Tremendous advances in technology has changed the face of dental treatment and consequently changing the patient’s perception of dental treatment. Laser treatments are comfortable and considerably reduce treatment time.
At Sparks Cosmetic and Dental Centre, lasers are effectively used to treat minor oral surgeries, disinfection of infected tissues and root canals, laser gum surgeries, frenectomy, facial pain management, wisdom teeth surgeries, laser teeth whitening and other minor applications such as laser vaporization. Aphthous ulcers, hemangiomas, lymphangiomas and verrous carcinomas.
Invented in the 1900s LASER is the shorter version of Laser Amplified Stimulated Emission of Radiation. The light monochromatic and the collimation and coherency are what makes it unique.
The medium is stimulated by an energy source in a controlled manner in a single wavelength with high energy intensities, coherent and collimated. It thus penetrates and incises the tissue, seals nerves and blood vessels and vaporizes diseased tissue.
Use of Laser in Dentistry
Some of the common lasers used in dentistry are Nd:YAG, Diode laser, Erbrium and CO2. Each of these lasers have specific procedures attached to them. Laser procedures in dentistry are divided into soft tissue lasers and hard tissue lasers.
Hard tissue applications are used predominantly for caries removal, Class I, II, III, IV and V cavity preparations, roughening or etching of hard tissue surface, excavation of fissures to place sealants and enameloplasty. There are several advantages of the hard tissue lasers such as diminished anaesthetic usage, less vibration, less noise, minimal tooth reduction and effective bonding of the tooth surface.
Soft tissue applications usually comprise of 810nm to 980nm diode laser which have remarkable long term bactericidal effects. Laser wavelengths determine the characteristics of absorption in the biological tissues thereby determining the efficiency of the surgery. Several components of the tissue determine the absorption of the laser light. The A.actinomycetemcomitans is an invasive pathogen responsible for periodontal diseases. At other times it may be difficult to eliminate but responds effectively to laser treatments. The diode laser is set to replace every restorative treatment soon. At Sparks Cosmetic and Dental Centre the doctors determine wavelengths that are specific to the tissue for greater precision and minimized risk of lateral damage of the tissue. Direct contact with the tissue allows the surgeon to experience tactile sensations similar to that of a scalpel.
Smile make over:
Smile make over is the procedure of improving the appearance of the smile through few cosmetic dental treatments namely
Composite / esthetic restoration
A laminate or veneer is a layer of material placed over a tooth to improve the aesthetics of a smile and/or protect the tooth's surface from data-dismissge. There are two main types of material used: composite and ceramic.
These are tooth coloured material are used for filling and many esthetic procedures especially for the anterior tooth (front tooth) their insoluble and transparent properties make them more stable and esthetically appealing.
Tooth whitening is an effective way of lightening the natural colour of the teeth without removing any of the tooth surface. It cannot make a complete colour change, but it may improve the existing shade.two types of whitening are used conventional and laser / power whitening.
Dental composite resins
(better referred to as "resin-based composites" or simply "filled resins") are types of synthetic resins which are used in dentistry as restorative material or adhesives. Synthetic resins evolved as restorative materials since they were insoluble, of good tooth-like appearance, insensitive to dehydration, easy to manipulate and reasonably inexpensive
What is orthognathic surgery?Orthognathic surgery is cosmetic jaw correction surgery. It treats conditions related to the jaw to reposition upper jaw, lower jaw or both. Jaw reconstruction surgery helps in treating malocclusion problems, TMJ disorders, sleep apnea and other conflicts arising at the jaw. Bones are cut and re-aligned and fixed with screws and plates.Orthognathic sugery repositions the upper and lower jaws in appropriate anatomical positions restoring facial balance and appearance. Facial structures and appearance are enhanced revealing aesthetically pleasant features, as a result orthognathic surgery.
Need for orthognathic surgery
Difficulty in chewing food
Difficulty in swallowing
Jaw joint pain
Excessive wearing of upper teeth
Imbalanced facial appearance
Injury to the face affecting the jaw
Congenital defects of the jaw
Inability to make lips meet
Breathing through the mouth
Sleep apnea – problems with breathing when asleep such as snoring
Initial treatment Physical exam and initial consultation will determine the condition of the jaw and its treatment process. Braces might be fixed to straighten teeth in both the jaws so that they align properly. Before the surgery simulation of jaw movements may be done and acrylic splints constructed to be used at the time of the surgery.
SurgeryAfter administration of general anaesthesia, incisions are made inside the mouth to uncover the bony surfaces of the jaw. The mobile fragments of the jaw are moved into position using the acrylic splints. The jaws are fixed into the correct position and bone plates and screws applied. Depending on the complexity, the operation might last anywhere from 3 to 5 hours.
Post operative treatment It usually takes a patient an average of 3-4 months to recover completely and achieve a fit. The braces are gradually removed and extensive post-operative care is planned for the patient. Some swelling may be noted in the area which is simply due to trauma of the surgery which subsides in about 5 days. Nasal and sinus congestion along with difficulty in chewing food will be experienced for a few days following post operative recovery.
CLEFT LIP AND PALATE
What happens?Development of the palate entails the formation of the primary palate first and then the secondary palate. The fusion of the medial and lateral nasal and the maxillary processes occur at about 37 days of gestational duration. Functional deformities of the cleft lip and palate occur when the requisite muscles fail to fuse with their coorelatives during embryonic development.CLP or cleft lip and palate deformities are clearly distinguished against cleft and palate (CP) anomalies and both are believed to have multifactorial etiologies. Both are differentiated on the basis of genetic and embryonic factors with both being having perceptible syndromes. Technological advances in DNA diagnostics aid in early diagnosis of the cleft lip and palate anomalies prenatally.
Managing cleft lip and palate deformities:
Neonatal management Patients with Robin Sequence present with respiratory distress and feeding difficulties. Comprehensive care would primarily require to secure the airway – the children have normal sucking reflexes but fail to produce negative pressure. The nutrition is therefore delivered through an external feeding bottle with large openings.
Unilateral cleft repairNormally performed during the 1st year of the child, the procedure is performed following the “rules of 10”
Haemoglobin > 10 g
Age > 10 weeks
Weight > 10 lb.
Local tissue flaps are used for reconstruction and closure of the deformity.
Presurgical orthodonticsPalatal segments are adjusted into normal positions using simple devices. Splints are placed across the face to align the premaxilla before conducting a standard cleft lip repair is conducted. The cheeks and prolabium are secured with adhesive tape for initial correction of bilateral clefts. These devices aid in converting a wide and complete cleft lip into a restricted incomplete lip thereby decreasing dehiscence and tension of the wound upon surgery.
Bilateral cleft lip repairBilateral cleft lip deformity is rare and the surgical outcomes are usually dependant on the position of the premaxillary sinus, the level of asymmetry and sufficiency of the deformity. It is due to this that presurgical orthodontics align the maxillary arch and the premaxilla.
Sparks Dental Clinic’s surgeons manage and correct paediatric cleft lip and palate deformities by conducting complex procedures such as repair of cleft lip, repair of cleft palate, closure of palatal fistulae, alveolar cleft bone grafting, cleft lip septoplasty, cleft lip rhinoplasty and LeFort I maxillary osteotomy to name a few.
FACIAL DEFORMITY CORRECTION
Craniofacial syndromes and their manifestations The study of disordered development with identifiable morphologic abnormalities is called dysmorphology. Recognizably, these fall outside the range of normal facial variation in human beings. The aim of dysmorphic assessments is to interpret their pattern and diagnose the structural anomalies. More frequently, congenital anomalies have caught the medical attention with gradual and growing advances in the field of clinical genetics. The human genome consists of approximately 80000 genes and some rare syndromes are yet to be identified.
Missing corpus callosum
Facial clefting anomalies
Lateral facial clefting
Oblique facial clefting
Median mandibular imperfections
Dentofacial deformities – When there is an imbalance in the orientation of the jaw bones where they are not in harmony with each other such as:
Overbite – class II malocclusion known as excessive overjet – associated with excessive growth of the maxillary or deficiency in mandibular growth
Underbite – class III malocclusion or negative overjet – deficient growth of the maxillary and excessive growth of the mandible
Open bite – upper and lower teeth gaps
Occlusal cants also known as crooked smile or facial asymmetries
Overgrowth of the upper jaw also known as vertical maxillary excess with too much exposure to the gums
Presurgical analysis will include –
Lateral cephalometric x-ray with a cephalometric analysis
Prediction tracing is done based on Le Fort I
Orthodontic alignment, coordination and decompensation of the dental arches is conducted.
CHIN AUGMENTATION AND IMPLANTS
Surgeons at Sparks Dental recognize the aesthetic need for chin augmentation along with rhinoplasty or rhytidectomyin restoring facial symmetry and balance. We believe that the chin defines the face and for long a person with a long chin is immediately associated with power.
Chin augmentation is usually integrated with rhinoplasty and rhytidectomy procedures to tackle problems of the prejowl sulcus. It helps in the correction of retrusion of the chin or microgenia which is a distinct form or a component of micrognathia. Microgenia or small chin is common deformity and usually detected during a rhinoplasty evaluation.
Chin deformities should be reviewed on the vertical, transverse and AP planes since the morphology of the mandibular symphysis varies from individual to individual. Geniplasties can reduce and advance the chin.
Advancement genioplasty: Augmentation or advancement genioplasty can elevate chin projection by using an autogenous bone graft and conducting a sliding horizontal osteotomy of the mandibular symphysis.
A vestibular incision is performed
The inferior border of the symphysis is degloved
To reduce the tension after advancement, the digastric muscles are separated from the mandible
Another incision releases the periosteum to provide enough coverage after the advancement procedure
A horizontal osteotomy is conducted 4 mm to 5 mm below the apices of canines and are completed through the lingual and buccal cortices
Forward and inferior mobilization of the segment is achieved with an osteotome
The segment is pedicled over the geniohyoid muscles
Bony interferences are removed
Towel clips are used to advance the mobilized segment into the required position
The external facial contour is checked and sutured
Reduction genioplasty:Reduction genioplasty is an adjunctive procedure and can be performed in the anteroposterior and vertical planes.
a. Horizontalostetomy: Fragment setback and horizontal osteotomy – the segment is fixed after resection of excessive amount of bony wedges
b. Verticalreduction: Alteration of the angle of the osteotomy can affect changes in vertical heights.
Two horizontal osteotomies are made
First the lower cut is completed and then the superior cut is made