Wisdom Teeth Extraction

Wisdom teeth need to be extracted in the following situations:

Paul Dental Clinic applies micro-invasive extraction handpieces. For sensitive or fearful patients we also provide laughing gas. Gentle,fast and painless are always the comments we hear from our patients.

Autogenous Tooth Transplantation

A healthy wisdom tooth of a proper size can be autotransplantated into the extraction socket of the tooth that has to be removed as an alternative. This is a much more economic, esthetic and durable way to replace the missing tooth, compared with implants or a bridge.

Treatment of Traumatic Lesions

Commonly seen traumatic lesions include fracture, concussion, subluxation and extruded luxation.

Dental Pulp Regeneration

If the decay of immature permanent teeth, especially those newly erupted ones, has involved the pulp, pulp will stop developing because of the inflammation. The tooth with underdeveloped pulp is more likely to experience root fractures in the future. But if those immature necrotic permanent teeth can receive biologically based endodontic therapies in time, root development will continue — dentinal wall thickness will increase, and apical closure will be achieved.

Teeth Whitening

Before teeth whitening/bleaching, teeth should be checked and evaluated carefully by the dentist. In cases with enamel defects and so on, teeth ought to be treated or protected in advance. For the sake of effect and safety, the whitening process is strongly suggested to be carried out by licensed dentists.

Periodontal diseases affect the supporting areas of the teeth, which can be divided into two main divisions: gingivitis and periodontitis. Periodontitis is the main cause of tooth loss in adults. It is also found that there is a close correlation between periodontal health and major body diseases, such as stroke and circulatory illnesses.

Indications of periodontal disease are: gum bleeding, gum recession, erythema and edema, loose tooth, and toothache under pressure.

Factors related to Periodontal Diseases

The major contributing factors are plaque and calculus. Therefore, bad oral hygiene, smoking and prosthesis with overhands are the most common reasons, but genetic make-up, stress, diabetes and anomalous formation of teeth also play a part in the chances of periodontal disease:

Periodontal Treatment Methods

1. Nonsurgical Treatment of the Periodontium

a. Supragingival Debridement (Teeth cleaning)

With the involvement of ultrasonic tips, this treatment aims to remove supragingival plaque, calculus, and stain through tooth-crown scaling. Superior equipment and technique guarantee both a thorough cleaning and comfortable experience.

b. Subgingival Debridement

Subgingival Debridement is to remove subgingival plaque and calculus through root-surface scaling and root planning. This treatment usually involves hand instrumentation.

2. Periodontal Surgery Techniques

a. Periodontal Flap Surgery

In cases with deep periodontal pockets, a loosened section of tissue is separated from the adjacent tissues to enable elimination of deposits under better viewing.

b. Guided Tissue Regeneration

This method can restore and adjust the marginal ridge, encouraging the growth of new periodontal attachment.

c. Gingival Augmentation

Soft tissue grafting helps to restore the gingival crest to a natural height, solving the esthetic problem and sensitivity by covering exposed roots. Ridge augmentation is usually applied in collapsed areas where the implant is placed.

Primary teeth have their own unique physical structure, while stages of child development have their own unique behavior features. Helping children smoothly transition from primary dentition to a permanent one requires pedodontists to have skilled hands, a wide dentistry background including orthodontics, handpieces and other facilities specialized for pediatric dentistry, behavior management and anaesthesia & sedation technique.

We strive to motivate the patient and their family by demonstrating that primary teeth are not disposable and restore primary dentition because it helps:

Paul Dental Clinic wishes to, together with parents’ effort, manage children’s teeth well, helping them achieve a life-long healthy and pretty smile.

Cavity Treatment

1. Composite Filling

Minimally invasive drill especially made for children is used to minimize the loss of healthy enamel. Pediatric dental care requires precise techniques completed rapidly and calmly.

2. Stainless Steel Crown

Badly decayed or broken-down milk teeth, that cannot be restored with filling, need to receive a straight edge or contoured stainless steel crown.

3. Pulpal Treatment

If the cavity has affected the pulp, the inflamed pulp needs to receive pulpal treatment. Experienced pedodontists will take the developing stage of the primary and permanent teeth into consideration, to work out a treatment plan which can guarantee the normal development of permanent teeth.

Space Maintenance

Early loss of deciduous tooth because of trauma or caries may lead to ectopic eruption of the underneath permanent tooth or dental crowding, for the adjacent teeth can drift or tilt toward the space. It is necessary to maintain or reclaim premature spacing in the arch until eruption of the secondary teeth with placement of fixed or removable appliances.

Interceptive and Corrective Orthodontics

Malocclusion such as crooked teeth or biting problems due to a failure in space maintenance, mouth-affecting habits or congenital factors requires interceptive or corrective orthodontic care. Interceptive procedures are usually performed to lessen the severity of any existing malfunctions or to correct improper growth patterns. For example once the jaw growth stops, it is almost impossible to guide the jaw growth toward the ideal direction, and thereupon the complexity of orthodontic treatment increases, e.g. chances of extraction of permanent premolars to provide ample space for movement of other teeth may rise greatly. While corrective procedures are usually taken to reduce or eliminate existing malocclusion.

1. Correction of Mouth-Affecting Habits

Mouth-affecting habits like thumb sucking and mouth breathing can result in dental crowding and unsatisfactory facial bone function or esthetic. Please refer to our popular science article—What every parent needs to know about mouth breathing.

2. Early Fixed or Removable Orthodontics

Early fixed or removable orthodontics is mainly used in conditions like anterior crossbite, rotation of front tooth, canine displacement, narrow arch and so forth, aiming to correct wrong biting relationship, teeth position, teeth angle and widening the narrow arch.

3. Functional Appliance

In cases with mandibular retrognathia, (usually combined with deep overbite), functional appliance (e.g. Twin blocks) is often used to guide the forward development of mandible in the early stage of orthodontic process.

Treatment for Primary Teeth Injury

Injury to the primary teeth and mouth tissues can result from trauma or abuse to the head and face. The most common complaint is a tooth fracture, others include tooth dislodging, thrusting into the alveolus, or even being forced out of its socket. The patient needs to go to a nearby dental clinic immediately for fixation or extraction in order to protect the permanent tooth underneath.

Tooth loss can be due to periodontal disease, cavity or dental trauma. If the missing tooth is not restored in a timely fashion, teeth adjacent to the space created by the lost tooth will tilt and drift, and teeth opposite to the lost one will extrude, leading to an unevenness in bite and smile. A prosthesis may be a fixed or removable appliance that replaces removed or non-erupted teeth.

Fixed Prosthodontics

1. Fixed Bridge

If the missing teeth are not too many, the adjacent teeth can act as abutments, being cemented with fixed a bridge.

       A fixed bridge is highly demanding (e.g. periodontal membrane area of abutments should not be less than that of the missing teeth, otherwise a heavy burden from biting can hurt the abutments).

2. Maryland Bridge

Usually a Maryland Bridge is used to replace anterior teeth and is cemented directly to the adjacent teeth with little preparation. For patients who want fixed prosthesis but want neither implant nor fixed bridge (because the fixed bridge sacrifices a moderate amount of natural teeth), a Maryland Bridge can be an alternative choice.

3. Implant

Titanium implants act like roots, providing stabilization and retention for the teeth. After they have been fitted and have healed in place, dentures, bridges or crowns can be attached to them. At present, implants are the best way to restore a missing tooth.

Removable Dental Prostheses

A removable prostheses can be taken in and out at will by the patient. These devices include full mouth dentures, as well as a replacement for a single tooth, but they are mainly used in cases with multiple teeth loss. Removable dental prostheses are also very demanding techniques, especially for design and dental impression. The procedures involve design, fabrication of customized tray, preparation of abutting teeth, dental impression, finalization of occlusion, and try-on and adjustment. It usually takes 1 month for the whole process.

1. Elastic Denture (Invisible Denture)

Elastic dentures are a good choice when missing a few front teeth. It has good aesthetic effect, but offers a poor masticatory function.

2. Cast Frame Prostheses

The masticatory function of cast frame prostheses is relatively good, but the clasp that encircles a tooth may interfere with the smile; it also needs to be taken out after meals for cleaning and regular disinfection.

3. Complete Denture

Complete dentures are full dentures designed to replace the entire dentition of an upper or lower arch. Because there is no tooth that can be used to help retention, all retention force comes from the negative pressure generated under the denture base and uses help from facial muscles. Good margin sealing, precise alignment of artificial teeth and adjustment of occlusion are keys for success.

4. Precise Attachment Denture

The retention of traditional removable dentures may not be enough for multiple teeth missing. In these cases, precise attachment dentures usually can provide more satisfying retention through united fixed and removable connections with abutting teeth. Meanwhile, no metal clasps currently exist in precise attachment dentures, which greatly promotes a more pleasing appearance.

5. Overdenture Supported by Implant

When prosthodontic appliances do not fit properly or are difficult to retain in the mouth, titanium implants may be suggested by the dentist to provide stabilization and retention.

A malocclusion is a misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the jaws closes. It may result from heredity or bad oral habits, like mouth breathing, tongue thrusting, a soft diet, or sleeping posture. Malocclusion can adversely affect the following:

Fixed Appliances

Fixed appliances are attached to the teeth. Not only does the attachment on the tooth surface (called a bracket) allow the tooth to be moved vertically or tilted, but also a force couple can be generated by the interaction between the bracket and an archwire running through the bracket metal (self-ligating brackets and ceramic self-ligating brackets).

Removable Appliances

Removable appliances are fabricated mainly in acrylic and wire, and can be removed from the mouth by the patient. The removable appliance is only capable of producing tilting movements of individual teeth, which can be used to a patient’s advantage where simple tipping movements are required.

Functional appliances

Functional appliances utilize, eliminate, or guide the forces of muscle function, tooth eruption and growth to correct a malocclusion. They are most effective at changing the anteroposterior occlusion between the upper and lower arches.

Clear Aligner Therapy

Clear Aligner Therapy use CAD-CAM technology combined with laboratory techniques to fabricate a series of custom appliances that are esthetic and removable, and can move teeth from beginning to end. It is becoming more and more popular among patients and dentists for its esthetics, comfort and easy to clean feature.

Tooth defects because of cavities or trauma, unaesthetic problems related to dental fluorosis or tetracycline teeth, and aiding retention and strength of remaining teeth after RCT, can be fixed by one of the four methods:

Composite Filling

A small cavity involving only one tooth’s surface can be filled with composite, a tooth-colored resin material. It has moderate strength and a natural look.

       If the cavity involves two or more teeth surfaces, a composite filling is not the best option because the strength of a composite for large fillings and junctions of the composite and tooth is not satisfactory. So, it is vital that dentist has great filling skill, which may compensate the disadvantages of composites, otherwise the failure rate will increase, leading to food impaction, secondary decay or filling cracks. Inlay/onlay is preferred for complex cavities.

Inlay/Onlay

Inlay/onlay is a solid-casted or milled restoration, involving some occlusal and proximal surfaces cemented into a tooth; onlay covers some occlusal tooth cusp and side wall area. With sufficient strength and excellent junction to tooth, and without the possibility of microleakage caused by the shrinkage of composite over time, inlay/onlay can serve properly in a mouth for tens of years, if maintained well.

Crown

A crown is a fabricated, tooth-shaped cover replacement for a missing crown area cemented onto the remaining prepared crown surfaces. A tooth with a large defect or a back tooth after a root canal treatment needs to be restored by a crown to prevent the remaining cusp from being fractured off.

Veneer

Veneer is a thin ceramic layer cemented onto the prepared front tooth. Veneer is mainly used to improve the aesthetic appearance of front teeth with unsatisfying texture or shape. The most attractive advantage of veneer is that the preparation of the tooth’s enamel can be as little as 0.6mm, some cases don’t even need to be prepared because the thinnest veneer can be fabricated up to 0.2-0.3mm. Specific cement with strong bonding strength is used to retain veneer, therefore it is very rare for veneer to fall off, if design, preparation, fabrication and cementation all achieve the international standard. Veneer can save as much of the natural tooth as possible while improving the aesthetic appearance; it is a minimally invasive prosthetic method.

Veneer for Tetracycline Stained Teeth

Chemically stained teeth, such as the tetracycline brown band line, can be repaired by veneer application.

Veneer for Enamel Fluorosis

Fluorosis is a condition that can cause molting and discoloration of enamel tissue. The mottled enamel can be covered by aesthetic veneer.

Veneer for Tooth Malformation or Dentural Diastema

Malformation of front teeth or dentural diastema (the open area between adjacent front teeth) presents an unattractive appearance, but with very little preparation of the related tooth, veneer can restore the normal tooth shape and contact area.