One of the most common cosmetic dental treatments we provide at our Fulham dental practice on a daily basis is composite bonding or composite edge bonding. Now, let us explain what composite edge bonding is exactly. This is where a tooth, normally a front tooth, is enhanced by adding composite ( which is a white filling material). This would usually be to change the shape such as the length or width, to repair a chip or fracture or protect a worn down tooth. For edge bonding, the composite typically just replaces PART of the tooth and there is usually a bevel finish where the composite is blended in with some sound tooth enamel. Most of the tooth away from the edge bonding remains exactly the same.

This is inherently different from a composite veneer where the composite covers ALL of the outer surface of the tooth right up to the gum level.
 

Our case of the month for April 2024 is one using one of our favourite treatments; Invisalign. As you may be aware, Invisalign is the most well know orthodontic system in the world and for good reason. The science and technology behind the system means that we can predictably correct even the most crooked teeth including severe rotations. The key is in the planning. Not all Invisalign is the same! We spend a great deal of time planning each and every case to achieve the best possible results. This case highlights that beautifully.
 

Composite bonding is a well know and popular technique that we have been using for over 15 years. The process is generally minimally invasive, requires very little tooth preparation, no needles or anaesthetic and is more affordable than other cosmetic dental options such as porcelain veneers. The procedure can be used for a number of treatments including closing spaces between teeth especially front teeth.
 

We love to create new smiles with the most modern technology and techniques available that are kind to the teeth, are natural and long lasting. In many cases, E-Max porcelain veneers will give the best aesthetic and functional results. This is especially the case when teeth already have been filled and are now starting to show discolouration or are worn and chipped. Porcelain veneers will completely transform a smile by creating new outer surfaces for the teeth. This is shown superbly by our case of the month for February 2024.

Most celebrities and television personalities have porcelain veneers on the upper teeth. If you take a close look, the lower teeth are often slightly darker and a little uneven!
 

Peri implantitis is becoming a major issue for dental implants and it is important to be aware of this when embarking on implant treatment to replace missing teeth. The term relates to a number of factors around implants but the main issues are:

1. Inflammation of the surrounding mucosa ( gum )

2. Increased pocket depths around the dental implant

3. Bleeding on probing

4. Suppuration ( pus oozing from the tissues)

5. Loss of bone around the implant either in a horizontal , vertical or both directions. 

This differs from peri implant mucositis where there is bleeding on probing, possible swelling and inflammation and increase in pocket depths BUT there is NO loss of bone around the implants. Peri implant mucositis is reversible but peri implantitis is irreversible. Diagnosis is essential and the earlier the treatment, the better the diagnosis. Often, the disease may go un noticed, very much like gum disease, but once symptoms develop it is often too late to prevent bone loss. It is essential that regular dental and hygiene visits are maintained after dental implant treatments so that any problems can be spotted at an early stage. In general, we would advise twice yearly appointments or quarterly hygiene appointments if there has been past gum disease present.
 

Our case of the month for December was one using Invisalign Comprehensive to widen the smile line, correct crowding, create a symmetrical smile line and close an open bite. In the past, treatment of an open bite was considered a complex situation which often would involve surgery on one of the jaws. However, with careful planning and utilising all of the technology now at our disposal, we can plan open bite treatments with confidence.
 

Porcelain veneers are one of the most popular ways of transforming a smile. Veneers are outer facings that cover the tooth/teeth to repair issues such as chips, fractures, asymmetry, discolouration or protect old fillings. The transformation of a smile can be life changing. A smile is one of the first things that is evident on a person and this can radiance confidence and self-belief. The treatment for veneers is not a straightforward one and requires careful planning and execution to achieve an outstanding result. Our case of the month highlights the beauty of this treatment and the process that is involved.
 

Our case of the month for September 2023 involves the use of Invisalign Comprehensive to close large spaces between the teeth and correct an open bite. With such cases it is critical to plan properly with a realistic view of the end result in mind before embarking on treatment. We spend a great deal of time planning our Invisalign cases so that aesthetic, functional and natural results can be achieved. Invisalign Comprehensive is the option that we use the most as this allows us unlimited numbers of Invisalign aligners, refinements and modifications within the overall package. We also provide the final retainers, tooth contouring and a tooth whitening pack as part of the package.
 

One of the main aesthetic challenges we face as dentists, is a dark discoloured front tooth. This usually results from after a root canal treatment which may be needed for a variety of reasons but is usually from trauma. The reasons for the discolouration do vary. This could be from remnants of the pulp tissue being left within the root canal system and then decomposing within the tooth permeating into the dentine. There can also be rupture of the blood vessels within the pulp allowing blood products to seep into the dentinal tubules and discolour the tooth as this degrades. Another common reason is not so well known. Studies have shown that another factor could be the result of not removing all of the root canal sealant material once the tooth has been treated. van der Burgt TP, Mullaney TP, Plasschaert AJ. Tooth discoloration induced by endodontic sealers. Oral Surg Oral Med Oral Pathol. 1986;61:84–9. [PubMed] [Google Scholar] [Ref list]

The chromophores resulting from the disintegration of root canal sealer remnants penetrate through the dentinal tubules into the coronal tooth structure gradually causing progressive discoloration. The key factor is that most root treated teeth do appear darker than non root treated teeth and when this is on a front tooth, it is a major aesthetic issue.