Valplast® is a type of flexible, nylon resin that is developed for the use in flexible removable denture. Valplast® Flexible Partials were invented in the early 1950’s as an alternative to traditional metal and acrylic removable partial dentures (RPD’s). By using a flexible nylon base, Valplast® eliminates the need for metal frameworks or acrylic resins for the construction of removable partial dentures.
Tooth Replacement Options
When you’re ready to replace missing teeth, you have a number of potential solutions available, each with its own set of advantages and disadvantages. Replacing your missing teeth is a big decision and it is important to consider several factors.
When considering a removable partial denture, many people find the Valplast® Flexible Partials to be the most comfortable option, and the final restoration can be made very quickly. While the cost is often higher than a partial made with visible clasps, the results of the flexible partial are beautiful, and patient satisfaction is very high. The Valplast® Flexible Partials involves only non-invasive procedures, and gives you confidence in your restoration while talking, eating and most importantly: smiling.
If you can’t bear the thought of visible metal clasps or a series of temporaries that change with each appointment, Valplast® Flexible Partials is an option that looks very natural and will stay beautiful and comfortable for years to come. Even fixed restorations that look good at first could deteriorate over time due to gum recession or changes in your mouth.
Valplast Denture can be flexed
Denture acrylics and metal alloys may be prone to breakage and fracture over the course of time. Valplast® Flexible Partials come with a lifetime warranty against breakage and fracture for the denture base under normal use. Valplast® Flexible Partials can also be rebase and have teeth added to it if modifications are necessary over time.
If cost is your primary consideration, removable restorations are the more affortable solution, Valplast® combines great value with excellent aesthetic that often rival the appearance of more expensive fixed restorations.
A consultation for braces by dentist/orthodontist is a necessary to determine the need for braces, to size the braces and decide on various other factors concerning the impending braces. The consultation will last about a half an hour and cover various aspects of the braces as well as provide patients and their parents with all the necessary information.
During consultation, you will be asked questions such as:
What you don’t like about your teeth/face?
What do you want to achieve at the end of the treatment?
You expectation form the treatment
Next, the orthodontist will examine your face profile (such as skeletal pattern, facial height and symmetry) , position of you nose, upper and lower lips and position of you chin.
Then, he will looks into your mouth to see the position of the upper front teeth; how much the teeth inclined, whether they are in front or behind the lower front teeth. He will examine each segment of your teeth; whether the teeth overlap each other (insufficient space) or spacing, any tooth tilted, submerge
Finally, oral hygiene, any teeth need to be restored, decayed teeth or impacted wisdom teeth to be extracted.
Photos of patient face for orthodontic assessment
To complete the assessment, photos of your face and teeth as well as X-rays of the mouth will be taken at the consultation, and a molding of the teeth may be taken.
Photos of patient’s teeth
Dental Panoramic Tomogram or OPG radiograph
Cephalometry Analysis done with computer software
Two radiographs that required you to have are the dental panoramic tomography (OPG) and lateral cephalometry radiograph. Dental panoramic tomography (OPG) allows orthodontist to examine the whole upper and lower jaw; to look of any missing teeth, impacted or embedded teeth. It is a good radiograph to look for any pathological lesion in the jaw bone. Lateral cephalometry radiograph is used to determine the upper and lower jaw relationship. Computer software is used to analyze the severity of jaws discrepancy and is it important for treatment planning.
Dental Model – Duplication of patient’s mouth
The main focus at the braces consultation is determining the need for braces. This diagnosis is often obtained before the consultation appointment but will be discussed in reference to treatment plans for your orthodontic problems.
Each specific treatment plan will be discussed and outlined at the braces consultation. Treatment plans may include wearing a retainer for a few weeks before having the braces placed. The amount of time the braces will need to remain in place will also be discussed at the consultation. It is during the discussion of treatment when the orthodontist will explain to you the necessary care for braces. At the consultation visit, you will be allowed to decide the types of braces (metal or crystal) and the colors of each brackets.
He will also discuss with you other dental treatments that you needed before orthodontic treatment such as scaling, restoration work and extraction. Sometime, you are required to undergo minor surgery to remove impacted or embedded tooth prior orthodontic treatment.
Alternative treatments will also be discussed at the braces consultation. Alternative treatments may include only wearing a retainer or wearing a clear mouth guard apparatus.
At the consultation appointment, the orthodontist will discuss the risks and complications associated with wearing braces. The orthodontist will then warn you about pain and discomfort associated with the braces and possible problems the braces can create, such as the removal of enamel from the teeth and gum soreness and bleeding. He will ask you to clean your teeth very well to prevent teeth decay during orthodontic treatment. You will have to wear a retainer at the end of the treatment to minimize relapse.
Because braces are expensive, it is important that payment arrangements be discussed at the consultation appointment. At the consultation, the orthodontist may ask the patient and guardians if the patient has dental insurance. If the patient does not have dental insurance, the orthodontist may be able to set the patient up on a payment plant or may require the total cost of the braces be paid up front or by installment.
Most people want a gap in their mouth filled for cosmetic reasons, and understandably so: beautiful smile is a very important part of the impression you make to the outside world. However, there is a more important reason to close gaps in your mouth where teeth are missing; it is actually harmful to have a missing tooth, because teeth tend to drift out of place when there is a gap and move forward into the space that has been created. This leads to all kinds of serious problems, including bone loss, and, if left untreated, you can loose more teeth. Therefore, replacing a tooth is important!! Usually it can be done by fabricating a denture, bridge or implant.
What is a dental bridge?
Bridge stting on the implants
A bridge is a way of replacing one or more missing teeth in the mouth. It is also known as fixed partial denture, which used to replace a missing tooth by joining permanently to adjacent teeth or dental implants. Unlike traditional removable dentures, a dental bridge is permanent as it’s anchored to the teeth at one, or both, sides using metal bands held in place by resin or cement. If well cared for, a dental bridge should last for 10 to 15 years.
Anatomy of a dental bridge
A bridge consist of a ‘false teeth/tooth which is called pontic connected by connectors to retainers. Bothe retainers sit on the abutment teeth:
Retainers. Part of the bridge will have metal castings, called retainers. They are made to fit onto what the dentist has cut away on the abutment teeth. Retainers also secure and support the bridge’s artificial tooth or teeth.
Pontics. A pontic is an artificial tooth that is suspended from the retainer casting. A pontic occupies the space formerly filled by the crown of a natural tooth.
Connectors. A pontic is attached to a retainer by a connector. Connectors can be rigid or nonrigid. Nonrigid connectors take the form of male- and female-locking arrangements. Rigid connectors are classified as either cast or soldered.
Abutments. The teeth that support and hold the retainer are called abutments. It is almost mandatory that an bridge be supported by an abutment at both ends. This requirement is waived in special situations. When a pontic is suspended from only one retainer, it is cantilevered.
Composition of a dental bridge
The materials used for the bridges include gold, porcelain fused to metal, or in the correct situation porcelain alone (full porcelain). The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. The recipient of such a bridge must be careful to clean well under this prosthesis.
Types of dental bridge
There are three types of dental bridge: fixed, resin bonded, and cantilever. The type of bridge used will depend on the quality of the teeth on either side of the gap, as well as the position of the gap.
1.) Fixed Bridges
With a fixed bridge, the false tooth, or pontic, is anchored to new crowns attached to the teeth either side of the gap. These crowns are usually made from porcelain with the new tooth made from either ceramic or porcelain. This forms a very strong bridge that can be used anywhere in the mouth.
2) Resin Bonded Bridges
Sometimes called Maryland Bonded, these dental bridges do not involve crowning the adjacent teeth, so are useful where these show little or no previous damage. The new tooth is generally made from plastic and is attached via metal bands bonded to the adjacent teeth using resin. This type of bridge is particularly suitable for front teeth where stress is minimal, and the bond can be made out of view behind the teeth.
3) Cantilever Bridges
These dental bridges are used where there is a healthy tooth only on one side of the gap. The bridge is anchored to one or more teeth on just one side. As a result, this type of bridge is generally only suitable for low stress bridges such as front teeth.
How your bridge is fitted
Getting a bridge usually requires two or more visits. While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown. Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated. In addition, a temporary bridge will be made and worn for several weeks until your next appointment.
At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit. Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge. The new bridge will be permanently cemented at a later time.
Cases done in our clinic:
Case One: Multiple missing teeth
This patient was a young female, wearing denture for more many years. She came to us, wanted something fix or permanent which looked more natural than her denture. She presented with multiple missing (below). After assessing her, we suggested a 9 unit bridge extending from upper left canine to her upper right molar with non-rigid connector between her upper right canine and first premolar. We also suggested her to have a implant-supported bridge for her upper left quadrant.
Shade or colour selection was chosen and the remaining teeth were prepared for bridge construction under local anaesthesia.
Impression of her teeth were taken and a dental model was fabricated. The laboratory technician construction the bridge on the model.
The non-rigid connector just behind the right canine used to connect the rest of the bridge a the posterior right (above)
The connector at the back of the upper right canine was covered properly with porcelain.
The anterior part of the bridge was cemented onto patient’s mouth (above and below – the back view)
Finally, the back portion of the bridge is cemented to the back molar
Case Two: Multiple missing teeth
This gentleman complained that his old denture was getting shorten and he wanted something permanent
His denture looked really old with discolouration over the ‘pink’ part of the denture
On the palatal view showed multiple missing teeth involving the upper front and right side.
A 9 unit bridge was constructed and cemented onto patient’s mouth. Due to bone resorption at the front part, ‘pink’ porcelain was added to supported his upper lip giving him a youthful look.
Palatal view: the bridge extended from left canine to right molar
Maintenance of dental bridge
Dental hygiene becomes a little more complicated if you have a bridge, making normal flossing impossible in that area, nevertheless you do have to take care that the teeth adjoining the artificial tooth are thoroughly cleaned. Even the best fitting bridge will still have gaps around and beneath it, and these can quickly accumulate damaging debris if you do not follow a strict hygiene regime.Your dentist can show you how to do this, using special floss (eg. superfloss) or flossing needles. These floss go ‘under’ the pontic area and area near to the abutment to remove the food usually stagnant there.
How Long do Bridges Last?
While crowns and bridges can last a lifetime, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your crown or bridge is to practice good oral hygiene. A bridge can lose its support if the teeth or bone holding it in place are damaged by dental disease. Keep your gums and teeth healthy by brushing with fluoride toothpaste twice a day and flossing daily. Also see your dentist and hygienist regularly for checkups and professional cleanings.
To prevent damage to your new crown or bridge, avoid chewing hard foods, ice or other hard objects.
Resin Veneers or better know as composite veneers are thin shells of tooth-colored, translucent filling, custom made to fit over teeth and improve their color, shape and overall appearance. Placement of composite veneers can dramatically improve your smile and appearance.
Composite veneer technique
Courtesy of Dr Markus Lenhard, Heidelberg, Germany
description=”An IVOCLAR/VIVADENT video. Courtesy of Dr Markus Lenhard, Heidelberg, Germany”
Types of problems that composite veneers can correct
Placement of dental veneers is sometimes referred to as “instant orthodontics” because they can be used to cover a variety of dental problems involving teeth in the “smile zone” including:
Generalize spacing and ‘peg’ shape right lateral incisor
Unsightly or stained fillings
Dental veneers (either composite or porcelain veneer) can improve the appearance of the teeth but they cannot realign the jaw or correct overbites and underbites. Orthodontics are required to correct these more complicated problems.
Composite veneers can be done on the spot. The time spent might be from 30 minutes to 2 hours or more depends on the number of tooth involved. They do not required second visit.
Composite veneers produce the same aesthetic result as porcelain veneers. Therefore, no one can tell whether you have a composite or porcelain done except your dentist!
Composite veneers can be repair if there is any chipping or fracture.
Composite veneers are very cheap (From MYR150 toMYR250 per tooth; depends on how difficult and big the defect is).
The major disadvantages of porcelain veneers over composite resin include the following:
Porcelain veneers are not made at chairside. Porcelain veneers are fabricated in a dental laboratory and therefore require at least two visits. Composite resin veneers are accomplished in one visit. An adequate amount of tooth structure is removed to allow for placement of composite resin in the desired shape without added tooth bulk. Bonding agent is applied. Composite resin is then added, light cured, then finished and polished.
Porcelain veneers are more expensive than composite veneers. The placement of veneers requires more time, expertise and resources in order to fabricate and bond and therefore cost more.
Porcelain veneers cannot be repaired. If they break porcelain veneers must be replaced.
The advantages of porcelain veneers
Porcelain veneers have several advantages compared to composite resin including:
Porcelain veneers are very durable. Although porcelain veneers are very thin, usually between 0.5 – 0.7 millimeters and inherently brittle, once bonded to healthy tooth structure it becomes very strong. Porcelain veneers can last for many years, usually 10-15 years, if you take good care of them using good oral hygiene and avoiding using them to crack or chew hard objects like ice.
Porcelain veneers create a very life-like and natural tooth appearance. The translucent properties of the porcelain allows the veneers to mimic the light handling characteristics of enamel giving it a sense of depth which is not possible with other cosmetic bonding materials such as composite resin.
Porcelain veneers resist staining. Unlike other cosmetic dental bonding materials, porcelain is a smooth, impervious ceramic and therefore will not pick up permanent stain from cigarette smoking or from dark or richly colored liquids or spices.
Porcelain veneers are conservative. Only a small amount of tooth structure is removed, if any during the procedure.
Cases done in our practice using composite veneers…
This young man complaint of generalized spacing and a peg-shaped right lateral incisor. Composite material was used to close all the gaps between his teeth (Below).
This patient fell down and broke her front teeth while playing spot. The tooth was restore with composite veneer. ‘Stained’ or chalky white patches resin composite was place on the front surface of the veneer to mimic the neighbour teeth (Below).
Old filling at the center of his upper front teeth looked yellowish and rough. Those fillings were removed and replaces by new composite veneers (Below).
Yellow stain due to uneven surface at the front teeth and old yellow filling were replace by composite veneers (Below).
Multiple decays at the front teeth were treated with composite veneer (Below).
Defect of the lateral incisor was repaired with resin composite (Below).
Generalize unevenness of this young man front teeth gave a older look. With composite veneer correction, he looks youthful again!! (Below).
Old composite veneers on all the six front teeth on this lady was stained at the margin. The composite were removed and were replaced with the new one (Below).
Are you a good candidate for dental veneers?
Dental veneers are not appropriate for everyone or every tooth. Case selection is an extremely important factor in the success of this technique. Veneering teeth is not a reversible procedure if tooth structure must be removed to achieve your desired result Only an examination by your dentist can determine whether dental veneers are appropriate for making the changes you want. Some of the situations where certain teeth or people are not good candidates for dental veneers include:
Unhealthy teeth. Dental decay and active gum disease must be treated prior to fabricating and bonding dental veneers.
Weakened teeth. If a significant amount of tooth structure is missing or has been replaced by a large filling the teeth will not be strong enough to function with a dental veneer.
Teeth with an inadequate amount of enamel present. Dental veneers are more successfully bonded onto tooth enamel.
People who habitually clench or grind on their teeth. Habitual clenching and grinding of the teeth can easily chip or break dental veneers. Dental nightguards may be a solution for this in some cases.
Persons without a stable bite.
Severely malpositioned teeth or misaligned teeth. Orthodontic treatment may be required to achieve the desired result.
How to maintain Dental Veneers?
Dental veneers can chip or come off if not cared for properly. To improve their durability and longevity you need to maintain consistent good oral hygiene and have regular dental examinations and cleanings at least twice each year. In addition, you must avoid using them to bite or crack hard objects like nuts and ice.
What are the alternatives to composite veneers?
The closest cosmetic alternative to composite veneers is porcelain veneers which are more durable and more resistance to staining. However, they are more costly and require at least 2 visits. On top of that, there is another method to improve smile: Snap-on Smile, a multi-purpose restorative appliance that requires no preparation or altering of tooth structure, no injections, and no adhesives. It is non-invasive, making it completely reversible.
Dental crowns may also be used to correct the same problems that dental veneers correct, however it is a much less conservative procedure.
Basically, denture (false teeth) is prosthesis device to replace missing teeth. The denture is supported by the surround soft and hard tissue. It is the most economical and easy-to-make prosthesis. Denture can be further divided into complete denture (denture to replace all missing teeth) or partial denture (denture to replace a few missing teeth)
Beside denture, there are other options to replace missing teeth:
Root canal treatment or sometimes refers as RCT is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form (below).
What is root canal?
Root canal is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth’s nerve lies within the root canal.
A tooth’s nerve is not vitally important to a tooth’s health and function after the tooth has emerged through the gums. Its only function is sensory — to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.
What Damages a Tooth’s Nerve and Pulp in the First Place?
A tooth’s nerve and pulp can become irritated, inflamed, and infected due to:
repeated dental procedures on a tooth and/or large fillings
a crack or chip in the tooth
or trauma to the face.
How does dentist know whether the tooth needs RCT?
There are several symptoms that usually lead dentist to conclude that the tooth requires RCT:
Pain which is severe and prolong that affect daily activities
Throbbing pain that usually disturb sleep at night
Feel painful when biting on the affected side
Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)
Discoloration (a darkening) of the tooth
Swelling and tenderness in the nearby gums
A persistent or recurring pimple on the gums (gum abscess)
From dental examination:
A very large cavity or deep restoration on that tooth
Feels very painful on percussion on that tooth
Not responsive to the vitality test using a Pulp Tester
A radiolucency lesion over the tip of the root on radiograpghic examination
How does Root Canal Treatment done?
Step-by-step of root canal treatment
A) Placing the rubber dam.
After local anaesthetic is given, dentist usually need to “isolate” your tooth. He will first punch a small hole in a sheet of rubber. Then, he will then slip this sheet over the affected tooth and position a small tooth clamp to hold it there. The purpose of a rubber dam is to keep the tooth saliva-free therefore, avoid contamination of bacteria from saliva .
B) Creating the access cavity.
The tooth was isolated using rubber dam and a hole was made (cavity access) to reach the pulp chamber
As a starting point for performing root canal treatment, dentist must first gain access to the nerve space (or the pulp chamber) within the tooth.
He do this by using a dental drill to create an access cavity. This hole will extend into the interior of the tooth to its pulp chamber. It’s the hole through which the dentist will perform their work.
On the molar teeth, the access cavity is made on the chewing surface of the tooth and for the front teeth, the access hole is made on the tooth’s backside.
The overall size of the access cavity will vary according to factors such as the location of the individual canals and how hard it was for the dentist to find them. Additionally, beyond just that portion of the tooth that must be removed for access, the dentist will also need to remove any decay that’s present and any loose or exceptionally fragile tooth parts or fillings.
C) Cleaning and shaping the tooth’s root canals.
The next step of the root canal process involves “cleaning and shaping” the interior of your tooth (the pulp chamber and all root canals). In regard to the cleaning process, its purpose is to remove bacteria, toxins, nerve tissue, and related debris that are harbored inside the tooth.
The shaping process refers to how the tooth’s canals are enlarged and flared, so the have a shape that facilitates the filling and sealing process.
What instruments are used?
For the most part, a tooth is cleaned and shaped using endodontic files. These files look like straight pins but on closer inspection you will find that their surface is rough, not smooth. These instruments literally are files and are used as such.
How are the files used?
Dentist works the file up and down, with a twisting motion, in each of your tooth’s root canals. This action will scrub, scrape and shave the sides of the canals, thus cleaning and sculpting them. He will perform this same type of action using a series of files, each having a slightly larger diameter.
The idea is that each consecutive file is used to slightly increase the overall dimensions of the root canal. Since some canal contaminates are embedded within a canal’s walls, this enlargement assists with both the procedure’s cleaning and shaping goals.
While performing this work, the dentist will also periodically flush out (irrigate) the tooth. This helps to wash away accumulated debris and contaminants. While a number of different solutions can be used for this purpose, sodium hypochlorite (bleaching agent) is the most common one. An added benefit of bleach is that it is a disinfectant.
Some dentist may have a handpiece that can manipulate the files for them.
Traditionally, files have been hand instruments. This simply refers to the fact that the dentist creates their filing action by manipulating them with their fingers. Some dentist may, however, have a special dental drill (handpiece) that produces the needed file motion for them.
Rotary Endodontic System
As a variation on this same theme, there is yet another type of dental handpiece that produces a cleaning motion by way of holding a root canal file and vibrating it vigorously.
Measuring the length of the root canals.
Determine the length of root canal with a radiograph
The goal of root canal treatment is to achieve cleaning of the entire length of each of the tooth’s root canals, but not beyond.
As a means of determining the precise length of a canal, dentist will use apex locator to get the measurement for the length of the tooth (from the crown to the tip of the root). By doing so, the dentist wouldn’t go beyond during cleaning.
Usually, he will confirm the measurement by taking a x-ray of the tooth with a file placed in the tooth. The x-ray picture will show if the file extends the full length of the canal or not.
D) Sealing the tooth – Placing the filling material.
Once the interior of the tooth has been thoroughly cleansed and properly shaped, it is ready to be sealed (have its hollow interior filled in). In some cases, the dentist will want to place the filling material immediately after they have finished cleaning the tooth. With other cases, they may feel that it is best to wait about a week before performing this procedure.
What type of root canal filling material is used?
Sealing of the root canals
The most frequently used root canal filling material is a rubber compound called gutta percha. It comes in preformed cones whose dimensions match the size (diameter, taper) of the files that have been used to shape the tooth’s canals.
A root canal sealer (a paste) is usually used with the gutta percha. It is either applied to a cone’s surface before it is placed into a canal, or else applied inside the root canal itself before the cone is inserted. Several individual cones of gutta percha may be needed to fully fill the interior of the tooth.
Dentist will warm the gutta percha (either before or after it has been placed into the tooth) to soften it. This way it can be molded to closely adapt to the shape of the tooth’s interior.
As an alternative, a dentist may place the gutta percha via the use of a “gun.” This apparatus is somewhat similar to a hot-glue gun. It warms a tube of gutta percha. The softened material can then be squeezed out into the tooth.
Once your dentist has finished sealing your tooth, they will place a temporary filling, so to seal off the access cavity created at the beginning of your treatment.
How long does root canal treatment take?
The total amount of time that’s needed for a tooth’s root canal therapy will of course hinge on how many appointments are needed (one visit, or two or more) and how long each one will take. Usually, root canal treatment for molar usually take about 3 to 4 visits. Each visit takes around an hour. For the front teeth, usually take fewer visits as they are simpler and located at the front region.
Summary of Root Canal Treatment:
Cases of root canal treatments
RCT on upper left first molar
RCT on lower right first molar
RCT on lower right first molar
RCT on lower rigth first molar
E) Post Root Canal Treatment
At this point, while the individual steps of performing the root canal process have been finished, the tooth’s treatment is not yet complete. The tooth is no longer alive since the pulp has been removed. And this can make the tooth brittle and more prone to fracture.
Therefore, a permanent restoration must still be placed. Choosing the right type of dental restoration, and having it placed promptly, will help to insure the long-term success of the tooth’s endodontic therapy.
There are a few options:
1) Crown (recommended) as it is strong, durable and more aesthetic
2) Dental filling – cheap, can be done on the spot (doesn’t required 2 visits)
F) Final words…
Tooth infection can recur in treated teeth (even RCT treated tooth), hence, good oral hygiene, including brushing, flossing and regular dental examination are necessary to prevent further problems. For more info on good oral hygiene click here.