DEPARTMENT OF ENDODONTICS, THE DENTAL SPECIALISTS.
WHO IS AN ENDODONTIST?
An Endodontist is a Root Canal Therapy specialist. After 4 years of dental school the Endodontist takes 3 years of intensive speciality training.
The CROWN and the ROOT are the 2 parts of a tooth.
Crown part is visible in the mouth. The roots are surrounded 3 dimensionally by bone, under the gums.
The gums are a protective type of skin which are pink in colour that surrounds the neck of the tooth/ teeth and covers the bone.
Incisors are teeth in front jaw. Canines are adjacent to lateral incisors and Premolars. Molars are back teeth. They usually have two or three roots. Most other teeth have one root.
PARTS OF CROWN:
There are 3 parts of crown. The tooth crown has an outer layer made of a very hard substance called enamel.The inside of the tooth is made of a less hard substance called dentin. Below dentin layer is the 3rd layer called Pulp. In the root portion the pulp narrows to become a small canal called Root Canal. Every root canal ends at a tiny opening at the end of the root called Root End Opening. Usually there is one canal in each root, for example: central incisors have one root and usually they have one root canal, but sometimes some teeth have more than one. For eg: Lower molar teeth have 2 roots but 3 canals will be there.
THE PULP TISSUE:
The pulp tissue is a living tissue present in the pulp chamber and root canals.The pulp tissue contains small arteries, veins, and nerves. The veins and arteries nourish the pulp tissue with blood supply. This blood supply helps in defense against any kind of infection of the pulp tissue. The pulp is not just the nerve. But there are nerves which form a part of this complex living Pulp tissue.
PULP AND JAW INFECTION
Pulp infection occurs because of bacteria. Mouth is full of bacteria because of the food particles and ither products keft out in the mouth. This bacteria invades and destroys the pulp tissue.
This pulp infection Toxins ( poisons) destroy the pulp and leak out of the root end and invade the jawbone. This jaw bone becauss of chronic infection can lead to face, neck, jaw sudden serious painful swelling.
Implantologists often face challenges with implant placement, because of poor bone support caused by extractions, gum disease, poor finances and/or extreme expectations from patients.
Serving thousands of patients over 15 years, the implantologists at The Dental Specialists understood that conventional implants meant a huge financial burden on patients, physical trauma and pain of sinus lifts, bone grafts and membranes, and technique sensitive procedures requiring great skills and experience. Moreover, the long waiting periods were frustrating to patients and doctors alike.
After 15 years of laborious research, the implantologists at The Dental Specialists developed TTPHIL and created a revolution in implantology.
TTPHIL implants (Bicortical or 2 Piece Cortical Implants) are a combination of surgical principles of basal implants for stability and immediate loading and prosthetic principles of conventional screw retained technology, for irretrievability and aesthetic considerations. Orthopaedic specialists introduced basal Bicortical Implantology that spread to dentistry.
Less time consuming – 72 hours loading possible
Less painful – no bone graft or augmentation required
Less surgical procedures – minimally invasive with less drilling
Less number of visits
The team utilizes the best of implants, manufactured in Germany and Israel, which are approved by FDA, CDESCO.
Why TTPHIL implants?
Basal bone is a highly dense jaw bone, which is prone to infections. It provides the best support to the implants as it is stronger than the crestal alveolar bone. Unlike conventional implants which are placed in the crestal bone, basal bicortical implants are always placed in the basal bone.
COMPARISION BETWEEN BASAL, CONVENTIONAL AND TTPHIL IMPLANTS
Unlike conventional implants, basal implants can be used for those with poor bone quantity and quality. TTPHIL Implants can be used for both poor and ideal quantity and quality bones.
Basal implants stabilize by Osseofixation, conventional implants stabilize by Osseointegration and TTPHIL implants stabilize by both Osseofixation and Osseointegration, making immediate loading possible.
Unless loaded in 72 hours, Basal implants fail. Extractions and surgical procedures make the gums shrink over time, creating a space between the teeth and the gingiva, causing food lodgement leading to halitosis and infections.
Conventional implants take 3-4 months to load, as it takes 3-12 months to build the new bone.
TTPHIL implants can be loaded between 2-14 days depending on the case. The doctor is the decision maker, not the implant system. If the doctor feels there is no stability of the implant, waiting may be advised to avoid failures.
TTPHIL and Basal implants have a very simple kit. In both these techniques flapless procedures are done.
Conventional implants have complex kits consisting of surgical kit, sinus lift kit, ridge split kit, planning kit etc.
Basal implants are cheaper compared to conventional implants. However, 12 implants have to be placed to restore 6 teeth in each quadrant only till 1st molar, thus making it an expensive proposition. Basal Implants have abutments and implants connected, which make them easy to fabricate. They are not approved by FDA. Other doctors may hesitate to work on the case in future.
Conventional and TTPHIL 2 PIECE CORTICAL implants might be a little more expensive than basal implants, but safer. They use 4-6 implants to restore all the teeth till 2nd molars ensuring maximum chewing efficiency.
While 2 piece implants have screw retained prosthetic solutions, basal implants have only cement retained solutions which need to be cut when problems or complications occur.
In basal system, prosthesis has to be delivered in 72 hours. This is an advantage and disadvantage. Offering accurate and perfect prosthesis in such a short time is a challenge. There will be gaps between the prosthesis and gums, affecting cleaning, speech and aesthetics.
In TTPHIL and conventional system, prosthetics can be digitalized reducing the number of appointments.
SURFACE OF IMPLANTS:
Basal implants are smooth and conventional implants have a rough surface increasing risk of infections. Currently, basal implants come with antibiotic coated rough surfaces that fight infections and get stability by Osseofixation. TTPHIL Implants are rough to improve BIC (Bone Implant Contact) and are placed way below the bone (subcrestally) to prevent chance of infections. TTPHIL implantology uses longer antibacterial gold anodized abutments which prevent risk of infections.
MAINTENANCE: TTPHIL, Basal and Conventional implants need maintenance visits, and regular evaluation of prostheses.
PATIENT SELECTION: Smokers and periodontitis patients can get basal and TTPHIL implants done, but not conventional implants as bone grafting has to be done, requiring more healing time.
TTPHIL and Basal implants don’t need any additional surgery or augmentation. Conventional implants almost always need additional painful traumatic surgeries.
Basal implants have prosthetic disadvantages and conventional implants have surgical disadvantages. TTPHIL implantology takes the advantages of both Basal and conventional implantology, while overcoming the disadvantages of both.
Although all comparisons indicate that TTPHIL basal cortical implants are better when compared to conventional and basal implants, why are they not used in all cases?
The answer is not simple. The physiology and biochemistry of jaws differs from person to person. The implantologist considers various factors before deciding which would be best for you.
While conventional implants can be done by general dentists, TTPHIL implants need specially skilled and experienced experts in the field.
TTPHIL implants designed by Dr. Venkat Ratna Nag, gather all the basic necessities like osseointegration, osseofixation and osseocondensation for the best stability. Tall Tilted, Pin Hole immediate loading, is the technique that’s bringing wonderful results with excellent prosthetic work and beautiful aesthetics. Utilizing two piece implant system ensures amazing results, as the technique uses the surgical advantage of a single piece system and the prosthetic advantage of two piece system. Screw retained prostheses would enable the dentist to evaluate effectively periodically. Cement retained system is not retrievable. Screw retained system is retrievable and very comfortable to manipulate and follow up. These implants are longer implants which have better surface area over the conventional implants which are very short. That’s the reason why these conventional implants cannot be loaded immediately.
1. WHAT IS PTERYGOID IMPLANT? Implants which placed from maxillary tuberosity to pterygoid bone. Other names: Pterygoid implants/ Tubero Pterygoid Implants/ Pterygo-maxillary Implants
2. WHY PTERYGOID IMPLANTS? 1. Posterior maxilla Quality and Quantity: QUALITY: D4 Poor Trabecular Soft Bone QUANITY: Available bone is less. Crestal Alveolar Bone Resorption from bottom + Sinus Pneumatization from the top
2. PRE IMPLANT PROCEDURES are must What are the different treatment options in these situations? Sinus Lifts: Direct/ Indirect Bone grafting/ Bone Augmentation
3. PTERYGO MAXILLARY BUTTRESS: Butress is anatomically designed to take up the forces. 6-7mm thick cortical bone attached to active muscles. 3rd cortical and 2nd cortical bones have minimum remodelling capacity. 2 to 2.5% compared to 25% of cancellous bone/ year. Macro mechanical anchorage BONE QUALITY : Alveolar Bone Density BONE QUANITY Alveolar Bone Volume Minumum inventory: Drills Handpiece Equipment
PTERYGOID ANATOMY: WHEN SO MANY ADVANTAGES WHY IMPLANTOLOGISTS ARE SCARED?? TO DO THEM?? Complicated: Pterygoid anatomy – Part of Spenoid bone – 2 perpendicular plates: Lateral Pterygoid: attachment to masticatory muscles Medial pterygoids: – Pterygoid fossa – Pterygoid hamulus: Medio Inferio extent of Pterygoid. Sharp point. So we need to place the implant lateral and superior to the Pterygoid hamulus. – pyramidal process of palatine bone Ptergo Palatine Fossa or Pterygo Maxillary Fossa Target : pterygo maxillary fissure: Vital structures??
Less time consuming – 72 hours loading possible
Less painful – no bone graft or augmentation required
Less surgical procedures – minimally invasive with less drilling
Implant placement most of the times is a challenge faced by implantologists. These challenges can be very poor bone support due to extractions, gum disease, poor finances and/or extreme expectations from patients. Our implantologists at The Dental Specialists have faced these issues right from the beginning. Conventional implants needed huge finances, bone augmentation or sinus lifts. It’s not an easy task, both for the implantologist and the patient. Serving thousands of patients since 15 years, whenever conventional system was tried, there was a huge financial burden on the patients, not to mention the physical trauma and strain of sinus lifts, bone grafts, membranes, that increase the costs and make them even more painful, and very technique sensitive procedures requiring great skills and experience from the implantologist concerned.
Moreover, the waiting periods are very long, frustrating both patient and doctors alike. Our team felt there is an immediate need for an implant procedure that is
Less time taking
Less surgical procedures and
Less number of visits
The good news is that all these traits are available in TTPHIL Implantology. Its a combination of Surgical principles of Basal Implants for high primary stability and Immediate Loading and Prosthetic principles of conventional screw retained technology which is very important for retrievability and high esthetic considerations TTPHIL implants are also known as Bicortical or 2 Piece Cortical Implants. Our team utilizes the best of implant companies manufactured from Germany and Israel which have been approved by FDA , CDESCO. Orthopaedic specialists introduced basal Bicortical Implantology that spread to dentistry.
Why TTPHIL implants? Basal bone is the highly dense bone in the jaws. It’s less prone to infections. This is the bone area that provides the best support to the implants. Basal bone is very much strong compared to crestal alveolar bone. Crestal alveolar bone has less strength and less load bearing capacity. The conventional implants are always placed in the less strong crestal bone. But the basal bicortical implants are always placed in the much stronger basal bone.
ADVANTAGES OF TTPHIL IMPLANTS
72 hour loading possible.
No bone graft or augmentation required unlike the conventional, where almost always bone graft would be necessary, increasing cost, time and trauma
Minimally invasive and minimal drilling procedure COMPARISION BETWEEN BASAL AND CONVENTIONAL AND TTPHIL IMPLANTS
1.INDICATIONS:Basal implants are used generally in poor bone quantity and quality. Conventional cannot be used in poor bone quantity and quality. TTPHIL Implants can be used for both poor and adequate ideal bone quantity and quality bones.
2.MECHANISM:Basal implants stabilize by Osseofixation. Conventional implants stabilize by osseointegration TTPHIL Implants stabilize by both Osseofixation and Osseointegration. Hence Immediate loading is possible.
3.IMPLANT PROCEDURE: Basal implants are forced to be loaded in 72 hours. Basal implants if not loaded in 3 days will fail. So your doctor has to force you to get the teeth immediately. Because of the extractions and surgical procedures the gum shrinks over a period of time which creates space between the teeth and the gingiva which creates space for food lodgement leading to halitosis and infections. Conventional implants take 3 to 4 months to take loads. They believe in bone building concepts. Here quantity of bone is built not quality of bone. Here we need to wait for 3 months to 12 months to build the new bone. TTPHIL implants can be loaded between 2 days to 14 days depending on case to case. You are not forced to load the implants. The doctor is the decision maker and not the implant system. In case your doctor feels there is no stability of the implant , to avoid risk you can wait to avoid failures.
4.ARMAMENTARIUM: TTPHIL and Basal implants have a very simple kit. In both these techniques flapless procedures are done. Conventional implants have complex kits consisting of surgical kit, sinus lift kit, ridge split kit, planning kit etc
5.PRICE: Basal implants are cheaper compared to conventional implants . Basal Implants have abutments and implants connected. It’s easy to fabricate and machine these implants. These implants are not approved by FDA. Conventional and TTPHIL 2 PIECE CORTICAL implants are affordable. Maybe a little expensive than basal but safer than basal implants. 2 piece implants have screw retained prosthetic solutions. Basal implants have only cement retained solutions which need to be cut when a problem or complication occurs. Basal on a long term is very expensive. No doctor tries to touch your case. You need to go back to the same doctor again to get it repaired. Basal implants are cheaper. But 12 implants have to be placed to restore 6 teeth in each quadrant only till 1st molar. Is it worth spending so much. Now you calculate which is cheaper??? On the other hand Conventional or TTPHIL IMPLANTS use 4 to 6 implants to restore all the teeth till 2nd molars giving maximum chewing efficiency to you. BASAL IMPLANTS
6.PROSTHETIC PROCEDURE: In basal system, prosthesis has to be delivered in 72 hours so it’s an advantage and disadvantage simultaneously. Offering accurate and perfect prosthesis in such a short time is a challenge. There will be lot of gaps between prosthesis and your gums. It makes it difficult to clean, speech and esthetics are compromised. In TTPHIL and conventional system, prosthetics can be digitalized reducing the number of appointments.
7.SURFACE OF IMPLANTS: Basal implants have smooth and conventional implants have rough surface. Rough surfaces have increased risk of infections. Hence recently basal implants are coming with antibiotic coated rough surfaces that fight infections and get stability only by Osseofixation. TTPHIL implants have both advantages of Basal and Conventional Implants. TTPHIL Implants are rough to improve BIC (Bone Implant Contact) and are placed way below the bone ( SUBCRESTALLY) to prevent chance of infections. TTPHIL IMPLANTOLOGY uses longer antibacterial gold anodized abutments which prevent risk of infections. TTPHIL have advantages of both Conventional and basal! 8.MAINTENANCE: TTPHIL, Basal and Conventional implants need maintenance visits, and prostheses too need regular evaluation. 9.PATIENT SELECTION: Smokers and periodontitis patients can get the basal and TTPHIL implants done. But they cannot get conventional implants done if bone grafting has to be done. It takes more healing time. TTPHIL implants takes the osseofixation and osseointegration as advantage. 10.ADDITIONAL SURGERY: TTPHIL and Basal implants don’t need any additional surgery or augmentation. Conventional implants almost always need additional painful traumatic surgeries. Basal implants have lot of prosthetic disadvantages and Conventional implants have lot of surgical disadvantages. TTPHIL IMPLANTOLOGY takes the advantages of both Basal and conventional implantology and overcomes the disadvantages of both Basal and Conventional implants. When all the above comparisons indicate that TTPHIL basal cortical implants are much better compared to the conventional implants and basal implants then why get conventional implants? Why don’t we simply use TTPHIL implants in all cases? The answer is not simple. The physiology and biochemistry of the jaws differ from person to person. Depending on a lot of factors, your implantologist will decide which one would be best for you. Usually conventional implants can be done by many general dentists too. But TTPHIL implants need specially skilled and experienced experts in the field. That is what exactly our implantologists do at The Dental Specialists. 15 years of laborious research has given birth to an innovation called TTPHIL that’s creating a revolution in Implantology. In this technique designed by Dr Venkat Ratna Nag, the implants gather all the basic necessities like osseointegration, Osseofixation and osseocondensation for the best stability. Tall Tilted, Pin hole Immediate loading is the technique that’s bringing wonderful results with excellent prosthetic work and beautiful aesthetics. Utilizing two piece implant system is bringing out amazing results as the technique uses the surgical advantage of single piece system and prosthetic advantage of two piece system. Screw retained prostheses would enable the dentist to evaluate effectively periodically. Cement retained system is not retrievable. Screw retained system is retrievable and very comfortable to manipulate and follow up. These implants are longer implants which have better surface area over the conventional implants which are very short. That’s the reason why these conventional implants cannot be loaded immediately.
At The Dental Specialists, India we strongly recommend TTPHIL technique for most of our patients who need a dental implant. Dr. Venkat is a pioneer of this TTPHIL technique. He has written about this technique of dental implants in several international magazines and also in various dental conferences across the world.
While the key advantage of TTPHIL is the quick turnaround (you can get a permanent set of teeth in as little as 2-9 days) and its economical nature, as a patient, we feel it is important for you to understand the treatment procedures and also understand the options available to you. Hence this article aims to provide clear differentiation between the conventional method of dental implants and the TTPHIL technique of Implants.
Conventional Dental Implants vs TTPHIL Implant Technique
TTPHIL ALL TILT TECHNIQUE
CONVENTIONAL IMPLANT TECHNIQUE
Immediate loading: Permanent teeth given within 48 hours
Delayed loading: Permanent teeth given after 3 -6 months
Tall (16-25mm) and tilted(30⁰-70⁰) implants
Anchorage from basal bone
Anchorage from crestal bone
Two piece cortical implant
Two or three piece crestal implants
Single stage implant system
Double stage implant system
Time taken minimum 48 hrs
Time consuming around 4-12 months
Pin hole flapless, no sutures
Sutures are needed as flap is reflected to expose bone
Various implant designs and sizes are available
Limited implant designs and sizes available
No surgical sinus lifting and bone augmentation required
Invasive surgical procedures like sinus lift and bone augmentation are needed in case of insufficient bone
Expensive surgical add on procedures
Can be done in severe gum disease, smokers and diabetics
Can be done with minimal success rate
Proven to be successful in compromised bone conditions
Not a good choice in compromised conditions as the chances of failure are more
Fast and simple
Complicated and time taking
Micro-movement of implant in cortical bone is minimal
Micro-movement in crestal bone is high
Bone loss around the implant in future is around to zero
High chances of bone loss around implant overtime
Basal bone capable of bearing heavy chewing forces
Dr.Narendra, famous periodontist at The Dental Specialists talks about common gum and teeth diseases and how to prevent them. If you are suffering from gum disease, please check out the video and also how we are treating patients with gum problem.
Taking care of your children’s teeth is a critical aspect of their health and well being and while as parents we try to do our best, we often miss out on small and simple stuff that can help make our little ones smile brighter. Here in this video, Dr.Sarika, one of the top pediatric dentist in Hyderabad shares her tips about common teeth problems that children and how to take care of them.
Patients undergoing orthodontic treatment in the current generation not only demands a beautiful smile at the end of the treatment but also are equally concerned with appearance during treatment. As there is an increasing demand for an alternative to conventional braces, clear aligners are the new age aesthetic orthodontic treatment. Invisalign is a virtually invisible treatment that uses an innovative approach to gently yet effectively straightens your teeth. Invisaligns are thin transparent removable plastic aligners formed with CAD-CAM laboratory techniques for moving teeth into the required position.
Virtually invisible – gives confidence to patent to smile
Maintain good oral hygiene as they are removable
Comfortable – individually customized
Ideal for retreatment/relapse cases
Shorter dental appointments
More precise treatment duration than braces
Non-invasive appointments during recall visits
Uses 3D computer modelling technology to create a customised treatment plan
Can visualise the progressive movements and expected final results using 3D SOFTWARE
Limitations of Invisalign
Personal motivation of the patient is required
It should be worn 20-22 hours a day
Devices should be removed during meals
Common teeth straightening issues that can be fixed with Invisalign aligners
Gapped teeth occur when you have extra space with your jaw.
Cross bites occur when the upper and lower jaws are misaligned.
A deep bite occurs when upper teeth overlap significantly with lower teeth.
Open bites occur when upper and lower teeth do not overlap normally.
Crowding occurs when there is no proper arch space in the jaws.
Treatment Process for Clear Aligners / Invisalign
Consultation with your dental provider to determine if Invisalign is suitable for you.
Using Align technology’s proprietary software, your doctor creates a customized 3D treatment plan and explains you regarding pre and post-operative treatment result.
Your aligners will be custom made and shipped to your dentist’s clinic
Your series of custom made aligners will be given to you
You need to visit the dentist for check-ups every 6-8 weeks
Congratulations! you have finished your treatment. Maintain your newer, better smile with the use of retainers.
Frequently Asked Questions About Invisalign
What is the duration of treatment with Invisalign
The treatment can last between 28-48 weeks depending upon the type of the dentition and severity of the malocclusion. The aligners need to be changed every two weeks. The initial appointment involves the opinion of orthodontist followed by which, clinical pictures will be taken for treatment plan. In the next visit, impressions are taken to allow the construction of accurate cast, which can be scanned to produce a virtual 3D model. The 3D model can then be manipulated by the dentist and malocclusion is nearly treated using proprietary software. After which, within 3-4 weeks aligners will be ready for usage.
Is the time reduced when compared to conventional braces
Yes, braces are adjusted much less often compared to Invisalign. Hence the time is reduced compared to conventional braces. The patient is advised to wear the aligner for approximately 20 hours per day. Each set of aligner will shift the teeth around 0.25 to 0.3 mm.
What is Invisalign made of?
Invisalign clear aligners are made of a patented thermoplastic material called smart Track which is FDA approved. They are comfortable and easier to put on and take off. It is free of BPA, BPS, latex, gluten.
What is this Smart Track Material
Smart track material is a highly elastic orthodontic material, its elastic properties allow it to return more closely to programmed aligner shape. It is made of polyurethane resin and does not contain bisphenol – A, an industrial chemical better known as BPA.
How long do we need to wear Invisalign in a day
Invisalign aligners need to be worn between 20 -22 hours per day. They should remain in the mouth as much as possible for the treatment to be effective. Each aligner needs to be replaced approximately every two weeks. During your Invisalign treatment, each aligner slowly moves your teeth in to correct position as you wear them.
How does Invisalign help in maintaining oral hygiene
Since Invisalign is removable in contrast to conventional braces oral hygiene can be maintained efficiently. Aligners need to be removed while eating or drinking.
What precautions are needed during treatment?
Eating or drinking should be strictly avoided with Invisalign. Eating sticky foods can pull and tug at the aligners, possibly breaking or damaging them, while drinking specific drinks can potentially stain aligners.
Is there a particular age range / best age for using Invisalign?
Invisalign can be started after the child attains complete dentition of permanent teeth which is around 12-14 years of age. While the skeletal and dental components are more conducive to straightening.
Does Invisalign give Lisp / difficulty in speech?
In some patients, it can cause lisp/speech defects which can alter pronunciation initially. Mild discomfort might be present initially after starting the treatment with a fresh set of aligners and gets better as we use them.
What if I stay out of the country?
The initial appointment with orthodontist will give an idea about the treatment plan. Then, the virtual 3D model can be constructed using the software. This is used to produce a series of clear aligners that steadily correct the malocclusion, which is shipped to your home address.
Tooth whitening is a procedure to lighten teeth and remove stains and discolorations. The peroxide in the bleaching agent penetrates the enamel and breaks down the complex stains(which are darker in nature) into smaller products thereby making the tooth appear lighter in shade.
How do teeth become stained?
There are many reasons why teeth become discolored
Discoloration can result from a traumatic injury(such as when the tooth gets hit in an accident) resulting in darkening of the tooth because it gets devitalized, trauma or infection of the related primary tooth can also cause irregularities in enamel color of its subsequent permanent tooth.
Intrinsic discoloration/ staining i.e. discoloration that occurs within the dentinal layer of the tooth is due to excessive fluoride content present in drinking water leading to fluorosis and use of certain medications like tetracyclines during the developmental stage of fetus or during childhood can result in staining.
Teeth get stained from metals like iron supplements or consumption of stain-causing beverages like tea, coffee, soft drinks, alcohol, and certain foods like dark-colored berries, tobacco use can result in tooth discoloration.
Some causes of yellowing teeth are beyond our control like discoloration that occurs during ageing. As we age, the tooth enamel thins, thus making our teeth to appear more yellow in colour.
Bleaching for Teeth Whitening Works Best
Extrinsic stains i.e., superficial stains that occur on the outer surface of the tooth are easier to treat compared to intrinsic stains whether they are congenital or acquired. In most cases, professional teeth whitening treatments can restore your smile’s former glory and give you back the ability to smile without feeling embarrassed. Severe discolorations may be best treated with microabrasion and subsequent bleaching to achieve desirable results. Dental whitening may be accomplished by using either professional or at-home bleaching modalities.
Patient Examination for Tooth Bleaching
Before a decision is made that tooth bleaching is the best possible treatment available for the patient, the dentist takes a thorough patient history that would include the patient’s opinions regarding the cause of tooth discoloration, any history of allergies, especially to the ingredients used in bleaching materials, information regarding any past problems with tooth sensitivity which has to be investigated carefully to determine the cause(s) and whether treatment before tooth bleaching will benefit the patient.
Additional examination considerations include tooth/enamel cracks, exposed root surfaces and other smile considerations such as translucency or defects in tooth form or anatomy.
Some tooth discolorations may be the result of a disease or condition that requires root canal therapy, restorations or dental surgery.
Examination of tooth function and para-function may reveal conditions such as bruxism (involuntary grinding of teeth) or temporomandibular joint dysfunction. If not examined properly, these conditions may be aggravated by the use of bleaching trays that are prescribed by dentists.
Patient habits (tobacco, alcohol, food habits) and lifestyle, as well as the presence of removable or fixed appliances, should also be considered during an examination.
When not to do dental bleaching
Pregnant & Lactating Women
In pregnant or lactating women, teeth whitening is not recommended as in these cases, due to hormonal changes gums become inflamed and sensitive and the bleaching agents used can aggravate the condition.
People who have restorations such as fillings implants, crowns and dental bridges
Tooth-colored fillings and resin composite materials used in dental restorations like the crowns, veneers and bridges do not whiten. Therefore, using a whitening agent on teeth that do and do not contain restorations will result in uneven whitening. The teeth without restorations appear lighter than those with restorations. Therefore, any whitening procedure should be done prior to the placement of composite fillings, veneers, crowns, dentures, or porcelain restorations in order to best match the degree of whitening to your new tooth color.
For the enamel to remineralize and optimize the bonding strength, a minimum of 2 weeks following a whitening procedure should be allowed before any prosthesis is given. Tooth colored fillings will have to be replaced after the bleaching process is completed so as to avoid shade mismatch.
Children under 16 years of age
Bleaching is not recommended in children under the age of 16 because the pulp chamber, or nerve of the tooth, is bigger and wider until this age. Teeth whitening under this condition could irritate the pulp or cause it to become sensitive. Also, the enamel of a primary tooth is thinner when compared to the permanent tooth, because of this tooth coloration within a dental arch may vary significantly during the mixed dentition stage of the patient. If a full arch cosmetic bleaching is done during this developmental stage, it would result in mismatched dental appearance once the child is in the permanent dentition stage. Adolescents have unique dental needs to maintain their self-image. Tooth whitening has been a
successful procedure for adolescent patients.
Patients with gum disease, worn enamel, tooth decay, exposed roots due to receding gums, defective restorations
Patients with these conditions should always consult with their dentist prior to using a tooth whitening system. Individuals with gum disease or teeth with worn enamel are generally discouraged from undergoing a tooth whitening procedure because bleaching aggravates sensitivity in such patients.
Tooth decay has to be treated before undergoing any whitening procedure because the whitening solutions can penetrate into the decay and the inner areas of the tooth, which can cause sensitivity. Also, whitening procedures will not work on exposed tooth roots because roots do not have an enamel layer to absorb the bleaching agent. Roots resist the bleaching agents.
Allergic to peroxide
People who are allergic to teeth whitening agents like peroxide are contraindicated for bleaching procedure.
Individuals with Sensitive teeth
Such patients are also contraindicated in whom sensitivity occurs due to cracked or chipped teeth.
Sometimes tooth becomes sensitive when vital bleaching is done. This is due to permeation of enamel and dentin by hydrogen peroxide resulting in a mild, transient inflammatory response. It should not be used at high concentrations and for extended period of time. This kind of tooth sensitivity can be managed with the use of non-steroidal anti-inflammatory drugs (NSAIDs), fluoride, casein phosphopeptide-amorphous calcium phosphate or potassium nitrate containing products.
Individuals who expect their teeth to become brilliant white may be disappointed with the results of bleaching. Bleaching definitely makes the teeth 2 shades lighter but not completely white. In the case of smokers, limited results will be seen unless the habit of smoking is ceased, particularly during the bleaching process.
The Right Candidate for Tooth Bleaching
Taking all the above-mentioned details into consideration, it can be concluded that, the best candidates for professional teeth whitening are those who have healthy teeth without fillings or restorations and healthy gum tissues. Better results with bleaching can be seen in patients whose teeth have a yellowish shade.