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News - Nothing but the tooth

{ Dental News }

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Jul 2015
4th
4th of July 2015

Breaking News! Fluid Abrasion Is Coming To Progressive Dentistry

As one of London's leading dental practices, we strive for the very best treatments for our patients. As such, we invest in the latest technology that can have a major benefit for our clients. We have just invested in fluid abrasion. This product will enable us to treat decay, remove old composite fillings, aid bonding, clean inside of crowns and bridges and much more WITHOUT drilling. Just imagine, no horrible noise or sensation from the dental drill! What's more, in many cases, we can do this without ANY anaesthetic. So no needles and no drilling, what could be better? Well, the technology also allows us to clean and polish teeth using the latest powder called Slyc which also de sensitises teeth. All of this fits in with our ethos of minimally invasive dentistry. 

So if you would like to benefit from the latest technology, please do not hesitate to contact us. Dental treatment does not have to be something you fear. We are here to help and provide the very best in dental care.


Jun 2015
16th
16th of June 2015

Late evenings now available on Tuesdays until 8pm!

We are delighted to announce that late evening appointments are now available on Tuesdays until 8pm. This session will be taken by Dr Deborah Philips and will initially be available on alternate weeks. This will include general dental and hygiene appointments. So if you would like a dental appointment after work or in the evening due to other commitments, we have a solution for you. We are also open early morning every Tuesday from 8am, offer another late evening every Wednesday until 7pm and are open every Saturday. So no excuse that you are too busy to see the dentist- we can accommodate you!


Jun 2015
13th
13th of June 2015

The Truth About Teeth Part 2

BBC 1 recently screened the second part of the series The Truth About Teeth. The program highlighted some very valid points which are worth repeating: 

1. Gum inflammation can cause inflammation elsewhere in the body taking years of your life. Many studies are now linking gum disease with other systemic diseases. Maintaining oral health has never been so important.

2. Acid erosion is one of the biggest causes of tooth surface loss. Acid in foods and drinks can be deceptive. For example, fruit tea is incredibly acidic. Apple juice is actually more acidic than orange juice.

3. Hidden sugars in food are a major cause of tooth decay. Did you know that in a bowl of fruit and fibre cereal, there is the equivalent of 6-7 cubes of sugar! 

4. Fear of the dentist is ten times higher than fear of seeing a doctor. This is one of the main reasons for not visiting the dentist. 

If you would like to discuss any of these points with us, please do not hesitate to contact us via e mail or telephone.


May 2015
28th
28th of May 2015

Dental Implant Systems at Progressive Dentistry

We have recently been asked which types of dental implant systems we use at Progressive Dentistry.

The answer is: 

1. Nobel Biocare Implant System.

2. Astra Tech Dental Implant System.

3. Implant Direct System.

4. Ankylos Implant System.

5. Southern Dental Implant System.

We also have restorative capability for the Straumann implant system. However, we are happy to accommodate any implant system. 

If you have a problem with your dental implants and need some help, contact us. We will not simply dismiss your case because we do not use that particular implant.


May 2015
14th
14th of May 2015

Screw Retained Dental Implant Crowns

The great advantage of screw retained dental implant crowns is that there is no cement at all. Therefore any of the potential problems of excess cement extruding beyond the crown margin and instigating Peri-implantitis is negated. 

Another advantage is that if the crown needs to be removed, it is relatively easy to do so and there is no damage to the porcelain work by forcibly removing the crown.
 

Planning for Screw Retained Implant Crowns

In general, the screw access hole should be down the long axis of the implant. This is important in relation to ease of placement, avoiding damaging lateral tension forces when torquing the screw which could lead to screw loosening and avoiding the issue of possibly threading the screw if proper access has not been made. Therefore, prior to placing the dental implant, it is important to plan what type of restoration is to be placed. 

However, recent advances in prosthetic design have evolved and Nobel Biocare now have an angulated screw channel. This allows a angulation difference of 25 degrees, which is significant. This can be applied to the posterior and anterior regions. This is possibly a game changer in dental implant prosthetics.
 

Placing Screw Retained Dental Implant Crowns

The placement is generally quite simple. The crown and abutment is a one piece prosthetic device. The crown is then placed within the dental implant. There is only one path of insertion and therefore a placement jig is not required. Initially, screw down gently until the crown is stable and in it's fully seating position. Check the marginal adaptation, contacts, embrasure space and occlusion. Take a peri-apical radiograph to ensure correct seating. If so, make any necessary adjustments. 

Once all of the relevant checks have been made and verified, torque the screw to 20Ncm using a prosthetic torque wrench. The screw should be covered with sterile cotton wool and the access cavity restored with composite. 

Tip: for metal based substructures, to avoid a grey shadow use an opaque flowable composite around the periphery and on the base. Voco have an excellent one which I routinely use to block out dark areas whilst placing composites.
 

Removing Screw Retained Implant Crowns

Simply remove the composite and cotton wool carefully and unscrew the abutment screw. Simple. 

Tip: be very careful not to damage the abutment screw! Use an ultrasonic to remove the final layer of composite.
 

Conclusion

In many cases, screw retained implant crowns are the desired option. With the evolution of the Nobel Biocare angulated screw access, the scope for these restorations has increased hugely. With the huge advantage of no cement, I would suggest considering screw retained restorations for single implant crowns as the first choice option.

An article for dentists by Dr Nissit Patel


May 2015
3rd
3rd of May 2015

Cement Retained Dental Implant Crowns

When restoring dental implants, the choice is screw retained or cement retained. Cement retained crowns will often be used when the screw access hole is not positioned down the long axis of the implant. There may be angulation issues or aesthetic issues that arise from this. Cement retained crowns may also be preferred by the patient due to the unaesthetic appearance of the access cavity for screw retained crowns, which often looks grey and discoloured if the underlying crown has a metal sub structure. Patients now often regard premolar and molar teeth as being in the aesthetic zone and are highly dental aware. Quite rightly, they expect dental implant crowns to look like natural teeth.
 

What Abutment Is Best for Cement Retained Crowns?

In my experience, Atlantis abutments are far superior to any other system. Think about how you would prepare a tooth for a crown and amplify the precision ten fold. With the digital age we live in, technology should be used to enhance the outcomes for our patients. This is one system that certainly does that. There are also other scanning centres which produce excellent abutments. It is worth talking with your dental implant technician and using a few systems. Of course, there is a cost implication involved and Atlantis may not be suitable for all.
 

How To Fit The Cement Retained Crown

When fitting cement retained crowns it is imperative that excess cement does not exude the margins and act as a plaque trap. This is one the main causes of Peri-implantitis and is avoidable. 

There is an excellent technique which will help you to avoid any issues with excess cement: 

1. Once you have verified the margins, occlusion, contacts, embrasure space and aesthetics you are ready to cement the crown. 

2. Use your PVS bite registration material and insert within the crown creating a tag at the end to act as a handle. 

3. Remove this index. 

4. Mix the cement, which is usually a temporary cement (Tempbond NE) or a dedicated implant cement and place within the crown. Do not overfill. Make sure the abutment screw is covered. I use pre sterilised cotton wool. 

5. Insert the index into the crown to remove the excess. This will leave a very fine layer of cement. 

6. Place the crown and wait for setting. There should be no excess at the margins.

7. Perform the usual checks and take a PA radiograph to verify. There should be no exudate whatsoever. 

8. A useful tip for removing any fine smears of Tempbond on the crown is orange solvent. Spray some onto a ball of cotton wool and clean any fine residue. 

9. Review as required.
 

How To Remove Cement Retained Implant Crowns

There are times when implant crowns will need to be removed. For example, if the abutment screw loosens. This is why temporary cements are used. In my experience, cement retained crowns can be removed with minimal fuss. However, you must pre warn the patient that some force is required. I would over emphasise this fact. To avoid damage to the porcelain, use rubber coated crown removing pliers. GC have an excellent one. Grip the crown firmly and exert pressure in a bucco-lingual direction initially and then rotational. The crown should ease off within a few seconds.
 

How To Maintain Dental Implant Crowns

Dental implant crowns, screw or cement retained, require maintenance just as natural teeth. However, your hygienist must be trained in this field. Regular scalers, hand or ultrasonic, should not be used for fear of scratching the titanium. Satelec have introduced some excellent ultrasonic tips for implants. We have invested in these with great success. Specific implant hand scalers can also be used. We are also keen on adjunctive methods of cleaning such as Philips Airfloss.
 

Feedback

Article for dentists written by Dr Nissit Patel. 

I hope this article has been of use. It comes from many years of experience of placing implant crowns, cement and screw retained. I welcome any feedback that you may have, please e-mail me: nissit@progressivedentistry.co.uk 

My next article will focus on screw retained crowns.


Mar 2015
21st
21st of March 2015

Almost There! Shortlisted For Best Aesthetic Practice South & More Award News

We were recently shortlisted for the Best Aesthetic Practice South by the Aesthetic Dentistry awards, which was a fantastic achievement. The awards were held last night in central London. Unfortunately we did not win the title but to make the final was a real honour. Dr Veehar Malde also made the shortlist for the Best Case Full Mouth, which was a great achievement considering the level of expertise on show. His case was an amazing smile transformation and had a profound effect on the patient.

Dr Nissit Patel has also been shortlisted for the Best Dentist South awards by the Dental Awards, which is due to be held in April. Fingers crossed!


Mar 2015
9th
9th of March 2015

Progressive Dentistry Achieves Third Award Nomination!

Following on from our two nominations at the Aesthetic Dentistry Awards for Best Aesthetic Practice South and Best Full Mouth case (Dr Veehar Malde), Progressive Dentistry have just learned about another nomination. Dr Nissit Patel has been shortlisted for Best Dentist South at the Dental Awards. The Dental awards are the longest running in the dental profession and to be shortlisted into the final for such a vast category is a huge achievement. The Aesthetic Dentistry Awards take place on the 20th March 2015 and the Dental Awards on 17th April 2015. We will keep you posted! In the meantime go to our awards page to see all the awards we have won to date.


Mar 2015
3rd
3rd of March 2015

Continual Professional Development - CPD

We strongly believe in continual professional development or CPD for short. The developments in dentistry are moving at a rapid rate and it is vital to keep up to date with the these advancements. On Friday, Dr Nissit Patel and Paula Ryan will be attending a core CPD meeting in Kensington. This will address important issues such as oral cancer, dental radiology, medical emergencies, decontamination and cross infection. As a practice, we are committed to being at the forefront of dental care. We undertake hundreds of hours of CPD per year, above and beyond the minimum requirements.