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Direct Bonding

Direct Bonding

This treatment was accomplished with direct bonding to close the gap between the teeth and Icon to diminish the white spots.

No anesthetic was required for either procedure.

Conservative, painless and aesthetic. It’s always a good day when we can achieve all three!

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Dark Front Teeth

Dark Front Teeth

“Rebecca” has been self conscious about her dark front tooth ever since she had the accident. She fell and her front tooth took a hard hit. As a result, the tooth needed a root canal treatment. ⁣⁣⁣

A tooth can darken considerably after trauma and although Rebecca never had any pain in the tooth after the root canal, the discoloured tooth was an aesthetic issue for her. We tried to bleach the tooth from the inside, what we call internal whitening. This lightened the tooth somewhat but it still remained noticeably darker than the other teeth. ⁣⁣⁣

We decided on a porcelain crown to solve the problem. To match one front tooth crown to the natural teeth is one of the biggest challenges that we have in dentistry. I had to be sure that my preparation of Rebecca’s tooth was precise to allow my lab technician to mask the dark tooth. Also, I had to make sure that the where the crown meets the tooth, what we call the margin, was just below the gums so that it was not noticeable. Going too far below the gums with the margin can cause red, sore gums, so this was a very important consideration. ⁣⁣⁣

Cosmetic or aesthetic dentistry not only involves making sure the teeth look nice but also making sure that the gums are healthy and aesthetic as well. They are just as important to the final result! ⁣⁣⁣

In the end, we have a natural looking crown that blends well with the other teeth. The gums around the crown are healthy and happy. I finished Rebecca ‘s smile by fixing the small chip in the tooth beside the crown with a little bonding. ⁣⁣⁣

The greatest pleasure for me is seeing Rebecca smile with confidence. She now smiles freely and openly. And seeing her so happy has me smiling as well. It’s always more than just fixing teeth! ⁣⁣⁣

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Dental Implant Maintenance

Does cleaning dental implants differ from cleaning natural teeth?

In a nutshell, cleaning around implants differs from maintenance of natural teeth for two reasons: The first is that each attaches to surrounding bone and gums in a very different way; secondly, the materials from which implants are made are very different from natural teeth.

Dental implants replace the root parts of the teeth. Artificial crowns, bridgework or removable dentures — tooth replacements that make up the visible (crown) part/s of teeth — are attached to the implants. In between the implant and the crown of a tooth there is often a connector known as an abutment. The success of the whole system is based on the implant’s attachment to bone. Titanium, the metal of which implants are made, is uniquely osteophilic — literally “bone-loving.” It fuses to bone in a process called osseointegration (“osseo” – bone; “integration” – fusion or joining).

Above the bone where the integration process ends, the abutment comes in contact with the gum tissue where it is supported by a connective (i.e. “connecting”) tissue composed of fibers made of a tough material called collagen. The fibers run beneath the surface parallel to the implant ending at the top of the bone. They hold the gum tissues against the implant surface.

At the very top of the implant assembly, the abutment and lower part of the crown attach to the gum (the surface “skin” layer) via a specialized structure known as an epithelial attachment (“epi” – on top; “thele” – nipple). The cells actually attach to the highly polished metal or ceramic, of which the implants are made, by means of microscopic suction pads.

By contrast, a tooth root is attached to the bony socket that surrounds it — by a periodontal ligament (“peri” – around; “odont” – tooth). The ligament is composed of tiny fibers that insert into the bone on one side and into the tooth root on the other. Above the bone, the fibers attach from the tooth into the gum tissue. An implant has no such attachment. Since the whole periodontal ligament has a greater blood vessel supply through which it can bring cells and nutrients, it is more readily able to resist and fight against infection.

Infection Is The Enemy

Cleaning implant-supported tooth replacements is just as important as cleaning natural teeth, as both depend on healthy surrounding tissues for support. Bacterial biofilm (plaque) collects on implant crowns just as it does on natural teeth, and must be removed on a daily basis at home. Without daily biofilm removal, infection can develop known as peri-implantitis (“peri” – around; implant “itis” – inflammation), which can result in loss of the attachment described above. Unlike inflammation around teeth, this reaction can be quite catastrophic both in rate and amount, quickly leading to a well- or dish-shaped loss of bone around an affected implant. Bone loss can rapidly progress to loss of the implant.

The dental hygienist has an important role to play in keeping dental implants infection-free, and there are many factors to be considered in selecting the right instruments for a professional cleaning. They include: the nature of the debris, meaning whether soft (biofilm, foods) or hard (calculus or tartar, calcified material); the location of the deposits; the type of surface on which they accumulate; and the stubbornness with which they adhere.

The Right Tools For The Job

Your hygienist must select instruments for cleaning that will not damage the crown, abutment, or the implant itself. Maintaining the highly polished, smooth surface of the abutment and crown are critical. If they are scratched they can attract and harbor bacteria. That’s why the instruments used, called scalers and curettes, are most often made of plastics and resins. Natural teeth don’t scratch in the same way, and therefore metal instruments can be used to clean them.

A number of power (ultrasonic) instruments have nylon or plastic sheaths or tips to minimize implant damage. They clean by using high-frequency vibration, which may be necessary if large quantities of debris have accumulated. They are used on a low power setting with a lot of water irrigation, and sometimes antibacterial solutions, to clean and flush material.

If any part of the implant body (root replacement portion) itself is visible, this may mean there is infection that has resulted in gum and/or bone loss. The implant surface becomes exposed following loss of its fusion to the bone. Implant surfaces are generally microscopically “roughened” to increase surface area for bone attachment. But this surface roughness makes implants difficult if not impossible to clean and disinfect. Additionally, some implants are screw-shaped and their threads just add to the cleaning dilemma.

Brushes are used to clean biofilm from exposed areas of an implant wherever possible. If calculus or dental cement (used to secure the crowns) is present on an implant surface, the hygienist needs to use instruments that are effective in removing these contaminants. In such cases the clinician must ensure no scratching or damage is caused by completing the task.

Despite these special cleaning challenges, implants are highly successful. In fact, studies indicate long-term success rates well over 95%. However, the prevention of peri-implant disease is fundamental to implant health, maintenance and function. And cleaning implants and their related components is an important part of success. Your question indicates that your hygienist is on top of it.


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Filling Cavities in the Front Teeth

In our latest video watch a time lapse procedure of the filling of cavities in the front teeth of a patient at Soho Dental in Toronto. This is a common, simple and relatively painless procedure we regularly perform at our clinic.
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What is microleakage around a filling?

The first picture above shows microleakage around an old filling. All fillings have a lifespan after which they are no longer functional. In this example, the old filling is intact, it is not broken but there is another problem. The seal between the filling and the tooth structure is longer exists. This can be seen as the dark staining between the filling and the tooth. This means that salivary fluids and bacteria have entered the tooth and will very likely cause decay underneath the filling. If this is not repaired and the decay progresses, this can then cause sensitivity, discomfort and possibly a tooth abscess.

The second picture shows the tooth repaired with a new filling. Notice the seal between the filling and the tooth. This new restoration will function comfortably for the patient for many years to come.

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Goodbye Fiona

Many of you have had treatment by our dental hygienist Fiona Taniredjo. Fiona has been with Soho Dental for over 5 years. Fiona is ready to start her new life and new adventures await her. It is with regret that I announce her retirement from Soho Dental but we all wish her the best of luck and every happiness in her new endeavours! Thank you Fiona for all your efforts and your high commitment to patient care. You will be missed.

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All Porcelain Crowns

We are fortunate that modern dentistry allows us to repair discoloured or damaged teeth with all porcelain crowns.  A crown or cap covers and replicates the entire tooth right down to the gum level. The dental porcelains that are available today are very strong but also highly aesthetic allowing us to make the crown appear very natural. The following example shows a tooth that had been discoloured for many years.  The tooth had trauma and root canal treatment, both of which have discoloured and weakened the tooth.  The all porcelain crown masks the underlying tooth colour, allowing us to recreate a better tooth form and to protect the tooth structure underneath the crown from further damage.

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Restoration of Large Fracture in Maxillary Central Incisor

Repairing a large fracture of a front tooth, either with a crown or with composite resin is a challenging task. A single front tooth can have multiple shades of colour, each of varying translucency and opacity. In addition, teeth have very specific anatomy and contours which need to be replicated if the restoration is to be esthetically successful.

The following video outlines how we replace natural tooth structure with composite resin while trying to mimic all these parameters. Be sure to see the “before” and “after” photos at the end of the video.

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Composite Resin Veneers

Composite resin has many advantages,  the most important being that we can be very conservative in our tooth preparations in order to place it.  This is in contrast to porcelain which requires  more preparation to the tooth in order to allow enough room for the porcelain.  In the before picture above, you see the old composite resin veneers on the upper lateral incisors that were done many years ago by the patient’s previous dentist.

Over time, the resin has chipped and changed colour and the patient was ready to have it redone.  I replaced the old composite resin and we were able to get an improvement in shade, as well as in tooth contour. The new composite resin veneers should serve the patient well for many years to come.

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Unbalanced Bite

Worn Teeth From Grinding
Teeth Restored With Composite Resin


One of the most common signs that there is a problem with one’s bite is worn teeth.
Teeth that fit in harmony with the temporomandibular joints and the chewing muscles do
not wear down with normal function.  When there is a disharmony within this system, we
notice that the teeth have a tendency to wear very quickly. The first picture shows worn
teeth due to grinding.  The grinding often is triggered by a disharmony between the
healthy position of the jaw joints within their sockets and the way the teeth fit together.

The second picture shows the teeth restored very simply with composite resin.  For this
treatment to have a lasting result, the patient is obliged to wear a nightguard to protect the
teeth from grinding forces. The nightguard is fabricated not just to protect the teeth but
also to support the jaw joint and to allow the muscles to relax. A long term solution for
this patient would also include balancing the bite so that there is no disharmony between
the position of the jaw joints and the way the teeth fit together. This would offer a long
term solution which would protect the teeth from further wear.

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