Dental Care

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Restorative
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Advanced Dental Services

CAD/CAM intra Oral Scan and Same Day Restoration

Computer-aided design (CAD) and computer-aided manufacturing (CAM) provide same day restoration treatment to patients. Inlays, onlays, veneers, crowns and bridges that do not contain metal can be made without the need of taking teeth impressions.

CAD/CAM intra Oral Scan and Same Day Restoration Procedure:
Consultation and oral examination Scan the area after necessary tooth trimming to create a digital model Use specialized computer software to design the final restoration on the digital model Grind out the designed restoration from a milling machine Cement the all-ceramic dental restoration to the tooth

Pros of CAD/CAM intra Oral Scan and Same Day Restoration:
Restoration can be completed in one visit No need to make temporary dental crown or bridge to minimize discomfort and inconvenience No need to rely on the traditional way to make a mold. The process is much faster, more comfortable for the patient and cleaner to the environment

Surgical Wisdom Teeth Extraction

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Wisdom teeth are the last molar teeth to grow in the mouth. Since these teeth grow in the innermost position of the dental arch, it is very hard, if not impossible, to clear them. The most common situations where the dentist recommends extraction of an impacted wisdom tooth are tooth decay, recurrent periodontal infections and problems of the tooth next to it.

Oral diseases that may be caused by impacted wisdom teeth:
Tooth decay, either the wisdom tooth itself or the tooth impacted by it Pericoronitis, a condition where the gum covering the partially erupted is swollen due to food debris accumulation. The symptoms are swelling and pain, and sometimes limitation of mouth opening A cyst may be formed occasionally around the wisdom tooth, resulting in extensive bone resorption

Wisdom Teeth Extraction Procedure:
Pre-operative assessment through oral examination and panoramic X-ray, or even CBCT when the tooth is very close to the nerve Inject local anesthetics If the wisdom tooth is impacted, it is necessary to raise the gum flap, section the wisdom tooth into several pieces and remove them one by one Clean and stitch the incision Make an appointment for follow-up consultation
Normally, pain and swelling will last for 2 to 3 days after the operation. Pain-killers and sometimes antibiotics will be prescribed. Swelling and pain will usually subside within 2 to 3 days and the wound will heal completely after 1 to 2 weeks.

Implant

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A dental implant is an artificial tooth root that is integrated into the jaw bone. In this way the missing tooth can be replaced without the need of neighbouring teeth as support. It can achieve excellent asesthetics and chewing function.

There are two techniques for installing dental implants: traditional open flap and minimally invasive flapless. Flapless surgery has the advantage of shorter surgery duration, smaller wound and less patient discomfort.

No matter which technique is adopted, a careful pre-operative assessment will be performed. This includes taking medical and drug history, X rays and if necessary, Cone beam CT to evaluate available bone volume and positions of important anatomic feature such as the maxillary sinus and inferior dental nerve.

Limitations of implant treatment:
Bone grafting and augmentation may be necessary when the alveolar bone volume is not sufficient. This may prolong the treatment time Patients with uncontrolled diabetes, history of periodontal disease or heavy smoking habit may have higher chance of implant failure
Points to note after implant treatment:
Daily cleaning similar to natural teeth Avoid eating food that is too hard Regular follow-ups to assess the status of gum and bone around the implants

Endodontics (Root Canal Treatment)

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Endodontics (Root Canal Treatment) is the procedure to treat the diseased pulp, with the objective of saving the tooth from being extracted.

Reasons for endodontics (Root Canal Treatment):
Deep decay Cracked tooth Fractured tooth Severe periodontal disease Traumatic injuries Elective root canal treatment in order to change the shape of a tooth
Points to note after endodontics (Root Canal Treatment):
After root canal treatment, the tooth may become weaker so it is necessary to place a crown to protect it from fracture After pulp tissue is removed, the tooth may be discoloured gradually. A crown can maintain the appearance of the tooth Avoid eating hard food, tooth that has lost the pulp may not be able to support excessive biting force Regular follow-ups to check if the tooth has problem like reinfection, root fracture or presence of abscess If temporary filling material is lost, patients must seek for help as soon as possible to prevent bacteria in the saliva from infiltrating into pulp chamber

Periodontal Treatment

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Periodontitis is a chronic inflammation and destruction of the periodontal tissue around teeth. It can range from mild gingivitis to severe periodontitis. Teeth may become mobile and drifted, affecting chewing function and aesthetics respectively.

Signs and symptoms of Gingivitis:
Redness of gum margin Bleeding on probing Calculus formation
Signs and symptoms of Advanced Periodontitis:
Bone resorption and gum recession Mobile teeth with periodontal pockets Blood or pus from the pockets Drifting of teeth Chewing function deterioration
Treatment of periodontitis:
Root planing It is also called as deep scaling. Inflamed tissue will be removed with device, so that healthy gum tissues can grow back within a short period of time.
Root planing procedure:
Oral examination Use special dental instruments to reach the bottom of inflamed gums Remove calculus and inflamed gum tissue thoroughly
Limitations of root planing:
Can only stabilize the health of the tissues around teeth, but cannot regenerate the lost tissues Teeth may lose eventually, depending on the severity and the efficacy of treatment Patient has to comply to exercise vigorous oral hygiene maintenance When the periodontal pocket is too deep and bone loss is severe, it can only be treated with Periodontal Treatment
Periodontal Treatment

Surgical treatments can be divided into flap surgery and guided tissue regeneration. These methods can completely remove the inflamed tissues.

Flap surgery procedure:
Local anesthesia Make tiny incisions in the gum to separate gum tissues from the tooth Use ultrasound to clean the surface of tooth root, as well as tartar, plaque stain and biofilm under the periodontal abscess thoroughly Suture the incisions
Guided tissue regeneration procedure:
Access if the patient is suitable to receive the treatment Design treatment plan according to the status of gum and bone regeneration Fill the damaged area with dental bone graft material Cover with an artificial membrane to provide space for gum tissues to grow

Cone-beam Computed Tomography

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Cone Beam Computed Tomography (CBCT) is commonly used for oral diagnosis and treatment planning. It has the advantage of getting rich information of the jaws and associated structures but at reduced radiation dose. General x-ray images are in 2D, which limit the clinical diagnosis and treatment planning of the dentist. Patient's tooth structure, soft tissue, nerve pathways and bones can be reconstructed by the 3D images obtained through CBCT, so that dentist can have a thorough picture of various structures in order to provide suitable and precise treatment.

Cone Beam Computed Tomography (CBCT) features:
The scanning takes around 20 seconds only Low radiation Only a single rotation of 360 degrees is required, which is different from the traditional tomography that requires many rotations Can obtain X-ray instantly 3D images

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CAD/CAM intra Oral Scan and Same Day Restoration
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Q&A

Surgical Wisdom Teeth Extraction
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When should wisdom teeth be removed?
1. Gum tissues close to the wisdom teeth are often inflamed, swollen or painful
2. Wisdom tooth is horizonatally or angularly tilted, pushing the adjacent tooth
3. Wisdom tooth is decayed or cracked
Does wisdom tooth extraction hurt?
The discomfort of surgery is reduced with the help of local anesthesia. Medication is prescibed for the management of pain after surgery.
Do you need an X-ray before wisdom teeth extraction?
X-ray is needed before any tooth extraction. Under certain circumstances, extra scan is required to evaluate the risk from a better understanding of the position of tooth and nerve impairment.
Why wisdom tooth extraction harder than normal tooth extraction?
Wisdom teeth are located at the inner area. Mouth opening of a patient is sometimes limited. In addidtion, the wisdom teeth may be unerupted, horizontally or angularly tilted, increasing the level of difficulty. Sectioning approach may be an option to avoid nerve.

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Implant
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Who is suitable for dental implants?
Implant is suitable for following condition:
1. One or more missing teeth
2. Unable to restore missing teeth in traditional way
3. Want to improve chewing experience
Who is not suitable for dental implants?
Implant is not recommended for the following candidate:
1. Teenagers not having permanent dentition
2. Pregnant women
3. Patients with complex medical history
4. People who are addicted to alcohol and tobacco
5. Patients with immune system problems
6. Patients taking anticoagulants
7. Patients with high blood pressure or cardiovascular problems
A comprehensive examination is required to determine the suitability of implant placement.
What should I pay attention to after dental implants?
You must follow the instrcutions given by the dentist. No smoking or drinking is allowed. Soft diet is advised. You need to rinse by lukewarm saline so as to keep the area cleaned and avoid infection.
Does dental implant surgery hurt?
The discomfort of surgery is reduced with the help of local anesthesia. Medication is prescribed for the management of pain after surgery.
What are the risks of dental implants?
Implant has a success rate of 90% to 97%. The use of digital scan and CT enhance pre tratment assessment. With more information provided, a better and more accurate plan can be prepared. Hence, reducing uncertainty in placing an implant fixture.
What are the complications of dental implants?
Post-operative complication is rare. Wound infection or gum imflammation are more common due to insufficient attention to oral hygiene.
Can tooth extraction and dental implant be done at the same time?
Extraction with simultaneous implant placement is possible in some cases. Prior assessment of oral condition is required, with no bone loss or inflammation. Stability of implant is the most signifcant concern.

Q&A

Endodontics (Root Canal Treatment)
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Can toothache be solved after root canal treatment?
The acute pain is alleviated. Only the reaction of medication filled may cause slight discomfort at the first stage of treatment. It can be managed by pain killer.
Why is dental crown necessary after endodontics (root canal treatment)?
The tooth is still prone to fracture after root canal treatment. Protection by a crown on the root canal treated tooth is recommended.
What causes pulpitis?
1. Broken tooth
2. Severe tooth decay
3. Malocclusion or heavy grinding of teeth
4. Heavily restored tooth

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Periodontal Treatment
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Is gum infection a symptom of periodontal disease?
Gum swelling and bleeding after brushing are signs of unhealthy gum. Poor oral hygiene is the most common cause of periodontitis. The accumulated plaque and tartar leads to the inflammation of gum. The infection will further damage the soft tissue and destroy the bone supporting the teeth. The tooth becomes loose, shifted or even fall out.
Who is more prone to periodontal disease?
1. Smokers
2. Patients without regular oral examination and cleaning
3. Patients with systemic diseases (eg. AIDS, diabetes, etc.)
4. Patients taking long-term medication
Why do I still have periodontal disease even with regular teeth scaling and brushing?
Gum infection is not the only cause of periodontal disease. Recent studies indicate a certain relationship with diabetic condition. Bone indensity is another factor as well. Therefore, it is important to have regular examination and cleaning for a professional assessment by dentist.
Why my teeth is sore and sensitive after root planing?
It is normal to have tooth sensitivity after root planing, especially for those root exposed cases. The plaque and subgingival heavy calculus are removed. Exposed root surfaces will be sensitive.
How often do I need to have follow-up visit for periodontal treatment?
Patient with periodontal problem needs to attend review visits frequently. The number of visits affects by the severity and compliance of patient. Under noraml circumstances, review every 3-month is recommended for those situtaion under control.

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Cone-beam Computed Tomography
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Does the radiation dosage of dental irradiating apparatus affect human body?
The dosage of radiation from dental irradiating apparatus is relatively low especially if it is digital based. Personal protective measures are avaliable at clinic. Generally speaking, no radiographic investigation is recommended for pregnant mother.
What is the difference between CT scan and traditional X-ray film?
Traditional X-ray film is a 2-dimensional image showing the approximate distribution of teeth and nerve. There is a possibility of overlapping image. CT scan is a 3-dimensional data, presenting a more precise picture of teeth and condition of tissue. The uncertainty decreases with a better understanding.
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