pain when stretching or opening mouth is the alarming situation to call your dentist. They can examine your mouth and recommend a course of treatment, if that’s needed.

Treatment

  1. Splint/Jaw Reposition Appliances

These appliances may be used as a long term treatment to protect teeth from harmful grinding and eliminate problems that occur during a specific activity simply by wearing such an appliance, no further treatment would be necessary.

  1. Occlusal Equilibrium maintenance

This treatment is done to alleviate the pressure on individual teeth.  The jaw is able to adapt to tooth interference in malocclusion and if the irritant tooth is re-shaped, a better fit is achieved and the pain is reduced.

  1. Occlusal fillings

It involves the replacement or reconstruction of teeth by reshaping procedure.. This can be achieved with crowns, bridges, dentures or implants involving multiple teeth.

  1. Orthodontics

Orthodontic treatments can be restricted to just one or two teeth, but can be carried out at any age and is possible to achieve with new advanced invisalign braces that are practically invisible.