Prof Dr Christian Mehl
If you have ever cancelled a booked dental appointment; you may find that when you do attend, you may have a set of acute oral health issues arising – affecting several teeth. We would encourage all our patients to minimise their risk of having to undergo urgent or even just necessary multiple dental treatment sessions by always attending their scheduled appointments with us.
Know that our approach at Wimpole Street Dental Clinic is to offer some combined treatments (if applicable and as recommended after consultation) with the in-house capability that some of these procedures can even be done under sedation, if required/desired. We hope that this knowledge is helpful, particularly for nervous patients.
When a complete oral rehabilitation is both necessary and indeed possible
A complete oral rehabilitation and so restoration of the dentition means that most of the teeth are expertly treated in some way. The clinical necessity for such an extensive care plan for one of our patients often arises as a result of the presence of a significant risk factor, or a combination of them, such as: poor oral hygiene, a high tooth decay activity, periodontitis and the onset of tooth loss.
Other risk factors relating to lifestyle and confidence such as deliberate avoidance of scheduled dental appointments over a long period of time (years), dental phobia, a poor diet and/or a strong feeling of ‘dental shame’ commonly prevent many patients from actively seeking the dental treatment they may actually need. These additional concerns can often impact oral health to such a degree that the dental caries which develop can affect many teeth with periodontitis also being in evidence.
The initial clinic priority for your dentist would be, at your booked appointment for consultation, to both accurately assess and carefully examine which of your natural teeth are still viable (and so worth preserving) and which ones are so affected by either tooth decay/periodontitis (or both) that it is now necessary to remove them as painlessly and as expediently as possible. Your dentist, here in clinic, will opt to take a panoramic X-ray (OPG) to enable the careful and considered planning of the treatment now recommended, discussed at length and agreed. Your dentist can also take photographs, make teeth models, and create digital impressions, too. Obtaining as much clinical data as possible on the current condition of the teeth, the roots of the teeth and the surrounding oral area (and any other affected anatomical structures) is crucial in order for us to prepare to deliver the best possible clinical results once we have produced your bespoke dental care plan.
If one of our patients has a recommendation to receive dental implants, then a cone beam computer tomography (CBCT) is deployed to check if the jawbone presents in sufficient quantity (volume) and strength for this procedure to have the best chance of success. If, at this point, we find that the jawbone is not able to support a dental implant at this time, we can then discuss whether a bone augmentation procedure (available within our in-house capability) is a necessary pre-requisite. In addition, during our meticulous approach to gathering all the data we need, in as much magnified detail as possible, we can discover an ideal dental implant position, too; further assisting our pre-planning stage. Furthermore, we advocate that three-dimensional planning is a vital part of the approach we take, in order to be able to plan the entire set of subsequent tooth restorations as they are required.
Our perspective on resolving both periodontal disease and tooth decay
Our treatment approach, when delivering a complex oral rehabilitation, bespoke to the individual patient, is always to deliver it in carefully considered stages. First of all, we address dental hygiene, secondly we resolve tooth decay, root infections and periodontal disease issues, thirdly we prepare to deliver dental implants and bone augmentations (as recommended). The fourth stage focusses on the bespoke craft of a tooth restoration(s), the fifth stage is when we create and fit a tailor-made nightguard and the final stage is when we work with our patients to create a schedule of routine check-ups for them to attend in clinic, on a defined recall basis.
Dental caries are a disease of the tooth and periodontitis is predominantly a progressive gum condition (otherwise known as the periodontal apparatus) so both these critical clinical concerns now require targeted therapy. Rest assured that in most cases, dental caries can be treated relatively easily with the expert application of a tooth filling. Please note that if the bacteria have already reached the root of the affected tooth then a root canal treatment can become the next necessary clinical step to take.
Please also note that when we tackle periodontal disease it often requires a little more patience to achieve the best possible clinical outcome for teeth, for gums and for the effective restoration of oral health. From our extensive professional experience when successfully treating periodontal disease, your dentist will deftly adjust the optimum therapeutic measures we have available for use, depending on the severity of the condition as presented.
We would like to reassure all our patients that a dental hygiene appointment is always the first step to take when seeking treatment for periodontal disease. The step which follows is an individualised professional cleaning of the gingival pockets within the gums now identified. As part of the aftercare for this step, know that an antibiotic may be prescribed to provide effective support to the healing process. We would like to emphasise that a full oral rehabilitation of the dentition only take place when both the teeth and the periodontal tissues are healthy and inflammation-free. The concept of the final tooth restoration should only be planned after the finalisation of the pre-treatment stage(s).
Preparing the perfect delivery of your dental implants
At the right stage of your course of treatment with us, your dental implants can be inserted to replace lost teeth. Dental implants can be placed around 3-6 months after extraction of a tooth (delayed implant placement) or immediately after the tooth extraction (so-called immediate implant placement). The pre-condition for the immediate implant placement is for both a healthy oral cavity and sufficient bone volume to be present. With the use of computer-guided implant placement, your dentist can use state-of-the-art software to determine the best possible position of the artificial tooth root in the patient’s jaw, in advance. The dental implants can then be safely inserted using precise drilling guides. If the conditions are ideal, the implantologist can place the implant directly into the socket of the extracted tooth. A temporary restoration can then be attached to it immediately after implant placement, so as to replace the extracted tooth until such time as the final (and so permanent implant crown) is ready to be incorporated.
Step 1: Opening of the oral mucosa
Step 2: Drilling and insertion of the implant
Step 3: Exposing the implant to the oral cavity and closing it with a healing cap
Step 4: The implant supported restoration is either cemented or screwed to the artificial root (the implant)
Very often we find that minimal residual bone for implantation exists in patients without teeth as bone volume resorbs naturally (and fast) as soon as the tooth is extracted. Incidentally, note that a denture uniquely exerts greater than usual pressure on the bone, increasing the speed of the resorption further. If the bone volume is reduced, an implant placement is conducted in connection with a bone augmentation. In case of severe bone loss, the bone augmentation must be carried out before implantation.
We would like to outline that an additional bone graft in case of significant bone loss extends the total duration of the recommended treatment schedule, as we would need to account for the individual healing time for both procedures – the bone graft and the dental implant itself. In order to shorten the treatment time, it is possible to insert dental implants into the bone at a certain angle. The system of “fixed teeth in one day” (all-on-4™) is based on this approach and it is one we are delighted to offer, here in clinic. With this type of immediate implantation and restoration, two posterior implants are inserted at an angle into the toothless jaw, onto which a firmly screwed and bespoke crafted dental prosthesis is then carefully placed. Since they are placed in anatomically solid bone sites, the dental implants can be loaded immediately.
Dental crowns and dental bridges can offer the optimal choice when repairing damaged teeth
To complete a complex oral rehabilitation, we need to craft the final (and so permanent) tooth restoration. There are often many alternatives available with regards to the material we can select to create such a genuine transformation. Our bespoke production of partial crowns, full crowns and dental bridges takes 2-3 sessions. Initially, the tooth is shaped in the first session and then an impression is taken. We appreciate that, historically, with conventional impressions, the impression tray and impression material can trigger a gag reflex for the patient. Now, with the use of digital dental scanners and CAD / CAM processing techniques the need to take such dental impressions using solely this technique is no longer best practice within the highest standards of modern dentistry which we strive to practice in clinic.
Our digital impressions use a small camera which measures the oral cavity and the teeth, extremely precisely and sends the data to special state-of-the-art software. Together with a member of our expert team of master dental technicians, your dentist and dental technician can then use the computer to both plan and then implement the individual restorations precisely improving clinical efficacy and efficiencies in both professional and patient time. In the second treatment session, the restorations can usually already be inserted if the patient doesn’t first require a temporary placement on a trial basis (especially important for anterior – or front – teeth).
As much as you rely on our professional expertise; we rely on your co-operation as a decisive factor determining the overall success rate and durability of the dental restoration we so painstakingly create for you. We encourage both the commitment to practising the highest standards of oral hygiene at home together with the booking of and attending to an agreed schedule of regular check-ups with your dentist and professional cleaning appointments with your dental hygienist – to be essential.
We can also offer time-optimised dental restoration
We are delighted to offer the fact that many of the treatments as described above; can be combined to shorten the total treatment time you may need. This care pathway is particularly advantageous when treating a patient under sedation. Today, many medical practices offer treatments under sedation, with an expert anaesthetist or sedationist in dedicated place looking after the patient’s wellbeing whilst the recommended dental treatment is performed.
We can also offer distraction techniques such as watching a film during treatment so as to soothe those affected from any anxiety concerning the comprehensive nature of the clinical procedure we are delivering. Time-optimised dental restoration for our patients presenting to us with a toothless jaw, means that the dental transformation we can expertly affect; can be both life-changing and life-enhancing in a genuinely dramatic way. The results we can deliver this way is pleasing not just to the patient but to every member of our expert team who diligently contributed to their bespoke care.
Book an appointment to discuss your dental issues with a member of our expert team.