Dental Associates

Dental Anxiety

adrian — Mon, 07 Jun 2010 20:48:10 +0000

Afraid of going to the dentist?

You’re not alone! For many people the idea of seeing your dentist for even the simplest cleans generate anxiety, so much so that people would rather put off going rather than dealing with the anxiety.

For some people ignoring their regular visits will disadvantage them slightly, for others it can lead to cavities, gum disease and even abscesses.

To make your visit more comfortable, we offer the following:

1. A calming environment that does away with the scary “white” dental surgery – we find that combined with natural scents and ambient music, we create an environment that is different from what people normally associate dental clinics.

2. Oral sedation that will help calm your nerves, taken one hour before surgery in our relaxation room.

3. Intravenous sedation which is a deep, monitored, sedation technique that allows us to carry out most complex dental procedures and surgery.

Intravenous sedation is favoured by many of our patients needing extensive dental work as multiple fillings, extractions and/or implants can be carried out in a single appointment.

Call us for an assessment appointment:

(09) 365 1565

Tuesday – Friday 8.30am – 5.00pm

or email for more information:

info@dentalassociates.co.nz

Bone grafting

adrian — Thu, 25 Jun 2009 02:10:30 +0000

My dentist says I need a bone graft before he can place an implant. Why is this?

When a tooth is lost, and the socket allowed to heal, the bone that normally supports the tooth is lost in a process known as resorption, or alveolar resorption. Biologically, the bone is there to support the tooth, once the tooth is lost, there is no reason for there to be supporting bone, hence resorption. If enough resorption occurs, there is very little bone available to place an implant, hence you may need a bone graft.

Types of bone grafts

Autogenous – this is a graft made of bone harvested from a donor site in your mouth – sometimes the bone in the chin is used.

Allograft – this a graft made of human bone harvested from a donor.

Xenograft – this is a graft made of porcine or bovine bone (pig or cow).

What sort of graft do you use?

We tend to use xenografts for smaller graft areas, using a particulate grafting agent called BioOss (bovine xenograft); for larger areas we use an allograft called PurOss (human bone). These grafts are thoroughly sterilised and ALL organic matter is removed leaving only the crystaline, bony matrix.

Can I catch diseases from grafts?

No, the grafts are thoroughly sterilsed AND have all organic material removed, you cannot catch any diseases present in the donor. A procedure known as a Tutoplast process deactivates, destroys and removes all unwanted material, such as fats, cells, viruses and microbes, producing pure bone and only bone – plus selected minerals.

How long after the graft do I have to wait before I can have my implant?

Anywhere from 3- 6 months depending on the type of bone that is being grafted to, the size of the graft and how well the graft intergrates into your bone. Grafts can sometimes fail, requiring re-grafting.

Call us for an assessment appointment:

(09) 365 1565

Tuesday – Friday 8.30am – 5.00pm

or email for more information:

info@dentalassociates.co.nz

Bilateral anterior block grafts. Video courtesy of University Associates in Dentistry of Chicago (Dental Implant Institute Chicago) www.uadchicago.com

Interest Free Finance

adrian — Sat, 30 May 2009 03:02:51 +0000

We believe in providing high quality dentistry, whilst making it easy for our patients to afford treatment – by making easy installment payments ! In conjunction with GE Money, Dental Associates can provide approved clients with interest free payment options of up to 12 months.

This allows you to spread your dental treatment costs over a longer period, and allows you the freedom of making sound decisions about your teeth without worrying about the short term cost implications.

GET the treatment you need now. E.g. a NobelBiocare PROCERA, all-ceramic crown could only cost you as little as $51 per month*

A course of adult orthodontics with In-Ovation-Ceramic brackets could cost you as little as $255 per month*

* on a 36 month installment plan at 13.5% pa

6 months interest free if your treatment is between $500 and $2000.

12 months interest free for treatment plans costing more than $2000.

The prevailing interest rate applies at the end of the interest free start up period. All finance applications are subject to approval by GE Money, terms subject to conditions.

Orthodontics

adrian — Mon, 11 May 2009 09:30:44 +0000

Why orthodontics?

There may a few reason why you would be considering orthodontic treatment for yourself or your child, some common ones are:

1. Crooked teeth can often be troubling for young children, especially adolescent.
2. The irregularity of your child’s teeth is starting to affect his/her bite, or if the teeth are protrusive, they seem to get injured during play or sports.
3. You’ve always wanted straight teeth and did not get the opportunity when you were younger.
4. Your irregular teeth are causing difficulties in cleaning, and increasing your risk of gum disease.
5. Your dentist may be considering extensive reconstruction of your heavily filled, worn or irregular teeth, and orthodontic pre-treatment may be indicated.

Wherease orthodontic treatment for children and adolescents is almost considered a rite of passage now, orthodontic treatment amongst adults is increasingly more common, and there is NO reason NOT to consider treatment for yourself.

Are we orthodontists?

No, none of our dentists are specialist orthodontists. Adrian is a general practitioner with a special focus on orthodontics and has received post-graduate training in orthodontics. Complex orthodontic cases are often assessed and refered to specialist orthodontists that Adrian works closely with. Simple orthodontic cases do not have to be treated by a specialist.

What should I expect from treatment?

Unlike treatment in adolescents, adult treatment may sometimes only involve front teeth, especially if treatment is primarily to prepare your teeth for more restorative work. Treatment may also take less time than you would expect, especially if only minor movements are required. However, in some cases, extensive movement of teeth would require more time than in a child or young adult, and you may have to be prepared to wear your braces for a longer period of time.

Is treatment painful?

When you intitially have your braces placed, you may get an ache from the teeth due to the tension of the wire. This also happens when new wires are placed and braces tightened. You may also get discomfort on your cheeks and lips due to rubbing against your new braces.

Will I have to have teeth taken out?

Teeth are sometimes taken out to make extra space to align crooked teeth, but not always. As much as possible extraction of teeth is usually avoided.

Are braces very visible?

We use self-ligating brackets at our practice, these brackets are smaller than standard brackets and do NOT require elastics to hold the wires in place. We can also use ceramic bodied brackets that are tooth colour to limit the visibility of your braces, tooth colour wires can also be used!

What are self-ligating brackets and why would you use them?

Traditional orthodontic brackets have grooves into which orthodontic wires are placed, these wires are then held in place by elastic ties. Self ligating brackets do not require elastic ties, the brackets come with a special clip that hold the wires securely in place. As there are no elastics used, these type of bracket/wire systems are known as low friction systems – the advantages are that smaller wires can be used to move teeth, which means less discomfort for you, the patient. There is some evidence that these systems are able to move teeth more efficiently and are useful for expansion of the dental arch in treating adult patients.

What would it cost for me to have a course of treatment?

This would depend on the type of case and type of movement needed, typical costs start at $6000 and some cases may cost as much as $9000. Before anything is done a complete consultation and record taking appointment is carried out, and then your dentist will discuss your case with you at another session. The initial consult costs $190.

In-Ovation-R treated patient – 20 months treatment time

Parents of child wanted non-extraction orthodontics.

Child placed in In-Ovation-R – mid treatment approx 9 months.

Completed case – 18 months. No extractions needed!

An In-Ovation-R bracket showing the wire holding mechanism

Dental Titanium Implants

adrian — Mon, 11 May 2009 08:30:26 +0000

Implants will replace any lost tooth/teeth

Well almost, in some instances the bone underlying that is needed to support the implant is of a poor (or non-existent) quality and in these cases implants may not be placed or can only be placed with additional bone grafting procedures! Areas of the mouth that often pose issues with implants are the back portion of the lower and upper jaws – in the case of the upper jaw the air sinus can complicate matters and the lower jaw the inferior dental nerve!

Implants will look as natural as my own teeth

Yes, in most cases, they will. Look at the case that I completed on the right column, the implant placement and aesthetic components were carried out by myself.

Implants will “feel” natural

They should also feel 99% similar to having your own teeth, but sometimes the implant supported crown may have a different “feel” due to the materials used and the shape needed to fit properly into the implant. It’s funny to talk about feel when talking about teeth but the truth is that all your teeth are attached to your jaw bones by a specialized ligament called the periodontal ligament and within this ligament sits a whole range of nerve fibre endings.

These fibres transmit information about the pressure the tooth is under and the forces acting upon it. Don’t believe me? Ever inadvertently bite on a hard piece of stone whilst chewing a sandwich, you’ll soon understand how sensitive these nerves are!

The nerve endings also act as a safeguard so that you don’t end up putting too much pressure your teeth. Implants DO NOT feel the same – some patients say that a single implant can sometimes feel “empty” almost like it’s not there!

The implant will be placed and my tooth with be replaced in one surgical appointment

Well, no. Immediate loaded implants can work but only if there is enough bone in the area to adequately support and load the implant.

If not, then a two stage procedure will have to be carried out, where the implants are placed first and then a 3-4 month healing phase is allowed to occur before the placing of the crown atop the implant.

During this phase you can opt for NO temporary (rare this), a temporary denture, or a temporary resin bridge.

So what ARE the steps?

If a tooth has be extracted, then the tooth is normally extracted and if the site is suitable for immediate placement of an implant, the implant is then placed as soon as the tooth is taken out.

However, if the site is not suitable, a bone graft may have to be placed, and the implant placed 3 months later.

Once the implant is placed, a further 3-4 months is allowed to go by to allow the implant to integrate or “take”. The implant’s stability is then checked and then the construction of the crown is carried out. This normally takes 1-2 weeks.

My dentist says I need soft/hard tissue “augmentation” or “plastic surgery” together with my implant.

This is sometimes needed, the soft tissue procedure is known as a gingivo-plasty or if more extensive a mucoso-plasty or vestibulo-plasty; the hard tissue procedure is known as a bone graft.

Sometimes, depending on the length of time the missing tooth to be replaced has been gone, the soft tissues in the area would have shrunk and deformed during healing leaving little, if any, bone for the implant.

What sort of implants do YOU use?

Here at Dental Associates we use NobelBiocare implants.

What do implants cost?

This varies depending on the type of implant used and the amount of site preparation needed.

Costs can range from as little as NZD$4500 for the complete procedure to replace a single tooth to as much as NZD$10,000 for a difficult case.

You should discuss this with your dentist before undertaking treatment. Choices such as a full ceramic crown and full ceramic foundation, can also add to your cost.

Work on this page carried out by Dr Adrian Tan, who practices on Auckland’s beautiful Viaduct Harbour. Adrian is a graduate of Otago University’s Faculty of Dentistry and currently works to support his two fussy dogs.

Call us for an assessment appointment:(09) 365 1565Tuesday – Friday 8.30am – 5.00pmor email for more information:info@dentalassociates.co.nz

An example of a NobelBiocare Active implant

The central incisor to the left has a fractured root, resulting in localised swelling in the gum above the crown

The tooth was taken out and an implant immediately put in place.

This was then immediately loaded with a temporary crown and sutures were put in place.

Radiograph showing implant in place and temporary crown.

Implant ceramic foundations screwed into place.

Implant and crown in place, redness in gum is from manipulation prior to seating of implant. Minor laser surgery planned to remove grey mark on gum.

Finished smile! Laser wound still healing, this was taken one week post operatively.

Veneers

adrian — Wed, 06 May 2009 02:13:33 +0000

What are veneers?

Simply put, a veneer is a “coating”. In dental terms, the word veneer basically means one of three possible things – a crown (full coverage veneer), a porcelain veneer or a composite veneer. All work on this page carried out by our dentists.

Crowns – full coverage veneers

The term veneer is rarely used in New Zealand to refer to crowns, but you sometimes hear this word used in American programs (eg Da Vinci Veneers). Crowns are full coverage restorations made of stainless steel (rare), gold, or porcelain (with or without a metal inner “sheath”). Crowns placed on back teeth can often last between 15-20 years. Crowns on front teeth often last a shorter period of time, not because of strenght issues or wear, but because they start looking worse for wear 10-15 years down the line.

Porcelain veneers

These are thin pieces of porcelain used to cover over the outer surfaces of teeth – usually to improve colour and shape, but sometimes to improve the alignment between teeth (it straighten the appearance of your teeth). Veneers are very thin, usually less than 1mm in thickness, and require special cements to hold them in place. They can be made to look very lifelike and have a lifespan of between 10-15 years.

Composite veneers

Are similar to porcelain veneers but rather than porcelain, a special resin modified with ceramic fillers is often used. This composite of materials is hard and wear resistent and can be used in almost every situation as porcelain veneers. However, they are less wear resistant have a lifespan somewhere between 7-10 years. The main advantages are that composite is affordable and can be repaired if damaged. Composite veneers cost $540 per tooth.

Can anyone have veneers?

No, in order to judge suitability, your dentist will need to assess your teeth, your bite and the overall condition of your mouth.

All ceramic PROCERA ZIRCONIA crowns

Composite veneers used to correct mild irregularity (with ONE all ceramic PROCERA crown – can you tell which?)

Call us to make an appointment for a full SMILE ASSESSMENT!
+64(9) 365 1565

Or to ask a question:

info@dentalassociates.co.nz

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Wisdom teeth? Why the OUCH! do we have them?

adrian — Tue, 27 Jan 2009 19:59:07 +0000

Ah, wisdom teeth. The story is that these are called “wisdom teeth” because they then to come in when a person is between the ages of 17 and 21 – an age where you would expect to have some “wisdom” – although now that 30 is the new 20, I don’t quite know WHAT you’d call wisdom teeth! Common complains amongst people of this age that either their wisdom teeth are causing their front teeth to shift OR they are having pain from the region.

So why are wisdom teeth such a pain? Third molars, or wisdom teeth, are the last of the adult teeth to erupt and in most cases erupt into a jaw which is lacking in space to accept these large teeth.

Anecdotal evidence suggests that as our diets become more and more processed and refined we just do not use our jaws (and jaw muscles) to the extend that affords the bony accommodation towards larger jaws – our foods are too soft and we don’t need strong muscles and concurrently large jaws to mash it all up! As such, if mom and dad fed you the occasional side of raw meat and chucked you some unprocessed grains to go with it whilst you were growing up, you’re likely to have well developed jaw muscles and a consequently large jaw!

Commonly then, we end up with smaller jaws with less space for the wisdom teeth. Which become impacted (which is a fancy dental way of saying “stuck behind” something). There are many forms of impaction with the most common being soft-tissue impaction (stuck underneath gum tissue) and mesial impaction (stuck underneath the back of the second molar).

So why remove wisdom teeth? Well, firstly, it is not always necessary to remove these teeth and in some cases, removal would be more detrimental than leaving things as they are. The main reasons for the removal of these teeth are infection and the potential for the formation of an abscess and/or cyst in the jaw, damage to the molar tooth IN FRONT of the wisdom tooth due to resorption and decay with the potential for infection due to the inability to effectively clean the wisdom tooth.

It is really important to have your wisdom teeth assessed in your late teens and/or early twenties as any problems spotted early on can be treated more readily and with less complications!

The most common complication post-operatively is infection with subsequent pain and swelling, but the most dramatic complication of wisdom teeth extraction is nerve damage resulting in a numb lower lip or side of tongue – for life! Fortunately, the latter complication is rare and is a risk usually when the tip of the roots of the wisdom tooth come into close approximation with a rather important nerve that runs to your lower lip (or the nerve that runs to the side of your tongue)!

As part of my standard practice, I normally request a CT scan if I have doubts as to the relationship between the nerve and the root, but this is not commonly asked for – partly because of the cost involved!

Before undertaking wisdom teeth surgery, make sure you ask your dentist for the reasons why your teeth need coming out, what are the possible complications (and always specifically ask about nerve damage), what are the post-operative complications, and the costs involved.

Typically, surgery can cost anywhere from $1600 to as much as $4500 depending on the x-rays needed, and complexity of the case.

Dr Adrian Tan is a general practitioner based on Auckland’s beautiful Viaduct Harbour. He has a special interest in surgery and cosmetic dentistry, which helps him feed his two little dogs. He makes regular contributions to New Zealand’s largest charitable organisation, the IRD.

An example of wisdom tooth surgery. This is NOT for the faint-hearted! This was carried out by a surgeon in Italy.

Contact us for an assessment
Consultation $95
Panoramic radiograph $120
CT scan (off site) $250-$350

Phone +64 (9) 365 1565
Fascimile +64 (9) 365 1575
eMail info@dentalassociates.co.nz

The 5 Levels of Dental Care

adrian — Sun, 30 Nov 2008 01:24:42 +0000

The 5 Levels of Dental Care we offer our patients

Choosing a new dentist and dental health team can be a challenge, leaving you feeling somewhat uncertain. Let us share some insights about what we do for our patients. The philosophy guiding our practice is as follows:

“Our practicing philosophy is to ensure that each and every patient feels that their dental needs and wants are being catered for. We are here to help you reach a decision on what is best for you dentally. We aim to do this to the highest possible standard”

In other words, we’ll help you be or become as healthy as you choose. This is a major departure from the way dentists were trained. Instead of telling you how healthy you ought to be, we will try to help you understand your choices about dental health and then let you make a free and informed decision. Your first choice in this regard is how you would like to begin treatment with us. There are five levels on which people may choose to be seen in our practice.

Level 1 :: URGENT CARE

People in crisis or with an emergency problem such as pain, swelling, or bleeding that need my immediate help are at this level. I to try see emergencies immediately, whenever possible.

Level 2 :: REMEDIAL CARE

People who choose this level of care desire treatment only when something breaks or becomes uncomfortable. Generally people at this level expect a limited type of examination, focusing on obvious problems. They usually want to correct immediate problems with as little effort and cost as possible.

Level 3 :: SELF-CARE

Patients who choose this level of care want a thorough examination and take an active part in the treatment and prevention of present and future disease problems. However, they usually choose repair solutions that are short range in nature.

Level 4 :: COMPLETE DENTISTRY

Patients at this level are similar to people described in level 3. They choose to have a thorough examination. However, they decide on an OVERALL PLAN to formulate a long-term treatment plan for health and repair. These patients are very concerned about treating the causes of dental disease, not simply the effects. These patients want all dental treatment provided to be completed in the most lasting fashion possible.

Level 5 :: LOOK YOUR BEST

People in this group are in level 4 as far as dental health is concerned, but also want to look their best at alltimes. They know that their smile is the first things others notice about them and want to put their best foot forward.

Does this all make sense? It is not uncommon for people to begin at one level and progress to another over time. We are here to help you discover and decide at what level you are most comfortable. Thank you for the opportunity to serve you and provide you with the best dentistry appropriate for you.

Zoom! Whitening $499

adrian — Tue, 14 Oct 2008 01:19:07 +0000

*Pay less than $10 per week for our Zoom! whitening deals, with GeMoney Interest Free Finance. Credit criteria applies, and applications have to be approved before treatment. Approval can be obtained in less than 30 minutes! Email us for more information info@dentalassociates.co.nz or call 365 1565!

Back again is our fantastic ZOOM! offer! Zoom! Whitening for the fantastic price of $499!

Get a ZOOM2 in-chair, LIGHT whitening procedure, PLUS a custom mouthguard take home kit with 4 weeks of bleaching gel PLUS a full examination and clean for $499!

Call (09) 365 1565 for an appointment:

Offer available Weds to Friday only – from 8.30am to 5.00pm (subject to available appointments)

Email info@dentalassociates.co.nz

More information on bleaching – Bleaching article
Consent form – bleaching-consent-form

Our Zoom! offer includes:

1. A full dental check-up, including periapical digital x-rays and photographs if needed.

2. A full mouth clean and polish using ProphyFlex Pearls – a water jet cleaning system that gives you the deepest, most extensive cleans!

3. Zoom2! In-chair whitening – 45 minutes with Zoom!’s proprietary bleaching gel!

4. Upper and lower custom mouthguards, and 4 tubes of NiteWhite 10% home bleaching (approximately 4 weeks worth of home bleaching)!

Why do Zoom! AND a home kit? We’ve found that the one-hour in chair procedure just doesn’t give us the best results that lasts as long as the combined procedure. If you have a home kit or mouthguards of your own, please let us know when you make your appointment and the ZOOM! component only will cost $399!

My lower dentures don’t fit!

adrian — Tue, 14 Oct 2008 00:56:07 +0000

“My lower dentures don’t fit doc”, said my patient.”Hmm, I wonder if it’s anything to do with that rather large meaty growth there”, I answered.”What meaty growth?!?”, exclaimed my rather alarmed patient.

“That one.” I said, grabbing his tongue.

Okay, all a little tongue in cheek here (bad pun) but lower dentures are the bane of the denture making world. In many cases there is little room on the lower jaw for TEETH much less unwieldy bits of plastic!

When teeth are extracted, part of the healing process involves the remodeling of bone that once used to support these teeth, essentially this body “ridge” is remodeled almost flat resulting the the loss of a considerable amount of bone. This means that there is often not much more than a fleshy ridge that we are now going to try to support a denture upon. Whilst this is sufficient for forces directly perpendicular onto the denture (and therefore onto the bone), it is clearly not enough support when lateral (sideways) forces are applied – hence the influence of that meaty growth the tongue, which when thrust will push the denture off the ridge.

This destabilises the denture and results in the lower denture not “fitting”.

“Whatever doc, I just want my dentures to fit”, says patient, eyes glazed over from my little soliloquy.

Well, firstly, denture adhesives don’t work. Denture adhesives work by increasing the force needed to remove the UPPER dentures from the nice flat, fleshy palate. The adhesion is not enough to prevent lateral displacement of the LOWER denture.

The reality is that only two things will now present themselves as solutions:

1. Don’t wear a lower denture at all, get used to it, stay on softer foods.
2. Have 2 implants placed in the lower jaw to keep the denture in place.

Amazingly, quite a few people opt for option (1)!!! But if this is clearly not acceptable, then by placing two titanium dental implants into the lower jaw you can then fit housings into the lower denture allow IT to clip onto the implants and, viola, stability!

In the past few years the cost of this treatment has dropped considerably, and where it would have cost over $10,000 (including the dentures), it can be done for nearly half the cost now. There are a few issues to be aware off, including the complications associated with surgery, and there is a failure rate associated with implants, but for the most part this form of surgery is relatively successful.