What is a bridge?
Firstly we can make all bridges that are required for our patients. A bridge in dentistry is a method of replacing lost teeth. With the advent of affordable implants we are fitting fewer and fewer bridges. This is mainly because a bridge usually involves shaping the teeth on either side of the space into pegs to allow the bridge to be cemented in place. The bridge consists of two crowns joined together by a false tooth. They are traditionally constructed of dental porcelain fused to white gold so that the gold supporting framework is invisible. This provides a very strong and long lasting restoration if it is well constructed and designed. Recently more modern materials including Zirconia are used. Zirconia is one of the strongest ceramics that have been invented. Using modern milling machines a Zirconia block is custom shaped for your bridge and dental porcelain is fused to the surface to make an outstandingly aesthetic restoration that blends in with the rest of your teeth.
Other bridges are manufactured with a metal framework that is made with minimal shaping of the next door teeth and the false tooth is made with metal wings which are cemented to the teeth, this is called a Maryland Bridge. It is less popular than it was in the 80’s and 90’s because the metal wings tend to shadow through on the support teeth and make them look dark. They also tended to come unbonded unless great care was made in their design due to the natural movement of the support teeth eventually breaking the hold of the cement.
Crowns and Caps
Why do I need a Crown?
A Crown is simply described as a hat that fits on top of the prepared tooth. They are usually made for teeth that are severely broken down. The tooth is smoothed down to a peg shape and a very accurate impression is taken of the preparation. This impression is sent off to the technician and the crown is fabricated. Crowns are the strongest of restorations for broken down teeth because they wrap around the tooth and hold the remaining parts together. Crowns can be made of a variety of materials, including:
- Porcelain fused to metal (usually white gold)
- Ceramic fused to Zirconia (The most modern)
- Gold Alloy
- Acrylic or Composite resin made in the laboratory
- Milled Ceramic made at the Chair side
- Other metal alloys including chrome
The most successful crowns over the years are the first type where a white gold thimble is made on a copy of the tooth preparation and then ceramic is fired onto it in layers. Over the years it has been the most aesthetic of the crowns, and is certainly really strong but suffers from the fact that the gold is opaque and thus doesn’t let the light through. This means that if the gum shrinks back over the years, you often end up with a dark root showing above the crown. Modern Zirconia crowns have a very strong ceramic as the thimble which is transluscent, this allows the light to penetrate down the root and helps to stop the dark root problem.
Dental implants are one of the most exciting things to have happened to the Dental Profession over the last 25 years. When I was studying at Dental School, I went on an elective study abroad to Japan, and did a project on their studies into dental implants. Indeed King’s College Dental Hospital in 1986, where I trained, were at that time starting to place titanium dental implants invented by Brannemark.
I have chosen to use Nobel Biocare’s titanium dental implants, because they have the longest research history and track record. These implants are among the most expensive on the market, but are definitely the implants that I would want to have placed in my mouth after all my studies. There are many brands of implants on the market that are cheaper but it never pays to compromise on cost.
All those years ago Professor Brannemark discovered that pure titanium is biocompatible, that is bone and connective tissue actually join onto the surface of a prepared titanium surface and treats it as body tissue!
In the surgery, under local anaesthetic we prepare a ‘socket’ in the bone and shape it to receive the titanium ‘root analogue’. This is usually buried under the gum for at least three months and then later exposed once more and a healing connector placed and the gum replaced around it. After a short time a crown can be placed on the implant and “hey presto” you have a fully functioning ‘new tooth’!
Dentures | False Teeth
What are you looking for in replacing lost teeth? Most people would say comfortable well fitting dentures that look better than the originals! We can achieve that in most situations.
Dentures or false teeth don’t have to look like they are not your own teeth. Most of us have seen people whose teeth obviously look false. That does not have to happen to you! I like to treat you as an individual and choose the denture teeth to individually fit your facial shape and profile. If you happen to have a close up photo of your appearance before you lost your teeth bring it along and we will use it to create as natural a looking dentition as your own. There is no need to compromise on cosmetics when we make your teeth for you, and always go through two sets of impressions and then a ‘try in’ stage. This is where the teeth are set up in wax so that I can move them around to get the perfect shade of tooth and natural appearance that you are happy with.
So many of my patients say to me that they have never had a dentist that takes so much time over making them a set of teeth! I love to keep my good reputation even though it means that often people are so happy that we don’t see them for many years. I always tell my patients though that we do need to maintain dentures to ensure that you keep a healthy mouth. So regular check ups do still remain important.
Veneers are just like false fingernails that are permanently fixed to the front of a tooth to beautify it and to change its shape into one that is more aesthetically appealing. The most natural looking veneers almost always involve modifying the surface of the tooth to obtain the best profile and stop the tooth looking ‘blocky’ and unnatural.
Veneers can be made in many materials.
- Ceramic The most natural looking are made of ceramic in the laboratory by a skilled technician to an exact colour map that the dentist prescribes. They enable the tooth to be lengthened and lightened as required. Well designed veneers are almost as strong as the original tooth. Ceramic veneers are the most expensive but are also the most lifelike, they are the best material for masking darkened or root filled teeth. There are many different types of ceramic, ask your dentist if you are interested in more information.
- Composite Usually composite veneers are fabricated in the mouth by the dentist. The resin is patted onto the prepared tooth and using different shades and translucencies. It is then polished and shaped before the finished product is achieved. Modern composites can achieve a remarkable lifelike effect but it is much harder to mask dark teeth using this method. Because there is no laboratory component they are less expensive to make.
- Acrylic This is usually considered a material of the past due to the increased strength of modern composite resins. Acrylic veneers are made in the laboratory.
There are two main methods of bleaching teeth that are used at the dentist, these are the home bleaching technique, and the in surgery technique. I personally prefer the former because it is the most successful when used by itself and gives the best long term results with the present techniques.
Home bleaching involves taking impressions of your teeth and then casting these impressions up in Plaster of Paris. These models are modified and a clear silicon bleaching stent is vacuum formed over the top of it. It is trimmed up so that it covers the entire surface of the teeth up to the gum line. We get you back to the surgery and make sure these bleach trays fit your mouth comfortably and are well adapted to the gum margin to stop the bleach material leaking out. The correct techniques of applying the gel are then demonstrated to you and a shade of your teeth taken so that we have a record of the starting colour. I also like to take photographs of your teeth so that we have a record of how much the teeth lighten. Generally bleaching then proceeds in your home. I like you to wear the bleach trays at night while you sleep. Studies show that maximum effectiveness of bleaching occurs during the first six hours of the bleach being applied to your teeth. This is also more successful at night because the salivary flow rate drops when you are asleep and therefore there is less dilution of the gel by the saliva. Rarely some people find it difficult to sleep with the trays in, so in that case we find that the trays can be used in the evening straight after the evening meal once you have flossed and cleaned your teeth. This usually will give several hours wear time.
I find that we get good results after applying the gel for seven to ten nights. But prefer to wait for 3 weeks before reviewing you again because after you stop there is a little ‘bounce back’ as the teeth darken just a little as the enamel rehydrates. Normally there is a shade change of 7 tones on our shade guide.
Here lies the interesting fact. Most of the lightening that occurs during the in surgery whitening of your teeth – when a gel is painted on your teeth and light/heat is applied to activate the bleaching process, is due to dessication of the enamel. When the enamel is dried it goes several shades whiter! Once the process is finished the enamel will slowly rehydrate and go back to the original colour once more! Of course if the patient is given home bleaching trays to “top up” the bleach you will notice that the bleaching is more permanent!
Because it involves so much less surgery time the home bleach technique is normally the cheapest method, and because it works so successfully this is the method that I prefer. Of course you will then have the bleach trays which can be kept for several years. If you want to keep the teeth as white as they can go normally a couple of nights bleaching every six months is all you will require. Extra bleach gel is not expensive and we are happy to provide it if you require.