Root canal , Apicoectomy and Cancer

What Is Apicoectomy And Why It Is Done?

root canal procedure is a treatment to save a damaged, infected or badly decayed tooth.

Although root canal infections can be treated by conventional root canal therapy, but in some cases when the infection persists after root canal treatment or re-treatment, an APICOECTOMY is considered to be important to solve the infection and treat the problem.

  1. What Does Apicoectomy Mean?
  • Apicoectomy is a microsurgical treatment procedure where the very end of the tooth’s root (Apex) is removed along with the infection attached to the root tip. The apex is sealed with a filling to prevent micro leakage.

  1. What About Apicoectomy Procedure I Need To Know?
  • The endodontist gives local anesthetic to the already RCT treated tooth to numb the surgical site of the patient.
  • The gum and bone is cut and lifted to access and visualize the root tip/apex.
  • The root tip is resected and the infected tissue is curetted. The end part of root canal is cleaned and sealed with biocompatible sealer material. The endodontist then sutures the tissue back in the original place.

  1. Does The Procedure Hurt?
  • The endodontist will give local anesthesia to make sure that the treatment is painless and more comfortable.
  • Other than that, patients are prescribed with appropriate pain medications to help ease the discomfort.

  1. How Long Does The Apicoectomy Treatment Take?
  • The treatment is generally done in single sitting appointment.
  • The procedure takes about 1-2 hours depending upon the tooth location and complexity of the roots.

  1. If The Patient Doesn’t Want The Treatment?
  • If the patient is not willing for the treatment, then the tooth needs to be extracted and an implant can be surgically placed to replace the missing tooth.

Root Canal and Cancer

  • In new studies, Researchers found that patients had a 45% reduced risk of cancer with multiple endodontic treatments.

Till date, there is no valid, scientific evidence that proves any link between root canal-treated teeth and disease elsewhere in the body.

 A 2013 study published in a journal found that a patient’s risk of cancer doesn’t alter after a root canal therapy. Researchers also found that patients with multiple endodontic treatments had a 45% reduced risk of cancer.

There are also few myths about Root Canal Treatment shared by a large section of people onto which we would like to shed some light.

  1. MYTH –The Root canal treatment is painful.
  • TRUTH – In fact Root canal treatment doesn’t cause pain, it actually relieves it.
  1. MYTH – Root canal treatment makes you ill/sick.
  • TRUTH – There is no substantial, scientific valid proof which links root canal-treated teeth and disease elsewhere in the body.
  1. MYTH – An excellent substitute to root canal treatment is extraction of the tooth.
  • TRUTH – Saving your natural teeth, is always the ultimate best option if the tooth is not damaged beyond repair.
  1. MYTH – Root canal therapies often requires many visits, wasting your precious time.
  • TRUTH – Now due to introduction of advanced technologies, Root canal therapies can be completed in one or maybe two appointments.
  1. MYTH – If you’re not feeling any pain in your tooth, you do not need a root canal treatment.
  • TRUTH – Teeth are not always painful that require root canal therapy.

We at Dr. Sachdeva Dental Institute And Implant Center try to leave no question unanswered.

We practice endodontics with dental microscope which provides enhanced visualization and access to the most difficult angles of the teeth, mouth and jaws, and allows for a better and more accurate diagnosis and treatment.

It significantly improves quality of treatment and improved after treatment results.

For more information, contact us at: Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• http://goo.gl/yI8lGv
• http://goo.gl/DquAGr
• http://goo.gl/GsCcoS
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB

Intraoral welding of implants-known since decades- conveyed to practice

In cases of complete oral rehabilitation there are multitudes of complications which may occur with either the surgical or prosthetic phase of implant dentistry. In order to mend this, intraoral welding technique has been introduced as a rescue.

In cases of deficient bone or atrophic ridges, higher chances of implant failure occur due to micromotion of implants during healing phase.

This is one phase procedure to attain the goal of primary stabilization of implants while fabricating immediate prosthesis to the patient on the same day of the surgery or within a few days.

 Discussing about the advantages of welding, it rigidly splints the implants, helps in healing, distributes the force to all implants, and increases the success through Osseo integration of implants. In cases of implant overdenture, absolute stabilization of implants can lead to immediate loading and oral rehabilitation on the same day of surgery.

The welding of the implant abutments with titanium bars is done directly in the mouth. It also has an advantage of eliminating the possible errors or distortions due to the impression.

 The rigid splinting of the implant abutments done before the immediate loading provides retention to the implants & decreases the stress exerted on the implants. The method incorporates either welding a titanium bar or a wire to the abutments of these implants. Once the implants have achieved the stability and retention, they can be loaded with crowns/ bridges or over dentures.

weldone

This has been reported leading to lesser degree of implant fractures. This means ensuring success for the longevity of the implants, in a short period of time. For example in a case of complete rehabilitation of a patient required extractions are done followed by insertion of implants (either 6 or more if required) into the jaw bones.

 During the surgical stage the curettage of the gums is done simultaneously. The bite of the jaws is recorded at first before commencing any procedure.post implant insertion the intra oral welding of the abutments is done. Afterwards the fabrication of the hybrid denture prosthesis is done and fixed in the mouth.

 The stabilized prosthesis helps in chewing & speech of the patients along with the natural aesthetic look. The discomfort due to the movement and clicking of the dentures is avoided in such cases. The aim of this new technique is to find the optimal conditions for the success of the implants through continuous joint without alterations in the intraoral welding of titanium by electric resistance technique.

The proposed technique allows intraoral welding of titanium for solidarization of dental implants to improving their primary stability. Commercially pure titanium (c.p. Ti) wires and dental screws were welded by electric resistance technique. Worldwide, clinical cases have demonstrated the effectiveness of this technique in the improvement of dental implants primary stability practically.

“Start-Up” Program in Implant Dentistry Mentoring

Mentoring by Surgical Master Dr.Rajat Sachdeva

If you are looking for a Mentor to help you with your dental implant career then we may be able to help.

Dr Rajat Sachdeva has mentored and trained many Dentists over the years through formal courses and individually on a one-to-one basis.

If you have no experience of dental implants then it may be helpful to take a look at the section http://www.sachdevadentalcare.com/implanto-dontia.html

where details of our courses can be found. These courses are a great way to get started with dental implants.

Alternatively if you already have experience with dental implants but want to increase your confidence in certain areas then individual mentoring with Dr.Sachdeva may be more appropriate. For example, if you have already completed a few cases but want help with overall treatment planning then one-to-one Interaction with Dr Rajat could be very beneficial. Or, if you place implants confidently but want help with bone grafting techniques, Dr Rajat will be pleased to assist you.

Basically we can tailor individual mentoring to whatever level or area you require.

If you want to consider being mentored by Dr Rajat Sachdeva contact him directly on 01142464041 for an informal chat.

How to overcome dental anxiety

Have a visit due to your dentist that you have been avoiding for a long time? Is there a general sense of fear associated with that dental chair and the various sounds and noises it produces? Do not worry. You are not the only one. The idea of going to a dentist can cause as much anxiety as the pain that a decayed tooth may be causing. The responses are not age related. Different people could have different reactions dealing with dental anxiety. Some may be calm and composed and some may be total wrecks. A lot depends on the dentist and the environment he/ she creates for the patients. Understanding the patients and their levels of anxiety could be crucial in assessing their levels of anxiety and help them overcome it.

Assessment of dental anxiety

There are numerous ways available to assess dental anxiety, both in children and adults. A five point scale that is reliable and quick to administer. It has cut-offs for mild, moderate, and phobic levels of anxiety.

Interventions for individuals with low levels of anxiety

 For children attending with low levels of dental fear, approaches that can be adopted include:

  • Rapport building: like use of a magic trick. The use of magic trick increases cooperation when compared to no intervention or the use of tell-show-do technique.
  • Voice control: using loud voice with deep tone is more effective in reducing disruptive behavior of a child & interaction more pleasurable than the normal voice level
  • Distraction: there are number of ways which can be used for distraction such as: the use of video-taped cartoons, audio-taped stories and video games. Distraction techniques are equally effective as relaxation-based techniques, and superior to no intervention.
  • Modeling: modeling has been used extensively with children and is generally most effective if the observed child is similar in age, gender and level of dental anxiety to the child watching, if the child enters and leaves the surgery without adverse consequences.
  • Environmental change: three studies have sought to make the dental environment more attractive to children attending the dental surgery.

Approaches can be used in patients with low dental fear:

  • Enhancing the sense of control: One of the most commonly used techniques to do this is the stop signal.  In this patient can raise the hand and give signal to the dentist.
  • Cognitive distraction: the patient is encouraged to think about something other than the dental situation, be in  a happy place or think of a less stress causing situation.
  • Environmental change: soothing smell of lavender in dental waiting area to reduce the immediate fear of the patient but it will not reduce the underlying cognitive factor.

Interventions for individuals with moderate levels of anxiety

 Patients with moderate levels of dental anxiety may benefit from the prior preparatory information.

  • Information about what will happen (procedural information)
  • Information about what sensations the individual will experience (sensory information)
  • Information about what the individual can do to cope with the situation (coping information).

Interventions for individuals with high levels of anxiety

Pharmacological management

This includes relative analgesia, conscious sedation and general anesthesia. These management techniques are not much used but there are ongoing needs for such services when patient is not regular to visit for treatment or to the point where they are in severe pain or with compromised oral health

Cognitive behavioural therapy

It is a synthesis of behaviour therapy and cognitive therapy and uses both behaviour modification techniques and cognitive restructuring procedures to change maladaptive beliefs and behaviours. Behavioural aspects of CBT include learning relaxation skills, conducting mini-experiments and systematic desensitization. An important principle underlying CBT is its focus on the ‘here and now’ as what started a problem is often not the same as what is keeping it going.

The “All-on-4” Concept for Implant Rehabilitation of an Edentulous Jaw

When a patient loses all of their teeth, they are essentially relegated to living the life of a “dental cripple” and are compelled to see  Dr.Sachdeva’s Dental Institute, India to find resolution. The teeth are very essential to any human being and when a tooth or all teeth are lost, chewing efficiency is lost, their level of comfort declines and often they appear to age prematurely. The teeth provide more than a bright smile on someone’s face. A complete set of dentition maintains the bite and keeps all the structures in harmony. When changes occur after teeth are lost, patients begin to seek the dentist.

Edentulism can be a result of poor oral hygiene and dental disease. Sometimes patients who have received previous restorations meet a failure in their cases and their teeth are deemed restorable and hopeless. A growing number of the population possess a terminal dentition and the ability to retreat is restricted due to the poor remaining tooth structure and support, combined with limitations from the financial burden of full mouth reconstruction. How and why a person is edentulous varies. When patients come into the clinic, their oral condition is assessed and the appropriate solution is planned and presented—all encompassing the health and financial capacity of the patient.

It is well recognized that an edentulous condition has a negative impact on your life:

    • You need your teeth to eat because otherwise you will be limited to a soft, unappealing diet.
    • You need your teeth to smile, to flash a confident set of pearly whites to people.
    • You need your teeth to maintain the integrity of your facial structure, otherwise your bite will collapse and along with it, the face will sag and make you look much older.
    • You need your teeth to maintain the health of the jaw. The temporomandibular joints (TMJ) rely on the teeth. When the bite collapses, the changes that occur can be very damaging to the joints.

All-on-4” implants have become a leading choice in many teeth replacement cases.

A REVIEW ON BOTOX IN DENTISTRY

None can deny with the fact that everyone wants to look younger than one’s age. Hence one option available as BOTOX comes to the rescue to fulfill the needs in cosmetic & esthetic dentistry.

Chemically BOTOX is a toxin produced by bacterium clostridium botulinum also produced commercially for medical & cosmetic approach. There are two main commercial types: botulinum toxin type A (Botox, Dysport & Xeomin) & botulinum toxin type B (Myobloc).

Injecting Botulinum toxin type-A causes localized reduction in overactive muscle activity for some timespan by inhibiting the exocytosis of acetylcholine on cholinergic nerve endings of motor nerves preventing the vesicle where the acetylcholine is stored from binding to the membrane where the neurotransmitter can be released.

The use of Botox in Dentistry can be applied in bruxism, dental implant surgery, temporomandibular joint disorders, gummy smile, and mandibular spasm.

Botox is a safe, conservative, non surgical reversible, minimally invasive treatment modality for cosmetic needs. Training is absolutely required for dentists to administer this technique as a learning curve.

As we all know bruxism ultimately leads to periodontal trauma characterized by clenching by bracing of the mandible. Botox has shown promising results by alleviating the symptomatology of bruxism with botulinum toxin type A injections into temporalis & masseter muscles.

Post implant surgery overloading of muscles of mastication can impede osseointegration of implants. Hence the muscular relaxation is achieved with injecting botulinum toxin type A to the masticatory muscles therapeutically.

The appearance of excessive gingival tissue in the maxilla upon smiling is both an aesthetic issue as well as oral hygiene problem which require complex procedures as a cure. In such cases it is applied in small, carefully titrated doses proportionately weakening the contraction of upper lips particularly levator labii superiosis.

Botox is an emerging, latest, attractive treatment option as compared to other surgical alternatives. However there are still many dental conditions which require FDA approval to be treated by botulinum toxin. The use of BOTOX will surely progress the dentistry profession to one step ahead.

MAXILLARY SINUS LIFT

The tendency of the alveolar ridge to progressively resorb after tooth loss & typically poor quality of posterior maxillary bone, rehabilitation of this region with implant supported prosthesis has been challenging.

Anatomically maxillary sinuses are largest paranasal air cavities limited by six walls, separated from the nasal cavity, containing the neurovascular bundle & covering the tooth root by a Schneiderian membrane. The blood supply of the maxillary sinus is derived from the branches of maxillary artery, posterior superior artery, infraorbital artery & descending palatine artery. Anatomical knowledge of sinus vascularization is necessary to prevent bleeding complications during the sinus lift procedure.

Therefore, the surgical procedure of maxillary sinus lift has undergone considerable development & different variations with autogenous bone regarded as the preferred option.

Factors to satisfy the criteria for sinus augmentation are:-

-residual bone <10mm in height

-absent pathological condition/fibrous scars

-absence of multiple maxillary teeth & need for strong sinus floor for multiple implants

Preexisting local pathological conditions is an absolute contradiction to sinus lift procedure as grafting procedure can lead to fluid stagnation & exacerbated sinusitis.

At present there are two surgical approaches for maxillary sinus floor lift procedure.

First the lateral antrostomy (traumatic) being classical one described by tatum.The transcrestal approach has less morbidity but nevertheless it requires enough residual bone height for primary stability of implants i.e. prerequisite residual bone height should be >6mm to enable placement of implant 10mm in height. It is indeed a one stage procedure & less time consuming but as every procedure has its own pros & cons, its drawback is that only 2-4mm of bone height can be increased & its highly technique sensitive.

More recently, second approach i.e. crestal one (atraumatic or conservative) has been advocated by Summers using osteotomes.It includes same procedure as that of lateral approach with a crestal incision followed by full thickness flap raised & implant site prepared 1-2mm shorter than the subantral bone height using drills & osteotomes while in lateral approach antrostomy is performed using a round bur to create a U-shaped trapdoor on a lateral buttress of the maxilla.

The main advantage of this approach being less invasive procedure, improves the density of the maxillary bone allowing greater stability of implants which can be unproven if the residual bone height is <6mm.

Restoring edentulism with dental implants needs careful treatment planning especially in the posterior maxilla where the pneumatized maxillary sinuses can limit the amount of alveolar bone for implant placement. Hence maxillary sinus floor lift offers the most common & predictable preprosthetic procedures to address this problem.

Regards: Dr. Prof. Rajat Sachdeva

Director & Mentor

Dr.Sachdeva’s Dental Institute

www.sachdevadentalcare.com 

www.dentalcoursesdelhi.com

+919818894041, 01142464041

Alveolar Ridge Preservation

Tooth loss and subsequent ridge collapse continue to burden restorative implant treatment. Henceforth careful management of the post-extraction tissues is required to preserve the alveolar ridge.

The dimensional changes of the alveolar ridge after tooth extraction occurs due to alveolar atrophy by the osteoclastic resorption of the bundle bone in a more apical and lingual/palatal level resulting into modification of the alveolar ridge in both vertical & horizontal directions.

Clinical trials have been reported that mean loss of 3.87mm in the width and 1.67 mm in the height of the ridge post 3 months of healing.

Alveolar ridge preservation has been suggested to preserve ridge dimensions & soft tissue contour to facilitate implant placement with an emergence profile in the pontic area.

 This technique includes minimally traumatic tooth extraction with or without a flap approach,autogenous bone graft,freeze dried bone allografts,guided bone generation,use of growth factors or bone morphogenic protein or plasma rich fibrin.

Few alveolar ridge preservation procedures with a positive outcome in limiting post-extraction ridge dimensional loss & promoting partial bone regeneration in the extraction sockets are:-

Alveolar ridge preservation using GBR & barrier technique

-A full thickness flap is elevated through intracrevicular incisions depending upon osseous defect not extending more than 3-4 months from the buccal/lingual bony crest

-The tooth is atraumatically extracted by means of periotomes/luxators.During luxation extreme forces are avoided in the buccal plate & granulation tissue or any residual pathology is removed by means of bone curettes followed by saline rinsing

-before grafting any blood clot formed in the extraction socket is removed to ensure the graft is placed at the buccal & lingual/palatal plate to restore any possible fenestration/dehiscence defects avoiding any overfilling.

-A single or double layer of a resorbable barrier used to cover the graft is stabilized under the lingual & buccal flap extending 3mm on the sound bone surface.The flaps are coronally positioned & sutured by vertical mattress/double interrupted sutures interproximally & horizontal cross mattress suture in the mid part of socket

Alveolar ride preservation using the socket seal technique

– In-lieu of surgical augmentation to correct a ridge defect, the socket-shield technique offers a promising solution to support the buccofacial tissues

-Intracrevicular/intraligamentary incisions are made around the tooth to be extracted to dissect   epithelial and connective tissue attachment without raising any flaps.

-After atraumatic extraction followed in the previous technique marginal soft tissues are    deepitheliased by means of a fast angled hand piece & a thin diamond or micro scalpel.

-A free gingival epitheliased graft with a thickness of 2-3 mm harvested from the palatal site is filled into the socket.

By comparison, ridge preservation techniques may reduce the amount of ridge resorption but cannot prevent the loss of interdental bone and papillae. Preservation of supracrestal fibers however can better develop pontic sites in turn preserving the papillae.

Thus it has been shown that the retention of the tooth contiguous with the PDL, its fibers interconnected with bundle bone, avoids the physiological remodeling of the alveolar crest.

IMMEDIATE IMPLANT IN AESTHETIC ZONE WITH EARLY LOADING

   Dentistry has been revolutionized by the routine inclusion & higher rate of success of dental Implants. Implant insertion in aesthetic zone i.e. anterior maxilla or anterior mandible is the most challenging thing because of definite relationship between the implant& its adjacent restorations, bone, mucosa, lip line considered to fabricate a prosthesis corresponding to the natural dentition.

Standard implant treatment protocol has been challenged by various experiments aimed to reduce the number of surgical procedures resulting into implants being placed at the time of the extraction known as IMMEDIATE IMPLANTS rather than waiting for the healing period post extraction.

When implant placement is delayed for a period of time after tooth extraction,soft tissue healing may provide opportunities to maximize tissue volume to achieve proper flap adaptation & acceptable soft tissues, but it’s the bone loss which hampers the aesthetics.

The greatest reduction of the alveolar bone occurs after extraction in the first 6 months to 2 years. After implant placement bone loss occurs, gingival architecture will be collapsed leading to aesthetic compromise & inadequate bone for implant following conventional procedure.

Hence in the modern dentistry the driving philosophy behind recent implant / restoration protocol is PRESERVATION. This is aimed to determine the success rate of implants placed immediately into fresh extraction sockets. The concept of immediate implant loadinghas been accepted due to reduced number of surgical treatments & overall time between tooth extraction & placement of definitive prosthetic restoration, decrease in bone resorption, preservation of alveolar ridge, most importantly increase in patient’s acceptance & psychological benefit.

Immediate implant placement following tooth extraction is a viable & predictable solution to tooth loss.This procedure is technique sensitive and more difficult to execute than the conventional procedure.For the overall success of any immediately placed implant to succeed, primary /mechanical stability must be adequate to enable the implant to resist micro movement until adequate secondary stability is sufficiently accomplished i.e. the minimum insertion screw has to be equal or superior to 32 N/cm.

Occlusion is the key in Implants

Osseo integrated implant being the most sought after modality of treatment, optimal occlusion plays a key role in implant supported prosthesis. The probable reason for peri-implant disease or crestal bone loss & failure of implant prosthesis is occlusal overloading of implants.

This is a review to discuss the clinical guidelines for various occlusal schemes like balanced, group function, mutually protected occlusion. Appropriate occlusion is the foremost mandatory for long term survival of implants in absence of sound clinical situations. This is because poor occlusion increases the magnitude of mechanical stress & strains at the crestal bone.

Misch proposed implant-protective occlusion which states that by decreasing the occlusal forces increases the clinical success of implants & its prosthesis.

Keeping aside the conventional occlusal concepts, refinements proposed to reduce stress at the implant interface are

Ø Mutually protected articulation

Ø Implant body angle to occlusal load

Ø Crown height

Ø Quality of implant crowns

Ø Timings of Occlusal contacts

The biggest question of the hour is why occlusion is the most important factor? Since the periodontal ligament – mediated proprioception doesn’t occur with implants as in natural teeth; occlusal forces are to be carefully accomplished in order to regulate mandibular displacement.

Each of the prosthesis i.e implant supported prosthesis, tooth or tissue supported prosthesis exerts different range of forces in both the functional & resting movements. The implant supported prosthesis is designed as that of tooth supported single fixed partial prosthesis with an adequate interarch space with bilateral stability in centric occlusion & no interferences between retruded & centric position. In terms of posterior fixed implant prosthesis reduced inclination of cusps, narrow occlusal table, and increased proximal contacts provides stability to the restorations.

The current accepted paradigm shift is mid retrognathia-flat lingual incisal platform in skeletal class II div II, raise vertical dimension at occlusion to flatten anterior guidance in skeletal class II Div II, to slightly disocclude posterior or mild anterior disocclusion in skeletal class III.

In cases of natural dentition little degree of flexibility is acceptable but in implants the flexibility degree is supposed to be decreased to zero for the success of prosthetic rehabilitation.

Dr. Prof. Rajat Sachdeva

Director & Mentor

Dr.Sachdeva’s Dental Institute

I-101 Ashok Vihar Phase 1 Delhi 110052

www.sachdevadentalcare.com

www.dentalcoursesdelhi.com

+919818894041,01142464041