Q. Hi Doctor, I am interested to know the difference between mini dental implant and the normal dental implant.

1.What are the pros and cons ? Also the durability of the different implants.

2.Can the mini implant take the pressure of everyday biting of meat or fibre?

3.The cost and duration of the whole procedure for eg. A set of 4 front teeth and 2 incisors.

4.Will there be gaps between the gum and the implant, especially in the front teeth?

5.Is it possible for a patient to have both types of implant together? For both health n cost reasons.

Thanks, Alan

Dental implants replace missing teeth with man-made teeth that look, feel and function like natural teeth. Dental implant treatment is analogous to building a house – a foundation needs to be laid, and then the house is built on the foundation. There are two main steps - the placement of the implant (the foundation) in the jawbone, and the fitting of teeth (the house) on top of the foundation.

Conventional implants that are currently widely used are larger than 3mm in diameter. Long term scientific research of conventional dental implants has been conducted for over 40 years, dating back to 1965. Currently there are more than 27,900 scientific publications on conventional dental implants. The original research was conducted in Sweden and the same successful results were duplicated at the University of Toronto, Canada. The overall success rate of conventional dental implants worldwide is approximately 95% over several decades.

Recently, some clinicians have started using mini dental implants that are under 3mm in diameter and some have reported that these mini implants work well. However, there are very few scientific studies on the long term usage of mini dental implants, i.e., the functional outcome of mini dental implants is still not fully known from a scientific point of view. All patients considering mini dental implants should be informed of the possible implications of this.

The time and cost of dental implant treatment varies depending on each individual’s dental condition and medical history, and also on the experience and qualifications of the dentist or dental specialist doing the procedure. More information on the cost of the procedure is best obtained after consultation and examination by a dentist or dental specialist.

From the initial consultation to the time the final teeth are fitted, the conventional dental implant process may range from a few weeks to a few months. The factors that may affect the length of the whole process include whether bone grafting is needed, and also whether the patient has other medical conditions. Under the right circumstances, computer scans and CAD-CAM technologies allow the dental implant process to be completed within a few hours, e.g., Teeth-in-an-Hour dental implants. However, regardless of whether conventional dental implants or Teeth-in-an-Hour dental implants are used, there is close to no interruption in one’s regular daily life.

In general, mixing and matching of clinical treatment options of different long term outcomes is not a good idea, and thus, it is not recommended that a patient have both conventional dental implants and mini-implants together as part of the same treatment plan.

Dr. Ansgar C. Cheng
Specialist Dental Group (Henry Lee Dental Surgery)
3 Mount Elizabeth, #08-10, Mount Elizabeth Medical Centre
Singapore 228510
Clinic: 6734 9393
Website: www.specialistdentalgroup.com

Q. Hi Doctor, I am interested in laser whitening.I am 32 years old. I have few questions for your advise.

1) I have 3 veneers in front my teeth. I would like to know if I do my laser whitening will my composite veneers be the same colour like the original teeth? If it turns out not the same like the original colour of my teeth what should I do?

2) How much it is cost for laser whitening?

3) I saw from the website ,there are several type of laser whitening machine?Is there any different?

4) Do I still need to do the home kits whitening at home after doing my laser whitening?

Thanks.
Cheers, Sharmine

Teeth whitening refers to the brightening process for teeth that are discoloured or stained by ageing, coffee, tea, soft drinks, tobacco, and other foods. While there may be some technical differences between the various whitening methods and machines, they generally follow the same principle of activating a peroxide-based gel through the light. The activated gels oxidizes the stains, resulting in whiter teeth. It is important to have a dentist experienced in teeth whitening to perform the procedure predictably to reduce complications such as sensitivity in the treated teeth.

While laser whitening can predictably brighten your natural teeth, it has no effect on your composite resin veneers. Therefore you will notice a difference in colour between your whitened natural teeth and the veneers. Your only option would be to redo those veneers should there be a significant colour mismatch. You need to carefully consider your options and thoroughly explore this issue with your dentist before making a decision.

Laser whitening would cost approximately SGD$1500. This would include in-office laser whitening and a home bleaching kit. Home bleaching is usually recommended for five days to optimize the results. If your stains are more resilient, you will need more sessions of laser whitening and a longer period of home whitening. An experienced dentist would be able to advise you according to your type and degree of staining.

Dr. Neo Tee Khin
Specialist Dental Group (Henry Lee Dental Surgery)
3 Mount Elizabeth, #08-10, Mount Elizabeth Medical Centre
Singapore 228510
Clinic: 6734 9393
Website: www.specialistdentalgroup.com

Q. Hi,

I was being introduced to electric toothbrushes recently, which was claimed to be more effective than manual toothbrushes. Based on friends' advise, I've tried using electric toothbrush for the past month by placing the electric toothbrush between my gums and tooth at 45deg angles (facing the gums). However, I felt that my gums are slightly sore and seems to be receding.

1. Is it true that electric toothbrushes are more effective?

2. Would like to find out if my brushing technique correct?

3. Could it be that it takes awhile to get use to electric tooth brushing, which causes my gums to feel sore?

4. There are many types of electric toothbrush available in the market (e.g. rotation-oscillation, counter oscillation), which can range from S$50 to S$300. How do we know go about selecting the type of toothbrush that is suitable? I don't mind getting a relatively more expensive toothbrush, but would like to find out how different is it to use a basic electric toothbrush as compared to the professional series.

Appreciate your advise
Cheers,
Ling

Hello Ling,

This is a very useful question indeed. I think many would like to know the answers too.

1. The electric toothbrushes are as effective as the correct manual tooth brushing techniques. Therefore, for those who may have problems mastering the proper technique of manual tooth brushing, the electric toothbrushes are indeed more effective.

2. You have placed the brush heads of the electric toothbrushes at an angle to your teeth and gum junction. One of the things we have to note is that most electric toothbrushes have some angulations built into their brush bristles. This is why you tend to see the bristles splay outwards when you put pressure on the brush head. I would suggest that you place the brush head straight at the teeth-gum junction gently and let the brush mechanism do its work. Also, make sure that the toothpastes you use are not the abrasive types.

3. I think most brush bristles are a little harder when new. But it should soften after a few uses. The key is to place your electric toothbrushes on your teeth and gum gently. On the other hand, you may have the thinner gum biotype that may not take well to even normal brushing pressure. In this case, I strongly suggest you use the children's toothbrushes as they are usually softer than the soft of the adult toothbrushes. Some of the colours and cartoons on the children's toothbrushes are quite welcoming and cheerful too.

4.The electric toothbrushes have been around for some time now and they have gone through much modifications to make them more effective and gentler. Most major brands are safe to use. If you are into trying newer technologies, the sonic brushes and the ion brushes certainly look interesting. Incidentally, to the best of my knowledge, the very first generation of electric toothbrush was patented by a Singapore dentist. Speaks volume about Singapore dentists, doesn't it?

Hope this can help keep your smile sparkling and healthy.

Dr Wilson Goh

GPA Centre For Dentistry
600 North Bridge Road #14-04/05,
Parkview Square
Singapore 188778
Telephone: (65) 6 732 1020

Q. Hi Doctor,

I am 40 years old female married with a 3 year old son. My lower set of teeth have gaps in between them.

Are there are medical procedures that can help to close the gap? How much does it cost?

Thanks,
Ling

Dear Ling

Gaps between teeth can be due to a jaw size tooth shape discrepancy. It can be corrected with orthodontic treatment or cosmetic dentistry like veneers. If the problem is due to teeth displacement eg wrong positioning, then orthodontic treatment can correct it. Orthodontic treatment is less invasive and does not involve removal of any tooth structure. However, if the gaps are due to the intrinsic shape and size of the teeth then cosmetic dentistry is needed to correct the discrepancy. Age is no longer a limitation to orthodontic treatment. The new development in ortho

Orthodontic treatment costs range from $3000 onwards depending on the severity of the problem and treatment time range from 6 months to 2 years.

Porcelain veneers costs range from $1500 per tooth onwards and treatment can be completed within a month.

Dr VicPearly Wong

Please feel free to contact Dr VicPearly Wong if you need additional information.

T32 Dental Centre Pte Ltd
Address: 1 Orchard Boulevard
#17-00 Camden Medical Centre
Singapore 248649

Q. Hi Doctor,

I have what I call 'tiger teeth' on my upper row of teeth which are fang-like and sharp.

I am 21 years old so is it still feasible to remove them or can they be shifted downwards to be aligned with the rest of the upper row?

Other problems include slight discolouring and plaque formation, and some chips and uneven surfaces.

Would cosmetic or reconstructive procedures lead to a dental fee of an astronomical figure?

Many thanks,
Grace

Dear Grace,

The “tiger teeth” or canines are often crowded out when there is a lack of space in the mouth during eruption. More often than not, the first premolars (the teeth behind the canines) are taken out to allow that canines to fall back into space with orthodontic treatment. This is because the canines have the longest roots of all the teeth and hence they support the face at the corners of the mouth. Most orthodontists are inclined to keep the canines to avoid collapse of the face around the corners of the mouth. However, in instances where the canines are compromised (eg decayed or in an unfavorable position), then they will be sacrificed instead of a healthy premolar. An orthodontic evaluation is necessary to determine the final treatment plan.

Crowding of the teeth can lead to more plaque formation if the oral hygiene delivery is inadequate. If the discolouration is extrinsic eg coffee or wine stains, they can be easily removed with polishing or laser whitening.

Costs for cosmetic and reconstructive procedures depend on the type of treatment needed. A comprehensive evaluation will reveal the extent of dental work needed and a more accurate estimate of the price will be given. On average, orthodontic treatment costs range from $3000 onwards and a porcelain veneer costs $1500 onwards per tooth.

Dr VicPearly Wong

Q. Hi Doctor,

I would like to ask regarding teeth grinding. Both my husband (age 44) and my daughter (age 12) grind their teeth when sleeping. Are there any ways to stop it and what is the cause?

Teeth-grinding during sleep is known as nocturnal bruxism. Usually, those that grind their teeth when sleeping do not remember having done so. During a full night of sleep our body switches from light sleep to deep sleep many times. Teeth grinding usually occurs when the individual is in the light sleep phase. In adults, this condition is known to be related to stress. Scientific evidence also shows that we may grind our teeth higher than 8.6 times our usual bite force in nocturnal bruxism. By overworking the jaw muscles at night, it commonly results in facial pain in the morning.

Up to this point, a predictable way to stop nocturnal bruxism has not been identified. Our concern is that teeth grinding in adults may lead to premature wear and tear of the teeth, which may result in complicated treatment needs. The best and most economic way to prevent premature wear and tear on the teeth is to wear a night guard for sleeping.

Children usually outgrow their nocturnal bruxism and suffer no short-term or long-term ill-effects.

Q. Hi I'm Julie and I'm 35.

I have a few sensitive teeth. Usually I feel some "sensitive" sensation when I eat something sweet.

Sometimes it's mild but sometimes it's very strong. I've got my teeth checked by a dentist recently and she said that it's because of my receding gums.

She suggests brushing my teeth with toothpaste for sensitive teeth (which I have been doing for more than a year). I have recently changed to another type of toothpaste for sensitive teeth. She also told me to floss my teeth regularly. I also do not brush my teeth with a lot of strength. (My toothbrush can last for many months and the bristles still look good.)

I have noticed my receding gums for more than a year. After following the dentist's advice, I still feel the "sensitive" sensation and my gums still look the same.

Is there anything else that I should do before my gums recedes further?

Julie

Dear Julie,

First of all, I would like to highlight the few possible causes of receeding gums:

- Thin gingival biotype, i.e. thin gums. This is hereditary. Such gum type does not take well to heavy brushing, or brushing with medium or hard bristled brushes.

- Periodontal disease or gum disease. Such diseases cause bone around teeth to be destroyed and gum usually will receed at the same time.

- High frenal attachments. These are ligaments that are attaching gums to lips. When they are attached rather high up on the gum, they tend to 'pull' gum down, causing gum to receed.

- Less than ideal positioning of teeth in bone. This can occur when teeth are crowded, or has had braces treatment that may cause teeth to be positioned in bone in a less ideal manner. It tends to cause the thinner bone surfaces to receed and usually, gum will follow.

- Bruxism, i.e. teeth grinding. Teeth grinding may cause teeth to be tilted inwards, causing less ideal positioning of teeth in bone, thereby causing gum recession as mentioned above. Also, it may cause a phenomena called 'abfraction', or causing enamel to 'pop out' from the neck of teeth, giving the impression that teth may have been abraded by hard brushing.

Using a soft bristled brush would be helpful. I often find that children's toothbrushes are most useful as they are softer that 'adult soft'. The electric tooth brushes nowadays are also very good and kind on the gums.

If your gum recession is due to any of the above possibilities, I would recommend the following:

- Thin gingiva biotype: Use children's toothbrushes and sentsitive teeth toothpastes.

- Gum diseases: Have a dentist thoroughly examine your gum condition and treat. Lasers have proven useful in the treatment of gum diseases.

- High frenal attachments: They may be trimmed relatively painlessly and easily with a laser.

- Poor position of teeth: Consider braces to correct the malpositioning.

- Bruxism: Again, have a dentist thoroughly examine the situation and recommend appropriate preventive treatment, which may include an anti- bruxism device to be worn, and/or botox injections to reduce certain over reactive muscles of the jaw.

While prevention and treating the underlying causes are the first steps to take, in cases where gum recession is severe, surgical procedures such as GTR (guided tissue regeneration) or gingival grafts may be necessary.

I hope this is comprehensive enough for you to determine and understand the causes and possible treatments of your condition. It is still important to discuss with a dentist and have the dentist thoroughly check your conditions.

Dr Wilson Goh
Managing Director
Team GPA

Dear Tricia,

Thank you for your interest in our dental services.

Your baby tooth is becoming loose because the root is gradually being resorbed. That means that the tooth support is weakening and the tooth may eventually dislodge.

Because you are young, implant would be the best solution. The other option would be a bonded bridge. I would recommend a bonded bridge(instead of the conventional bridge) because it conserve your natural tooth structure. That means we do not need to trim down your natural teeth. However, you may only consider this as a semi-permanent solution.

When your circumstances change, I would still advise an implant unless there is a better technology at that time.

Please feel free to contact me with any question you may have.

Sincerely,
Dr Neo Tee Khin
Diplomate American Board of Prosthodontics
BDS (S'pore), MS (Northwestern, USA), FRACDS (Aust), FAMS (S'pore)

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