Oral Hygiene

A hygienist will help to keep your gums and teeth healthy and has a variety of techniques to suit each patients particular needs. Most patients will require a general scale and a polish about every six months , while others may need more intense treatment more often. Your dentist will decide what you need, and will instruct the hygienist on the treatment. You will need to see the dentist before any treatment can be carried out. A routine scale and polish will remove any hard calculus ( or tartar ) and this is done using hand instruments or a ultrasonic type instrument. Often both are used to do this. An ultrasonic scaler is a blunt tipped mechanical instrument which vibrates to remove the build up. It uses water to flush the debris away and to irrigate around the gum. After this the teeth are polished to remove stains. An added treatment to lift stains from the tooth surface is an airflow polish. This is a machine which uses bicarbonate of soda and silica under pressure to remove more stubborn stains from the tooth surface and is particularly good for tobacco and beverage stains. It is beneficial before whitening to boost the start of the whitening process, and leaves your mouth feeling extremely clean . Gingivitis is a common condition and is easily treated. It is caused by sticky plaque around the mouth especially around the gums and will cause the gums to become inflamed. They may bleed when brushing or eating hard foods such as apples. . It is reversible and the hygienist will advise you how to resolve it as part of your treatment . Periodontal disease (gum disease) is more serious and requires longer treatment . It is caused by long term poor oral hygiene and can become painful when in an advanced stage. You may have bad breath , bleeding gums and perhaps slightly wobbly teeth as it progresses. In severe cases teeth may be lost . There are different treatments depending on the severity and your dentist will asses this. Surgical treatment involves moving the gum away from the tooth and cleaning under this and then careful replacement afterwards. This is carried out by the periodontist ( gum specialist) using local anaesthetic. Non surgical is best described as a deep clean. It is a careful systematic removal of build up from below the gums and is often done using some local anaesthetic. You may need more than one appointment. Follow up appointments at regular intervals are essential to keep your mouth healthy . At all appointments oral hygiene levels are assessed and any advice required is given. You may be asked to try using electric toothbrush. Also cleaning in between your teeth is vital for fresh breath and preventing gum disease. You may be shown how to do this and any difficulties you may have will be taken into account.
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What is Periodontal Disease (Gum Disease)?

Periodontal disease is a chronic disease that affects the tooth- supporting structures (the bone, periodontal ligament, gums). The periodontal disease can be divided in gingivitis (Inflammation or infection of the gums) and periodontitis (where we have already destruction of the supporting bone). They are both induced by dental plaque.

What is Dental Plaque?

Dental plaque is a combination of bacteria (biofilm), which covers the teeth when there is lack of oral hygiene. At first it is not visible, but when brushing and flossing techniques are not carried out effectively, plaque accumulates, turning into a white-yellow deposit. The plaque results in an inflammation of your gums, known as gingivitis.

What is gingivitis (Gum Inflamation)?

Gingivitis is described as an inflammation of the gums surrounding the teeth, without affecting the supporting bone. It increases the bleeding and red gums. Periodontal diseases are often classified according to their severity. They range from mild gingivitis, to more severe periodontitis. It´s important to diagnose gingivitis at an early stage otherwise it may be irreversible.

What is periodontitis?

Periodontitis or pyorrhea is an inflammatory disease which affects the tooth-supporting structures. Periodontitis involves the progression of the bacterial infection to the deeper tooth-supporting tissues resulting in the gradual destuction of the alveolar bone around the teeth. This destruction is irreversible and results in deep periodontal pockets, or in recessions. The bacteria reside in the pockets and if it´s not removed the destruction of the alveolar bone continues, until the tooth can no longer be supported. If gingivitis is not treated, it may progress to periodontitis, and this will lead to the loss of teeth. The first risk factor for periodontal disease is plaque. But there are other factors like smoking, poor general health, and genetics … that can influence. A diagnosis of periodontitis is established by inspecting the soft gum tissues around the teeth with a periodontal probe (clinical instrument) and by evaluating the X-rays, to determine the amount of bone loss around the teeth. The treatment of periodontal disease begins under local anesthetic with the removal of sub-gingival calculus (tartar) and biofilm deposits through a procedure called scaling and root planning which seeks to remove calculus by mechanically scraping it from tooth surfaces.
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Periodontal surgery

If it’s determined that you have unhealthy tissue or non-supporting tissue that will not be corrected by non-surgical treatment, you may need to have periodontal surgery. It’s imperative that the gum tissue tightly attaches to your teeth. For patients who suffer from periodontal disease what happens is that their gum tissue will pull away from the bone which causes pockets to form around the patient’s teeth. This is where bacteria will build up overtime. Bacteria build under the gum tissue itself causing tooth loss and other oral issues. Here at the Marylebone Implant Centre, Dr. Santos will thoroughly examine the depth of each pocket. Overtime if the depth becomes too much he could recommend periodontal surgery. The procedure will involve gently pushing back the tissue as well as cleaning the roots of your teeth in order for the gum tissue to reattach to healthy bone structure in your mouth. Other procedures may need to be performed in order to reverse some of the damages that may have occurred from the unhealthy tissue and encourage healthy re-growth.

Periodontal Surgery Benefits

The most important benefit of having periodontal surgery is the fact that you will prevent the progression of periodontal disease occurring in your mouth. When combined with healthy oral hygiene and regular dental checkups you will greatly increase the chances of keeping your natural teeth for a very long period of time. Other treatment options for periodontal disease include:
  • Bone & Soft-Tissue Grafts
  • Crown Lengthening
  • Non-Surgical Therapy
  • Laser Treatment
  • Mini-Implants or Dentures
For more information about periodontal surgery or periodontal disease, please contact our trained staff here at Marylebone Implant Centre and let us explain your options to you over the phone or in person.
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Guided tissue regeneration

Guided tissue regeneration is a minimally invasive procedure which will attempt to regenerate the lost periodontal structures which includes periodontal ligament, connective tissue attachment, and bone that supports your teeth on your jawbone. Biocompatible barrier membranes are used to direct the growth of new soft tissue and bone, often in conjunction with bone grafts and tissue stimulating proteins. In many cases for those who have these issues, destroyed tissue between their roots or teeth can be partially regenerated. Once Dr. Santos is able to prepare the damaged area and special membranes are inserted, new tissue will begin to grow over the next couple of weeks/months. In the past the surgery procedures were considered to be extremely painful and could disfigure your gums and teeth. Years ago it seemed that there were limited treatment options regarding surgical procedures which would usually result in patients having exposure of their root surface. This could become very sensitive and painful. It also would give the patients the appearance of having “long” teeth which could be very embarrassing. Here at Marylebone Implant Centre, that’s not the case as Dr. Santos may be able to regenerate or restore the attachments and missing bone structure around your teeth that are subject to periodontal disease. For more information about periodontal gum disease and guided tissue regeneration, contact our practice and talk with one of our staff members so you can get a better understanding of the surgery could do for your overall oral health.
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A gingivectomy is a surgery that helps reform and removes gum tissue that is filled with disease or some other gingival build up that is relating to a very serious condition. This method is usually tried after other non-surgical methods have failed and there are no other options and the patient is at high risk of having the disease advance throughout the ligaments and the bone that is supporting the teeth around the gum disease. The procedure can be performed here at the Marylebone Implant Centre by Dr. Santos and his trained staff. Primarily the surgery is performed on one quadrant of the patient’s mouth at a time using local anesthesia. If this procedure is not sufficient in order to remove the unhealthy or excessive tissue, other procedures may need to be performed including regeneration of attachment structures using tissue as well as bone grafts. This surgery could be performed in order to remove excessive tissue and to improve the aesthetic look of the patient (ex: gummy smile), but it can be also used in combination with other restorative procedures such as porcelain veneers and porcelain crowns. The surgery is also performed to help eliminate issues that could lead to periodontitis or help to stop the progression of the disease from getting any worse. There are many factors that can contribute to the conditions that have an effect on a person’s oral health which include a patient’s immune system. Unless the surgery is performed, the patient’s likelihood of ridding themselves of the disease on their own is extremely low, especially since the presence of bacteria and other microorganisms are already present. In some extreme cases a patient may even need to have graft surgery to help restore both the bone tissues and tissue ligament which would have been destroyed by the disease. Patients could also have issues if they have external factors such as smoking and diabetes, which could increase the severity of the gum retreat from the patient’s teeth. For more information about gingivectomy and to find out if the surgery is right for you, talk with a trained staff member today. You can also find out more information about receiving dental implants or another cosmetic dentistry procedure offered here at Marylebone Implant Centre.
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Crown lengthening

Crown lengthening is a common procedure that can be performed here at Marylebone Implant Centre. It’s a procedure that is performed to expose greater amounts of your tooth structure. The procedure is done surgically by incising the gingival tissue around your tooth or teeth to give you a broader smile. You may also be advised to receive a crown lengthening procedure in order for you to get a cosmetic dental procedure performed correctly. There are many reasons why you may get crown lengthening including tooth decay, if you have a broken tooth below the gum line, or you don’t have enough tooth structure to have the tooth restored properly through a bridge or crown. Crown lengthening for cosmetic purposes will involve adjusting the levels of the bone and gum tissue around your tooth or teeth to achieve a more level tooth to gum ratio. Once the procedure is performed, you will then have the proper levels needed for the restoration process to happen correctly resulting in a beautiful smile. When performed properly you will not only have a beautiful smile now, but you will also have enough tooth structure in the event that you would have to undergo another restoration procedure in the future. It’s estimated that the procedure should take about one hour to complete but each patient is different. So talk with our trained staff to gather all the information needed before deciding if crown lengthening is right for you. After the procedure is over you will have sutures, in place to ensure that the new tooth-to-gum relationship will heal properly. You should expect to come back to see the dentist about two weeks after the procedure to ensure that everything is healing properly and the sutures are removed.
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Soft Tissue Graft

Whether you are looking to improve the appearance of your smile or you have recently been told that you need a gum graft to help protect your teeth from the serious effects of gum recession, you have no need to panic. In the process of gum recession a patient will experience tissue pulling away from one or more of their teeth, which could expose the root of the tooth or more of the tooth which could lead to damage of the bone that is supporting the tooth. This is a common dental issue that affects adults (between 5%-12%) and will go unnoticed for the most part until it becomes bothersome. While the problem can go unnoticed for a long period of time, once the root does become exposed it will begin to cause tooth sensitivity and look very unappealing. Patients could have trouble eating hot or cold foods, and if not treated it can lead to tooth loss. To help repair the problem, a dentist will propose performing a gum tissue graft procedure.

Depending on your specific needs, a dentist can choose from one of the three following graft procedures:

  1. 1. Pedicle Grafts – This procedure will have the dentist retrieving tissue from gum that is located closely to where the tooth needing repair is located instead of taking it from the palate. The pedicle (flap) is only partially removed so that one edge of it is still attached. The gum will then be pulled down in order to cover the root that is exposed and then it’s sewn into place. This procedure is popular for patients who have a lot of gum tissue near their teeth.
  2. 2. Connective-tissue Grafts – This is one of the most common methods to help patients who suffer from too much root exposure. For this a dentist will cut a flap of skin and tissue under the skin from the palate of a patient’s mouth and will stitch it to the gum tissue of the exposed root.
  3. 3. Free Gingival Grafts – This procedure is similar to that of the connective-tissue graft because it also will use tissue from the palate of the patient’s mouth. The difference here, though, is that the dentist will not cut a flap of skin under the top layer, he instead will use tissue that is removed directly from the roof of the patient’s mouth and attach it to the area that is being treated. This is a popular graft for patients who have extremely thin gum lines and need additional tissue to help build up the gums.
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Dentures are used to replace surround tissues and missing teeth in your mouth. There are two different types of dentures available- partial and complete. Partial dentures are used when there are still several of the patient’s original teeth remaining and complete dentures are used when the patient has no teeth remaining.
  • Complete or full When you are talking about complete dentures or full dentures, there are types- conventional or immediate. Immediate dentures are created ahead of time and be placed in a patient’s mouth whenever their old teeth are removed. Disadvantages of having immediate dentures is the fact that as your gums begin to heal, over time there will be some shrinkage which would require the dentures to not fit as securely as possible. For conventional dentures they will be able to be placed in the patient’s mouth about eight weeks after the patient’s teeth have been removed. For most patients, immediate dentures should only be used as a temporary fix until they are able to receive their conventional dentures.
  • Partial – This is a partial denture that can easily be removed and is made up of replacement teeth that would be attached to a matching gum-coloured base. Partial dentures can be used in both the upper and lower jaw. This is a great alternative for the interim stages of the implant treatment plan, while the final crowns are not fitted. Patients who might not qualify for dental implants could also be good candidates for removable partial.
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Fixed provisional crowns

A fixed provisional crown will temporarily replaced a single tooth or many teeth. It needs to be supported by adjacent teeth that would need to be prepared (filled down) before the provisional crown or bridge is cemented with temporary cement. Also, a fixed provisional crown can in some occasions be fitted over an implant (immediately or once the implant is healed). This would allow re-shaping and reforming the gum around the provisional crown – in the area of the implant. Also, it would allow immediately covering the gap of the missing tooth or teeth and avoiding the use of removable dentures.

What is involved in the process of having a Fixed Provisional Crown?

Initial impressions of the upper and lower jaw are taken. A bite registration is also taken in order to relate the top and bottom models. Next, the impressions are sent to the lab in which the crown will be manufactured. Before sending the impressions to the lab Dr. Santos will match the colour as closely as possible to your other natural teeth. Also, during your first visit it’s likely that you will have X-rays taken of the roots of the tooth or teeth where you will be receiving a crown. If there are complications such as tooth decay or there is a high risk for infection you may need to have a root canal treatment performed first. At the second visit the process of preparing the tooth for a crown includes some type of numbness medication given to you in order to help with any discomfort you may feel. The tooth will then be filed down to make room for the crown to be installed properly. In some instances, too much of the tooth is missing and in this case Dr. Santos would then help build up the tooth in order for it to better support the crown. After the tooth or teeth are prepared, Dr. Santos will reline (re-adapt) the provisional fixed acrylic bridge or crown to the prepared teeth and will then cemented with a provisional cement.. In case of a fixed provisional crown over and implant, this would be fitted over an implant abutment.
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Maryland bridges

Dental bridges are recommended for patients who may have one or more missing teeth in which their smile, eating habits, oral health, and speech may be impacted. One of the most popular types of bridges on the market today is the Maryland Bridge because there is very little adjustment that needs to be made to the teeth surrounding the bridge. This type of bridge is created using a special resin which is cemented to the enamel of your teeth along with a metal framework. Another benefit is the fact that there are only light preparations needed so there is no need to expose the dentin of the tooth. This helps for patients who would perhaps suffer from sensitivity issues after a regular bridge would be set in place. At the Marylebone Implant Centre the Maryland Bridge is often proposed as a fixed provisional treatment to replace a missing tooth or teeth, while the patient doesn’t have their treatment concluded, either because a tooth was extracted recently extracted or a bone graft or implant are still healing.

Maryland Bridge Fitting Procedure

For most bridges to fit properly in your mouth, a dentist will have to make some alterations to your original teeth. A mold will be made of your teeth and sent off to a lab in which they will create a custom bridge to fit specifically in your mouth. Once the bridge is manufactured and sent back to your dentist, you will then be ready to have it fitted into your mouth. There is little discomfort for this procedure, but many dentists will still give their patients a local anesthetic to help them cope with the discomfort. For Maryland Bridges there may be a little bit of shaving required to ensure that the bridge fits securely, but this will be minimal. After the Maryland Bridge is set in place, Dr. Santos will ensure that everything feels and looks right. He will also check for the bite and fit to ensure you are happy with the final product. After everything is perfect, your new Maryland Bridge will be permanently set in place using dental cement.

Maryland Bridge Care

A Maryland Bridge can last ten years or longer if it’s well maintained. The best way to care for your new Maryland Bridge would be to treat it as your natural teeth, so brushing your teeth as well as your bridges is extremely important. This will help ensure that you will not have bad breath or be subjected to tooth decay and gum disease. Flossing is also a very important step to ensure that your care for your new dentures properly.
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