Orthodontic Treatments

Thursday, 13 October 2016

Post-Operative Complications of Implant Placement

By : Dr.Rajat Sachdeva

With the increasing acceptance of Dental Implants as a viable tooth replacement therapy, complications & failure rates have also increased proportionately.

A range of possible post-operative complications & their prevention are described below:

1. Infection: Implants are made of titanium, which is strong & biocompatible, which means that is not rejected by the body. So the chances of developing post-operative infection are extremely rare. At times when dentist do not follow effective & strict protocol of sterilization, patient might be vulnerable to post operative infection.

Post-operative infection causes pain & discomfort to the patient, reason being- bacterial contamination of implant or surgical site during the procedure.

If the infection is limited to the soft tissue, a small gum boil will be noticed over the implant site. It can be punctured using a sharp probe & irrigated with chlorhexidine solution or citric acid. It heals & the pain subsides within 24hrs. In case of continuous pus discharge & severe pain which is not relieved by analgesics, this depicts that the infection has reached to the bone-implant body interface.

Prevention: one should follow strict protocol of sterilization in the operatory in order to avoid any bacterial contamination. Also, in such cases, the implant should be removed immediately & prescribe good antibiotic like tab Augmentin 1000mg twice a day for 5-7 days. A new implant can be inserted when the site gets healed in 6 weeks.

2. Post-operative Edema: Post-operative edema develops in cases of traumatic implant placement. High speed drilling & no constant stream of chilled saline causes bone to overheat & this leads to accumulation of fluids in tissue spaces i.e. edema.

Prevention: Unnecessary trauma to the bone must be avoided during osteotomy preparation. Drilling speed must be set according to the density of bone along with a pumping motion of the drill should be employed during drilling to allow the saline to cool down the bone. This prevents overheating & necrosis of the bone.

Patient must be advised to apply an ice pack over the facial skin of the surgical site intermittently for 45 min to cool down the bone in order to suppress heat generation & inflammatory oedema.

3. Pressure necrosis: results in cases where implant has been inserted & screwed at a very high torque, it may lead to pressure necrosis of the surrounding bone & the patient will complain of continuous pain not relieved by analgesics, for weeks after the surgery.

Prevention: Drilling at higher speed with maximum amount of chilled saline irrigation flow to cool down the bone. Use of final drill with the diameter only 0.2mm less than the implant diameter along with the use of bone tap to prepare threads in the bone to accommodate implant threads. Following these instructions help in reduction of post-operative pressure necrosis.

4. Suture line opening: leads to exposure of implant threads in the oral environment & may cause the collection of plaque over the exposed rough surface of the implant, which may further cause peri-implantitis & loss of hard & soft tissue around the implant.

Causes of implant thread exposure-

· Suture line opening & loss of graft in cases where simultaneous bone grafting has been performed with implant placement also leads to implant exposure.

· More superficial implant placement.

· Thin mobile soft tissue recedes with muscle pull.

Management:

· Tension free sutures should be used to avoid the suture line opening because of the tension in the flap.

· The open suture line should not be re-sutured but the patient should be instructed to keep it clean, as it heals by secondary intention in 2-3 weeks.

· If soft tissue healing has not covered the exposed threads, either cover the threads using soft tissue grafting with or without simultaneous bone grafting, or adequate grinding & polishing should be done to make the surface smooth & prevent accumulation of plaque.

5. Bone resorption: one of the most common complication in dental implantology. When occlusal forces are not distributed equally i.e. is off-axis to the implant prosthesis leads to resorption. Also, when implant with a wider platform is placed into the narrow crestal bone causes crestal bone resorption.

Prevention: Implant must be placed along the axis of the future prosthesis. For large mesio-distal diameter two implants should be placed with narrow occlusal table of prosthesis. Along with the maintenance of oral hygiene, soft tissue grafting for compromised soft tissue around the implant must be addressed.

6. Peri-implantitis: is an inflammatory reaction with the loss of supporting bone in the tissues surrounding a functioning implant. Peri-implantitis is characterized by bleeding/suppuration on probing, together with loss of supporting bone.

The peri-implantitis lesion exhibits histopathological features that similar, but not identical, to those in periodontitis. Similar to periodontitis, the treatment of peri-implantitis must be based on infection control. Under these conditions, progression of the disease may be arrested & subsequent, lost peri-implant tissues may be generated by bone augmentation & soft tissue grafting procedures.

With this increasing trend of replacing the lost tooth with an implant, at Dr. Sachdeva’s Dental Institute, we incorporate several associated procedures like bone augmentation to provide this therapy to the maximum number of patients. We follow strict protocol for sterilization & restore implants to minimize postoperative or post loading complications.

For More Information Visit Our Website: www.sachdevadentalcare.com

http://dentalcoursesdelhi.com/

Envision The Fate Of Dentistry – Facts/Predictions

THE FUTURE OF DENTISTRY IN 2020 AND BEYOND WRITTEN BY dR.rAJAT sACHDEVA

I thought I’d share a few interesting facts/predictions that I came across whilst researching.

The exposure towards treating diseased individual over a growing population – Over the next 20 years the population in India is predicted to grow by 1.252 billion to just over 1.454 billion. The number of Indians over the age of 60 years has hit an all-time high, accounting for 8.6 per cent of the country’s population. Based on statistics we would be treating an ageing population – Today almost 1 in 15 people over 60 years old and by 2020 it would be 1 in 5 people above 60 years with an overall grow in population. We will be treating an increasingly diverse population – By 2030, ethnic populations will make 30% of the population of India.There will be an increase in the number of dentists – India currently has 309 dental colleges, which churn out around 26,000 dentists every year as compared to only 8,000 dental students graduated annually in year 1970. It is now, however, estimated that there will be a surplus of more than 1 lakh dentists in India by 2020. The dentists: population ratio of India, on date is 1: 10,000. However, the reality is that; in rural India 1 dentist is serving over a population of 2,50,000. Thus, the real picture is not that simple as it seems. As, we are about step into the next decade, there lies an urgent need to analyze the dental work force for many underserved groups of the country that do not have any access to oral health care.We will be treating less caries or moderate periodontitis but more tooth wear and more peri-implant disease.We will be treating a population with increasing socio-economic inequalities – Men and women in the highest socio-economic class can, on average, expected to live just over 5-6 years longer than those in the low socio-economic state. There will be an obvious increase in focus on value and impact on quality of life with more expectation over results. Dental professionals will be working in multidisciplinary teams and promoting the importance of oral health for general health. With every passing year there has been surge in proportion of female dentists with about 5% in last 5 years, a trend which is expected to continue. In the recent years, female students outnumber male students in getting admitted in dental colleges( like 60- 70% of the seats are occupied by girls).Although only 30% are practically converted into private practitioners.A growing propoprtion of female dentists will work part-time according to the research.The use of virtual reality will be constitutive to dental practice. Google glass integrated with Dental Loupes can become next best tool for dentists. Technology such as CAD/CAM, lasers and perhaps even robotics may be routinely used in practice.The evolution of materials would continue with bioactive,bone regenerative materials reproducing some compelling results.The impact of smart phones and social media will continue to grow for both dental professionals and patients.

For More Information Visit Our Website: www.sachdevadentalcare.com

http://dentalcoursesdelhi.com/

Envision The Fate Of Dentistry – Facts/Predictions

THE FUTURE OF DENTISTRY IN 2020 AND BEYOND WRITTEN BY dR.rAJAT sACHDEVA

I thought I’d share a few interesting facts/predictions that I came across whilst researching.

For More Information Visit Our Website: www.sachdevadentalcare.com

http://dentalcoursesdelhi.com/

Thursday, 6 October 2016

Understanding Nursing Bottle Tooth Decay

Your baby teeth are important, but are also vulnerable to decay, so special care in their oral hygiene maintenance is must. Dentists recommend that parents should start brushing their baby’s teeth as soon as the first teeth erupt in their oral cavity.

Causes of Nursing Bottle Tooth Decay

Nursing bottle tooth decay often affects upper front teeth, but other teeth may also be affected.

There are many factors which lead to tooth decay. One of the most common causes is prolonged exposure to sugar containing drinks. For our convenience, we often put our baby to bed with milk bottle or pacifiers especially at night, bacteria in the mouth thrive on this sugar & produce acids which eventually results in teeth decay.

Prevention of Nursing Bottle Tooth Decay-

Baby teeth are very important for your baby to fulfill the form & function of teeth like smiling, chewing, & speaking also they are the placeholders for their permanent teeth. So it’s very important to implement good oral hygiene to prevent decay & lead a normal healthy life.

· Parents must take care of their infants when it comes to bottle feeding & nutrition. Bottle & breast feeding must be refraining while the kid is in bed. Nocturnal bottle & breast feeding increases the likelihood of developing caries. However, parents must be certain that their infant finishes bottle feeding before going to bed.

· After each feeding, parents must clean baby’s gums with a clean gauze pad.

· In order to maintain proper oral hygiene, parents should begin brushing their child’s teeth, without toothpaste, as soon as the first tooth erupts in their oral cavity. Even if parents use toothpaste, use a fluoride-free one.

· When all the deciduous/ baby teeth have come in, do not forget to floss them.

· Parents must make sure that their child is getting enough fluoride, in order to prevent dental clinic. In order to confirm whether you need a supplement, you can visit your dentist.

· Schedule regular dental visits for interception & prevention of decay.

Proper preventive practices & heed towards infants & children can affix a halt to teeth decay.

Written By Dr.Rajat Sachdeva

Tmj: The Pain And The Solution

The temporomandibular joint (TMJ) is the joint that connects the jaw to the skull. Temporomandibular joint disorder, or TMD, occurs when there is loss of harmony between the muscles and jaws in the face.

TMJ/TMD is a disorder which causes improper alignment of the jaw joint causing pain. This pain leads to severe pressure on the nerves present around the joint.

Onset of Pain

Most people make some adjustment to accommodate the fit of their teeth to their jaw joint which is a physiological and normal process that is not painful in general. A painful situation can arise when a person experience some change to the teeth, like trauma or may be long term wear to the teeth such as abrasion, improper fillings or emotional stress causing unnecessary clenching and grinding of teeth.

Treating facial pain and jaw problems

· Pain In Or Around The Ear

· Tenderness Of The Jaw

· Clicking Or Popping Noises When Opening The Mouth Or Even Head

· Neck Aches.

Swelling Of The Face

The Preventive Measures:

1. Stretching the jaw

· Press the tip of the tongue to the roof of your mouth, then slowly opening mouth as much as you can without it becoming painful. If you feel pain, stop performing the exercise; it may need more time before you can engage it.

· Close your mouth and your jaw is now as relaxed as possible. With teeth slightly apart, slowly open your mouth as wide as you can while looking up. Hold your mouth open for a few seconds, and then slowly close it.

· Once your mouth is closed again, move your jaw to the left side while looking to your right with your eyes without turning your head or neck. Hold this position for a few seconds, the move back to the center.

2. Strengthening the muscles

· For a resisted opening exercise, put your thumbs under your chin and gently push downward against it, slowly open your mouth, keeping it open for a few seconds before slowly closing it.

· For resisted closing exercise, keep your thumb under your chin and place your index finger from the same hand on the ridge between your chin and lower lip. Push gently as you close your mouth.

3. Relaxation techniques

If you feel tense, try inhaling, then slowly exhaling for a count of five or 10. Although it is not a form of exercise, but learning how to reduce the stress in your life can go a long way toward easing any TMJ-related discomfort that develops as a result.

4. Caring for Your Mouth

· While brushing and flossing, be careful not to open the mouth too wide, mostly when reaching the second and third molars.

· Pain when stretching or opening mouth is the alarming situation to call your dentist. They can examine your mouth and recommend a course of treatment, if that’s needed.

Treatment

1. Splint/Jaw Reposition Appliances

These appliances may be used as a long term treatment to protect teeth from harmful grinding and eliminate problems that occur during a specific activity simply by wearing such an appliance, no further treatment would be necessary.

2. Occlusal Equilibrium maintenance

This treatment is done to alleviate the pressure on individual teeth. The jaw is able to adapt to tooth interference in malocclusion and if the irritant tooth is re-shaped, a better fit is achieved and the pain is reduced.

3. Occlusal fillings

It involves the replacement or reconstruction of teeth by reshaping procedure.. This can be achieved with crowns, bridges, dentures or implants involving multiple teeth.

4. Orthodontics

Orthodontic treatments can be restricted to just one or two teeth, but can be carried out at any age and is possible to achieve with new advanced invisalign braces that are practically invisible.