Non-vital teeth or teeth that have an abscess do  not require local anesthetic as the pulp is already dead.  In other cases, local anaesthesia is provided to ensure a pain free experience.  Occasionally if a pulp is very inflamed, it may not respond fully to local anesthetic.  In case like this, where the patient is experiencing discomfort , then a minimal amount of work is done and the tooth dressed with a sedative dressing which should settle the pulpal pain down  and allow the tooth to be treated painlessly at the following visit.

In summary, a root canal treatment is a painless procedure that can take several visits and is quite time consuming.  It allows the patient to save a tooth that otherwise would require an extraction.

Deep tooth decay leads to death of pulp and abscess formation

The Root canals are cleaned out using root canal instruments

The root canals are shaped and then filled and sealed with root canal filling material(gutta percha) and a permanent filling placed

TOOTH WHITENING/BLEACHING

There are various techniques for tooth whitening.  By far the most successful, safe and predictable method is that using 10% Carbamide peroxide  in custom made bleaching trays worn at night.  This technique was pioneered by  Dr. Van B Haywood since 1988. www.vanhaywood.com Tooth whitening involves the following visits:

1. Consultation and assessment.
2. Impressions for bleaching trays.
3. Fitting of bleaching trays and pre bleaching shade recording with photographs.Review of bleaching and recording of new shade with photographs.
4. Review of bleaching and recording new shade with clinical photographs.

Consultation and assessment

At this visit a full examination is carried out of your teeth and gums to ensure that your teeth are suitable for whitening. If there are cavities, defective fillings or gum disease, these should be treated first.  It is important to note the presence of any tooth coloured fillings, crowns or veneers on teeth at the front of the mouth as these will not whiten along with the teeth.  The presence of any of these does not mean that tooth whitening cannot be carried out but that these restorations may need to be replaced so that they match the whiter colour of the teeth after the whitening treatment has been carried out.  Once the dentist has finished the examination, a full discussion of the case and suitability for whitening and any other treatment required discussed.

Impressions for bleaching trays.

Impressions are taken of the upper and lower teeth.  These are sent to the lab, where models of the teeth are made, on which bleaching trays are fabricated.

Fitting of bleaching trays

About a week later the bleaching trays are fitted and the patient given the bleaching gel.  The dentist shows the patient how to place the gel in the trays and fit them in the mouth.  Clinical photographs are taken at this appointment to record the shade of the teeth before whitening.  The patient will then perform the tooth whitening procedure nightly for about 2-3 weeks.  The bleaching trays are quite light and comfortable to wear.

Review of bleaching

After about four weeks the dentist will review the teeth to ensure that the whitening treatment has been successful and record the new colour with clinical photographs.  At this visit any fillings, crowns or veneers will be assessed as to whether they need replaced and an appointment arranged to have these done if necessary.

Some people do experience some sensitivity of the teeth during the bleaching process but this will resolve once the bleaching has finished.  If the sensitivity is particularly bad, there are different gels that can be used in the bleaching trays to reduce this.  Desensitizing toothpastes such as sensodyne are also effective in reducing sensitivity and it may be of benefit to be using such a toothpaste  for a few weeks prior to bleaching.

INSIDE AND OUT BLEACHING TECHNIQUE

Sometimes a single tooth becomes darkened or discoloured.  This is usually because the tooth has had a root filling or the tooth has become non-vital.  In the case of a non-vital tooth a root canal treatment is required initially.  These teeth can be bleached very effectively by the inside and out bleaching technique.  This requires the following visits(presuming an adequate root canal filling is already in place)

1. Examination and assessment.
2. Impression for bleaching tray.
3. Removal of filling from back of tooth and fit of bleaching tray with bleaching gel.
4. Review of bleaching and placement of temporary dressing in back of tooth.
5. Review and placement of permanent filling in tooth.

Examination and assessment

This will require a xray to assess the tooth and root canal filling and clinical pictures to assess the colour of the tooth followed by a discussion of the proposed treatment with the patient.

Impression for bleaching tray

An impression is taken of the tooth arch containing the discoloured tooth.  This is then sent to the laboratory, where the bleaching tray is fabricated.

Removal of filling from back of tooth and fit of bleaching tray with bleaching gel

The filling is removed from the back of the discoloured tooth.  This ‘access cavity’ is thoroughly cleaned and the root filling sealed off.  The patient is then shown how to place the bleaching gel inside this access cavity and then fit the bleaching tray in place so that the gel is in contact with both inside the tooth and the outer surface.  This gel should then be removed and the technique repeated every 2-3 hours for 2-3 days until the  tooth colour matches the other teeth.

Review of bleaching and placement of temporary dressing in back of tooth

After the 2-3 days the dentist reviews the tooth to ensure the bleaching is satisfactory and fills the access cavity with a temporary filling.

Review and placement of permanent filling in tooth

A few weeks later the tooth is reviewed again to ensure the colour is stable and the permanent filling can then be placed in the access cavity and clinical photographs taken of the end result.

GALLERY OF BLEACHING CASES DONE AT BLACKROCK DENTAL SURGERY

Case 1- Before treatment. Very discoloured fillings on front teeth, discoloured front tooth.

Case 1- After treatment. Inside and out bleaching on central tooth followed by full mouth bleaching and replacement of discoloured fillings

 

 

 

 

 

 

Case 2- Before treatment. Badly discoloured lower central tooth.

 

 

Case 2- After treatment. Inside and out bleaching on lower incisor followed by full mouth bleaching

 

 

 

 

 

 

 

 

Case 3- Before treatment. Discoloured front tooth

 

 

Case 3- After treatment. Inside and out bleach, followed by full mouth bleach and replacement of old filling

 

Teeth on either side of the gap support a bridge which replaces the missing tooth

Bridges

Bridges are used when there are teeth missing.  The teeth on either side of the space are prepared as for crowns and the crowns are linked by the bridge tooth.

Traditionally metal bonded to porcelain was mostly used for bridges but with modern ceramic bridges such as Procera and Lava are now providing a suitable alternative with superior appearance.

Procedure

The teeth supporting the bridge  must first be prepared under local anaesthetic and then impressions of the preparation of the prepared teeth and opposing teeth taken .  Temporary crowns are usually cemented at the end of this visit and the impressions sent to a dental laboratory where the bridge is fabricated.  Usually about 2 weeks later the temporary crowns are removed and the bridge is cemented into place.

Complex crown and bridge cases sometimes require diagnostic study casts and wax ups of the proposed crowns/bridges for the dentist and patient to assess how everything will look at the end of treatment.

cracked.

• Gold
• Metal(inside) bonded to porcelain(outside)
• All ceramic
• Composite resin

Gold Crowns are probably the best in terms of function and durability but appearance is obviously an issue and cannot be considered at the front of the mouth.

The 3 other types are tooth coloured with the new ceramic crowns being the best esthetically (particularly their appearance at the gum).

Procedure

The tooth to be crowned must first be prepared under local anaesthetic and then impressions of the preparation of the prepared tooth and opposing teeth taken .  A temporary crown is usually cemented at the end of this visit and the impressions sent to a dental laboratory where the crown is fabricated.  Usually about 2 weeks later the temporary crown is removed and the new crown is cemented into place.

Complex crown and bridge cases sometimes require diagnostic study casts and wax ups of the proposed crowns/bridges for the dentist and patient to assess how everything will look at the end of treatment.

Example of superior esthetics of Procera (all ceramic) crown on middle tooth.

Before treatment- Patient unhappy with poor appearance of upper front teeth.

After treatment- 6 composite resin crowns on upper front teeth

The images shown illustrate the difference in appearance between the highly esthetic all ceramic crowns, which have a very life-like appearance and are difficult to distinguish from normal teeth, and the composite resin crowns (shown in the bottom picture), which although improving the appearance considerably, are not as life-like.  Please note that these are 2 separate cases.