Dental Treatments

CEREC – a procedure with a long tradition

The CEREC procedure was developed at Zurich University and has been successfully developed in dental practices since 1985. We have been using CEREC technology in our practice since 2008.

Worldwide more than 25,000 practices in over 50 countries work with the CEREC system. Since 1985 over 8 million patients have been treated using the CEREC procedure. More than 20 million Ceramic restorations have been created and placed. Long-term clinical studies demonstrate that in terms of durability – CEREC restorations are at least equivalent to gold restorations.

Depending on the individual case, CEREC fillings can achieve even better results than gold fillings. The CEREC treatment procedure means:

• NO conventional impressions – The CEREC 3D measuring camera scans the prepared tooth in just a few seconds. This eliminates the need for unpleasant silicone impressions.
• NO temporaries – CEREC restorations are milled out of a solid ceramic block in just a few minutes. They are then ready to be placed immediately. This eliminates the need for temporary fillings and crowns. It also means that you need only one appointment. And you don’t have to wait for days on end until the ceramic filling is finished.
• NO long waiting periods – Because CEREC restorations can be placed immediately, you need only one appointment. And you benefit from tooth restorations which have demonstrated their durability time and time again.
• Guarantee – We guarantee all CEREC restorations for a period of two years if regular check-ups and hygienist appointments are kept up to date.

Ceramic fillings with CEREC

• Do you want highly aesthetic, tooth- coloured fillings- created and placed during a single dental appointment?
• Would you prefer metal-free, biocompatible materials?

All this is now possible. Thanks to CEREC. And these ceramic restorations can be created and placed during a single appointment.
CEREC is a sophisticated CAD/CAM system for the production of all – ceramic inlays, onlays, partial crowns, veneers and crowns for anterior and posterior teeth.

Benefits at a Glance

• One visit
• No impressions
• No temporaries
• Metal-free
• Highly aesthetic
• Long lasting

Modern CAD/CAM technology makes it possible.

Dental Implants

Dental implants are fantastic options for replacing missing teeth. If you have one or multiple missing teeth then implants are an effective solution to replace these helping to not only restore your smile but also;

• Preserve your remaining bone – the presence of the implant will slow the change in the bone and gum that follows after a tooth is lost
• Independent of adjacent teeth – replacing a single tooth with an implant avoids having to cut into these healthy teeth to support a dental bridge
• Single implant looks and functions like your own tooth
• Maintaining good oral hygiene is easier with an individual implant crown or bridge than a tooth supported bridge. Reducing the risk of adjacent teeth being lost prematurely.

Replacing a single tooth with an implant is a highly conservative treatment option, as the implant is a replacement for the natural tooth root onto which a crown can be attached. This means it avoids drilling adjacent teeth and damaging these to replace one missing tooth with a bridge as it would have been traditionally done.

Replacing several teeth can be done with implant supported bridgework, for example three missing teeth can be replace with a three unit bridge supported on two implants.

For people who have loose dentures these can be anchored to implants making them stable and firmly attached increasing their retention and therefore function.

Alternatively people who wear dentures can replace these and have complete jaw reconstruction with implant retained full arch bridgework. This would usually be supported on six implants and a bar to connect them all.

Computer guided planning for Dental Implant Surgery
Dr Ivo Raitchev BDS London MFDS RCS(Ed) uses advanced digital dentistry techniques to diagnose and pre-plan your implant surgery.

The 3D radiographic imaging method (CBCT) uses high-definition digital scans of your jaws combined with optical scans of your teeth to be imported into our powerful computer guided planning software. This then generates a 3D digital model of your teeth and jaws.

With this method Dr Raitchev can plan simple and complex implant surgery cases meticulously and establish limitations and problems in advance. Therefore being able to diagnose and treat patients far more effectively and accurately because of our modern 3-dimensional view under the skin of each patient’s individual anatomy.

Computer guided keyhole surgery in dental implants will become the mainstream workflow, however, not all implant surgery is carried out this way. Here at Confidence Dental & Wellbeing we have heavily invested in 3D systems and 3D printers to be able to fabricate customised surgical guides to increase the accuracy of implant positioning and reduce the treatment time of patients, but most importantly to make implant treatment almost completely painless.

Your implant procedure is calculated and considered in great detail, being rehearsed by Dr Raitchev numerous times before your procedure takes place during the 3D planning phase. This makes the entire surgical process faster, less invasive and more accurate, which means you heal more rapidly and have a fantastic result with less visits to the dental surgery.

Mini Implants by Dr Grahame Atkins BDS
Mini Implants have been developed in recent years as an alternative treatment to conventional Implants where appropriate. These Implants have a smaller diameter and a simpler design. They consist of a one-piece titanium screw and integral attachment component.

Mini Implants are primarily used for retaining removable dentures. A full denture for example is often retained with four or six Mini Implants placed at the same appointment.

Although the procedure is simpler and less invasive, these Implants are not as strong as conventional Implants because of their size.

In some cases these Implants are also used to replace fixed single teeth although we will usually recommend a conventional Implant for this.

Mini Implants are inserted into sound, healthy bone under local anaesthetic without the need for the surgical intervention that is required with conventional Implants.

Most patients experience mild discomfort for up to 48 hours after the procedure which is easily managed with paracetamol or ibuprofen.

Dental Sedation

Dental sedation helps to make lengthy or complex dental treatment much more comfortable and easy for you to manage. It can help remove the anxiety, stress, discomfort, and awareness of the procedure. You will enjoy a relaxing sleep whilst you maintain your reflexes and are able to breathe for yourself, whilst being able to respond to us if required. It may also produce sensations of drowsiness, warmth and tingling in the injection area. In the dental setting, it will not induce unconsciousness. You will be able to swallow, talk and cough as needed.
Contradictions: Please let us know if you have any of the following medical conditions, because we may not be able to safely use sedation;

• Congestive heart failure
• Chronic obtrusive pulmonary disease (COPD)
• Chronic bronchitis
• Emphysema
• Chronic asthma
• Bronchiectasis
• Pregnancy
• Tuberculosis
• Macrocytic anaemia
• Immune disease
• Respiratory diseases
• A history of substance abuse.

Preoperative guidelines: Dental sedation requires that we place a small cannula (access for the medication) in to your vein following which we will also give you a local anaesthetic once you are sedated. We will continuously titrate your required sedation dose so you will feel completely relaxed during the procedure. Throughout the treatment you will be relatively aware of your situation until the procedure comes to an end. At that time, no more titration dose will be administered and you will be slowly allowed to recover from the effects of the sedation medicine.

Before the procedure:

• You are advised not to eat at least 6 hours before undergoing sedation, or drink a minimum of 3 hours prior to sedation.
• You are advised to wear loose clothing & remove all jewellery for your comfort.
• We ask that you remove nail varnish and tie hair loosely.
• We will not be able to start the intra-venous sedation without an escort who can stay with you for 24hrs after your sedation is completed.
• We advise that you take your medications as prescribed by your GP and do not stop any medication without prior recommendation.
• Please do let your dental sedationist know if you have a change in medical circumstances or medication.
• We ask that you do not drink alcohol or take recreational drugs before attending to be sedated.

Following your procedure
You will be given appropriate recovery time in which you will be closely monitored with specialist monitoring equipment to ensure your safe recovery.
Our practice is specially equipped for IV sedation treatments; as well as our staff which have additional training. However, as we administer a sedative medication, certain precautions are necessary after the procedure to ensure a comfortable recovery:

• You will need supervision for up to 8 hours following the completion of your sedation treatment and it is recommended not to sign legal documents or make important decisions during that time.
• You may remain drowsy and lack time and space judgment after the procedure is completed. This could last up to 8 hours.
• You may experience nausea and vomiting following your sedation and our team will provide you advice to minimize this.
• Discolouration of the skin or bruising in areas of access to veins or attempted access may persist for some time.
• You may experience post-operative pain depending on the treatment carried out, areas of numbness, swelling, bleeding, and general post-operative discomfort.
• NO alcohol should be consuming for 24hrs after sedation
• You should not operate machinery or drive or sign legal documents for 24hrs after sedation is completed.
• DO NOT eat until the numbness has worn off, however, you can drink water as needed
• DO NOT travel home via public transport; preferably take a taxi or private car home.

Effective Tooth Whitening that will make you Smile

Everyone wants whiter teeth these days. A confident, dazzling smile makes you feel better about yourself while discoloured, unsightly teeth make you want to keep your lips tightly shut to hide the teeth behind them.

For some people, porcelain veneers may be the best way to correct irregular or discoloured teeth. But simple whitening, where possible, is much less invasive (and less expensive).

The procedure is simple and effective. It is also quite safe, as long as important factors are assessed first. Our experience has shown that home whitening using custom made “trays” and whitening gel supplied by your dentist is the most effective way to whiten your teeth.

Before treatment we check the teeth and gums for areas that may become over sensitive during the whitening. We will also be able to predict teeth that may not respond to the treatment because of existing fillings or crowns.

Whitening gels contain various forms and strengths of peroxide as the active ingredient. To ensure the gel stays in contact with the teeth without spilling onto your gums, we make perfectly fitting, vacuum-formed trays to fit closely over your teeth. These are then used at home for one or two hours a day for about two weeks or until your teeth reach the required degree of whiteness. The trays will often last a few years so can be used repeatedly to “top up” the whitening if needed.

The whitening trays are made on plaster models of your teeth, which in turn are cast from impressions of the teeth and gums. It only takes a few minutes to take the impressions so the treatment involves minimal time with the dentist and this keeps costs to a minimum.

FAQs

Can tooth whitening damage the teeth?
When properly planned and supervised, modern tooth whitening causes no lasting damage to the teeth. Although the whitening effect penetrates into the tooth structure, it does not weaken the tooth in anyway.

How long does tooth whitening last?
This varies according to how much strong coloured food and drink a person has in their diet. Many people find the effect of whitening lasts for months or years without fading. However, if you drink a lot of tea, coffee, red wine etc. you may find you need to top up your whitening every six months or so.

Will whitening make my teeth sensitive?
Tooth sensitivity can be a temporary side effect of some whitening procedures. But this is now less common with the gentler products available today. It is also possible to reduce the likelihood of sensitivity by pre-treating the teeth with fluoride gel.

Can all teeth be whitened?
It is nearly always possible to whiten natural teeth. However, most dental materials already in your teeth such as fillings, crowns, and veneers will not respond to whitening. This is not usually a problem with back teeth but a single crown on a front tooth for example may look yellow next to newly whitened teeth. Your dentist will be able to tell you if you have any existing fillings etc. which may affect the final result. One option is to have these replaced to match the newly whitened teeth.

Can whitening be done in the surgery?
There are single visit treatments available including “laser” whitening. We have tried these alternative systems but found the results disappointing. In our experience, home whitening achieves the best results. Whitening takes some time and cannot be rushed.

Do whitening toothpastes work?
Whitening toothpastes can be of some benefit, but their effectiveness is quite limited and will take much longer. This is because the active components necessary are much weaker. They are certainly not strong enough to compare to the home kits supplied by dentists.

Smile Design Makeover

Many people only need minimal dental cosmetic work to improve their smile and appearance. For others, a complete makeover is a priority.

Feeling unhappy with your teeth and smile can affect so many aspects of life such as relationships and confidence.

Improving your smile so that you are happy with the way you look can produce dramatic results.

We offer a FREE Initial Cosmetic Assessment (DR Grahame Atkins BDS or Dr Ivo Raitchev BDS London MFDS RCS (Ed) ONLY) which is an opportunity to discuss your concerns and begin to identify possible remedies.

We will consider all options including dental implants, orthodontics (braces), tooth whitening as well as (or instead of) porcelain veneers or resin/ceramic composites

It may be necessary to combine various different treatments to get the best result.

In some cases we will suggest a complete “Smile Design” service from quality photos and scans of your teeth. The proposed results are presented on screen for review with the dentist so that you can see in advance how the alterations will affect your appearance. We will then produce a tailor made treatment plan to give the desired result.

Porcelain Veneers
Dentists have been making thin Veneers in tooth coloured porcelain for many years to repair worn, damaged or discoloured teeth. Veneers are often made less than 1mm thick and usually require the removal of a thin layer of tooth enamel. The porcelain is bonded to the tooth structure with resin materials resulting in natural looking and remarkably strong teeth. With regular dental care, Veneers can last for 20 years or more.

Cerec or lab-made Veneers?
The traditional way to make porcelain Veneers involves taking impressions of the prepared teeth and sending these to a dental laboratory where they are made on plaster models. These are then returned to the dentist for fitting – typically 2-3 weeks later. With our CEREC digital technology we short-cut this process by manufacturing the Veneers at the dental practice, usually on the same day that the teeth are prepared. Depending on the experience of the dentist, the resulting restorations are of the same quality as those made by a dental technician. There is the added advantage that we work directly with the patient in matching the tooth colour and characteristics and there is no need for plastic temporaries. In some cases, we might advise sending the work to a specialist laboratory in order to get the best result. This may involve additional costs.

Dr Atkins and Dr Raitchev have been making porcelain Veneers using the CEREC technology for a number of years. Over the years, the range of available materials and tooth shades has grown along with our experience in selecting the best of these for each case. As a result, we have been delighted to see increasingly successful results as many happy patients will testify.

What is involved?
Before undertaking treatment with Veneers, we undertake a full dental examination to make sure we know as much as possible about the patient’s teeth and oral tissues. Long-lasting restorations depend on careful and thorough planning including assessment of the patient’s previous tooth wear, diet, oral hygiene, gum health, and occlusion (bite). We also want to plan the ideal end result so with some cases, we undertake a full “Smile Design” process with the help of state-of-the-art computer software.

In many cases, the first stage of treatment is tooth whitening to achieve a desirable tooth colour for the teeth that we are not planning to Veneer. The Veneers are then carefully matched to the same tooth colour. We have found the most effective method for this is guided home whitening which takes about two weeks. In some cases, there may also be a need for periodontal (gum) treatment to eliminate gingivitis or correct irregularities that would otherwise affect the final result.

On the day of the treatment we allow enough time to complete the procedure as quickly as possible and with the minimum discomfort. Up to ten teeth can be completed in a single day.

The teeth and gums are anaesthetised with very small injections which are then topped up painlessly as needed. Preparing the teeth by shaping the enamel, removing previous fillings etc takes about 10 to 15 minutes per tooth. When this has been done the prepared teeth are digitally scanned onto the CEREC computer so that the manufacturing process can begin. At this point, the patient is free to relax outside the surgery leaving the dental team to make the Veneers. Each tooth is separately designed on screen using 3D imaging and then carved from a solid block of porcelain on the CEREC milling machine.

The milled Veneers are then adjusted by hand before being fired in a computerised furnace which hardens and glazes the material to match the patient’s own teeth.

The CEREC process takes about one hour per tooth so we usually allow a whole day to complete up to six teeth. If the Veneers are to be made in a dental laboratory, a silicone impression is taken and temporary plastic Veneers fitted to the teeth.

When ready, the finished Veneers are placed onto the teeth and further adjustments made as necessary before being bonded and finished to ensure everything is just right.

Guarantee
We guarantee all CEREC restorations for a period of two years if regular check-ups and hygienist appointments are kept up to date.

Possible complications
As with all medical procedures, occasional problems can arise during or after treatment and need to be considered at the outset. The initial assessment and diagnosis phase is intended to foresee such eventualities and eliminate them in advance. However, a small number of unexpected complications do occur for example the need for root canal treatment. This may be necessary where there has been significant previous damage to a tooth or where heavy tooth reduction is needed. De-bonding of veneers is rare these days especially where teeth have been minimally reduced. But the unexpected loss or fracture of a Veneer can occur as a result of unforeseen factors such as night time tooth grinding (bruxism) or unusual bite problems. For this reason, we usually recommend the use of a mouthguard at night to protect expensive restorations such as Veneers and to increase their longevity. The good news is that if a Veneer does suffer loss or damage, a new one can usually be made in advance at the practice and fitted at a short appointment.

After care
We will expect to review the finished work at three months and thereafter at regular dental check-ups. We also strongly advise regular hygienist visits for all our Veneer patients. In this way the work can be monitored, and possible problems avoided.

What to do next
For a FREE Initial Consultation to discuss Dental Veneers please contact us.