MICROSCOPIC DENTISTRY

It is one of the newest advancement to the field of dentistry. The key to successful treatment in dentistry depends on proper accessability and visibility.

With the advancement in technology we are able to provide a better quality of dental treatment to the patient.

Dental procedures are difficult to do in the posterior area of the mouth, but with microscope we are able to carry the treatment with ease and high success rate.

WHAT TYPES OF TREATMENT WE DO WITH MICROSCOPE?

Initially reason of failure for the treatment was  lack of vision however now with advent of loupes and microscope this difficulty is overcomed.

 

In present scenario microscopic based treatment has gained popularity in almost all field of dentistry.

  • Useful in diagnosis and clinical procedures.
  • Assessing craze or fracture line
  • ENDODONTICS:

During root canal therapy, magnification provides better visibility of canals, thereby eliminating chances of any missed canals.

Surgical endodontics can also be carried out with ease.

Repairing of perforated canals can be done.

Obturation of immature open canal can be done.

  • RETREATMENT:

Performing retreatment is simplier with microscope like removal of gutta percha from poorly obturated canal.

WHY MICROSCOPE IS WIDELY USED NOWADAYS?

  • Better visualization
  • Increased quality of treatment
  • Increased precision and accuracy
  • Improved ergonomics

  • Gingival health and crevicular status can be determined
  • Any lesions in mouth can be easily assessed
  • Crown preparations can be very accurate

IMPROVED OUTCOMES

The microscope is beneficial for both dentist and the patient. The dentist can involve the patient in treatment decisions and most important is the success rate which has increased to manifold with the advent of microscope.

 

Veneers Or Crowns

crown-bridges

Porcelain Laminate Veneers and Crowns are the successful and popular of all the options available for improving the look of your smile.

What Is Porcelain Laminate Veneer?

  • Porcelain-made translucent, thin laminates bonded to the front surface of a tooth are known as Porcelain laminate veneers.
  • These veneers enhance your smile with little or no discomfort to you.
  • These veneers are indistinguishable from natural teeth and are made individually according the patient’s needs.
  • Porcelain veneers are made to improve the shape, spacing, color of natural teeth.

What Are The Indications For Veneers?

  • Teeth with multiple fillings
  • Odd shaped, cracked, chipped teeth
  • Spaces between teeth
  • Discolored teeth/ crooked teeth
  • Fractured teeth
  • Unsatisfactory shape, size and form of teeth

 What Are The Advantages Of Veneers?

Advantages:

  • minimal tooth preparation
  • short span for results
  • durable
  • feel completely natural
  • highly resistant to external staining

 

What Happens When I Go For A Veneer?

  • Your dentist will analyze your smile
  • Depending on tooth shaping, anesthesia will be required.
  • Minimal shaping of your teeth is done and an impression is then taken.

 Ceramic veneers take between 1-2 weeks to be made, during which your teeth may be fitted with temporary veneers to prevent sensitivity.

What Are The Post Treatment Care Instructions?

You should:

  • Brush and Floss regularly
  • Use a non abrasive toothpaste
  • Avoid any shearing force on front teeth
  • Go for regular check-ups

 

How Is A Crown Different From A Veneer?

A crown is known for covering the entire tooth unlike a veneer which covers the front surface of a tooth only.

A crown involves more shaping and prepping of the tooth structure.

It often leads to strengthening, weakening or broken tooth.

Crowns are extremely durable, aesthetic and are mostly used for the front and the back teeth in the mouth.

 

Indications for a Crown

  • Grossly/badly decayed teeth with large fillings / root canal treated teeth
  • Fractured teeth with little tooth structure left
  • Faulty bite
  • Worn down teeth
  • Mobile teeth
  • Missing tooth
  • Over an implant

 

 

 

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.

PORCELAIN LAMINATE VENEERS

Also called as PLV

Veneers are translucent ceramics bonded on the prepared surface of natural tooth/teeth by transparent luting resin.

They exhibit fluorescence and reflect and transmit light exactly as natural tooth structure.

STRENGTH

  • Normally they are weak in strength in comparison to porcelain fused to metal (PFM) or all ceramic crowns.
  • But once they are bonded to the prepared tooth surface, they integrate with the tooth structure and become extremely durable.
  • It also requires less invasive tooth preparation and the natural strength of the tooth is also maintained contributing to the longevity of the tooth and the veneer too.

LONGEVITY

The union of etched enamel and porcelain combined with the bonding composite resin luting agent with a silane coupling agent, enables the dentist to perform restorations that are solid as well as long lasting

93% success rate

 “The Smile Is The Reflection Of An Individual”

 Creating natural looking smile

A pleasing smile is important to the patient’s morale and self-esteem while the loss of it will have effects negatively.

Attention to the details examined by dentist is very crucial as it will help in getting the desired results from the technician too and appreciation from the patient.

The dentist’s skill, awareness and understanding the patient’s needs, personality and psychological state will lead to acceptance of the proposed treatment plan.

“Aesthetic Dentistry Is The Art Of Dentistry In Its Purest Form”

Dentofacial Attractiveness

  • An attractive smile has always been the focal point of attention.
  • Esthetic dentistry seeks not only to improve the Esthetic appearance, but to improve the patient’s self-esteem and it should not be underestimated.
  • A display of pleasing intact dentition is the key element in the creation of an attractive smile.
  • As it has been said “Better smiles are being equated with better living.”
  • A beautiful smile seems to reflect a style of living, and enchantment of facial beauty is why patients are seeking elective dental care.

 New concept of dentistry

Esthetic dentistry has opened an entirely new world for most clinicians and changed the lives of hundreds and thousands of patients in a very positive way.

 Esthetics and function

It is the esthetic dentist’s responsibility to produce treatment plan that is esthetically pleasing, functional as well as biocompatible.

 Natural looking restorations

Restoring the tooth and achieving the esthetic harmony by maintaining the natural morphological state of the tooth.

Surgical Treatments for Gum Diseases

Flap surgery/pocket reduction surgery: In this procedure the gums are lifted & calculus is removed. Irregular surfaces of bone are smoothened. The gums are then placed so that it fits snugly around the tooth. This reduces the size of the space between the gum & tooth, decreasing the areas where harmful bacteria can grow.

Bone grafts: involves using fragments of your own bone, synthetic bone to replace bone destroyed by gum disease. The grafts serve as a platform for the regrowth of bone, which restores stability of teeth.

Soft tissue grafts: This procedure reinforces thin gums or fills in places where gums have receded. Protect root surface from sensitivity, caries/abrasions & improves hygiene.

Depigmentation of dark gums: Pigmentation affects most of gum tissue with a complete brown appearance. The pigmentation can be completely removed surgically. Discomfort to the patient pre & post surgery is minimal.

Crown lengthening: is a surgical technique for gummy smile. It is a procedure performed to expose greater amount of tooth structure to restore prosthetically & esthetically. Appropriate crown margins can violate the requirements for periodontal health. An Inappropriate crown margin increases plaque accumulation in close proximity to bone crest.

Guided tissue regeneration: is a procedure in which a barrier membrane is placed under the gum & over the remaining bone. It is performed to stimulate growth when the bone supporting your teeth has been destroyed. A small piece of mesh-like fabric is inserted between the bone & gum tissue.

Bone surgery: modifies bone support altered by periodontal disease, either by reshaping the bone, without removal or by the removal of some alveolar bone.

Looking for treatment of periodontal disease?? 

                                 Find experts advice on periodontal disease treatment at                   

 Dr. Sachdeva’s Dental Institute. We believe in conservative approach for periodontal treatment.

LASERS IN ENDODONTICS

  • Endodontic procedure carried out by conventional methods may not be successful in spite of utmost care.
  • Despite the mechanical removal, irrigation and disinfection of canals, the bacteria can still persist which cannot be reached by conventional techniques.
  • As the technology has advanced, now lasers are used in endodontic procedures to improve the prognosis of the treatment of tooth.
  • Laser light penetrates upto >1000 micrometre into the dentin and provides a distinct advantage since the bacteria can immigrate upto 1000 micrometre into tubules.
  • When in contact with laser, cell membrane gets destroyed due to the impact of direct heat and this damage is enough to stop the growth of the bacteria depending on the wavelength and frequency of laser irradiation used by the dentist.
  • It is a very effective tool for disinfecting the root canal after mechanical root canal treatment as it has sufficient penetration depth.
  • It is effective in curved canals also and the energy is transported by thin flexible fibres which have diameter of only 200 micrometer.
  • Laser eradicates the microbial flora of root canal and also has same effect on surrounding dentin without affecting the surrounding tissue and has good disinfection mechanism without causing pain and improving the prognosis of the endodontic treatment.

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

LASERS IN PREVENTIVE DENTISTRY

  • Laser treatment is becoming widely recognised and can be applied to prevent caries from developing and to reduce the progression of caries.
  • The mechanism of laser should be understood before a dentist could apply in his daily practice.
  • The Enamel surface of tooth is made of crystals called ‘Hydroxyapetite’ and it is permeable in nature therefore allowing diffusion of ions.
  • During laser treatment, moderate heat(CO2 laser produces temp > 1000 degree celcius) is produced which changes the composition of Enamel from ‘hydroxyapetite’ to ‘carbonated apetite’ in which there is loss of water in the crystals, as a result the pores of Enamel shrink down to form ‘Microspace system’. The Microspace system provides a means for trapping Calcium, phosphate and fluoride ions which release during demineralization and acts as site for re-precipitation.
  • The trapped minerals phases inside the Enamel and impedes lesion formation and progression causing enhanced resistance against demineralization.
  • As the microspaces are smaller in size, it decreases the permeability of the Enamel thereby reducing the diffusion of ions in and out thereby reducing the demineralization process. Thus a seal is achieved and so is resistance to caries.
  • The Dentin also gets acid resistance as there is increased mineral content due to burning of organic matter from tissue so there is increased Calcium and Phosphate found in recrystallized Dentin.

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

Soft Tissue Grafting

This is in preposition of a treatment planning of an appropriate surgical technique for increasing the width of the attached mucosa in order to maintain Peri-implant health.

The soft tissue around gingival being divided into gingival and mobile alveolar mucosa, the gingival width varies individually as 2-9 mm.There is a time-point to distinguish the peri-implant mucosa from the gingival around the teeth:  The peri-implant connective tissue has less number of fibroblasts & more collagen fibers’ as compared to gingiva.  The junctional epithelium is more permeable with scarce number of blood vessels than that of around the tooth. 

The peri-implant connective tissue fibers’ run in a parallel direction to the implant or abutment surface without being attached rather being perpendicular to the root cementum.

It has been concluded that presence of non-elastic collagen fibers’ in the connective tissue is responsible for keratinization. Based on findings, >2 mm of keratinized tissue is required for maintenance of healthy gingival tissues.However,around the dental implants, the crucial role of an adequate width of keratinized /attached mucosa for the clinical success is still controversial.

Recent studies have shown that lack of adequate width of Keratinized alveolar mucosa around dental implants is associated with more plaque accumulation, inflammation, soft tissue recession, attachment loss.

Since implant surgery includes one or two stage bone augmentation procedures, displacement of the mucogingival Junction does occur.hence, in order to regulate the width of keratinized attached mucosa, two different peri-implant soft tissue augmentation procedures can be concluded:

Increase in soft tissue volume using a sub epithelial connective tissue graft or soft tissue replacement graft

Enlargement of keratinized mucosa width by means of an apically repositioned flap/vestibuloplasty.

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.