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.
 

Invisalign is one of our favourite treatment techniques. It is a phenomenal clear aligner therapy which is head and shoulders above the rest. The technology behind the treatment is simply amazing and we can treat virtually every case with Invisalign. The days of 'this can only be treated with fixed braces' has gone! However, it is important to understand that each treatment is bespoke and planned by us carefully. We do not just simply accept the algorithm from Invisalign and we put our mark on each and every case. Not all Invisalign is the same.
 

Tooth wear is one of the most prevalent dental conditions that we see in practice day to day. It would not be an exaggeration to say that almost 90% of adult patients suffer from some form of tooth wear albeit to varying degree of severity. Minor tooth wear can lead to issues such as sensitivity to hot and cold whereas severe tooth wear can impair everyday function of chewing and mastication. Severe tooth surface loss will also cause a reduction in the occlusal vertical dimension (OVD) which is a measurement from under the nose to the chin. This will lead to a change in the shape of ones facial structure which is not desirable. The good news is that there are a number of treatments available that are minimally invasive, pain free and far less costly than traditional methods of reconstruction.
 

Our case of the month for October 2022 was the laser treatment of the gum pigmentation due to genetic reasons.
 

Our case of the month for September 2022 is a lovely smile transformation done the Progressive Dentistry way with invisalign full, teeth whitening & a new front dental crown. When we plan these types of treatments, we often will look at whether the teeth are in the right place first. Why is this so important? Well the reason is simple. If the teeth are not in the right place or well aligned, any cosmetic treatment will be a big compromise. For instance, in the days gone by, there was a fad for porcelain veneers and crowns. If the teeth were wonky to start with, this would mean having to cut a lot of healthy tooth to make the ceramic veneers or crowns. This is not a good idea! For every heavily prepared tooth, around 17-20% of the nerves die. This means root canal treatment and a risk the tooth will not last a life time.
 

Our case of the month for February 2022 is one involving 2 dental implants to replace 3 missing back teeth. Dental implants are considered the gold standard to replace missing teeth but what are dental implants? Well, essentially implants are the replacements for the roots of the missing teeth. They provide the foundation to allow us to place new teeth on top. Simple? Not really! Dental implant treatment is complicated and requires a huge amount of training, experience and ongoing education. Of course, some cases are more complex than others but in general, here is our workflow from missing tooth to replacement:

1. Full case assessment and records including x rays and CBCT scans.

2. Diagnostic planning on digital software.

3. Manufacture of surgical stent.

4. Surgery - placing the dental implant(s) using the surgical stent.

5. Allow healing of 12 weeks.

6. Take new records.

7. Place implant tooth/ teeth ( try in stage needed for several teeth).

Our case had lost several teeth over many years which meant she was unable to eat on the right side of her mouth. By using 2 dental implants, we were able to provide 3 teeth by 'bridging' the gap. A lovely end result and the ability to chew again! Life changing? Maybe not but certainly life enhancing.
 

Our case of the month for October 2021 was a simple yet effective one involving three of our favourite techniques: Invisalign, tooth whitening and cosmetic bonding.

Crowding of teeth is so common, we would probably say the majority of the population suffer some form of mis alignment of some sort. Luckily, modern day treatments mean that teeth straightening is actually a simply and pain free process. In our case, we used Invisalign Lite which is the 'middle of the road' version which typically takes less than 6 months. We have access to 14 initial aligners and then 2 sets of additional sets of up to 14 each for fine tuning.

Once this was complete, tooth whitening was done at home using our favoured Zoom gel followed by some expert cosmetic bonding. All treatment was carried out by Dr Nissit Patel. Please take a look at the before and after photos. Quite a transformation!
 

Our case of the month for September 2021 was a simply stunning one using ultra minimally invasive E max veneers. Our client disliked her front teeth composite bonding which had discoloured, worn and chipped over time. Although teeth bonding is a superb treatment, there are disadvantages compared to porcelain such as those mentioned above. Porcelain will not stain or change colour and it is far more durable than composite. However, in the past, porcelain needed considerable preparation to create space for the material which was a huge disadvantage. Today, material technology and modern techniques allow us to create beautiful veneers without having to cut teeth.

Our case highlights this, just take a look:
 

Dental implants are the best way to replace a single missing premolar tooth; at present there is no alternative that can offer the same benefits as dental implants. These include: 

1. A fixed tooth to replace the missing one
2. The adjacent teeth do not need cutting down
3. Preservation of the bone and gum tissue
4. Restoring function to that of the natural tooth
5. Excellent aesthetics as the new tooth emerges from the gum line
6. Dental implants cannot decay
7. Longer lasting than traditional alternatives such as dentures or bridges