Winning Smiles

Alignment, bleaching and bonding vs teeth veneers

2010-08-28T15:55:00Z

Or the story of how three techniques (alignment, bleaching and bonding), when skilfully combined, can save you money and give you better results than just one (wall to wall teeth veneers)…

Before alignment, bleaching and bonding

After alignment, bleaching and bonding

Alignment Bleaching and Bonding vs Wall to wall teeth veneers

Here in Essex, Cosmetic dentistry is evolving. A decade ago when decent porcelain veneers came along cosmetic dentists were very keen on placing lots of veneers – in 2010 there are still a lot of veneers being placed by cosmetic dentists, but here at Winning Smile we believe that the Age of the Veneer is on the wane.

A colleague of mine Dr Tif Qureshi (www.dentalelegance.co.uk) recently addressed the profession with his ‘evolved’ concept of Cosmetic Dentistry – updated to reflect the progress in dental knowledge and treatments within the profession and changing attitudes among our patients. Tif brought the Inman Aligner to the UK from the States and combines this brilliant little brace with 2 other treatments to produce significant dental transformation without the need to grind away good teeth as is the case with veneers.

Tif’s concept is called ABB: ‘Alignment, Bleaching and Bonding’

Alignment

Using the inman aligner the front teeth can be lined up orthodontically in as little as 10 weeks

Bleaching

The cosmetic dentist’s best friend – professional teeth whitening to noticeably ‘lift’ the colour of all the teeth

Bonding

The addition of cosmetic filling material (like our Italian HFO system) where necessary to add the finishing touches.

Here at Winning Smiles we have been using the bleaching and bonding techniques for years and Michael Fennell one of our orthodontists has been doing the straightening. We are no strangers to these ideas. But Tif has put a label on it for us, and we think people will be hearing of this costmetic dental technique a lot more.

As always my regular readers will notice that I like to bullet point the pros and cons

ABB Advantages over Teeth Veneers

No grinding off of the front surfaces of the teeth
No porcelain veneers that can fracture easily and begin to lose their looks after a few years – ABB simply enhances your own teeth
Cost – ABB costs around £2000 at Winning Smiles, 6-8 veneers cost £3600-£4800!
ABB is one hit: veneers usually need to be replaced every 10 years or so (think of the cost implication of that)
ABB is kind to the teeth – occasionally a veneered tooth will need a root filling because the nerve reacts badly to the grinding process

Disadvantages of ABB vs Veneers

Very badly discoloured teeth or teeth with lots of visible fillings may be better treated with crowns or veneers
Teeth that have always been the wrong shape (eg too small, or misshaped) usually benefit from veneers/crowns despite the drawback
ABB will take on average 12 weeks – veneers can be done in 2-4 weeks
Jodie Marsh lookalikes need porcelain veneers for that level of whiteness

Are false teeth now history?

2010-08-30T14:24:23Z

How old, dodgy dentures have given way to beautiful, permanent replacement teeth

Truly transformational: the full arch titanium/acrylic fixed implant bridge:

Times (they are) a changing. I’m actually not listening to Bob Dylan as I write this, but times are definitely changing in the world of UK dentistry, and where dentures are concerned, the change is accelerating.

20 years ago if you had lost all your teeth, false teeth or ‘falsies’ were your only option. Cheap and cheerful, available free on the NHS…and utterly hopeless as a functioning pair of teeth. Some of them looked ok and even stayed in when you were talking, sometimes!

20 years ago dental implants were in their infancy, only a few brave dentists with hugely rich patients ventured into such unchartered territory..

Fast forward 10 years and things had changed dramatically:

10 years ago if you had lost all your teeth (or a complete top or bottom set) then it was possible to find a few dentists with the ability to replace a whole set of top or bottom teeth - but the costs, although vaguely affordable for those with serious property equity, were still somewhat eye-watering. A full set of porcelain teeth needed 10 implants to support them and each tooth was lovingly crafted – the dental technician would spend days or even weeks making them.

Some dentists realised that there must be ‘another way’ and started to use fewer implants to fix dentures in place: the implant-denture was born. The beauty of the implant denture is that instead of needing 10 implants to hold a complex custom made porcelain bridge in place, with the extra support that the implant denture gained from resting on the gums, the implant dentists could use fewer implants to hold these teeth in place:

Result! Dentures that stay put and can be used for eating most food without any fear of them falling out when discussing the latest episode of the Simpsons [Grandpa should have implant-retained dentures by now surely? -ed]

The only problem with implant retained dentures is that in patients’ eyes they are still dentures! They need to be removed for cleaning purposes every night….and no matter how well they stay in with their super-duper implant-connectors, they still have the ‘false teeth’ label.

2010

Enter the new era of ‘full arch’ implant dentistry [full arch: aka a top set, bottom set or complete set of implant-teeth].

Combining the ease of construction of implant-dentures with the satisfaction of having a set of fixed teeth that really feel like your own, without resorting to using 10 implants at a time and without the days and weeks of painstaking construction time at the dental lab…..it has become possible to completely replace a top set, bottom set or both for a rather less eyewatering fee than those huge ceramic bridges….

How?

This has been made possible by using digital scanning/CNC technology to produce titanium ‘backbones’ with micro-tolerances that are screwed into place on as little as 4 implants for a full set.

Top quality acrylic teeth are then firmly attached to the titanium backbone and the full arch titanium/acrylic fixed implant bridge is complete.

How do they look? The photographs speak for themselves.

At Winning Smiles prices start at £9500 and typical delivery time is 2 months from start to finish.

Why precision 3D X-ray images are essential for safe and successful dental implant surgery.

2010-08-18T14:30:17Z

It should be fairly obvious that in order to fit dental implants safely and successfully, you need to have a skilled and experienced surgeon. But did you know just how much the procedure also relies on having incredibly precise 3D images of the jaw bone? These are the X-ray images that allow the surgeon to plan the exact position and placement of an implant and they make sure that:

-the implants don’t ‘hit’ any vital structures during insertion (like arteries and nerves)
-the implants are placed so that the final implant crown or bridge ends up in the right position in the mouth

So what are the consequences of getting this wrong?

-a numb lip (possibly forever)
-a haemorrhage during surgery
-teeth ending up in the wrong place and looking ‘goofy’!

At Winning Smiles we know how crucial this precise 3D imaging of the jaw bone is. That’s why we use the latest Specialist Dental CT scanner to produce 3D images of the jaws before surgery. These machines provide superb high resolution, high definition images. Armed with this level of information we have safely and successfully fitted around 600 dental implants in the last few years.

And because the new generation of ‘cone beam’ dental CT units work with a radiation dose many times below that of hospital CT Scanners, they are not only more convenient (the whole procedure can be carried out here at our clinic), but they are also much safer.

So if you’re looking for safe, convenient, successful implant surgery…..you can rest assured that that all comes as routine for you here.

An example screen grab from our Specialist Dental CT Scanner

How long do Dental Implants last

2010-04-27T11:49:39Z

The truth about Peri-implantitis….(which in English means HELP, my implants are failing!!)

I recently had a new patient consultation with a chap who had had a quote for implant work at another practice. Nothing extraordinary about that I hear you say….except that

he had been told – your implants will last a lifetime

Which prompted some immediate questions from me, like for instance

who’s lifetime, the dentist, the patient or the implant?!
who’s going to guarantee those implants for a life-time?

Because it’s all very well making longevity-promises to people but without a back-up plan and some ‘what-ifs’ in the

contract, those promises start to sound rather hollow!

Here’s what we do at Winning Smiles to ensure that our implants survive for the longest time possible

Having the right attitude helps!

Admit that implants can and do fail both short term and long term (denial is indefensible, see above)
Keep abreast of the latest evidence-based studies on what causes implant failure and what the best failure avoidance strategies are recommended – (Like the European Forum on Peri-implantitis held in London in January 2010)

Having a clear, well defined follow up protocol for each and every implant patient, tailored to individual needs eg

- Regular implant-hygiene sessions with our implant-trained hygienists
- Bi-annual inspections (x-rays when indicated) with the implantologist
- Hygienists trained to carry out our screening protocol for signs of early problems (eg the beginning of peri-implantitis)

Giving patients the right information

Peri-implantitis leads to implant failure if undetected (or not looked for – head in sanditis)
15% of implant patients will suffer from some form of peri-implantitis (from recent long term studies in Europe)
Patients who have lost their teeth from gum disease have a much higher risk of losing implants
Patients who don’t manage to keep plaque off the implants also at higher risk
Patients who smoke have a much higher risk of peri-implantitis and implant failure
Patients don’t know when they haver peri-implantitis because it doesn’t hurt, right up until the implant tooth falls out!

But look on the bright side!

we detect problems early using our screening protocol
we can treat them easily in the early stages
late stage treatment is more complex but still possible

And most of all, as with teeth, as with implants: keep them clean, stay off the fags and please please turn up for routine checks

and maintenance…..implants are not fit and forget…

To: Our dental implant page

Pain Control and Dental Implant Surgery Part I

2010-04-10T18:54:52Z

It is quite common that patients who are considering, or about to undergo dental implant surgery to be in the dark when it comes to predicting how much pain to expect.

We hope this will help understand the implications from

a) the surgery itself
b) during the recuperation period immediately post-surgery (ie the next week or two)

And although at Winning Smiles we always encourage new implant patients to have a chat with patients who have had the whole ‘implant experience’, most patients won’t actually take us up on that offer – even though our previous implant patients are usually very happy to talk about it!

So I thought it might be useful to pen a broad classification of what pain and trouble you might expect from our implant procedures here at Winning Smiles. All implant surgery is not the same, so I have divided it up a bit (with a note on sinus surgery/bone grafts at the end)

1) Simple implant surgery ie 1-2 implants, no ridge splitting, no sinus work, no grafting

No need for sedation unless you are a nervous patient

Pain during surgery: none

Recuperation period: 2 days, mild soreness around gums, most patients will go back to work next day without the need to take even an aspirin.

2) ‘Middle of the road’ cases ie 3-4 implants or 2 implants with ‘extras’ like sinus surgery/sinus ‘tap up’/simple bone grafting/ridge expansion

Sedation recommended

Pain during surgery: none! (No, really!)

Recuperation: 3-10 days. Mild to moderate soreness around gums, mild swelling. Individual patients respond very differently in these cases.

For some patients it is very easy and they get only minor post-op soreness. At the other end of the spectrum a few patients will have to take painkillers for a few days and may bruise (in fair skinned patients the bruising can be quite noticeable).

3) Complex cases ie a whole upper jaw/lower jaw, 4-16 implants, ‘block’ bone grafts, etc

Sedation strongly recommended

Pain during surgery: none

Recuperation: 7-14 days. Moderate soreness around gums, moderate swelling, pain killers for the first week. Bruising can be quite widespread in fair skinned patients (ladies – buy concealer before you come!)

4) Sinus surgery:

no pain during surgery, little or no pain afterwards with mild swelling. Bruising on fair skinned patients.

5) ‘Block’ bone grafts – where we take bone from the chin or lower jaw and screw it into place somewhere else (often upper front area)

Ok, again we would expect no pain during the surgery but considerable soreness/bruising and some swelling for 1-2 weeks afterwards.

Similar to ‘complex’ cases above, it’s not something we enjoy doing to patients but in some cases the only way forwards – and they do work very well.

This is a lot of detail, but we find people would rather know these things up front, rather than find out after the event.

Dental Bridges or Dental Implants

2010-01-13T14:06:02Z

A video!

Andrew explains the pros and cons of the implants vs bridges argument and why he generally prefers to use dental implants to replace missing teeth these days. This is the blog about dental bridges referred to in the video.

Length: 1 minute 50 seconds.

Why quality dentistry will save you in the long run

2009-12-18T10:09:02Z

Can you spot the grotty ‘white’ filling in the middle of the picture? Believe it or not this filling was not done at the turn of the century but completed a couple of years ago!

If you look at the tooth to the left of the one with the grotty ‘white’ filling you may be surprised to know that 15 mins previous to this photo it looked exactly like the grotty one. We are replacing this chap’s ugly white fillings with nice shiny new ones that look their age (ie well into the 21st century)…

People often ask if we enjoy dentistry. But who wouldn’t like being able to take out that grotty old filling and replace it with a nice shiny new one. We can get this invisible effect using our beautiful italian white filling materials, and a little bit of technique to go with it!!

Ok here’s the rub:

Grotty white filling in the middle of the picture
Estimated cost £20
Estimated time involved 5 mins
No guarantees
Replace every 2 years?

Shiny new Italian composite filling on the left
Time involved 15 mins
Cost £70
Cost of filling material: at least double that of the cheap stuff
5 year guarantee.

Quality dentistry costs less over time and makes you feel good.

Spot the crown competition

2009-11-12T22:44:29Z

Just for fun

Winning Smiles spot the crown competition take 2:
Clue: there is one crown in this picture, can you tell which one?

Spot the crown

Some of the simplest jobs are the most satisfying.

Invisible filling in front tooth – as good as new

2009-07-08T10:58:02Z

Sometimes its the little jobs that make such a difference.

This chap said he had been hiding his smile for years. His main issue was the general yellowness of his teeth and an old filling in the upper central incisor.

We carried out some (minor) bleaching and replaced that old filling with a new one using Enamel Plus HFO material with Dr Lorenzo Vanini’s technique – see our best white fillings blog article.

Not sure if these pictures do it justice (it may depend on your computer settings). The real-life difference was more remarkable, but I’m sure you can see the difference anyway.

Recent dental implant case studies

2009-06-23T14:48:12Z

Dental implants are an increasingly popular choice for my patients as I’ve been doing a lot of them recently.

So I thought it was about time I posted a few case studies. Here they are:

Tooth replacement and smile makeover: Case Study

A full set of replacement teeth: Case Study

Implant bridge: Case Study

Implant retained dentures: Case Study

I’d love to hear what you think – or if you have any questions about dental implants at all, please do post something in the comment box below.