SERVICES

The presence of tartar will come as a surprise to some patients, because usually the inner side of the lower teeth is not visible. A picture with a special camera gives an overview of the situation both before and after the removal of tartar. In order to remove the tartar, a soda dental wash is first carried out, which cleans the dental plaque and softens the tartar, so it can be easily removed later.

Tartar is removed from the teeth after the soda wash with an oscillating ultrasonic scaler. As this procedure is relatively uncomfortable, it often is performed under anaesthesia. Tartar that has accumulated to difficult locations is later removed mechanically.

Finally the teeth need to be polished properly with a special gel to make them smooth in order to avoid a new plaque formation on the rough tooth surface. Minor gum bleeding after the deep wash is perfectly normal and it will end after a couple of days.

It is recommended to avoid the consumption of coloured foods and beverages, such as wine, coffee and beetroot on the day following the removal of tartar. Smoking should be avoided for as long as possible (at least two hours after the cleaning). In addition, a new toothbrush should be used in the evening in order to avoid the bacteria from the old brush getting immediately back to the mouth. The efficacy of the procedure can be increased with a subsequent mouth water cleaning treatment.

Dental caries is a demineralising chronic disease of tooth’s hard tissues, enamel, dentin and root cementum that causes cavity formation to the teeth. It is caused by acid-producing bacteria that adhere to teeth surface and dissolve minerals in its tissues. The process is irreversible, i.e. dental tissue does not recover by itself

Overview

Dental caries is one of the most common diseases in the world. There are not many countries in the world where more than half of the people have teeth free of dental caries.  The prevalence of dental caries in Estonia is higher than average: 60–65% of children and 83–100% of adults.

1. Surface caries
2. Caries of enamel
3. Caries of dentin
4. Spreading of the process to the nerve causing dental nerve inflammation (pulpitis).
5. Spreading of the process to the root tip area causing inflammation around it (periodontitis).

Treatment

Active dental caries treatment consists of removal of cariotic tissue and filling of the defect (restoration) with artificial materials and restoration of the tooth’s crown and its surface.

If the cariotic process has reached the tooth’s nerve and the nerves and blood vessels in the pulp and root canal have devitalized, the inflammation spreads to the tip of the root area.  The goal of root treatment is the cleaning of the infected root canals, treatment of inflammation in the jaw and tight closure of the root canals.

Root canals are cleaned by a special root needle which is a time consuming and complicated procedure. Often the tooth has multiple canals (from 1 to 4) and access to the teeth in back of the mouth is difficult. The canals may also be very curvy.

Treatment of chronic inflammation is time-consuming because bone recovery in the tip of the root is a time-consuming process. The tooth that is being treated may sensitize or ache, because the root canal treatment may flare up the inflammation in the beginning of the treatment. But these symptoms should pass with time. Root treatment success is assessed one year after the end of treatment.

Prosthetics is a tooth or its partial replacement with a construction that is manufactured in cooperation with a laboratory. Prosthetics can therefore include removable dentures, non-removable prosthetics (bridges and crowns) as well as fillings made in the laboratory.

Prostheses may be broadly divided into removable (dentures) and non-removable (crowns, bridge prostheses, laminates, etc.) Selection of a specific design may sometimes be quite complicated but in collaboration with the patient and the doctor we can find you the optimal solution.

CROWNING

Crowning is a permanent covering of a tooth with a material, which restores a tooth’s shape and appearance. If little left of the tooth or if it consists mostly of fillings, it should be crowned. Extensive fillings, especially in the molars, are not intended for intensive chewing loads and therefore wear out relatively quickly. After the root treatment it is recommended to crown the tooth. The tooth with treated root canals can easily break.

Dental crown supports the dental tissues and reduces the risk of breaking. It is also possible, under certain conditions, to successfully crown a tooth of which only the root is preserved. A prerequisite for it is the preparation of a pillar into the root. A high quality crown may persist for decades in the mouth.

Dental crowns and bridges

We use both metal-ceramic and full ceramic solutions for the preparations of crowns and bridges.

Metal-ceramic prostheses are made of metal framework (CrCo, Ti, Au) and a covering ceramic (porcelain) layer.

Their strength is:

• Good functionality and durability
• Good aesthetic appearance
• Moderate price

The advantages of full ceramic zirconium crowns are:

• very good aesthetic result (no dark line on the gingival line)
• biologically the most suitable material (allergy-free)
• strong and durable—zirconium oxide is one of the few ceramic materials, that can withstand the strong mastication forces in the back of the mouth.
• No cracks, the microstructure of zirconium does not change
• Exact fitting—exceptional accuracy is achieved thanks to the precise scanner (< 20 µm) and computer modelling. The suitability of the crown to the tooth is achieved through very exact removal of the enamel.

Dental coverage with a crown is necessary if

• More than 1/3 of the tooth consists of filling
• Little is preserved of the tooth’s crown and a large extent of it needs to be restored
• Root treatment has been carried out on the tooth
• It is necessary to elevate the tooth
• It is necessary to change the colour or the position of the tooth

BRIDGE

The bridge is a non-detachable construction replacing a missing tooth that is supported by neighbouring teeth. The bridge construction is indicated, if the teeth adjacent to the defect are strongly damaged and need to be crowned. If the adjacent teeth are healthy or a little damaged, then the missing a tooth (or teeth) are better replaced with an implant (or implants).

Laminates

Laminate is a thin ceramic plate manufactured in a dental laboratory that is glued on the outer surface of the (frontal) tooth to achieve the desired shape and colour of the tooth.

Laminates are indicated as

• It is necessary to change the colour of teeth, but whitening has not produced the desired result
• It is necessary to slightly adjust the shape/position of the teeth

PLATE DENTURE (removable prosthesis)

This is a plastic prosthesis, with metal elements only used for necessary clasps. It is prepared only if all teeth or most of them are lost. It can also be used as a temporary replacement prosthesis for a missing tooth.

Although it is a cheaper type of prosthesis, is not recommended for prolonged use, since this type of denture has a negative effect on teeth and gums.

BUGEL PROSTHESIS (removable prosthesis on a metal framework).

Bugel prosthesis has a metal framework that gives it strength and smaller dimensions, which in turn makes its use more comfortable.

Bugel prosthesis replaces the missing teeth and is used if bridges or implants are not indicated.

COMBINED PROSTHETICS

This is a combination of different types of prostheses. For example, some teeth are restored with bridges or crowns, but some are replaced with a removable prosthesis. Mostly the comfort of use is very good.

They are used if it is not possible to replace all of the teeth with a non-removable prosthesis.

IMPLANTS AND PROSTHESES ON IMPLANTS

A missing tooth can be restored with an implant which is planted into the bone and onto which a laboratory-prepared crown part is attached. The end result is similar to that of natural teeth. Similarly, it is possible to prepare bridges that are supported by implants. Implants may also be used to support removable prostheses. Sometimes these are the only opportunity, if the removable prosthesis does not stay in the mouth.

Teeth that no longer can be treated should be removed, because untreated teeth accompanied by chronic inflammation are dangerous to the health of the entire organism. Easier removals are done in our office, but more complicated procedures (if a tooth is totally decayed and entirely inside the bone) are carried out by our neighbours, maxillofacial surgeons, whose daily work it is. If it is necessary to remove a lot of teeth or in the case of insurmountable fear of the procedure, we can use general anaesthesia (narcosis), from superficial to deep.

An implant is a titanium screw which is placed into the jawbone. Depending on whether it is a maxillary or mandibular implant, the ossification process takes 3–6 months before a support column of artificial crown can be placed on it. Under certain conditions, modern implants can support a crown or denture immediately.

The key advantage of an implant to other types of prostheses is that the adjacent teeth can be preserved.  To replace one missing tooth with bridge prosthesis, two neighbouring teeth need to be polished. With an implant only the missing tooth is replaced. It is also possible to fix removable dentures strongly and without clasps to the implant.

Implant is placed either immediately after the removal of a tooth or later if the condition of the bone does not enable it. If the time between removal and implantation of the tooth is very long, it may be necessary to also grow the bone at that site. Implanting is a safe procedure with small number of contraindications nowadays. The major counterargument is often the price.

Laser can be used for minor surgical procedures, such as gingival hyperplasia removal, correction of gingival shape and treatment of gingival inflammation.  With laser processing the gum tissue evaporates and blood vessels are closed and therefore the incision is clean and sterile and does not bleed. The bio-stimulating effect of the laser beam promotes and speeds up the healing of the wound.

We use an American LED laser (diode laser), which allows for very different procedures thanks to its effects.

Teeth whitening

Whitening of teeth with a laser is an effective, fastand safe method to achieve an irresistible white smile. A special laser beam at a particular wavelength activates photochemically a whitening gel containing chromophores during laser whitening. It is safe because the nerve of the tooth is not thermally irritated.

Thanks to that, the whitening procedure is comfortable to the patient. Even more, the whitening gel is in contact with the teeth only for up to 30 minutes, which is enough to achieve an effect. Individual tooth whitening may be limited to 5 minutes. To minimize the possible occurrence of tooth sensitizing side effect, the teeth are covered with a special gel.

Root treatment

The aim of root treatment is to clear the root canal of bacteria that cause inflammation of the tissues surrounding the root tip. A classic method is the mechanical and chemical treatment of the root canal by special tools and bacteria-destroying substances. The root canal consists of thin dentin tubes that hide the bacteria so that the effect of drugs is usually quite moderate, especially in the lateral canals. Since the laser rays penetrate the dental tissues, its effect extends to all parts of the root, ensuring an environment free of bacteria before closing the root canal with filling.

Treatment of infections in the root tip area

Commonly, following the root tip treatment, an area of chronic inflammation persists and that resolves fairly slowly. Thanks to the bio-stimulating effect of the laser, the inflammation retreats faster than under normal circumstances where the disappearance of the lesion may take a year or more.

Removal of gingival hyperplasia

In the case of a caries cavity or a broken tooth below the mucosal edge, the gingival mucosa will grow to the empty space to fill the defect. That makes it impossible to set a correct filling or a pillar into the root. Gingival hyperplasia removal with a scalpel is not accurate enough, it can produce bleeding and takes time to heal. With laser incision in the excess tissue evaporates, blood vessels close and the bio-stimulation of the remaining tissue ensures a quick healing. Therefore, it is possible to carry out a surgical procedure and restoration of the tooth at the same visit.

Aesthetic correction of the gums

In the area of maxillary front teeth, after crown preparation and after achieving a good result of the teeth line, we often encounter problems with asymmetric wavy line of the upper part of the teeth while smiling. A gingival adjustment of one to two millimetres in 1–2 teeth is often enough to eliminate the problem. Laser produces clean surgical lines, it is bloodless and heals quickly, allowing for a production of beautiful crowns within a short period of time.

Herpes treatment

An itchy feeling of the lip detected in the morning is a sensation that 90% of people are familiar with and which means a painful sore for the evening that ruins mood and feeling for a week.  The problem is caused by the herpes virus. The virus is present in the body and it is activated when resistance of the organism is lowered by cold, infection or stress. LED-laser beam wavelength will destroy the virus and with 1–2 sessions it is possible get relief and avoids the development of the classic herpes sore.

Treatment of canker sores

Herpes virus often causes painful ulcers in the mouth that, although not directly harmful, will cause a lot of discomfort. Laser beam destroys the virus and is therefore perfectly suitable for the treatment these ulcers. The laser has three effects: direct destruction of viruses, tissue bio-stimulation which raises their natural resistance and analgesic effect and therefore a remarkable improvement of the condition is possible already after the first session.

Fluorescence diagnostics of oral tumours

Abnormal tumours can appear in the oral cavity as well as everywhere else in the organism.  The tumour may be benign or malignant. Oral cavity tumours (incl. cancer) are commonly associated only with male patients from lower social classes who smoke and abuse alcohol. But this is not true. According to the American Cancer Society 33% of the patients are women. 25% of them neither smokes nor drinks alcohol. The number of diagnosed malignant tumours in the oral cavity, lips and larynx in Estonia was 133 in 2007 and 178 in 2008. The same diagnosis was the cause of death to 86 patients in 2011.

If the cancer is detected in at a late stage, the probability of survival is about 28%. At an early stage the percentage is approximately 82%. As a rule the cancers are detected at stage III or IV (late) when the effectiveness of treatment is substantially worse. The cause for late detection is that the process develops under the mucosa and does not cause complaints. The fluorescence diagnostics of tumours is based on different intensiveness of fluorescence in the healthy and pathological tissues. If we explore the oral cavity we see healthy and diseased tissue in different colours

The method is rapid, simple, informative, and painless. The oral cavity is illuminated with intensive filtered light that brings out the possible tissue changes. Pictures can be taken, if needed, and the patient can be sent for biopsy to clarify the diagnosis. Since the method is non-invasive (nothing is cut or pricked), regular prophylactic check-ups of the oral cavity are reasonable (just as we do chest X-ray or measure blood pressure) to ensure us that everything in order.