Dental Implants

Dental implants are surgical-grade root devices that support permanent tooth crowns manufactured to last a lifetime. These artificial roots are anchored in the bone beneath the gums where they become fused into the jaw. A crown is mounted atop the implant for a long-lasting and natural looking smile. Most patients prefer dental implants because they offer the same function as natural teeth, prevent reduction of adjacent natural teeth and help prevent bone atrophy in the jaw. Dental implants may be used to replace a single missing or damaged tooth or to restore an entire smile.

Frequently Asked Questions

You may qualify for dental implants if you have missing, broken or severely decayed teeth and are in relatively good overall health. The only way of determining your eligibility for implants is to consult with us, your oral care provider to identify whether you have adequate bone support and healthy gums that will support the new tooth structure.

The placement of dental implants is a multi-step process that typically takes between 6 and 9 months to complete. It begins with a full diagnostic check-up, X-rays and a CBCT scan. Following this, a surgical procedure under local anaesthesia will be performed to place a titanium root where the previous natural tooth root once was. The gums are sutured shut over the implant, where it will stay for 4 to 6 months while it heals and fuses with the surrounding bone. At the conclusion of the healing period we will revisit the site and fit you with a gum shaper. Once this heals ( 2 weeks) you will receive your permanent crown.

Post-operative care following a gummy smile corrective procedure is essential for healing and preventing complications.

General Care :

Activity : After leaving our dental clinic post treatment, we suggest you consider relaxing or at least limiting your activity as much as possible for the remainder of the day. Avoid strenuous activity and aerobic exercise for the next 3 days.

Oral Hygiene : Brushing and oral hygiene procedures should continue as usual in all untreated areas. In exposed, operated areas, limit your oral hygiene to brushing using a soft bristled toothbrush. In areas covered by periodontal dressing, brush only the chewing surfaces of teeth. Avoid dental flossing in operated areas during the first week following surgery. Undiluted medicated mouthwash, salt water or peroxide rinses should be used during the first week following surgery. Also avoid the use of water irrigation devices such as Water-pik for 1 month following surgery. The exposed operated areas should be gently swabbed with a cotton bud saturated with Betadine or Chlorhexidineas as a last oral hygiene procedure at bedtime and again in the morning, after eating and drinking.

Diet : Care should be taken in the immediate postoperative period to minimize contact with the implant. Aside from normal hygiene, it is best to completely leave the implant alone for the first 2 weeks after placement. You may want to limit foods to softer items and chew in an area away from the implant during the 10 to 12 week integration stage

Do's :
  • Some discomfort may be present when the anesthesia wears off. You will be given a prescription for an anti-inflammatory analgesic. If the pain does not subside please do call us and we will guide you further.
  • It is normal for some swelling to occur after surgery, particularly in the lower jaw. To minimize swelling after surgery, apply an ice bag wrapped in a light tea towel or handkerchief on the outside of your face over the operated area. This should be left on your face for about 20 minutes, then removed for 20 minutes, or alternated from side-to-side, between operated areas, for 2-3 hours after surgery. Use of both ice and the medicine as described above will reduce the amount and duration of facial swelling.
  • It is common to have slight bleeding for a few hours following periodontal surgery. If bleeding persists, apply a tea bag to the surgical site with firm but gentle pressure for 15-20 minutes. Rest yourself for 15 minutes then repeat the application of the tea bag for a second time if you still have slight bleeding. If excessive bleeding continues, please call our clinic. Remember, most of the blood you may see in your mouth is actually a little bit of blood mixed with a lot of saliva. Blood is a very strong “dye” and a little bit of blood will color your saliva dramatically.
  • If you are prescribed an antibiotic, it is important that you complete the course of treatment to prevent infection.
Don't :
  • Do not eat until all the anesthesia (numbness) has worn off.
  • Avoid spicy, salty, acidic, very hot or very cold foods or liquids.
  • Avoid nuts, chips or other crunchy or fibrous foods which may become caught between your teeth.
  • No smoking, drinking through a straw and no carbonated or alcoholic beverages for 48 hours following surgery.

use of removalble dental appliances : If you normally wear a removable appliance which replaces missing teeth, and it rests on the operated area, it is best to minimize the use of this appliance as any pressure on the surgical site could be detrimental to healing and cause discomfort.

Did You
Know ?

that approximately 30 million people live with no natural teeth in one or both jaws? But more and more dental patients are opting for dental implants as a means of tooth replacement. Modern titanium implants were first developed in the 1950’s, but archeologists have determined that ancient Egyptians and Mayans were the first cultures to implant artificial teeth.

Dental Crowns

A dental crown is a tooth-shaped "cap" that is placed over a tooth -- to cover the tooth to restore its shape and size, strength, and improve its appearance.

The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

Frequently Asked Questions

A dental crown may be needed in the following situations :

  • To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth
  • To restore an already broken tooth or a tooth that has been severely worn down
  • To cover and support a tooth with a large filling when there isn't a lot of tooth left
  • To hold a dental bridge in place
  • To cover misshapened or severely discolored teeth
  • To cover a dental implant
  • To make a cosmetic modification
  • For children, a crown may be used on primary (baby) teeth in order to :
    - Save a tooth that has been so damaged by decay that it can't support a filling.
    - Protect the teeth of a child at high risk for tooth decay, especially when a child has difficulty keeping up with daily oral hygiene.

In such cases, a pediatric dentist is likely to recommend a stainless steel crown.

Temporary Crowns : These crowns are usually made of a tooth coloured resin or acrylic and are cemented in place. They are used as a temporary measure until your permanent dental crown is fabricated by the dental lab.

Permanent crowns : can be made from stainless steel, all metal (such as gold or another alloy), porcelain-fused-to-metal or all ceramic dental crowns.

Stainless steel crowns : These are prefabricated crowns that are used on permanent teeth primarily as a temporary measure. The crown protects the tooth or filling while a permanent crown is made from another material. For children, a stainless-steel crown is commonly used to fit over a primary tooth that's been prepared to fit it. The crown covers the entire tooth and protects it from further decay. When the primary tooth comes out to make room for the permanent tooth, the crown comes out naturally with it. In general, stainless steel crowns are used for children's teeth because they don't require multiple dental visits to put in place and so are more cost- effective than custom-made crowns and prophylactic dental care needed to protect a tooth without a crown.
Metals used in crowns include alloys that have a high content of gold or platinum, or base-metal alloys (for example, cobalt- chromium and nickel-chromium alloys). Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, metal crowns rarely chip or break. The metallic colour and the high price of gold is the main drawback. Metal crowns are a good choice for out-of-sight molars.

Porcelain-fused-to-metal (PFM crowns) : These dental crowns can be colour matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal crowns. The crown's porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown's porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth as well as long bridges where the metal is needed for strength.

All-ceramic or all-porcelain dental crowns : These crowns provide better natural colour match than any other crown type and may be more suitable for people with metal allergies and are also lighter in weight. All-ceramic crowns can be used for front and back teeth.

Preparing a tooth for a crown usually requires two visits to the dentist -- the first step involves examining and preparing the tooth, the second visit involves placement of the permanent crown.

First visit : Examining and preparing the tooth

At the first visit in preparation for a crown, our crown and bridge specialist will take a few X-rays to check the roots of the tooth receiving the crown and surrounding bone. If the tooth has extensive decay or if there is a risk of infection or injury to the tooth's pulp, a root canal treatment may first need to be performed. If the surrounding gum tissue is excessive or the tooth is too short then a further gum procedure called crown lengthening procedure (CLP) will need to be performed as well.

Before the process of making a crown begins, your dentist will anesthetize (numb) the tooth and the gum tissue around the tooth. Next, the tooth receiving the crown is reshaped along the chewing surface and sides to make room for the crown. The amount removed depends on the type of crown used. If, on the other hand, a large area of the tooth is missing (due to decay or damage), your dentist will use filling material to "build up" the tooth to support the crown.

After reshaping the tooth, your dentist typically will use a paste or putty to make an impression of the tooth to receive the crown. Sometimes, though, impressions are made with a digital scanner. Impressions of the teeth above and below the tooth to receive the dental crown will also be made to make sure that the crown will not affect your bite.

The impressions or scans are sent to a dental lab where the crown will be manufactured. The crown is usually returned to your dentist's office in two to three weeks. If the crown is made of porcelain, your dentist will also select the shade that most closely matches the color of the neighboring teeth. During this first office visit your dentist will make a temporary crown to cover and protect the prepared tooth while the crown is being made. Temporary crowns usually are made of acrylic and are held in place using a temporary cement.

Second visit : Receiving the permanent dental crown

At the second visit, your dentist will remove the temporary crown and check the fit and color of the permanent crown. If everything is acceptable, a local anesthetic will be used to numb the tooth and the new crown is permanently cemented in place.

Because temporary dental crowns are just that -- a temporary fix until a permanent crown is ready -- most dentists suggest that a few precautions. These include :

  • Avoid sticky, chewy foods (for example, chewing gum, caramel), which have the potential of grabbing and pulling off the crown.
  • Minimize use of the side of your mouth with the temporary crown. Shift the bulk of your chewing to the other side of the mouth.
  • Avoid chewing hard foods (such as raw vegetables), which could dislodge or break the crown.
  • Slide rather than lift out dental floss when cleaning between your teeth to avoid pulling off the temporary crown.

Discomfort or sensitivity : Your newly crowned tooth may be sensitive immediately after the procedure as the anesthesia begins to wear off. If the tooth that has been crowned still has a nerve in it, you may experience some heat and cold sensitivity. Your dentist may recommend that you brush teeth with toothpaste designed for sensitive teeth. Pain or sensitivity that occurs when you bite down usually means that the crown is too high on the tooth. If this is the case, call your dentist. He or she can easily fix the problem.

Chipped crown : Crowns made of all porcelain or porcelain fused to metal can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. This is usually just a temporary fix. If the chipping is extensive, the crown may need to be replaced.

Loose crown : Sometimes the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth that remains. If a crown feels loose, contact your dentist's office.

Crown falls off : Sometimes crowns fall off. Reasons include decaying of the underlying tooth and loosening of the cementing material used to place the crown. If your crown comes off, clean the crown and the front of the tooth. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact your dentist's office immediately. He or she will give you specific instructions on how to care for the tooth and crown for the day or so until you can be seen for an evaluation. Your dentist may be able to re-cement the crown in place; if not, a new crown will need to be made.

Allergic reaction : Because the metals used to make crowns are usually a mixture of metals, an allergic reaction to the metals or porcelain used in crowns can occur, but this is extremely rare.

Dark line on crowned tooth next to the gum line : A dark line next to the gum line of your crowned tooth is normal, particularly if you have a porcelain-fused-to-metal crown. This dark line is simply the metal of the crown showing through. While not a problem in itself, the dark line is cosmetically unacceptable and your dentist may have to replace the crown with an all porcelain or ceramic one.

Onlays and 3/4 crowns are variations on the technique of dental crowns. The difference between these crowns and the crowns discussed previously is their coverage of the underlying tooth. The "traditional" crown covers the entire tooth; onlays and 3/4 crowns cover the underlying tooth to a lesser extent.

On average, dental crowns last between five and 15 years. The life span of a crown depends on the amount of "wear and tear" the crown is exposed to, how well you follow good oral hygiene practices, and your personal mouth-related habits (you should avoid such habits as grinding or clenching your teeth, chewing ice, biting fingernails, and using your teeth to open packaging).

While a crowned tooth does not require any special care, remember that simply because a tooth is crowned does not mean the tooth is protected from decay or gum disease. Therefore, continue to follow good oral hygiene practices, including brushing your teeth at least twice a day, flossing daily -- especially around the crown area where the gum meets the tooth -- and rinsing with an antibacterial mouthwash at least once a day.

Costs of crowns vary depending on what part of the country you live in and on the type of crown selected (porcelain versus gold, for example). Generally, crowns can range in cost from $800 to $1700 or more per crown. A portion of the cost of a crown is generally covered by insurance. To be certain, check with your dental insurance company.

Dental Bridge

As many of us know, when you have a missing tooth, it can be difficult to communicate, speak, bite or even eat effectively. When a tooth is missing, it is essential to visit your dentist to discuss the dental options for replacement.

Dental bridges are utilized in dentistry to replace missing teeth and provide a dental prosthesis that connects the adjoining teeth. The teeth on either side of the missing tooth are called abutment teeth and the replacement tooth is called the pontic (false tooth). The pontic teeth are usually made from gold, porcelain alloys, or a combination of materials. The anchor teeth (abutment teeth) can be your natural teeth or implants and they act as the main support for your bridge. Fixed bridges are strong and reliable and in most cases, they feel and look very much like natural teeth!

Dental Bridges have been an integral part of modern dentistry since the early part of the last century and prior to the use of dental implants was the preferred method for replacing missing teeth. Bridge technology is still viable and therefore we’ll be sharing some basic information and discussing the advantages (in certain cases), bridges can provide over dental implants. This is in lieu of the fact that dental implants are now the tooth restoration treatment method of choice for us and most dentists globally!

Some of the general advantages of dental bridges :

  • Dental bridges are usually small, lightweight, providing excellent chewing comfort
  • They correct and re-distribute the normal bite force, compromised by your missing teeth
  • Getting used to your new dental bridge is usually easy and comfortable
  • Controls shifting and moving of adjoining teeth
  • Only 2 – 3 appointments are needed to complete your bridge restoration
  • The longevity factor and general prognosis is good, if your hygiene and home care is maintained at a heightened level

Disadvantages of Dental Bridges :

  • Please remember that if something goes seriously awry with one of your abutment teeth, your entire dental bridge could be compromised. For example, if you develop a deep cavity, dental infection or periodontal (gum) disease with either supporting tooth, then you may lose the entire bridge. Therefore the space involved, design, fit and loading capacity, along with the diagnosis of whether to do a bridge or not is critical and should be done by a specialist in dental crowns and bridges.
  • A common error when making a dental bridge is their often too long! According to physical law (Ante's Law), the longer the span of the bridge, the more force is placed on the abutment teeth. This excessive force can cause intolerable stress on the adjoining abutment teeth. Therefore, careful consideration of the biting forces, relative to your dynamic occlusion and what you eat determines what should be done.
  • The biggest disadvantage with dental bridges is the adjacent tooth preparation, especially if it involves young teeth with little or no restorations. We at Therapeuo really don’t like preparing these virgin teeth to act as abutments, because studies indicate that these teeth will most likely need root canal therapy in the future. This condition occurs, because preparing a tooth or teeth for a dental bridge is still an injury to the tooth. Reducing much of the enamel from your tooth can lead to inflammation of the nerve which leads to tooth sensitivity or dental pain, a side effect occurring in 1-3% of cases. To reduce or prevent this unnecessary side effect from occurring, at TDMC we rely on a special minimally invasive lab process to prepare your tooth – teeth. This technique allows for the creation of strong crowns, requiring only 1mm of support tooth prep, and also limits the heat generated during the process. As a result, we can reduce the incidence of side effects to less than 1 in 500 cases.

Frequently Asked Questions

Our Restorative dentist and Crown and Bridge Specialist (prosthodontist) will provide you with the best choice for you to decide whether you're the right candidate for a bridge or not. In order to even consider the design and construction of a dental bridge, two stable, healthy, abutment teeth must be factored into the equation. X-rays and a thorough oral examination will be carried out to assess the adjacent teeth prior to providing you with a dental bridge option.

Before either a crown or a bridge can be made, the adjacent teeth (abutment teeth) must be reduced by contouring and reshaping them by removing enough tooth enamel to provide space for a dental bridge to be mounted on top of the remaining tooth stub. The removal of your anchor teeth's original shape and structure is the biggest disadvantage associated with traditional dental bridge designs. This causes the loss of significant amounts of healthy tooth tissue which can weaken the tooth, reducing its longevity potential.

In contrast, bridge restorations that are designed and supported exclusively by dental implants, offer a big plus to the adjacent natural teeth which will remain unscathed during the treatment process.

Before your dental bridge is made our prosthodontist will take an impression and perhaps, a digital scan of your mouth! The subsequent results will produce an exact model which will be used in the fabrication of your bridge. Using this impression, a dental lab then makes your crown or bridge, in the material your dentist specifies. If porcelain is to be used, our restorative dentist will determine the correct shade for the crown or bridge to match the color of your existing teeth.

The entire dental bridge making process is overseen by a master dental lab specialist. The crowns will fit like a glove onto your anchor teeth, because once your final bridge is cemented into place it'll be with you for a long time.

A temporary crown or bridge will be put in place to cover the prepared tooth while the permanent crown or bridge is being made. When the permanent crown or bridge is ready, the temporary crown or bridge is removed, and the new crown or bridge is cemented over your prepared tooth or teeth.

Fixed bridges are strong and reliable and in most cases they feel and look very much like natural teeth. Dental bridges can last 5 – 15 years and even longer if they remain stable, and if your personal hygiene and home care is maintained at a high level.

While dental crowns and bridges can last a lifetime, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your bridge is to practice good oral hygiene. A bridge can lose its support if the teeth or bone holding it in place are damaged by dental disease (dental decay, cracked teeth, dental infection). Keep your gums and teeth healthy by brushing with fluoride toothpaste twice a day and flossing daily. Also visit us at TDMC regularly for checkups and professional cleanings.

This is an important question and it should be considered whenever you're thinking about using dental implants. Please note the examples shown below to illustrate this point!

  • Let's say you have two broken down teeth next to the missing space. This is a perfect example of why you should consider a dental bridge, as both of these teeth require crowns to protect them from future breakage disease or decay. It is mandatory for long term health and functionality of the teeth that they are examined thoroughly and carefully. We must make sure they're stable (no movement), the roots are long enough, and you have enough teeth remaining to support this bridge.
  • A focus on esthetics may also guide you to decide on a traditional bridge over an implant. Sometimes placing an implant can jeopardize the gum situation if the gum height is already low.
  • Patients with a very high and visible smile line need to carefully consider both possibilities! If you have a failed implant, sometimes changing plans and doing a bridge is better, because it's likely the implant site is compromised. There are many cases in which esthetics drive the decision for a dental bridge or implant, with a bridge you can instantly control the color and shape of three teeth.
  • Another strong advantage is that bridges can be done quickly, in fact, at TDMC a standard bridge can usually be completed in 4 days. Yes, a completed restoration with beautiful ceramics, whereas a dental implant takes a minimum of 4 to 6 months for the bone and implant to integrate fully. If you're told that you can have an implant and the final crown done in a week, please proceed with caution. Studies show that without adequate osseo-integration (bone cells adhering to the implant) you may be facing an unpleasant surprise, if your new implant has not integrated properly. At TDMC our oral surgeons perform hundreds of implant placement surgeries each and every year. We’re experienced, highly skilled and never take unnecessary risks with our patient’s oral care.
  • There is another reason why installing dental bridges makes sense, and it's directly related to your health condition and concerns. Some patients are not capable of undergoing implant or other larger surgical procedures due to cancer, diabetes, certain medications or auto-immune disease. Furthermore, because of your unique oral condition you may not want to engage in a complex bone reconstruction or implant surgery.
  • You may choose to go with a bridge if you have very little bone, which requires an additional bone grafting procedure in order to safely support an implant.

Using implants to support a bridge is an excellent way to save costs, by spacing your implants apart it will make them easier to clean and maintain. If you can't clean around your implants well, then you risk the development of premature bone loss. At TDMC, we routinely refrain from placing more implants than are structurally needed, as it is our intention that the implants we do place will be stable, functional and long lasting

  • It is mandatory for the long term stability of your dental bridge that you make sure your remaining-surrounding teeth stay strong and healthy.
  • Until you are used to your new bridge, you must consume soft foods or chew small morsels.
  • You must refrain from eating a lot of sugary or other unhealthy foods, as it will accelerate the accumulation of plaque and unwanted bacterial decay on your compromised anchor teeth.
  • After your bridge has been installed you may experience tooth sensitivity while eating hot or cold foods. This will subside over time.
  • You must maintain a high level of oral hygiene and home care in order to maintain the stability of your bridge.

You still need to clean your teeth (synthetic or not) twice a day and floss at least once every day. This video shows the basics of good oral hygiene. Check with your National Dental Care practitioner if you’re unsure of your technique.

Make sure you have a checkup every six months, or more regularly if you have a concern about any tooth. Your National Dental Care practitioner will examine your mouth and inspect the margins of the tooth carefully for any signs of decay. Your dentist may take x-rays as part of this process.

There are many variables that can affect the price including :

  • number of teeth needed to fill the gap
  • materials used, such as composite resin, zirconia, or metal alloy covered in resin
  • complexity/difficulty of the placement
  • additional treatments for other dental issues, such as gum disease, root canals or fillings

At Therapeuo the starting cost for a porcelain fused to metal bridge for three teeth starts at Rs 21,000 (three individual crowns costing Rs.7000 each).

tooth

Cost of treatment:
Minimum billing for a Three-unit bridge : Rs.21,000

tooth

Number of sittings required :
Minimum 2 sittings

tooth

Duration per sitting :
around 60 to 90 minutes

Did You
Know ?

The Etruscan civilisation were the first to use crowns as a means of restoring damaged teeth? In fact, the materials they used – ivory, gold and bones – were still the standard in dentistry as recently as the 20th century, when porcelain crowns were first invented. Today, crowns and bridges are customised specifically for the patient’s bite and can usually be placed in as little as two dental visits. With proper cleaning and regular dental check-ups, crowns and bridges can last many years, or even a lifetime.