Orthognathic Surgery

Picture above shows occlusion before surgery

After surgery

After eleven months of orthodontics, the patient underwent a bimaxillary surgical procedure in which the lower jaw was pushed back by 6mm via a sagittal split osteotomy and the maxilla was pushed forward by 3 mm via a Le fort I osteotomy. The picture below shows the patient six months after the operation. Note that the profile has much improved and the occlusion was restored to a Class I skeletal as well as dental relationships.

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Here’s Why You Should Worry More About Your Gums

This article first appeared on Dr. Rezzuan’s Medium blog. Most of the advertisements for dental health show gleaming pearly white teeth. Which isn’t wrong, considering that is what the public expect. Unblemished and shiny teeth. But oral health encompasses more than just healthy and white teeth. Enter the periodontium. That word is derived from Greek with peri meaning around and odont; tooth. It consists of 4 parts, the gingiva (gums), alveolar bone (bone under the gums), periodontal ligament (microscopic ligaments attaching your tooth to the socket ) and cementum (cement, obviously). But before you all click away from this article, let’s just focus on the gums and why you should be more worried about it. The gums are the unsung hero of the oral cavity. The hero it deserves, but not the one it needs. You might be having gum disease Raise you hand if you have bleeding gums while brushing. Good, now put your hands down and call the nearest dental clinic for an appointment. Bleeding gums are a sign of gingivitis, which is a the baby of the gum disease family. It’s the first step towards having periodontitis, the meaner alcoholic elder brother of gingivitis. If left untreated, several […]

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Dr Firdaus on Majalah 3

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Mind The Gap!

Introduction Often enough we see lots of patient who come to our clinics wanting to replace a missing or an unsightly tooth in the anterior part of the mouth. Usually the tooth missing is the first or second upper incisors. Traditionally the dentist can offer a bridge to fill this gap. That means preparing the adjacent teeth which would often be completely healthy teeth to support a bridge. Not only the bridge preparation would mean an unwarranted destruction of the adjacent teeth, but as in our case report below, it would mean unacceptable aesthetics. Case Report Mary (Not her real name) came to see us 9 months ago for a consultation on a missing tooth. Upon examination we found that she was wearing an upper denture after a loss of an upper right central incisor. She had seen another dentist from elsewhere and had replaced the lost tooth with an extraordinarily big tooth to cover the gap. She complained that her plastic tooth looked odd as it was bigger than her other teeth. Upon further questioning we discovered that she always had a gap between her front incisor teeth, also known technically as a median diastema. She was clearly unhappy […]

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Incredible Zirconium Crowns: A Case Report

Introduction For many years dentists have relied on normal porcelain fused to metal crown as the restoration of choice in the treatment and rehabilitation of a tooth. These crowns are reliable, safe and have proven to last for many years. However, with any metal laced restorations, the aesthetics is compromised at the gum level as there would be a shadow at that critical margin. Although the porcelain colour might be very nice, there will always be a dark shade at the gum line. The solution may be to use gold as the base metal. However, with the price of gold at record levels, this may not be economical for the patient. The solution in past years was to create full porcelain crown especially in the anterior teeth. Unfortunately, these crowns proved to be very weak and most fracture within the span of 5 years. The solution today is to use Zirconium base crown. Zirconium is a transition metal that has similar properties to Titanium. In the form Zirconium Dioxide, it is inert and white in colour. The strength of a zirconium crown is compatible to the metal of the porcelain fused to metal crown. Due to the white colour of […]

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Teeth in One Day! With ICP Implant

Introduction The advent of dental implant has made it possible for patient to liberate themselves of conventional crown and bridges as well as removable dentures. However, implant treatment has its inherent disadvantages as well. Since conventional implants will need some time for it to osseo-integrate, these conventional implants will need to be protected from the everyday occlusion. Therefore dentures or temporary Maryland Bridge will be a natural solution for these cases. Most of the time, it will mean dentures, which could be the very least annoying to the patient or at worst, a social embarrassment for them. The Alternative System The one piece dental implant would be ideal in this case. However choosing the right type of implant as well as careful case selection is paramount in insuring a successful outcome. The implant system must give good primary stability as well as easy to restore immediately after surgery. The advantage of a one piece implants is that it has no interface between the abutment and the main fixture, therefore this will eliminate the problem of micro-gap an screw loosening of the implant, The argument of biological width and wether to have “platform switching” procedure will disappear. However there are inherent […]

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Berita Harian Article

Penggantian gigi tiruan Implan dibuat daripada titanium, boleh sebati dengan tulang dan berfungsi sebagai penambat gigi PERNAHKAH anda terfikir untuk menanam gigi baru bagi menggantikan gigi yang rosak? Tidak kira sama ada kerosakan itu disebabkan kemalangan atau penyakit, inovasi bidang pergigian menjanjikan anda boleh memiliki senyuman menawan dengan susunan gigi yang sempurna. Presiden Persatuan Pergigian Implan Malaysia, Dr Firdaus Hanapiah, berkata implan gigi bukanlah kaedah baru, sebaliknya ia sudah diperkenalkan sejak 1960an. Beliau berkata, implan gigi bermaksud penggantian akar gigi tiruan dan ia dirintis oleh Prof Per-Ingvar Brånemark dari Sweden. Katanya, Brånemark mendapati implan yang dibuat daripada titanium boleh sebati dengan tulang dan berfungsi sebagai penambat untuk gigi. “Titanium yang bertindak sebagai implan dimasukkan ke dalam tulang gusi. Kini asas penciptaan Brånemark diperbaharui dan terdapat pelbagai jenis implan gigi yang boleh dipilih oleh pesakit,” katanya. Lubang implan selepas gigi dicabut. Process penanaman implan. Berbanding dengan alternatif rawatan pergigian yang lain, implan gigi lebih kuat dan lasak. Ia juga berfungsi hampir menyamai gigi asal. Oleh itu, ia adalah jawapan kepada masalah kehilangan gigi kekal. Dr Firdaus berkata, implan bukan saja boleh dipasang secara sendiri tetapi ia juga digunakan sebagai sokongan kepada kaedah pergigian terdahulu seperti jejambat gigi (bridge) atau bertindak menambah […]

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Immediate Loading of Single Free Standing Implant : A Realistic Options for Our Patient?

Introduction When Professor Branemark introduced the modern implant in the late 1960’s as we know them today, he applied a set of rules for his disciples to follow to ensure that the outcome of their treatment is a successful one.(1) One of the principles that he stipulated was to leave the implants in the jaws fully covered by mucosa and free of occlusal loading. This was, rightly so, to ensure that osseointegration occurred in a gradual manner, free from excessive occlusal load as well as bacterial attack from the oral mucosa. However in the late twentieth century it was observed that if several implants were linked together, it was possible to place a denture or a temporary bridge linking these implants and immediate function was possible. This means that it was not a necessity to wait for osseointegration to occur before oral function can be restored for these patients. It was also found that there was no loss of both quality and quantity of osseointegration if these implants were subjected to appropriate loading (2). Recently the envelope was pushed even further by introducing the concept of immediate loading for single implants. This concept is not new as it is practiced […]

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A Step By Step Look at the Process of Dental Implantation

ONE A 39-yr-old patient presented with a missing lateral incisor after an old crown fractured. TWO It was decided that she would need a single implant to replace the missing tooth. THREE The surgery was relatively simple and took no more than 20 minutes. FOUR A temporary bridge was installed and the implant was left in the bone for 3 months after which the implant was re-exposed to take a final impression. FIVE The impression coping was sent to the dental laboratory for processing and a final crown was inserted. The advantages of having implants are that it is truly a full restoration and substitute to the original tooth. It is easy to maintain and does not require the cutting of adjacent teeth as with traditional bridge. Also, it is easy to clean and looks great!

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Rehabilitation Of An Edentulous Mandible With Five Implants And Fix Prosthesis

Introduction Rehabilitation of the fully edentulous has always been a problem for prosthodontist especially when there a considerable resorption of the maxillary and mandibular bone. In the past , remedies were created to counter such problems. These may include from tissue adhesive to denture or more invasive procedure such as sulcus deepening or bone graft augmentation of the ridge. These procedures were however only partially successful in countering such problems and often enough created new problems as a consequence. With the advent of dental implants, the bridge over denture could be secured directly to the underlying bony support thus preventing any displacement of the over denture. It is also beneficial over the longer period of time due to the direct loading of the bone thus slowing down ridge resorption. Case Study A 63-year-old Chinese man requested permanent fix prosthesis due to denture intolerance. Upon examination it was discovered that he had a resorbed ridge and a high mentalis muscle attachment. After discussion with the patient it was agreed that a total of five implants would be placed on the mandibular ridge. The surgical procedure, which took about 45 minutes, was performed without complication and is left to heal. Three month […]

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Implant Placement On The Narrow Maxillary Ridge

Introduction In many cases where patients require implants to rehabilitate the occlusion, clinicians find that there is not enough bone. Traditionally the clinician determines the bone quantity using the radiographs and clinical probing of the mucosa. However, with the advent of CT scans, three dimensional computer software solutions, and stereolithographic drill guides, the process of determining where ideally to place implants in bone has been greatly enhanced. Case Report A 46-year-old woman requested to have implants placed to support her partly edentulous ridge. Upon examination we found that there was a very thin maxillary ridge, at some points not more than 3 mm in thickness of bone. Therefore a technique had to be applied to place implants in the areas where there was enough bone and to angle them precisely to avoid bone dehiscence. SimPlant was used to simulate the implant placement. Fig. 1 shows an axial CT scan of the patient’s maxillary ridge. Note the extreme resorption of the left ridge. With SimPlant the most appropriate diameter and length of the implants were determined. It was only possible to place two regular platform Branemark implants (NobelBiocare) with diameter 3.3 mm. The anterior right also showed resorption, it was only […]

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A twenty-year-old man was referred by his dentist to the Oral and Maxillofacial Department University of Malaya, Kuala Lumpur, Malaysia. He dislikes his large jaw and wants something done to it. It was decided that some decompensating orthodontic treatment would be done and after that, a bimaxillary osteotomy is planned and carried out. Picture above shows occlusion before surgery After surgery After eleven months of orthodontics, the patient underwent a bimaxillary surgical procedure in which the lower jaw was pushed back by 6mm via a sagittal split osteotomy and the maxilla was pushed forward by 3 mm via a Le fort I osteotomy. The picture below shows the patient six months after the operation. Note that the profile has much improved and the occlusion was restored to a Class I skeletal as well as dental relationships.

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Scaling

Here’s why your dental scaling costs RM200 I’ve been a dentist for almost 6 years now. Currently I’m working in the private service and I haven’t met any patients who haven’t complained to me about the costs of private dental care. That’s why most of them flock to the government clinics, braving through the long waits and horrible parking. I mean, for RM 1 tooth extractions. Why not? Most of them have this preconceived notion that being a dentist is a surefire way to earn a huge salary. Which is not entirely true. And it’s not all rosy in a dentist’s life. Here are some reasons why dentists charge so much for a 30 minute visit The cost of setting up a clinic This kinda goes without saying. Most of the dental clinics you are accustomed to are basically shop lots, with the clinic usually on the 2nd floor (there’s a reason for that, we’ll get to that some other time). Let’s get this straight from the get-go. A private clinic is a business. It’s there to make profit and to provide employment opportunities for dentists and dental staff alike. So the dentist in charge has to play a secondary […]

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Gigi Bongsu

Kenapa gigi bongsu selalu sakit Setelah anda melepasi umur 21 tahun, mesti ada perasan suatu benda dalam mulut yang selalu membuat anda tidak selesa. Gigi bongsu yang baru nak tumbuh mesti akan tumbuh senget la, bengkak la dan kadang- kadang sakit yang teramat seksa, sampai rasa nak ambil pliers di rumah dan cabut sendiri. Kenapa gigi boleh sakit macam tu? Berlubang ke? Sebenarnya, gigi bongsu adalah gigi geraham yang memang ada dalam mulut semua orang. Apa yang berbeza adalah samada gigi itu tumbuh dengan elok atau tidak. Masalah keradangan gigi bongsu bermula pada umur 18–25 tahun kerana masa itu la gigi bongsu akan tumbuh. Jika rahang anda terlalu kecil dan tidak cukup ruang, gigi itu akan tumbuh senget. Dan akan ada bermacam-macam posisi yang boleh terjadi. Kebanyakan dari kita mempunyai gigi bongsu yang tumbuh dengan elok, sihat walafiat dan tidak menganggu kehidupan siapa-siapa. Ia juga akan tumbuh bukan sahaja di rahang bawah, tetapi di rahang atas juga. Tapi yang selalu memberikan masalah adalah gigi di bawah. DIambil dari ahmedabaddentalcare.com Apabila gigi tumbuh sedemikian rupa, banyak masalah boleh berlaku. Disebabkan posisi gigi tersebut, makanan akan lebih senang sangkut di celah-celah gusi dan gigi. Makanan ini akan menyebabkan bakteria membiak di mulut […]

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Case Report Wan

Case Report Wan Wan Saiff This is Wan, a 16-year old boy. He came to us with an underbite. His upper tooth was trapped by the lower teeth. He smiles less because he’s not confident of his appearance. After an evaluation of his dental hygiene and health, it was decided that he’ll undergo braces treatment. Conventional metal brackets were sufficient to correct this. Pre-operative photo After 18 months of braces After 22 months of braces treatment After braces After 22 months of conventional braces, Wan is now more confident with his smile. Post-operative reviews will be done every 6 months to monitor any relapse. -Dr Rezzuan Original post at @personadental Instagram

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Ariff – Discolored tooth

Ariff – Discolored tooth This is Ariff. He works in the corporate world and meets with a lot of clients. He has had a discolored and stained tooth for years. The decay and stain was removed and a composite veneer was placed. Pre-operative photo. Before treatment After decay removal and composite restoration Original post at @personadental Instagram

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Gigi Merana Angkara Fake Braces

Gigi merana agkara fake braces Di KPF Dental, kami ada menerima pesakit yang pernah membuat rawatan braces dari doktor gigi palsu. Pesakit ini akan datang ke klinik kami dengan keadaan gigi yang rosak, ulser di mulut dan tartar & plak yang berleluasa. Di dalam mulut, akan ada ‘bracket’ di gigi depan sahaja, dengan dawai yang terjuntai sebab dipotong terlalu pendek. Bila ditanya braces ini dibuat di mana, jawapan yang kami terima; “Di hotel, doktor. Saya nampak iklan di FB.” atau ‘ Di rumah orang, dia buat gigi saya atas sofa.” Ya Allah, sedih kami mendengar jawapan begini. Ramai anak-anak muda kita terlalu ghairah mengejar trend sampai tidak tahu rawatan ortodontik braces bukan untuk estetik semata-mata. Rawatan braces adalah untuk menggerakkan gigi supaya fungsi mulut & pertuturan boleh diperbaiki. Siapa yang buat fake braces? Selalunya yang buat fake braces bukan doktor gigi yang bertauliah. Malah barang-barang membuat pendakap gigi berkemungkinan dibeli dari penjual online yang diragui kesahihan mereka. Ada juga yang pernah bekerja di klinik gigi & sekarang membuat servis ini di salon kecantikan atau rumah mereka. Kalau di Instagram atau Facebook, kita akan nampak servis mereka diiklankan dengan harga yang murah, dalam RM300 ke bawah. Mungkin mereka merasakan membuat fake […]

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Rawatan ‘braces’ tanpa besi?

Rawatan ‘braces’ tanpa besi? Kadang-kadang besi braces itu akan menyebabkan ulser mulut. Makanan pun boleh tersangkut dan kita kena rajin bersihkan gigi. Mesti ramai yang tertanya, “Bagaimana saya boleh ratakan gigi tanpa pakai besi?” Kita ada memberikan perkhidmatan ‘clear aligners’ atau pun pendakap gigi yang lutsinar (invisible braces). Baca lebih lanjut untuk mendapatkan info. Apa itu Clear Aligners? Clear Aligners adalah suatu rawatan ortodontik yang dibuktikan berkesan dalam meratakan dan menyelaraskan gigi tanpa menggunakan apa-apa besi. Ia diperbuat dari bahan plastik yang keras yang perlu dipakai oleh pesakit. Pendakap gigi itu akan memberikan tekanan minima dan berterusan untuk menggerakkan gigi ke posisi yang kita mahu. Justeru, ia akan memberikan anda senyuman yang anda selalu idamkan tanpa menggunakan dawai. Bagaimana Clear Aligners berfungsi? Langkah 1: Satu imbasan 3-D akan dibuat di mulut pesakit. Langkah 2: Imbasan tersebut akan dihantar ke makmal untuk analisa. Doktor terlatih kami akan membuat pelan rawatan yang sesuai. Langkah 3: Pendakap gigi akan dihasilkan melalui proses pencetakan 3D (3D printing) Langkah 4: Pesakit akan dipanggil semula ke klinik untuk diberikan pendakap gigi untuk dipakai. Bilangan pendakap gigi terpulang kepada kerumitan kes. Setiap pendakap akan dipakai selama 2 – 4 minggu. Langkah 5: Pesakit akan dipanggil ke klinik […]

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Picture above shows occlusion before surgery

After surgery

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