Restorative and Cosmetic Dentistry｜Oral Exam & Treatment Plan

Orthodontics

Q&A

Teeth malalignment not only affect the overall appearance, crowding of teeth will encourage more plaque accumulation which in turn will increase the risk of periodontal disease and dental caries. Masticatory efficiency can also be affected. Prolonged chewing function problem can lead to Temporomandibular joint disorders.

Objectives of orthodontic treatment:

Improve facial profile and aesthetics Improve masticatory efficiency Reduce risks of periodontal disease and dental decay Improve self esteem

Orthodontic treatment options

Orthodontic treatment can mainly be divided into three types, which are metal braces, lingual braces and clear aligners. Treatment time varies depending on patients’ oral condition. It usually takes between 1 to 1.5 years, or may take 2 or more years for complicated cases.

	Metal braces	Lingual braces	Clear aligners
Principle	Brackets are attached on the surface of teeth. Using an arch wire to connect brackets to exert pressure to move teeth into proper positions	Brackets are attached on the surface of teeth. Using an arch wire to connect brackets to exert pressure to move teeth into proper positions	Use computer to demonstrate teeth movement during treatment. Patients need to change tailor-made braces regularly to correct teeth position gradually
Material	Metal/ Enamel / Resin	Metal/ Enamel / Resin	Medical-grade plastic
Removable	Cannot be removed by patients	Cannot be removed by patients	Can be removed and worn anytime
Can be removed and worn anytime	Attached to the outside of teeth, easy to be noticed	Attached to the inside of teeth, hard to be noticed	Invisible aligners, virtually invisible, very hard to be noticed
Cleaning	Need to use tools to clean the braces and the arch wire	Need to use tools to clean the braces and the arch wire	Can clean it after removing from teeth
Effectiveness	More suitable for patients with crooked teeth	More suitable for patients with crooked teeth	Suitable for patients with mild or moderate teeth irregularity
Others	Brackets may cause discomfort	Brackets may cause discomfort	The surface of aligner is smooth

Orthodontic treatment procedure:

Orthodontist will check and evaluate patient’s facial profile and oral condition to confirm whether orthodontic treatment is indicated Take extra oral and intra oral photos, panoramic and lateral cephalometric X-rays, and teeth impressions to produce plaster models for space analysis Orthodontist explains the condition in details and the treatment plan Wear the braces and have regular follow-ups After completion of the treatment, regular follow-ups are required. Patients need to put on retainer at night to help teeth stay in place

Note: Usually orthodontic treatment can be commenced after all deciduous teeth have exfoliated but there are some exceptions where intervention is necessary

Crown and Bridge

Q&A

Crown

A crown is an artificial “cap” placed on a single tooth. When the tooth is damaged, caused by extensive decay, cracked tooth, fractured tooth or after the completion of root canal therapy, etc. It is more desirable to place a dental crown to strengthen and protect the fragile tooth, rather than removing the entire tooth.

Crown treatment procedure:

Trim and reshape the tooth which needs to be capped Take an impression and construct a temporary crown to protect the trimmed tooth Remove the temporary crown and clean the tooth thoroughly Cement the actual crown over the tooth

Teeth that are suitable for crown treatment:

Need to restore the shape of tooth When orthodontic treatment is not possible Badly broken down because of gross caries or traumatic injuries Need to place a crown to improve the appearance and strength of the tooth because it is badly damaged, or turns into greyish and yellowish brown colour

Bridge

Using a bridge to replace missing teeth. It is suitable for people who still have healthy adjacent teeth. Dental bridge is not only able to repair appearance, but also to restore normal chewing function and improve pronunciation problem resulted from loss of teeth.

Bridge treatment procedure:

Remove damaged tooth Trim the natural teeth that are used as bridge support Take an impression and construct a bridge Cement the bridge on the adjacent natural teeth to replace the missing teeth Polish and adjust occlusion

Advantages

Improve the stability of artificial teeth Create support which can restore chewing function Fixed design so it is not necessary to remove at night time Simple and safe procedure, surgery is not needed

Disadvantages

Difficult to clean and floss If one of the teeth used for bridge support is diseased or broken down, the entire dental bridge may need to be removed for treatment

All-Ceramic Crown and Zirconia Crown

There are various materials for making dental crowns, including full metal, porcelain fused to metal (PFM), all-ceramic and zirconium. Each material comes with its pros and cons, your dentist will recommend a suitable one depending on your situation.

	Full metal crown	Porcelain fused to metal crown	Zirconia crown	All-ceramic crown
Pros	·Great strength and durable, suitable for posterior teeth that require greater bite force ·As resistant as natural teeth ·Strong even very then, so no need to trim a lot of precious tooth substance Unlikely to wear the opposing tooth	·Metal inside and with ceramic covers outside, making the crown tooth-coloured but still as strong as metal crown	·Great strength and durable, which is as strong as full metal crown ·Aesthetic natural-looking tooth-coloured	·Most natural-looking, reflects and transmits light like natural teeth Suitable for anterior teeth where the highest aesthetics is required
Cons	Metal colour which is not suitable to use on anterior teeth Expensive if precious metal like gold is used May cause inflammation or metal allergies	Have double layers, so the crown is relatively thick, more tooth substance has to be trimmed Unnatural colour because light cannot shine through May leave visible grey lines at the margin which affect appearance The outer ceramic layer can chip off from the metal core	Thicker than full-ceramic crown, so the original teeth need to be trimmed more	Not as strong as metal crown

Complete and Partial Denture

Q&A

Denture is a removable set of false teeth. It can be divided into complete and partial denture depending on whether some or all teeth are lost. Partial dentures have clasps that attach on teeth next to missing teeth for retention. Removable denture is a simple and least invasive way of replacing multiple teeth.

Consequences of missing teeth:

The adjacent teeth next to missing teeth may drift into unoccupied spaces which will lead to malocclusion and food trapping Affect chewing function which leads to poor digestion and nutrient absorption Food debris can easily get stuck between teeth. It will increase the risk of tooth decay and periodontal disease

Partial Denture

Partial dentures are suitable for patients who still have healthy teeth remain. There are metal framework or clasps on the denture. The clasps help to retain the denture and allow the patient to remove easily.

Complete Denture

Complete dentures are for patients who have lost all the teeth. They are supported by oral mucosa and alveolar ridge. Patients can remove them by themselves. However, the chewing force of complete denture is significantly different from natural teeth. It can keep moving in the oral cavity by movements of oral muscles and the tongue causing discomfort and speech problem. It takes time for patients to get used to.

Pros:

Replace missing teeth to restore chewing function Easy to clean as it is removable Restore facial profile by improving the “sunken face appearance”

Cons:

Mucosal ulcers may develop, so more visits of follow-ups are required for adjustment May affect pronunciation Require thorough clearing

Differences between fixed and removable prosthesis

	Fixed prosthesis	Removable prosthesis
	Crown Bridge	Partial denture Complete denture
Suitable for	With healthy tooth root Tooth substance loss is too extensive Received root canal treatment Have adjacent healthy teeth next to the missing tooth The entire tooth is removed	Some healthy teeth remain All teeth are lost
Material	Metal, porcelain-fused- to-metal, all-ceramic and zirconium	Metal framework and clasps False teeth are usually made of plastic Plastic framework False teeth are usually made of plastic
Pros	Can keep the root of the natural teeth “Fixed” false teeth	Can wear and remove freely
Cons	Need to trim teeth Need to trim the adjacent teeth Need to remove the entire bridge if one of the supporting teeth is decayed or damaged	Easy to develop tender areas or ulcers Long adapting time Long adapting time as the bite feeling is significantly different from natural teeth Easily displaced

Teeth Whitening

Q&A

A tooth consists of three layers, the outmost layer which is the transparent enamel, the middle layer which is the slightly yellowish dentin, and the innermost layer which is pulp tissues. Most people’s teeth are in ivory white to light yellow colour. For those who have thicker enamel layer may have whiter teeth.
However, teeth will turn yellow with aging due to tooth wear. In addition, consuming food or drinks that include pigmentation, such as tea, coffee, cola, red wine, curry, and chocolate, as well as smoking may affect teeth color.

Teeth whitening method：

Currently, there are several effective teeth whitening procedures, the choice of which depends on different situations.

In-office bleaching : Apply whitening gel onto the surface of the teeth. After that, it is “activated” by laser to remove intrinsic and extrinsic stain. Home bleaching: Add prescribed bleaching gel into a customized tray. The gel will penetrate for teeth whitening.

In-office bleaching procedure:

Compare teeth colour with dental colour palette, and select a suitable one Apply a protective agent on the gums to prevent blue light and whitening gel from damaging the gums Apply whitening gel “Activate” the whitening gel by laser light for 2 to 3 times Clean the whitening gel and the protective agent on gums Compare the selected dental colour palette with the teeth colour to evaluate the effect of the treatment

Pros of in-office bleaching

Remarkable result, teeth can be at least 8 shades whiter Immediate result after completion The effect can be maintained for at least one year Can deal with stubborn stain

Cons of in-office bleaching

May cause teeth sensitivity for a short period of time

Contra-indications of in-office bleaching

Situation	Reason
Tooth decay	Whitening gel may penetrate into the inner layer of teeth through cavities. This may cause irritation to the dental pulp, so it is recommended to fix all other dental problems before in-office bleaching
Sensitive teeth	Whitening gel and blue light may cause irritation to teeth. This can make sensitive teeth even more sensitive

Ceramic Veneer

Q&A

Veneers can modify the shape, colour and alignment of teeth to improve aesthetics. Dentist will attach a thin covering of tooth-coloured shell over a tooth by dental adhesive. After a veneer is placed, the colour of the natural tooth can be restored and appearance can be improved.

People who are suitable to use ceramic veneer:

Teeth colour is too dark even teeth bleaching cannot restore the whiteness Unevenly shaped teeth (e.g. teeth are too small, dents or bumps on the teeth surface) Large gaps between teeth Teeth in faulty positions Teeth are injured, chipped or broken Teeth are injured, chipped or broken

Ceramic Veneer treatment procedure:

Dentist will do a thorough examination and provide essential cleaning and fillings where necessary Confirm to start the treatment Removing enamel on the teeth surface by trimming the teeth a bit shorter and thinner Take impressions Design and customize the veneer Cement the veneers on the teeth Check the fit and colour of the veneer Follow-ups to check the gum condition and the position of veneer

Pros of ceramic veneer:

Correct the position and colour of teeth within a short period of time The amount of tooth substance to be trimmed is small The material of veneer can resist stains caused by food Do not affect normal biting and chewing functions Easy to adapt Natural result

Cons of ceramic veneer:

Risk of cracking or falling off If veneer is not accurately attached to the surface of teeth, it can easily lead to dental problems such as tooth decay, gum inflammation and periodontitis Highly technique sensitive

Full Mouth Rehabilitation

Full mouth rehabilitation can enable people who have extensively missing, injured, broken or cracked teeth due to tooth grinding , tooth decay, periodontal disease, etc. to restore to normal oral function and health through artificial implants and dentures. Dentist will customize a treatment plan according to required teeth function and appearance. Treatments include braces, dental crowns and bridges, veneer and implants.

Full mouth rehabilitation methods:

Full mouth dental implants
Using surgical method to implant all missing teeth. Dental implants are stable and the chewing function is close to natural teeth. Complete Denture
Use the remaining teeth and oral mucosa to fix the denture in the mouth. It can stimulate the condition of natural teeth to support chewing and eating. This treatment is cheaper and can be completed in shorter time, but it may take longer for patients to adapt wearing a denture. All-on-4 Dental Implant
Place 4 to 6 metal dental implants to fix a whole set of teeth bridge on it. All-on-4 dental implant can stimulate the biting function of natural teeth. This treatment will make less wounds on the gum, and the recovery time is shorter. The price is also lower than full mouth dental implants.

All-on-4 Dental Implant Treatment Procedure:

Dentist will do a cone beam CT first to plan the sites and sizes of implants. Then, a surgical guided will be fabricated by dental laboratory with the aid of a software Before the surgery, dentist will assess the general health condition and medical history of the patient On the day of the surgery, 4 to 6 metal implants will be placed into the upper and lower jaws with the aid of the surgical guide, under local anesthesia After inserting the dental implants, the patient will need to take impression to make a temporary full arch dental bridge. The temporary bridge will be fixed with screws After several months, the implants will integrate firmly with the jawbone. Dentist will attach a permanent metal or all-ceramic denture or dental bridge on the implants After the treatment is completed, the patient is required to have regular check-up, maintenance and cleaning every year

Pros of All-on-4 Dental Implant Treatment:

The surgery does not need to work on boneless area, so bone grafting is usually not needed Can complete the dental implantation surgery of upper and lower jaw on the same day to reduce total treatment time Can eat on the same day after surgery Strong biting force and good aesthetics False teeth can mimic the natural shape of gums and bones. Patients with severe jawbone shrinkage or facial distortion can restore their natural appearance

Laser Dentistry

Laser dentistry is suitable for various dental and oral treatments. It creates much less pain, soreness and discomfort during treatment. The recovery time is usually shorter than that of traditional treatment.

What is included in laser dentistry?

General dental treatment (e.g. periodontitis) Cosmetic dentistry (e.g. modify gum line, remove stains on the gums) Dental surgery (e.g. expose dental implants, wisdom tooth extraction, treatment of oral ulcers, lesions and polyps, etc.)

Advantages of laser treatment:

Short recovery time Reduce bleeding Treatment is more precise which requires smaller incision, so there is less chance post-operative swelling and pain Do not generate as much noise compared to turbines and motors that dentists traditionally use The laser has disinfection and sterilization functions enabling more efficient periodontal and root canal treatments

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