FAQs

General Dentistry

A professional teeth cleaning (also known as prophylaxis) is recommended at least twice a year. The aim of a prophylaxis is to remove the tartar (mineralized plaque) that has been hiding in these difficult areas in between each tooth, below your gum level, and at the back part of your last molars. Even if you brush and floss your teeth daily, there are areas that are difficult to reach. Professional cleaning includes the use of ultrasonic equipment and special ultrasonic points and brushes in order to scale and polish your teeth. This procedure is painless and takes roughly 30 minutes. If it is uncomfortable or you have sensitive spots, local anesthesia can be applied.

A professional teeth cleaning is a preventive treatment for diseases called gingivitis and periodontitis (gum and bone inflammation), and is intended to prevent cavities (dental caries). It is an excellent habit to have your mouth and teeth checked by a professional of dental health. Prevention is the key, and is less expensive than repairing the damage.

Having a healthy and beautiful smile can give you confidence and increase your self-esteem. But our teeth can’t always look as white as we would like due to natural fading. Food, drinks, smoking, and aging can cause staining. It happens to almost everyone eventually but that doesn’t mean you have to accept it. You probably have seen many over-the-counter products claiming to whiten your teeth in varying degrees. However, the strongest and fastest-acting whitening solutions are only available at a licensed dentist office. Professional teeth whitening can lighten teeth from 3 to 8 shades in a single visit and last from 6 months to 2 years.

In Office Whitening

First your dentist will protect your gums and if necessary the roots of your teeth to ensure safety. Then a professional strength bleaching solution is applied to your teeth. Often a special light or laser will be used to make the bleaching solution work faster.

Take Home Kit

First the dentist makes molds of your teeth. Then plastic mouth trays are created to fit your mouth, allowing you to apply the bleaching gel at home. While this process takes a little longer, it gives great results.

What you need to know before whitening your teeth:

  • Potential side effects of teeth whitening include teeth sensitivity and gum irritation that are minor and disappear after a short period of time.
  • The sensitivity could be more serious if you use over-the-counter trays instead of custom trays, or if the bleach is applied by untrained persons.
  • Bleaching solutions don’t have effect on existing crowns, veneers, or fillings.
  • Whitening is not permanent, but it is possible to slow the fading process by avoiding foods and habits that cause staining and by doing a minor touch-up every so often.
  • Studies have found teeth whitening to be safe when a professional performs it.
  • Teeth whitening is the most popular and cost-effective way to dramatically enhance your smile.
  • If you are considering teeth whitening, then talk to your dentist so they can come up with a solution to bring your smile back to its better days.

Cosmetic dentistry has taken huge steps forward in recent years and fillings are a perfect example.

In the past, when you had a cavity you would go to your dentist to have it cleaned and filled. The material for filling the hole, after the cavity was clean, was a mixture of different metals called amalgam. This mixture of metals included mercury, which is said to cause alterations in our bodies. Another disadvantage was that dentists had to “design” a cavity with a certain shape that undercuts and size in order to fit the amalgam properly. This resulted in a very large, grey looking filling.

Those days are gone. Today’s dentists have an impressive variety of tools and materials to work with, and repairing a tooth has become a lot like sculpting a fine piece of art. Tooth colored fillings are made of composite resin. Composite is a mixture of plastic and glass that is not only natural looking but also better for your teeth.

Composite fillings:

  • Don’t need to undercut or extend the cavity.
  • Attach or bond to tooth structure.
  • They look and react more like natural teeth.
  • Amalgam is so hard that it may cause your tooth to break or make it susceptible to fractures while composite fillings are strong yet flexible. When you chew they absorb and transport the forces similarly to natural teeth.

Cosmetic Dentistry

A great smile is a wonderful asset at any age. If you are not happy with your smile, you are not alone. It’s actually quite normal for your smile to fade over time because as teeth age they tend to wear and discolor. Small chips and cracks accumulate and old fillings can become unattractive.

Communication between you and your dentist is an important part of the process. He or she will talk to you about your options, timing, results, and budget. Regardless of which procedures you choose, changing your smile is bound to change your life. It is a transformation that will open up all kinds of new possibilities that you can only truly realize when you share your dazzling new smile with the world.

Maybe you are not missing any teeth but rather have a chip or crack. This can be properly and esthetically restored with what is call tooth bonding. This involves the use of esthetic materials such as resin and composite materials to correct the imperfections. It’s a painless procedure and can be done in just one visit.

For staining and yellowed teeth, whitening could be your answer. For more information please view our section on general dentistry.

There are two main types of material used to fabricate a veneer:

Composite resin veneers: Think of a composite resin as a tooth-colored paste that is hardened with a special light. There are a variety of colors to choose from so it looks just the way you want it to.

Porcelain veneers: This is the most popular type of veneer. They are fabricated by a dental technician in a dental laboratory. Porcelain is a material that in order to harden requires high temperatures and special ovens. It’s a very esthetic and hard material.

Porcelain Veneers are slim prosthetic pieces made to enhance your SMILE.

Unlike dental crowns that cover the whole tooth, veneers cover just the front surface of a tooth and require less “grinding” of your natural tooth and sometimes no “grinding” at all. They are custom-made according to your esthetic goals and are then placed and bonded over the front surface of your teeth.

Porcelain Veneers can correct many cosmetic imperfections. They can improve the size, shape, and color of teeth; close spaces between teeth; lengthen or shorten teeth; and fix cracks and chips.

COMMON STEPS

  1. At your first appointment, we take x-rays and pictures, and study your case. Then we come up with a diagnosis and treatment plan.
  2. After you have accepted the treatment and costs we then start with the preparation. To prepare a tooth for a veneer we will remove about 1/2 to 1mm of enamel from the tooth surface. This could be totally painless for some patients, however others may require local anesthetic to numb the area.
  3. After the preparation is done, we will take an impression of your teeth that we immediately send to our dental laboratory. Temporary dental veneers will be placed on this same appointment. These temporary veneers are made of a material called acrylic and resembles the color of your teeth.
  4. Your second appointment is to bond the porcelain veneers once returned from the dental lab. Before we permanently cement your veneers, we will examine the fit, color, size, and whether you like them or not. Sometimes a little trimming and selection of the color of the glue are necessary to make them perfect.
  5. Next, your tooth will be cleaned, polished, and etched before the veneer is cemented. A special cement is used to cement the veneers. This glue is then hardened with a special light beam. The excess of the cement will be removed and final polish and adjustments will be made.

Facts about porcelain veneers to know before hand:

  • Composite tooth bonding is reversible, while prepared porcelain veneers are not.
  • They provide a natural tooth look.
  • Gum tissue adapts very well to porcelain.
  • Veneers require less grinding of the natural tooth than a dental crown.
  • Porcelain veneers are much more esthetic and last longer than tooth bonding of composite veneers.
  • Porcelain veneers are more expensive than composite resin bonding.
  • If your porcelain veneers crack or chip, it’s not repairable and you have to get a new one.
  • Some cases require more removal of tooth structure and the tooth may become sensitive to cold and hot foods and beverages.
  • Once a veneer is placed, it cannot be altered in color or shape (besides shortening).
  • If you grind or clench your teeth, veneers may not be the best option for you as these activities can crack or chip the veneers.
  • Dental veneers usually last between 5-15 years and new ones can replace existing ones.

Tooth Bonding uses a special tooth-colored composite resin material which is applied to the tooth and then hardened layer by layer with a special light. When it covers the whole front surface it can be called a Composite Veneer.

Tooth bonding can:

  • Repair chipped or cracked teeth.
  • Fill cavities of decayed teeth.
  • Improve appearance and esthetics.
  • Change color and shape.
  • Close spaces.
  • Make teeth longer.
  • Protect sensitive spots of a root that has been exposed.

COMMON STEPS

  1. First our dentist will examine your case. Once a diagnosis and treatment plan is made, the tooth or teeth to be bonded are going to be prepared. This means a little grinding around the area and cleaning of some small decays. Depending on the case, anesthesia may be needed but sometimes is not.
  2. After the teeth are prepared, they are isolated so no saliva gets in and the process of bonding will be optimal.
  3. The surface of the tooth is conditioned with special liquids.
  4. Then the composite resin is applied and molded to the desired shape and hardened with a special laser light, layer by layer.
  5. The final step would be trimming and polishing to it give a brighter look.
  6. Dental bonding or composite veneers are usually completed in one appointment of 30 minutes to 1 hour depending on how many teeth are going to be treated.

Facts about dental bonding:

  • Advantages: It is a simple way to improve the appearance of your smile.
  • It usually only takes only one appointment.
  • It’s painless.
  • It requires minimal or no removal of tooth structure and it’s less expensive than porcelain veneers.
  • Disadvantages: With time, and especially if you eat staining foods or smoke, composite resin will vary in color. They do not last as long nor are as strong as veneers or crowns.

Bonding can last from 2 years to 10 years depending on patient’s habits.

Prosthetics

An inlay is a type of restoration (composite restoration) that is fabricated outside of the mouth. It can be made of a stronger, more solid material such as porcelain, gold, metal, or even some special kinds of composite materials. The design of the inlay will vary depending on the shape of the cavity. Once the cavity is removed & cleaned the doctor will analyze the remaining tooth structure. If the remaining tooth structure is weak, then the whole tooth is at risk of fracture and a normal composite restoration is not the best solution. An inlay restoration is made of porcelain, gold, or other metals because it is much more resistant to fracture.

COMMON STEPS

  1. The dentist will remove the cavity from the tooth or molar and design the remaining tooth structure to receive the restoration.
  2. In the worst case scenario, the tooth is left to rest with a temporary restoration or a temporary filling for some time. If that is not the case, then the doctor will proceed to take impressions of the tooth area.
  3. The impressions are sent to the lab for the fabrication of the inlay, which will take a few days.
  4. On the next appointment the restoration will be tested directly on the tooth. It may be necessary to adjust the restoration before being cemented or bonded to the tooth.

The procedure may take from 2-3 appointments.

These types of restorations are very similar to inlay restorations. The difference between these and inlay restorations are in the amount of remaining tooth structure. When more of the tooth structure is compromised (for example if more than one wall of the tooth or more than one cusp of a molar), then the restoration becomes an onlay restoration. The dentist will prepare the remaining structure of the cusp and use it as a platform to support the restoration.

When a significant amount of tooth has been lost by decay or cracks, a crown may be your best option. Crowns are a complete cover-up of the tooth. They don’t just fill the tooth, they cover the whole tooth. They also fortify and restore damaged teeth by allowing them to function normally again and look like natural teeth.

Dental Crowns can be made of different materials. They each have advantages, disadvantages, and different costs.

All Composite Crowns: These are the less expensive but they complete the function and cosmetic standards. Their average lifespan is roughly 5 to 8 years which is shorter in comparison to other crowns that could last up to 20 years or more.

All Metal Crowns: Nowadays these are not very common because of poor esthetics. Materials like gold, silver, and chrome-cobalt were used to fabricate these pieces. These are still available if patients ask for them. Gold is expensive but is a long lasting material. All metal crowns are not the natural color of teeth. The cost and abrasiveness to the surrounding teeth are their main disadvantages.

Metal Fused to Porcelain: This is the most common type of crown. The framework of these crowns are made of metal which gives a lot of strength and fits nicely. The outer part of the crown made of porcelain giving it the cosmetic touch.

Porcelain Only: These crowns are made only of porcelain. These are for patients who dislike any metal in their mouth, however the preparation of the tooth is more detailed.

E-max: This is an all ceramic crown. The crown is made from a single block of lithium disilicate ceramic and is a very tough material. They have great durability and are considered to be the one of the best matches for natural teeth. The only disadvantage of an e-max crown would be their price.

Zirconia Crowns: Zirconia is also a type of all-ceramic crown. Zirconia is a type of crystal which is almost unbreakable. They are strong, have great esthetics (specifically a natural translucent look), and preserve more of the natural tooth since they require minimal tooth preparation. Their disadvantage is they can be so hard that they can be abrasive to other teeth they are in contact with. Their cost is similar to e-max crowns.

A fixed bridge is a restoration to replace a missing tooth. They can be used to fill a gap and restore the function of chewing to prevent the remaining teeth from shifting or moving out of place. Fixed bridges are made of the same materials as individual dental crowns. One of the big advantages of this type of restoration is the fact that they will stay placed in the mouth without having to be removed. They can last up to 20 years if taken care of.

There are a few different types of fixed bridges:

Abutment Pieces

This is the most common bridge and is one that uses the neighboring teeth as anchors. A fixed bridge can be composed of three of more units or crowns. The pieces that will be replaced are called a pontics.

Cantilever Bridge

Also known as a flying bridge, it is used only in special situations. An example would be when there is a missing molar or tooth and there is only one adjacent piece. A specialist uses that only pillar to support the substitute tooth. The tooth used as a pillar must be subject to certain conditions before being considered.

Maryland Bridge

This type of bridge is used when preparing the neighboring teeth is not an option or wants to be avoided. Instead of being anchored to the pillars, it is only bonded with resin materials. This keeps the adjacent teeth intact or in some cases just slightly prepared.

COMMON STEPS

  1. The preparation for a fixed bridge involves re-contouring or preparing the neighboring teeth that will be used as pillars.
  2. Everything will be done under local anesthesia.
  3. The first appointment is the longest, as the teeth are prepared, impressions are taken, and you will leave the clinic with a temporary bridge.
  4. On the next visit, the temporary bridge will be removed and the permanent bridge will be tested, adjusted if necessary, and then cemented.
  5. The whole procedure usually takes 2 or 3 appointments at our clinic.

Also known as a removable partial prosthesis, removable bridges are used for patients who have partially missing teeth and wish to restore teeth for functional or cosmetic reasons (but are not candidates for a permanent fixed restoration). This option may be selected because a patient does not have enough teeth to build a permanent bridge, or for financial reasons.

This form of bridge is called “removable” because the patients can conveniently insert the piece when needed and remove it for cleaning purposes. It is a relatively quick and economic way of restoring teeth. Removable bridges can sometimes be used as temporary restorations.

Not all patients are eligible. People with Periodontitis (gum disease) or severe bone loss should be treated first and then evaluated before being considered for a restoration of this kind. Patients with a gag reflex should be considered for other procedures like dental implants. Patients with mental illness and dry mouth are also not good candidates.

There are a few different types of removable bridges:

Metal Acrylic Removable Partial Denture

This type of bridge uses a metal frame to balance the weight of the bite. It anchors on other teeth and molars using metal hooks giving partial retention. A metal skeleton is covered with pink acrylic and substitute teeth are placed where needed.

Precision Attachment Removable Partial

This type of bridge also uses a metal frame. However, instead of metal hooks that show, this system uses a precision male-female housing arrangement. The female part is placed on the patient’s own teeth and the male part is soldered to the metal framework of the removable partial. Using parallelism, they are meant to fit accurately in position.

Acrylic Removable Partial

This type of bridge is a more simple structure and uses acrylic rather than metal. It is used more as a temporary means to restore while preparing for something permanent.

Full mouth reconstruction is also known as an oral rehabilitation or restoration. This term is used when a patient is going to need far more work than just replacing a missing tooth or a few fillings. A full mouth reconstruction will involve various specialists in orthodontics, endodontics, periodontics, implant dentistry, oral and maxillofacial surgery, prosthodontics, etc. These are very complex cases and because of such, treatment of these requires much skill. Example cases are patients with severe bruxism, decay that has affected teeth extensively over the years, or teeth that have been worn out by acid erosion. Also, patients who have lost teeth and bone due to periodontal disease or traumatism may require full mouth reconstruction.

COMMON STEPS

  1. The patient will go through a full examination and also have photos, impressions, and x-rays taken. The dentist will evaluate the condition of the existing teeth, the supporting gum tissue, the condition of the temporomandibular joint, occlusion, and other factors. All of this is done to study the patient’s case together with other specialists.
  2. It may take a couple days to analyze and come up with a diagnosis and treatment options. The objective of a full mouth restoration is to give back the patient not only their functionality, but also a natural looking smile.

The time required for full mouth rehabilitation varies depending on the situation.

Dentures

Over the years and for various reasons, a person may lose all of their teeth because of periodontitis, cavities, or traumatism. If there are no pillars, no remaining teeth, and nothing to build a bridge on, this is where a denture comes in.

A denture is set upon the remaining gums and supported completely or partially upon them. When there are no teeth, there is a loss of volume in the face, giving the person an older look. A denture will give a patient back their smile, functionality, and return the missing face volume, giving a much younger look.

The most common denture used is an acrylic denture. This is made months after the gums have healed from teeth extraction. A denture is made to fit tightly on the patient’s gums and is supported on the roof of the mouth and gum ridge. The procedure to make a conventional denture may take 4-5 appointments and in every appointment the dentist will work together with the lab to take the correct measurements. It is crucial to have a perfect fit for optimal comfort.

Like the name says, “immediate” dentures are for more urgent cases when the patient is not eligible to wait for the healing process. The measurements are taken before the removal of the remaining teeth and the impressions are sent to a lab and made in close approximation to what the mouth would be without teeth. Once ready, the extractions are made and the patient will take home the immediate denture. Once the gums are healed and have returned to their normal size, this prosthesis will need to be relined, or in some cases remade, to ensure a proper retention and comfortable fit.

When there are few remaining teeth, sometimes it is convenient to use those teeth to give the denture support and retention. The teeth will be prepared and protected with a metal cover in order to fit the denture with precision. When there are no remaining tooth structures, and there is not enough gum ridge to hold the prosthesis, implants are the solution. After a clean surgical procedure, 2-6 implants will be installed on each arch of the mouth (depending on the case). The denture will snap on to the implants giving the patient a much stronger retention and favorable look.

Implants & Surgery

There are a lot of reasons why a tooth or a molar must be extracted. Some reasons are tooth decay from a cavity, severe periodontal disease, traumatism, or maybe an orthodontic procedure. You shouldn’t be afraid of such a procedure. It is a simple and relatively painless procedure done with all the safety protocols.

COMMON STEPS

  1. Almost every extraction begins with an x-ray to look at the shape of the roots to plan for an optimal extraction.
  2. A simple extraction requires local anesthesia, which will start with a numbing gel then an anesthetic shot in the tooth area.
  3. After the area is numb, the extraction will begin. The tooth will be loosened with special instruments so as not to create a traumatic extraction. Once loose, another instrument will be used to pull the tooth out. The area is cleaned out and checked for remaining debris.
  4. Most of the times a gauze will be enough to cover the area and stop the bleeding. If the doctor considers it necessary, he/she will use stitches to close the wound. You will be given care instructions for a comfortable recovery.

The third molars (also known as wisdom teeth) are the molars situated in the very back corners of the mouth. Sometimes these are visible and sometimes they can only be distinguished in an x-ray. The most common reason to extract these teeth is the lack of space in the jaw bone. This lack of space will cause the third molar to grow out in an abnormal direction, causing periodontal problems, cavities, infection, or pain. Sometimes an orthodontic specialist will order its extraction even if there is no apparent problem.

A wisdom tooth extraction sounds worse than it really is. With today’s x-ray technology and the surgical techniques done at SOTA dental, it is a whole different process than it was 20 years ago.

COMMON STEPS

  1. Similar in some cases to the simple tooth extraction, the procedure will begin with local anesthesia. You will be awake and conscious during the procedure in which you will feel pressure or movement but no pain. If necessary, a general sedation can also be done. In this situation you are asleep during the whole procedure and are woken up when the surgeon is finished.
  2. If the molar is not visible, an incision is made in the gums to expose the molar. If the molar is covered by bone, the bone is removed with a special instrument.
  3. Once there is access to the molar, it will be divided into sections for easier removal. The area will be cleansed of any debris of the tooth, bone, or infected tissue.
  4. Once finished with the extraction, the area will be closed with stitches to avoid blood from being expelled and causing an uncomfortable recovery.
  5. After the surgery you will be prescribed some anti-inflammatory antibiotics and analgesic, which is expected to be taken as prescribed.

A dental surgeon or maxillofacial surgeon performs this procedure. The sinuses are spaces inside the bone structure of both maxilars. They vary in size and shape from person to person and are located on top of the superior molars and premolars.

Bone loss is normal after tooth loss especially in the case of a periodontal disease.

A sinus augmentation is necessary when planning for implant surgery, and after the observation of the x-rays, if there is not enough bone left for the implant to be installed.

The sinus will be pushed inward and bone will be compacted in the area. That particular bone may come from the same patient, from a cadaver, or animal bone (autogenous bone, allogeneic bone, or xenograft).

COMMON STEPS

  1. A sinus augmentation surgery starts off by numbing the area with anesthesia, making sure the area has lost sensitivity.
  2. A small window is created in the bone in order to reach the sinus. A thin membrane is reached and pushed carefully inward. The space created is to be filled with the bone chosen for the patient.
  3. A specialist will decide whether to put the implant right after the sinus lift or rather stitch the gums and wait for healing.
  4. Each case is different and procedures may vary.

A bone graft is a surgical procedure used to fix problems with bones. In dentistry, it is used to correct the deficiencies of bone from things such as periodontal disease, trauma after an accident, or to help better prepare for implants.

COMMON STEPS

  1. To prepare for the surgery, the doctor will have you complete a detailed medical history form and possibly a physical examination. Some studies may be necessary prior to this evaluation.
  2. Depending on the patient’s health situation, the doctor may postpone the surgery for days or weeks to make sure that the patient’s wellness is ensured.
  3. After the surgery, the precautions are very similar to the tooth extraction. (Focusing on keeping the area clean, minimal efforts to avoid swollenness, and taking indicated medication at the indicated intervals).

Dental implants are one of the newest additions to dentistry. They have proven to be one of the best ways to restore a missing tooth. An implant is a titanium piece similar to the shape of a screw, which is installed in the jawbone or the maxilla bone, and it osseointegrates. The material that composes the implant is biocompatible with the human body, which is why it is used in all kinds of body prosthesis.

Implant dentistry has shown very good results in restoring the function of the bite by fusing to the bone, adapting in a permanent way, and making the patient feel like they never lost their tooth. There are a lot of advantages with implants over gum-supported dentures. There is absolutely no movement with implants (unlike dentures, which may give the patient some insecurity like trouble speaking or pronouncing). They become permanent, have no need of being removed at night, and give no trouble chewing.

For most patients, if there has been tooth loss, then an implant is an option. There are some indications, conditions, and situations were a patient must either wait some time, or may not qualify for an implant procedure. Patients with cancer or those going thru radiation treatment should wait due to the healing process that is affected. Diabetes that is not controlled is a contraindication because it can make the area prone to infection. Also patients with severe smoking habits may be put on hold due to the toxins of the cigarette that cause a diminution of the blood flow to surgical area of the implant. Gum disease will have to be treated, but once taken care of, a patient can go thru with implant surgery.

Single Implant

A single implant can be fixed in cases of single tooth loss. It can’t be right after the extraction of a tooth, due to the lack of a good prognosis. In the case of an extraction due to infection, it is better to heal the area with antibiotics over time first and then install the implant. The implant will substitute what used to be the root of the tooth with a titanium structure. The size of the implant will vary with the tooth it will be substituting.

Multiple Implants

When there is more than one tooth lost, it is necessary to consider more than one implant. Using the bone support given by these devises, they can recreate the function of a bridge with a porcelain or zirconium structure. (For example, replacing four missing teeth on the upper right side of the mouth using two implants on very good bone.)

All on Four

This technique is used when a large part of the dental arch or whole dental arch are missing. In this procedure there will be four implants equally distributed throughout the bone ridge. Once implanted and integrated into the bone (which will take from 3-6 months), the specialist will take the necessary impressions to build a metal frame. That metal frame will then be tested on the mouth, and after another impression, the metal frame will be used to mount the porcelain teeth and prosthetic gum. Four (or in some cases up to six) implants will be used to support a structure similar to a denture but with a much more stable and retentive structure. This structure can also be removed by the patient resulting in better hygiene.

Sedation is a process used before some dental procedures to relax the patient with the use of sedative drugs. These sedatives can be administered through different ways such as intravenous, enteral, or inhalation main streams. Sedation processes are safe and painless. These are administered by a specialist in anesthesiology who studies the patient’s health condition before going through with the procedure.

Sedation offers some advantages over local anesthetics. Because the patient is unconscious during the treatment, they won’t feel stressed or anxious during the surgery. Also, it is easier for the dental specialist, considering the patient will not be moving, which allows them work much more easily. This can reduce the number of appointments needed because more can be done in one appointment.

Endodontics (Root Canals)

Endodontics is the field of dentistry that studies and treats dental pulp. Endodontics is a specialty in dentistry and should only be practiced by specialists. Endodontists work with the tissues inside the tooth commonly called nerves.

There are other treatments in the field of Endodontics, like pulpotomy, pulpectomy, pulp capping, apexicogenesis, apexicoformation, and apicetomy. All but the apicetomy involve treating the pulp (nerve) either to prevent further damage or the extirpate part of it. These treatments are usually practiced on younger patients, especially kids.

At SOTA DENTAL, we use microscopes to work on teeth molecularly. The dental field has always been limited by the reach of our eyes. The mouth has so many small details and structures that go unnoticed to natural sight. Microscopes have turned endodontics into a much more calculable profession. Everything used to be just about hand expertise and digital touch, but now we can finally see molecularly thanks to new science. Dental microscopes have increased the quality of root canals in so many ways. We always recommend that your endodontist (and even general dentist) use a dental microscope. This is one of our founding principles at SOTA DENTAL.

The most common procedure in the field of endodontics is the root canal treatment. Root canal treatment is aimed at eliminating all the pulp or “nerve” on the inside of a tooth. The main reasons for RTC’s are deep decay and tooth fractures. Both can give a patient pain or sensitivity. Sometimes a patient can experience pain with hot/cold food and liquids, and sometimes when chewing. Deep decay and fractures can be commonly seen in teeth with large amalgams (silver) fillings or old restorations. If not attended to, the pulp (nerve) starts a process call necrosis (death of the nerve), and an abscess could develop. A RCT will be performed in order to relieve pain and infections so that your tooth stays in your mouth and functions as a normal tooth. RCT’s save teeth!

Many people ask if root canal treatments are safe. The answer is YES! There are some dentists out there trying to sell “natural” products. The studies in which they based their theories are not well documented and don’t follow the standards of scientific research. Infections left inside your mouth can travel to other areas of the body affecting other organs or tissues. A well done root canal treatment has proven to eliminate infections in clinical and laboratory studies throughout many years of studying. The key is that if you are having a root canal treatment, make sure you go to a SPECIALIST in root canal treatments. It is scientifically proven that the most common failure of a RCT is because of missed anatomy. This means that many general dentists don’t have the knowledge, tools, and expertise to be able to address all the intricate anatomy that a root canal system presents. Well done RCT’s have a 95% success rate (even higher when done with microscopes like SOTA DENTAL does). As with everything in medicine, there are no absolute guarantees. Properly performed RCT’s should last from 15 to 25 years or more.

COMMON STEPS

  1. Three main steps are involved in a root canal treatment. First, the patient gets local anesthesia applied so as not to feel pain.
  2. Access to the nerve is achieved by drilling into the tooth the same way a filling is done but deeper to ensure access to the root(s). The nerve is remove and the space where the nerve was is cleaned and disinfected.
  3. Sometimes a few days is needed to allow the medicine to fully disinfect the area, so a temporary filling is placed during this time.
  4. After the area is disinfected, the restorative dentist will do what is called a “post build-up” or “core” to give the tooth extra support (in most cases).
  5. The canal is then filled with a mixture of materials to fill the space tridimensionally. In 90% of cases, a crown will be molded and then sent to a lab for construction.
  6. This crown will be placed and sealed on the tooth once returned from the lab and then fitted to the patient’s mouth.

The time it takes to do a RCT varies on the case and specific tooth in question. For example, a very long root and curve would significantly increase the time of the treatment. Also it takes more time to do an RCT on a molar, which could have from four to five canals (unlike a front tooth that only has one). The average time for a RCT is between one and two hours. Nowadays, almost all RCT’s (without crowns) can be finish in one appointment. However, there are cases (very infected areas) that are not possible to complete in one appointment. In such cases, an antibiotic paste is placed inside the canals to help disinfect for at least three days, and then on the second appointment, the canals are filled.

When a tooth has already had a root canal treatment, but it was done poorly and is giving the patient pain or discomfort from a reoccurring infection, then an RCRT is needed. They usually are more expensive, because they are much more labor intensive and more material is needed. It is absolutely crucial that these are done by a root canal specialist due to their complexity. Due to previous errors, they have an 80% success rate (however higher when performed with a microscope).

Periodontics (Gums)

For some patients, cleaning may be difficult, or proper technique has not been used, and the patient ends up accumulating plaque and tartar in areas. This accumulation of bacteria around the teeth will affect the gums directly with the toxins that these bacteria create. This will cause an irritation in the gums and the surrounding supporting tissues of the teeth, reacting with their defense mechanism by swelling. This causes irritation. If this irritation persists, the tartar and plaque will be present in the area beneath the gum line and between the root and the supporting bone. These are also called “gum pockets” and will affect the teeth severely if not treated.

COMMON STEPS

  1. Before a deep cleaning, it is important to teach patients how to keep a very good hygiene to avoid this from happening again. This may include sharing with them the best techniques to brush and floss, and recommending the use of a mouth wash.
  2. The procedure of a deep cleaning will need the use of anesthetics because it is considered a minor mouth surgery. The specialist will make some incisions in the gum if necessary to have a better view of the affected area.
  3. With the use of special instruments, the plaque and tartar is removed, the area under the gum line is reached carefully, and the bacteria and microorganisms stuck to the calculus are cleaned out. This calculus is commonly found under the gums reaching to the root of the tooth. The root of these pieces is then washed and polished, making sure nothing is left inside.

A bone replacement is necessary when there has been bone loss for reasons such as periodontitis, a traumatism, or an infection. It is very commonly used before an implant procedure for supporting the implant. Bone replacement and bone grafts are also known as regenerative surgery. Before this surgery, and like most surgeries, it is very important that the patient is healthy. The main objective of this procedure is to add bone (synthetic or autogenous) to the needed area.

COMMON STEPS

  1. The specialist will use anesthetic on the work area. Once the area is numb, the specialist will separate the gums from the teeth in order to have visibility of the roots and bone area.
  2. If the bone is taken from another area of the patient’s body, that bone may be screwed to the bone with the ridge lost. That bone is left intact and covered by a membrane to avoid contamination with external fluids.
  3. Then the gums are stitched back in place covering both the membrane and the bone added. The procedure is then finished and left for healing.
  4. Some cases allow for the implant to be placed at the same time, for the bone to regenerate with the implant already in place. The specialist will decide which is better for the patient.

This procedure is done in one appointment.

Crown lengthening is done with the purpose of exposing more of the tooth’s structure by removing the soft tissue around it, and in some cases, even part of the bone. This procedure is done on patients who have lost a lot of tooth structure due to a cavity and now need more tooth structure to support a crown. If a tooth is going to be restored, but the decay has already reached bone level, the bone has to be lowered in order to not be in contact with the material used to restore. A crown lengthening is something the periodontal specialist will take care of.

COMMON STEPS

  1. First the specialist will evaluate the area with x-rays and measure the proportions of the gums compared to the bone. The specialist will make a plan for how much of the soft tissue will be able removed.
  2. Once the evaluation is done, the specialist can proceed to the crown lengthening. It is a very easy and painless procedure. With the use of local anesthetic, the area is numbed. And with a small incision instrument, the gums around the tooth are contoured to a new margin, which will now show more of the tooth structure.
  3. If a crown lengthening requires bone removal, the specialist will separate the gums a little to be able to reach into the alveolar bone crest. With a bur, the specialist will get rid of the bone necessary to create that new margin.
  4. The healing is very fast depending on how extensive the procedure is. The recuperation process might take from a few days to a couple weeks because the soft tissue is reaching its new natural shape.

This is done mostly for cosmetic reasons for patients who have a gingival smile (also known as gummy smile). These types of gums can make the teeth look very small or squared shaped and can make the gum line look very uneven. The objective of this procedure is to remove the excessive gum tissue and expose more of the structure that lies beneath.

There is a certain distance from the gum to the alveolar bone crest that is considered normal. That distance is going to be measured and evaluated to know if the procedure can be done and how much can be removed.

COMMON STEPS

  1. Gum remodeling only takes about an hour. It is a procedure done with local anesthesia.
  2. The dentist or specialist will then use a small incision instrument to gently remove and shape them in a more esthetic form, leaving the gum line more even and showing more teeth.
  3. After this procedure and during the recovery, the patient may feel a little sore or may have swelling for up to a week. This discomfort should however be minimal and the patient can continue with their daily routine. The patient will be given instructions to follow and will be given pain relievers in case of any discomfort.