Maintain a fresh smile
Prevent loosening and losing your teeth
Correct your receding gums
Gum disease (periodontitis) refers to an infection-induced inflammatory process involving tooth-supporting structures.
This most common human oral disease is caused by certain bacteria which start to increase in number and virulence when the related risk factors such as multiplying bacterial deposit can grow undisturbed under the unreachable gum pockets while producing by-products which may stimulate the body's defensive inflammatory response in the around the teeth. This inflammatory chronic disease may progress and cause gradual bone destruction over the years when untreated efficiently.
The inflamed gum called gingivitis may be recognized as red, swollen and bleeding gums during brushing due to remained discoloured layer of bacterial plaque on the teeth.
In some individual gingivitis may progress to gum disease (periodontitis) when untreated. Consequently, you might experience some changes over time such as Increased gum-bleeding during brushing or eating, bad breath, drifting teeth, gum recession, and tenderness in the gum.
Controversially, bleeding from the gums may be less noticeable in smokers, as nicotine has an adverse effect on blood vessels by reducing the local blood circulation and as a result reduced bleeding in diseased gum.
The presence of periodontitis can be left unrecognized until its very late destructive stages. Therefore, it is paramount that a dentist or a more specialised clinician such as a gum specialist (periodontist) will detect the specific signs and symptoms of the gum disease at an early stage of its progression in order to be able to treat and monitor the health status of periodontal tissues.
Inadequate teeth cleaning leads to accumulation of bacterial deposits (dental plaque) adjacent to the gums, which gradually may enhance the number and virulence of the bacterial colonies while reducing the natural local tissue defences.
The growing soft bacterial plaque can be combined with minerals over the time building up a harder deposit called tartar (dental calculus) which further encourages the growth of the bacterial plaque along the tooth roots surfaces causing an inflammatory process and destruction of the peripheral healthy tissue and a periodontal pocket around the gum as a result. The bacterial infection-induced inflammatory process which causes progressive destruction of the tooth-supporting/periodontal tissues is called periodontitis.
The pathologic pocket around the root surface favour the colonization, growth and multiplication of the virulent bacteria which are capable to destruct the tissues both directly by releasing enzymes, toxins and other bi-products the body's defence mechanisms, and indirectly by inflammatory stimulation of the local immune system.
Among the factors involved in the progression of the periodontitis, the number and type of virulent bacteria, the ability of the individual's local and systematic defence mechanisms coupled with the tissue healing capacity, the presence of the other risk factors such as smoking, stress, systematic disease e.g. diabetes, and certain drugs regulating the tissue response has been recognised.
Factors prevailing the chronic gingivitis should be recognised and addressed during professional dental and periodontal examinations and treatment sessions.
Recognised factors involved in the development and progression of periodontitis may be disease compromised the local and systemic health status such as diabetes, as well as stress, and smoking.
It is scientifically well-proved that smoking adversely affects the status of the local health, healing, and immune response of periodontal tissues and successful treatment of gum disease as a result.
Treated Advanced Generalised Periodontitis followed by the Restorative correction of the advanced Gum recession
Based on the case studies, clinical research, and epidemiological studies there are strong evidenced-based associations between periodontal disease and cardiovascular disease (CVD).
The rationales behind these reports are mainly association studies which support:
https://www.efp.org/gum-disease-general-health/perio-cardio/animations/
The association studies suggest a higher level of:
The epidemiological evidence, and the consensus report from by the perio-cardio Workshop & and the World Heart Federation (WHF) Global Heart held by EFP (The European Federation of Periodontology) in Feb. 2019, predict an increased future risk for atherosclerotic cardiovascular disease and make the basis for the Perio-Cardio Campaign.
Multiple gene-expression on chromosome 9 has been demonstrated to be linked to Type-2 diabetes and Alzheimer's Disease.
Ashley May USA TODAYPublished 12:41 PM EST Jan 27, 2019
Amada Martín, Manuel Bravo, Miguel Arrabal, Antonio Magán-Fernández, Francisco Mesa J Clin Periodontol. 2018; 45: 791-798.
https://www.efp.org/publications/jcp-digest/jcpdigest-2018-7-45-7-791-798.pdf?ga=bmo022019
With careful assessment and treatment, it is usually possible to completely halt the progress of periodontitis. The key to success is to eliminate the bacterial plaque which is triggering the periodontal disease process and to establish excellent oral hygiene practices.
Please refer your question regarding Periodontal Disease & Treatment to the following European Federation of Periodontology & implantology website: https://www.efp.org/gum-diseases/video-resources/
At London Specialist Dentist, we implement Triple-Wavelength-Technology using the latest generation of LASER in dentistry.
SiroLaser Blue is equipped with a high-tech laser versatility module in Laser Dentistry by providing three different forms of laser in one single device.
SiroLaser Blue wavelength of 445 nm provides the best surgical cutting efficiency of all dental diode lasers.
SiroLaser Infrared wavelength of 970 nm is effectively used in the decontamination of infected periodontal, peri-implant pockets, and infected root canals, as an adjunct to the mechanical and chemical debridement within the periodontal, peri-implant, and Endodontic treatment protocols.
This means the indication for adjunct use of antibiotics and their consequent side effects is drastically reduced.
The laser-assisted periodontal therapy (LAPT) results in improved periodontal health with minimal discomfort following both non-surgical or surgical periodontal treatment intervention.
During endodontic treatment, LASER is utilised after preparing and rinsing the root canal in addition to the conventional treatment.
The red wavelength of 660 nm is perfect for Photo-biomodulation (PBM) or Low-Level-Laser-Therapy (LLLT)
Photo-bio-modulation works through the application of photon energy of light to the tissue.
It passes through the skin barrier and is absorbed by the cells where it initiates physiological reactions within the mitochondria.
Photo-bio-modulation is associated with Improved wound healing & surgical tissue regeneration as well as reduction of acute and chronic pain in Temporomandibular joint dysfunction (TMJD)
https://www.bsperio.org.uk/patients
https://www.efp.org/for-patients/
Approximately 5% to 20% of any population suffers from severe generalized periodontitis even though moderate periodontal disease affects a majority of adults.
First visit
8 years after treatment
Characteristic of Severe furcation involvement:
with minimal interproximal bone loss
Baseline
12-month follow up
Straumann® Emdogain in conjunction & Coronally Advanced Flap (CAF)
Subepithelial connective tissue graft with CAF
Day of operation:
Week 1 postoperative:
2 - 6 weeks postoperative:
6 weeks postoperative:
6 - 12 weeks postoperative:
Millions of people end up at their dentist, requiring treatment for tooth decay and gum disease every year. With good dental education and a regular oral hygiene routine, many of these conditions and the suffering they cause can be prevented.
Dental hygiene clinic is the area of dentistry that focuses primarily on preventing oral disease and the maintenance of sound oral health of the teeth and gums.
Good oral care habits need to be established from childhood and are the foundation of lifelong healthy teeth and gums. Our Dental Hygienist is highly trained in this area to provide you with the following services:
It is estimated that millions of people suffer from Chronic Bad Breath (Halitosis). Halitosis is an embarrassing problem that can affect you both personally and socially.
An underlying medical condition could cause bad breath. Dental disease ranged from leaking fillings, caries, root infection, and gum disorders are the reason for most bad breath disorders. Bad breath can also be caused by poor dental hygiene resulting in the accumulation of bacteria, which release gases with an unpleasant odour.
Treatment is based on an integrated approach involving a detailed examination and correction of any underlying dental disease. An individually tailored self-performed plaque control and prophylactic care is planned for each patient following the completion of the hygienist work.
We recognize the concern the bad breath can bring to someone life and we will help our patients alleviate this common problem using modern techniques.
Bad breath, otherwise known as oral malodour or halitosis, is a build-up of several excess bacteria gases. These gases have an unpleasant odour, which is noticeable when one speaks or breathes out. This can often be worse after a night’s sleep and is called “Morning Breath”. This is also treatable.
Bad breath is a common condition, which usually originates in the mouth. Research shows 55% to 65% of people have halitosis chronically and 95% at some time or other. Even when the sufferer is diligent with good oral hygiene, bad breath usually comes from the “oral cavity”. Bad breath seldom comes from the gastrointestinal tract (stomach).
Oral malodour mainly occurs from an accumulation of oral bacteria if the whole mouth is not thoroughly cleaned daily. Other conditions that can cause bad breath are illness, low fluid intake, stress, lack of salivary flow and exercise.
It is notoriously difficult for anyone to detect whether they have halitosis. The best way to check if you have bad breath is to ask a family member, partner or a close friend for their opinion. Another simple way to check if you have bad breath is to lick your wrist, starting at the back of the tongue and wiping the inner wrist to the tip. Leave the saliva to dry for 10 seconds and smell the area for any unpleasant odours. Many people think they have a problem with halitosis when they do not. LSD can examine and test you to find out if there is a problem.
Oral bacteria cause the odour of the bad breath. People who have gum disease have more oral malodour than people without gum disease. If your gums have any redness, swelling or bleeding at all on brushing, flossing or interdental cleaning, then you may well have some gum disease. However, gums may not be the only area where bad breath originates due to bacterial build-up within the mouth.
An average of £258 million per year spent in the U.K. on mouth fresheners that do not work or are not used correctly. They disguise one odour with another that lasts no more than 15 minutes. Mouth rinses alone will not solve the problem. The treatment of halitosis is more complex and combines several approaches.
Yes! The modern techniques used at our clinic have successfully conquered the problems caused by oral malodour. The vast majority of patients have experienced a total cure or at least a very substantial reduction in bad breath. The treatment is both painless and not at all invasive.
Yes. This is known as “Food Breath”. It is a well-known fact that certain foods such as onions, pizza, garlic, alcohol, and spicy foods can cause bad breath. However, not eating these foods solves this problem. Likewise, many kinds of medication can have a similar effect.
Gum recession or receding gum could be defined as the clinical loss of gum margin toward and along the root surface. Gingival or gum recession could be caused by the damage to the tooth-supporting periodontal tissues, i.e. fibres, cementum, and alveolar bone, such as iatrogenic factors, orthodontic movement, infectious oral disease, chemical trauma, e.g. chewing betel nuts.
Periodontal disease, aggressive oral hygiene activities, frenal pull, bone dehiscence, a defective restoration, tooth misalignment, viral & bacterial infections have all individually or in combination been associated with the gum recession. The clinical signs & symptoms attributed to gum recession are tooth hypersensitivity, root caries, and disturbing aesthetic.
The most efficient clinical approach to the restoration of the gum recession defects both in the short- & long-term is the application of periodontal plastic /gingival transplant surgery to augment and replace the function and architecture of the lost tooth-supporting/periodontal tissues.
The periodontist in London Specialist Dentist with more than 2 decades of experience in periodontal specialism offers the most well-documented treatment strategies, i.e. free gingival, connective tissue transplant, and tunnel techniques combined with guided-tissue-regeneration (GTR) strategies to restore both the soft and hard tooth-supporting tissues to enhance the long-term prognosis of your tooth.
Photo 1: Gum recession on the tooth 31 (LL1) cervical margin
Photo 2: Root coverage following the surgical gum transplant
Gingival recession is a part of mucogingival deformities with a prevalence of ca. 50% in people aged between 18 to 64 years and ca.88% in people aged > 65 years.
The adverse impacts of gingival recession for the patient are as follows:
Cairo et al. described gingival recessions based on interdental Clinical Attachment Levels (CAL) and treatment-oriented classification:
A thin gingival biotype is more prone to develop increasing gingival recession lesions. There is evidence reporting a correlation between the gingival and buccal bone plate thickness (bone morphotype).
The severity of the gingival recession has also been correlated with 1) the interdental clinical attachment level, 2) the gingival phenotype, 3) root surface condition, 5) tooth position, 6) aberrant frenulum, and 7) the severity of adjacent recessions.
Based on the clinical observation that recession may occur during orthodontic therapy involving sites that have an “insufficient” zone of the gingiva, it was suggested that a grafting procedure to increase the gingival dimensions should precede the initiation of orthodontic therapy in such areas (Boyd 1978; Hall 1981; Maynard 1987).
As discussed previously, concerning orthodontic therapy, this would imply that as long as a tooth is moved exclusively within the alveolar bone, soft tissue recession will not develop (Wennstrom et al. 1987).
Predisposing alveolar bone dehiscences may be induced by uncontrolled facial expansion of a tooth through the cortical plate; thin gingival biotype without a gingival recession is at a greater risk for the future development of gingival recessions. The attention of the clinicians to prevention and careful monitoring should be enhanced.
1. Cause-related therapeutic schedule, treatment:
Traumatising tooth brushing technique & para-functional activities
2. Corrective/ rehabilitation phase of therapy (Muco-gingival/ periodontal plastic surgery):
Conventional Gingival Transplant
https://www.youtube.com/watch?v=QtWYxIT9ZGA
Gum Recession After Wearing Braces Can Now Be Treated Without Gum Grafting Surgery
https://www.youtube.com/watch?v=Cod9fYjctSA
Most periodontal plastic surgical protocols involve the correction of gum/mucogingival deficiencies and root coverage. Albeit, there is a need to optimize the currently advocated conventional treatment strategies and diminish the untoward postoperative surgical morbidity and optimise the clinical outcome.
The currently advocated minimally invasive surgical protocols have addressed some of the surgical trauma concerns when rectifying the soft-tissue deficiencies and root exposure.
The modified‐Vestibular Incision Supra‐periosteal Tunnel Access (M‐VISTA) has been claimed to implement the principles of minimally invasive mucogingival surgery to optimise the treatment outcome and patient-reported outcome measurements (proms).
The recently well-published minimally invasive (M-VISTA) consider supra-periosteal tunnel-access with graft stabilisation (Zadeh, 2011).
This M-VISTA technique is claimed to reduce surgical time and increase patient comfort by preventing excessive facial bone loss by traumatising the periosteum and reducing the grafted connective tissue vascularity.
Besides, studies have implied that the lamina propria consists of genetic information that dictates the overlying surface's keratinisation.
A tension-free coronally-advanced supra-periosteal mucosal flap will preserve the structural and vascular integration of the papilla. Compared to a non-autogenous graft, the connective tissue may enhance the zone of keratinization (Karring et al. 1975). In all procedures, graft stabilization is crucial for increased plasmatic perfusion and vascular circulation.
Miller Class II / Cairo RT1
Miller Class II / Cairo RT1
Incision & release of the mucoperiosteal flap
Tunnelling & release of the mucosal flap
Flap elevation and CTG in-Situ
Tunnelling & coronal advanced flap
External suturing of advanced flap & CTG
Internal stabilisation of advanced flap & CTGZadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet‐derived growth factor-BB. Int J Periodontics Restorative Dent.2011;31:65
Karring T, Lang NP, Loe H. The role of gingival connective tissue in determining epithelial differentiation. J Periodont Res.1975; 10:1‐11.
Excessive gingival display (EGD) or gummy smile is defined as a lack of balance between the anatomic variations within the static landmark of the gingival margins and the dynamic positioning variations of the upper lip in relation to the smile line.
While the patients subjective complains express mostly their increasing concerns about their gummy smile affecting their social and professional roles, the clinicians may analyse the clinical features of the excessive gingival display (EGD) in order to make a correct clinical diagnosis on the basis of which an appropriate surgical procedure can at best be planned.
Identifying the source of this oro-facial aesthetic concern whether of a dento-alveolar or neuro-muscular origin leads to a correct therapy plan.
Dento-alveolar aetiologies could be due to the gingival overgrowth, and/or dento-alveolar extrusion, which results in short clinical crowns and/or altered passive eruption (APE).
In periodontal practice, altered passive eruption (APE) and mild vertical maxillary excess (VME) are frequently identified in gummy smile cases (GS) cases.
In cases where the clinical features of GS or EGD are caused by combined aetiologies, cause-related interdisciplinary approaches are frequently indicated in the form of periodontal surgical approaches, orthodontics, and/or surgically facilitated orthodontic treatments.
Non-dento-alveolar aetiologies include skeletal and/or facial soft tissue anomalies, including a short upper lip, and/or vertical maxillary excess (VME) which is unfortunately recognizable more readily after the orthodontic treatment.
These cases may only be treated by orthognathic or facial plastic surgical approaches (e.g. myotomy or resection of the smile muscles through a nasal columellar incision).
Although Botulinum toxin A (BTX-A) could effectively rectify GS caused by hypermobile upper lip, in mild VME cases however, this approach requires repeated treatments.
To mask mild to moderate cases of VME due to hypermobile upper lip, lip-repositioning or reverse vestibuloplasty procedure has been popularized recently to correct such GS cases almost permanently.
Photo I. depicts existing hypermobility of the upper lip with a normal width and volume of the upper lip.
Photo II. Lip-repositioning or reverse vestibuloplasty procedure has been performed to rectify the gummy smile in this young gentleman.
We live in a fast-paced world where we demand faster and more predictable treatment outcome.
Accelerated Orthodontics provides you with the beautiful and harmonic smile within half of the treatment time required for traditional braces. With Accelerated Orthodontics, aesthetically pleasing ceramic braces and clear aligners, e.g. Invisalign®, can be worn in patients who prefer efficient results with non-metal braces.
The slow and continual application of mild orthodontic forces initiates and maintain biological processes resulting in a very slow type of tooth movement. Traditional orthodontics applied for the past 100 years requires longer treatment time due to the limitations of the bone remodelling activity.
Accelerated Orthodontics is a well-proven revolutionary adjunctive treatment approach culminated by clinical research over the last two decades to s prevail the clinical safety and predict faster orthodontic tooth movement by approximately two times.
The benefits are that if the orthodontic treatment is shorter, the problems that arise with long term braces such as tooth decay or gum problems are reduced.
With accelerated orthodontics, the patient sees the change quickly. This allows the patient to see the benefits of the treatment more quickly. It also helps the dental team and the patient decide on the ideal mouth disciplinary treatment plan.
Additional benefits of Accelerated Orthodontics due to the activated and augmented bone can be:
Accelerated Orthodontics facilitates tooth-movement into the desired position in just 4 to 10 months versus the 1 to 3 years of treatment time required conventional orthodontic. This offers the patients a clear advantage in reducing their normally-accepted orthodontic treatment period, and the orthodontists increased patient compliance and case completion.
The fast track patients undergoing accelerated orthodontics would complete their treatment less than patients having conventional orthodontics.
The older technique was an extensive surgery requiring direct exposure of the alveolar bone. The new method was developed by Professor Dibart and his team from Boston, USA. Therefore, the accelerated orthodontic by Piezocision involves only minimally invasive selective vertical fine incisions with a Piezo device using micro-vibrations in the bone surrounding the teeth. The stimulated bone accelerates the activity in bone remodelling (demineralisation and remineralisation) adjacent to the site of the activation.
Both upper and lower jaws can undergo the procedures at the same in-office appointment and a single tooth or groups of teeth.
This technique is ideal for most adolescents, young adults, adults, and adults wearing fixed braces and removable clear aligners, e.g. Invisalign®, provided there is no contra-indication to surgery, e.g. bone disease, ankylosed teeth, patient non-compliance, and heavy smoking.
There is a good body of evidence-based research to support that accelerated orthodontics cause no adverse biological effects on the periodontium. It is a predictable surgical procedure as long as all the postoperative instructions and care are followed correctly.
After consultation with DR Sidi, or Dr Kamosi, you will be provided with adequate information on different accelerated orthodontic treatments.
The procedure is painless and takes between 45min -1 hours, depending on how many teeth need to be treated. There might be mild soreness for one or two days after the surgery, while the recovery is generally very rapid.
During the recent decade, a few different methods of accelerated orthodontics have been developed. Similar techniques are described as:
Accelerated orthodontics utilising propelling technique involves making small perforations in the alveolar bone to initiate micro-trauma followed by healing of the bone. These perforations can be performed at sequential stages during orthodontic treatment. This technique is also minimally invasive; however, it is not always safe and viable when there is no space for bone perforation between the crooked teeth' roots.
If you have always been concerned about crooked teeth causing aesthetic disturbances or biting and chewing discomfort.
If you didn’t like the idea of wearing braces for many years, accelerated orthodontics could be a promising treatment option for you.
If you are interested in having an accelerated orthodontic treatment, make an appointment with a specialist.
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