Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
If at all possible, we want to save a tooth — it’s the best outcome for your overall dental health. In many cases, we can achieve this by filling the tooth or installing a crown over it.
Unfortunately, preservation isn’t always possible if the natural tooth has been irreparably weakened by decay or trauma. Replacing the natural tooth with a life-like artificial one is the next best option: the replacement will help you regain lost function and reinvigorate your smile. Filling the missing tooth’s space also prevents neighboring teeth from drifting into it, causing further problems with function and appearance.
Dental implants are widely recognized as the best choice for tooth replacement because of their life-like qualities, durability and positive effect on bone health. Even their biggest drawback, their cost, isn’t that great an issue if you factor in their longevity — they may actually result in less dental expense over the long-term.
A dental implant, however, isn’t always a viable option. Some patients may not have enough bone mass to support an implant. Those with certain systemic diseases like uncontrolled diabetes or a weakened immune system may not be able to undergo dental implant surgery.
Fortunately, many of these patients can benefit from a fixed bridge, a restoration option that’s been used for decades. A bridge is a series of life-like crowns permanently joined like pickets in a fence. The middle crown known as the “pontic” fills the empty space left by the missing tooth. The crowns on either side of the pontic are permanently attached to the natural teeth that border the missing tooth space. Known also as “abutment” teeth, they serve as the support for the bridge.
Bridges do have one downside — the abutment teeth must be prepared by filing them down so the new crowns fit over them properly. This will permanently alter and possibly weaken the teeth. Dental implants, on the other hand, have little to no effect on adjacent teeth.
Still, a bridge remains an effective option for many people. Properly cared for, a bridge can restore function as well as enhance your smile for many years to come.
If you would like more information on bridgework as a restorative option, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Crowns & Bridgework.”
One of the many reasons for dental implant popularity is their reliability — studies have shown 95% of implants still function well after ten years. Still, on rare occasions an implant will fail. We can minimize this risk by taking precautions before, during and after installation.
Long-term success begins with careful planning before surgery. We thoroughly examine your teeth and jaws, using x-rays or CT scanning to map out the exact location of nerves, sinus cavities and other anatomical structures. Along with your medical history, this data will help us develop a precise guide to use during implant surgery.
We’ll also assess bone quality at the intended implant site. The implant needs an adequate amount of bone for support — without it the implant will not be able to withstand the biting force of normal chewing. It may be possible in some cases to use bone grafting or similar techniques to stimulate growth at the site, but sometimes other restoration options may need to be considered.
The surgery can also impact future reliability. By precisely following the surgical guide developed during the planning stage, the oral surgeon can increase the chances of success. Still, there may be an unseen variable in play — a pre-existing or post-operative infection, for example, that interferes with the integration of the implant with the bone. By carefully monitoring the healing process, we can detect if this has taken place; if so, the implant is removed, the area cleansed and the implant (or a wider implant) re-installed.
Even if all goes well with the implantation, there’s still a chance of future failure due to gum disease. Caused mainly by bacterial plaque, gum disease infects and inflames the supporting tissues around the teeth; in the case of implants it could eventually infect and weaken the surrounding bone, a condition known as peri-implantitis. This calls for aggressive treatment, including plaque and infected tissue removal, and possible surgery to repair the bone’s attachment to the implant. Without treatment, the implant could eventually detach from the weakened bone.
Maintaining your implants with good oral hygiene and regular dental checkups is the best insurance for long-term reliability. Taking care of them as you would natural teeth will help ensure a long, happy life for your “third set” of teeth.
If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants.”
Nothing says confidence like a bright, beautiful smile. But problems with your teeth’s appearance — discoloration, abnormal shapes, or gaps — may be giving you reasons not to smile. If so, you may be a candidate for porcelain veneers.
A veneer is a thin covering of porcelain or other dental material permanently attached to the face of a tooth to improve its appearance. Veneers help resolve a variety of aesthetic issues: their life-like color can brighten dull, stained teeth; they can “lengthen” shortened teeth caused by wear or normalize congenitally misshapen teeth; they’re also helpful in reducing small gaps or used in conjunction with orthodontics for more serious misalignments.
The first step to a better smile with veneers is to assess your teeth’s current condition and develop a treatment plan. Your input is extremely important at this stage — what changes you believe would improve your smile. We would also offer valuable insight, based on our knowledge and experience, into what is realistically possible and aesthetically appealing regarding porcelain veneers.
Once you have decided to go forward, the next step is to prepare the teeth for attaching the veneers. Depending on their size and location, this preparation can range from no tooth structure removal to a relatively small amount of structure. If the latter is needed, we remove only what’s necessary to achieve the aesthetic result since structural reduction isn’t reversible.
After preparing an impression of your teeth, we would send it and other instructions to a dental technician to create the permanent veneers. In the meantime, we’ll install a temporary set for you to wear while the permanent set is under construction.
Once we attach the permanent veneers, they will adhere so securely a drill or laser would be needed to remove them. We achieve this attachment by creating microscopic pores on the face of the teeth and the inside of the veneer with a mild acid solution. The bonding cement seeps into these pores and creates a strong bond that virtually unites the tooth and veneer into one.
Although your new veneers are made to last, you’ll need to maintain them like your other teeth, with a little added caution when biting and chewing. All in all, though, you’ll be able to smile again with confidence — for many years to come.
If you would like more information on porcelain veneers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Porcelain Veneers.”
The preferred outcome when treating a tooth for decay is to preserve it. If the disease is still in its early stages, we can accomplish this effectively by removing diseased tissue and then restoring the remaining tooth with filling material.
There comes a point, however, when filling a tooth isn’t the best option. If it has already received several fillings, the tooth may have become too weak to receive another. Additionally, a filling may not be enough protection from further fracture or infection for teeth weakened from trauma or abnormal tooth wear or in the event a root canal treatment is necessary.
While a diseased tooth can be extracted and replaced with a durable and aesthetically pleasing dental implant, there may be another option to consider — installing a crown. Like a filling, a crown preserves what remains of a natural tooth, but with better protection, life expectancy and appearance than a filling.
Known also as a cap, a crown completely covers or “caps” a natural tooth. They’re produced in a variety of styles and materials to match the function and appearance of the capped tooth and adjacent teeth. Crowns made of porcelain are ideally suited for visible teeth because of their resemblance to tooth enamel. A less visible tooth that endures more biting force (like a back molar) may need the strength of a precious metal like gold or new-age porcelains that can also withstand significant biting forces. There are also hybrid crowns available that combine the strength of metal for biting surfaces and the life-like appearance of porcelain for the more visible areas of a tooth.
To prepare a tooth for a crown, we first remove any decayed structure and add bonding material to strengthen what remains. We then make a mold of the tooth and bite, which is typically sent to a dental technician as a guide for creating the permanent crown. Recent advances with digital technology have also made it possible to mill the permanent crown out of porcelain in the dental office while you wait.
After the permanent crown is received and permanently bonded to the tooth, you will have a protected and fully functional tooth. From this point on it’s important for you to clean and care for it as you would any other tooth since the underlying tooth is still at risk for decay. The good news is your tooth has been saved with a bonus — a long-term solution that’s also smile-transforming.
If you would like more information on crowns and other tooth restorations, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Crowns & Bridgework.”
According to popular culture, a root canal treatment is one of life’s most painful experiences. But popular culture is wrong — this common treatment doesn’t cause pain, it relieves it. Knowing the facts will help alleviate any anxiety you may feel if you’re scheduled to undergo the procedure.
A root canal treatment addresses a serious problem involving the pulp of a tooth that has become infected. The pulp is a system of blood vessels, nerves and connective tissues inside the tooth that helps the tooth maintain its vitality. It also contains a series of minute passageways known as root canals that interconnect with the body’s nervous system.
The pulp may become infected for a number of reasons: tooth decay, gum disease, repetitive dental procedures, or traumatic tooth damage. Once the pulp becomes irreversibly damaged it must be completely removed from the tooth and the root canals filled and sealed in order to save the tooth.
We begin the procedure by numbing the affected tooth and surrounding tissues with local anesthesia and placing a dental dam (a thin sheet of rubber or vinyl) over the area to isolate the tooth and prevent the spread of infection to other oral tissues. We then drill a small hole in the top of the tooth to access the pulp chamber. Using special instruments, we then remove the infected or dead pulp tissue through the access hole and then wash and cleanse the root canals and pulp chamber with antiseptic and antibacterial solutions.
After additional preparation, we fill the root canals and pulp chamber with a filling especially designed for this kind of treatment, usually a rubber-like substance called gutta-percha that easily molds and compresses when heated. We then seal the access hole with a temporary filling (until a permanent crown can be fashioned) to prevent infection from reentering the pulp space. After the procedure, you may experience some minor discomfort easily managed with over-the-counter pain relievers.
You’ll find the root canal treatment alleviates the symptoms prompted by the pulp infection, particularly acute pain. What’s more, a successful root canal will have achieved something even more crucial to your health — it will give your tooth a second chance at survival.
If you would like more information on root canal treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A step-By-Step Guide to Root Canal Treatment.”
Orthodontics is a specialty of dentistry dedicated to the diagnosis and treatment of misaligned teeth, or malocclusions. The goal is to help patients achieve better long-term oral health by improving teeth alignment. Sometimes, though, the misalignment is much more involved than the position of the teeth — it may be that the jaw structure is also misaligned. In that case, the skills of an oral surgeon may be in order.
The jaws are similar in shape to the arch of a horseshoe, hence the referral to either upper or lower sets of teeth as dental arches. In a normal jaw structure, the lower arch fits just inside the upper arch when you bite down and the teeth are able to function correctly. In some individuals, though, the lower arch closes in front of the upper arch, commonly known as an underbite. If the underbite is only slight, the malocclusion can be corrected by repositioning the teeth only, as with braces. If, though, the underbite is more severe it would require a surgical procedure to realign the jaws, also known as orthognathic surgery.
Orthognathic surgery can help relieve a number of functional complications caused by jaw-related malocclusions: difficulty chewing and swallowing; chronic jaw or head pain; or sleep apnea. It can also enhance the patient’s facial appearance by correcting an imbalance between the two lateral sides (asymmetry), or by minimizing a receding chin or protruding jaw.
Its primary benefit, though, is its effect on the patient’s bite and tooth alignment. For this purpose, the orthodontist and oral surgeon work together to achieve the best result possible. In some cases, the orthodontist may perform his or her work first by moving teeth into the proper position. This sets the stage for the oral surgeon to perform orthognathic surgery to complete the correction of the misalignment.
Each individual patient’s case is different — the best plan of action must begin with a full examination by an orthodontist, and a consultation with an oral surgeon if necessary. It may require time and the expertise of two specialties, but the final result will be better health and a better look.
If you would like more information on various orthodontic procedures, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Jaw Surgery & Orthodontics.”
Today's periodontal (gum) surgical procedures are less painful and have fewer complications than ever before. Nevertheless, the best outcome still depends on how well you care for yourself as you recuperate. Here are some things you can do after surgery to lessen its effect.
In the first twenty-four hours after surgery, your primary objective is to prevent swelling, the major source of post-operative discomfort. You can accomplish this by applying an ice or cold pack to the outside of your face in the area of the surgery. It's best to alternate five minutes on and off with the pack for the outside, and ice chips, cold water or ice cream inside your mouth as often as possible. Your aim is to surround the surgical site with cold as much as you can with the five-minute on and off strategy.
You should eat only foods that are cold and soft (Jell-O™, applesauce, yogurt, ice cream, etc.), to help ease any swelling. The next day switch to hotter foods like soup, mashed potatoes or buttered pasta, as well as hot, salt water rinses as often as convenient. Avoid crumbly foods like chips, cookies or popcorn for a few days to help keep the incision site particle-free.
We typically prescribe a number of medications during recuperation: analgesics (usually of the aspirin or ibuprofen family) for swelling and pain, and antibiotics and antibacterial rinses to inhibit bacterial growth. Be sure to follow directions with each prescribed medication, taking the correct dosage and for the specified duration.
There is a possibility of post-operative bleeding — but don't panic. You should first attempt to locate the bleeding area, clean it, and then apply gentle pressure with moist, sterile gauze for ten to fifteen minutes. If the bleeding doesn't stop, give us a call.
You should keep the wound site as clean as possible to help avoid infection. However, don't brush, floss or rinse during the first twenty-four hours to avoid bleeding, and limit hygiene activities to antibacterial mouthrinses like chlorhexidine near the wound site for several days to weeks. During the first few days to a week after surgery avoid activities like strenuous exercise, drinking alcohol, sucking through a straw, or blowing up a balloon, as these can also increase your risk for bleeding. You should also avoid tobacco products during this time as these can inhibit the healing process. Each surgery is different and you should make sure you follow the specific instructions your surgeon will provide for you.
Taking these precautions will help keep discomfort and complications to a minimum. They will also help you recover quickly so that you can get back to your normal life.
If you would like more information on periodontal surgery and what to expect, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Instructions Following Periodontal Surgery.”
Q: Why should I consider cosmetic gum surgery to improve my smile?
A: If you’re looking to enhance the natural beauty of your smile, you may have heard about various cosmetic procedures that can improve the appearance of your teeth. But don’t forget about the other, equally important element of a bright, appealing smile: the healthy-looking and well-proportioned gums that surround and support those pearly whites. Many times, cosmetic flaws are caused by gum tissue that’s covering too much or too little of the tooth’s surface; in other situations, the gum line is uneven, and covers some teeth more than others. Cosmetic gum surgery can successfully remedy these imperfections.
Q: How exactly does cosmetic gum surgery resolve smile defects?
A: There are several minor surgical procedures that may be recommended, depending on what’s best for your individual situation. For example, some people have a “gummy smile,” where teeth seem excessively “short” because they’re covered with too much gum tissue. In this case, a “crown lengthening” procedure can be performed, where gum tissue (and perhaps a small amount of bone tissue) is removed; this makes the teeth appear in better proportion to the smile. In the opposite case — where the teeth appear too “long” due to receding (shrinking) gums, tissue can be grafted (added on) to the gums. Gum recontouring procedures are used to re-shape the gum line for a more even, pleasing effect.
Q: Are there non-cosmetic reasons for having gum surgery?
A: Yes. A tooth with too much of its root area exposed is often more prone to decay, and may become extremely sensitive to hot or cold. Covering an exposed root with gum tissue is just one non-cosmetic reason why gum surgery may be necessary.
Q: What’s involved in gum surgery — do I have to go to the hospital?
A: Cosmetic gum surgery is normally performed in the dental office, and usually involves only a local anesthetic. However, if you need a deeper level of relaxation, other forms of sedation may be available. In some cases, lasers can be used instead of conventional surgical tools to remove excess gum tissue. If you need a tissue graft, the grafting material can be taken from your own mouth, or may come from donor tissue that is processed to ensure your safety. Gum surgery is minimally invasive, and most people experience only minor discomfort.
If you’d like to know whether cosmetic gum surgery could help you get the smile you’ve always wanted, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Gummy Smiles” and “Periodontal Plastic Surgery.”