Dental Implant Surgery
Teeth serve an important role in our daily lives as it affects our speech, our ability to eat well and the way we look. Its loss through disease or trauma sets in motion the loss of underlying bony support resulting in tooth loss. This in turn affects support for our lips and cheek leading to a more aged appearance. Failure to replace missing teeth often leads to the opposing teeth overgrowing and the adjacent teeth tilting resulting in areas of food trapping which in turn may result in gum disease tooth decay.
What are the different ways of replacing missing teeth
Traditionally, missing teeth were replaced by either removable plastic or metal based dentures, or fixed bridges made of either metal alone, or porcelain fused to a metal base. Developments in dental material science have focused on developing more aesthetic materials with adequate strength, such as all-porcelain and zirconia bridges. While all of these are still very much in use today, implant based methods of replacing missing teeth are increasingly preferred as it provides greater biting ability and a more comfortable and natural feel.
What are dental implants?
Dental implants are sterile titanium screws which are inserted into the jawbone as artificial roots to support and retain replacement teeth. It comprises 3 parts. The first part or “fixture” is placed within the jaw bone to replace the roots of missing teeth. The second part or “abutment” emerges through the gums and is used to carry the 3rd part, which may be a single crown or a bridge depending on how many teeth are missing. If we have lost all our teeth, we can use 4 to 8 implants in each jaw which when connected can support dentures or even a fixed bridge
How do Implants compare with alternative options?
When compared with removable dentures, they provide stronger support, firmer retention and are more stable. The implant supported and retained replacement teeth occupy less space and are more comfortable. They are also able to generate much stronger biting force. When compared with fixed bridges, they can be used even when more teeth are missing as they can provide stronger support over a longer span. They are also preferred when the teeth adjacent to the gap are weak or too small to provide sufficient support. Additionally, they provide an alternative to trimming healthy teeth.
Benefits of Dental Implant
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Are permanent replacement for missing teeth
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Has predictable and good long-term success rate
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Prevents supporting bone from shrinking after tooth loss
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Does not decay as it is made from Titanium
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Able to generate stronger bite forces for better chewing and hence better digestion and nutrition.
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Restores appearance thus creating more confidence and self-esteem Able to provide better support for lips and cheeks for a more youthful look
Types of Dental Implant
Dental Implants have been widely used for more than 40 years since the original scientific research was published. While many different implant systems are now available and are generally of high quality, our clinic prefers using implants from Nobelbiocare, Sweden and Straumann, Switzerland due to the extensive research and long track record. These implants come in different sizes and lengths and are generally at least 3.5 mm in diameter and 8 mm in length which differentiates them from “mini-implants” which should be used only as temporary supports or in very specific cases.
Are you suitable for Implants
Implants can be placed in most patients from age 18-80, even if you have lost your teeth for many years as we are able to regenerate bone in order to place implants as a foundation for your denture or bridge. Patients with health conditions should inform the dentist so that additional precautions can be taken, if required. Conditions which require attention include patients with significant heart disease, unstable high blood pressure, uncontrolled diabetes and patients on therapy for cancer. Surgery can still be performed after clearance from your medical specialist.
What is the surgical procedure like?
After giving some local anaesthetic, a small incision is made through the gums and a point of insertion decided. Drills of a predetermined length and with increasing diameters are then used to gently prepare the site to receive the implant. The implant is then rotated to the desired depth. The top of the implant channel is then covered with a temporary cap and the gums stitched either over or across after cleaning the surgical site and allowed to heal undisturbed for 3-4 months. A higher temporary cap called a healing abutment is often placed to avoid a second surgery to uncover the implant.
Is Implant Surgery Painful?
No, implant surgery is generally a minimally invasive procedure and in most instances the pain is minimal. If more major treatment is required, some post-surgical pain may be present. If you are fearful, we can arrange for you to have a complete pain-free experience either by performing the procedure under intravenous sedation or general anaesthesia within an operating theatre. The mix of drugs given will help you relax, sleep and eliminate pain. You will also usually be given a painkiller to take before the procedure so that you will be comfortable after the surgery.
How long does it take to recover from the Surgery?
After the operation, you may feel uncomfortable but this can be eliminated by taking the prescribed painkillers regularly. Some swelling and bruising is to be expected for a few days after the surgery. You can resume normal activity within a day but should avoid strenuous exercise and swimming. A normal or soft diet is advised and can be commenced after the numbness from the local anaesthesia wears off, usually around 2-3 hours after the procedure to avoid biting your lip or tongue inadvertently.
Same Day Teeth Replacement
Rationale for immediate tooth replacement
Losing a tooth, especially one of our front teeth can be very distressing for most patients. In addition to the effect on appearance and confidence, it affects our speech and on the long-term, the gums and the supporting jawbone will also shrink. A common request from our patients is to get a replacement for their missing tooth immediately, hence the advent of protocols for "same day teeth replacement". This could be done by partially loading the implant on the day of the surgery, or more commonly by using the adjacent teeth as temporary supports.
How long does it take for healing after tooth extraction and implant surgery
Teeth extraction and implant surgery are fairly routine and painless procedures and you will feel back to normal in just a few days. However, it takes around three months after tooth extraction for the bone to reform before placing an implant. In addition, it takes a further three months for the bone to grow around the implant in order to anchor it firmly in the jaw. During this waiting period, removable dentures, or temporary bridges made of plastic are used to prevent direct forces on the implant allowing the implant to heal.
Can this waiting period be shortened
Yes, it is possible to reduce this waiting period as implants can often be placed immediately into extraction sites for patients with missing front teeth. This reduces the waiting times significantly. In general, we are able to place implants to replace our front teeth on the day of extraction as there is usually adequate bone around and beyond the tooth socket to stabilise the implant. For back teeth, it is not always possible as there is usually insufficient bone after removing the tooth. Very often a bone graft will also be needed and is therefore a more technique sensitive procedure.
Immediately Loaded Implants
If the implant lies firmly within bone, it is possible to even allow partial loading immediately after the surgery. In combination, with the latest computer assisted techniques, it is possible to deliver aesthetic looking temporary teeth in selected cases within 3 hours after the surgery. The patients are however advised to avoid chewing on the implant, especially in the initial weeks after the surgery when the original bone anchoring the implant would have been resorbed with the new bone yet to form.
Is immediate loading of implants a new technique
No, the first controlled study of successful immediate loaded implants was published in 1997 after a successful 10 year study. Our lead clinician has been placing immediately loaded implants since early 1999. The success rate of immediate implants are comparable to that of implants placed using conventional protocols but is more technique sensitive as it requires the dentist to determine if the initial stability of the implant is sufficient for immediate loading. Done selectively, it is a useful option for patients with no other remaining teeth to anchor a temporary denture or bridge.
Dentistry
At Precious Medical, Paragon, our dental surgeons offer a range of dental services in Singapore, from general and cosmetic dentistry to dental implants, oral surgery and bone regeneration. In addition to basic preventive dentistry such as regular teeth scaling and polishing, our dental specialists also provide more complex treatments such as implant placement, smile makeovers using 3D computer assisted technology and pain-free dentistry under intravenous sedation. We cater to both children and adults and we are also a certified provider of Invisalign® clear aligners as well as conventional "braces". We work with maxillo-facial plastic surgeons in the surgical correction of jaw misalignment, and with specialists in the field of sleep disorders, jaw growth and development.
Our Facilities
Our dental clinic is located on level 12 of Paragon Medical in the heart of Orchard Road. We are part of Precious Medical Centre, a multi-disciplinary specialist centre which provides a one-stop solution including general practice medicine, health screening, diagnostic imaging including MRIs and CT scans, and operating theatres for endoscopy and day surgery procedures.
In-house Dental Laboratory
Our in-house lab is able to produce porcelain fillings, veneers, and crowns within hours and a customized smile makeover in only a few days
General Anaesthetic Operating Theatre
Our general anaesthetic operating theatre for dentistry allows us to perform a range of treatments for children and medically compromised adults
Our Philosophy
We believe in a patient-centric, problem solving approach to dental care. Having been in private practice since 1987, we understand the needs and demands of our patients and try our utmost to address them. The following are the common concerns:
Yellow or Discoloured Teeth
Tooth Whitening (Bleaching)
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In-clinic Laser treatment
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Take-Home Whitening Kits
Veneers
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Porcelain same day veneers
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Zirconia veneers for deep discolourations
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Composite veneers if cost is an issue
Missing Teeth
Implants
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Titanium rods placed directly into bone to replace missing teeth
Dentures
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Traditional removal plastic or metal supported dental plate
Fixed Bridges
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Using Teeth next to the gap to support the replacement
Cavities / Tooth Decay
Tooth Coloured Fillings
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Using composite resin as fillings
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Cosmetic porcelain or zirconia fillings
Crowns - Computer designed and made
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Porcelain same day fillings
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Zirconia fillings for higher strength
Crooked Teeth
Aligners or braces to straighten teeth
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Invisalign for adults and teenagers
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Early interceptive treatment for children
Veneers & Crowns - "Hollywood Smile"
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Reshape, Resize and Re-align within days
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Change facial profile and proportion
Gum Problems
Bleeding Gums
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Scaling, Polishing and Prophylactic Jet
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Root Planing and deep or surgical cleaning
"GummySmile"
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Lip repositioning Surgery
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"Crown lengthening surgery"
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Botox to Upper Lip
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Braces
Our Dental Surgeons
Dr William Chong
Aesthetic & Implant Dentistry
BDS (Singapore)
Master of Science in Dentistry (Singapore)
FRACDS (Australia)
Dr. William Chong graduated from the National University of Singapore in 1985 with distinctions in Medicine, Oral Surgery and Operative Dentistry. He was accorded both the Singapore Dental Association and the Malaysian Dental Association’s Silver Medals, honours reserved for the top student in the fields of Medicine and Oral Surgery respectively. He was further awarded the University Bronze Medal for achieving overall 2nd in the National University of Singapore’s Final Professional Examination.
More about William - www.drwilliamchong.com
Dr Chan Chee Hon
General Dental Surgeon
Bachelor of Science (Neuroscience) (UWA) Bachelor of Dental Surgery (HONS) (NUI)
Dr Chan Chee Hon graduated from the University of Western Australia with a Bachelor’s degree in Neuroscience. Following this, he pursued his studies at the National University of Ireland (University College Cork) and qualified with Bachelor of Dental Surgery (Honours). He was conferred the distinguished title of College Scholar for outstanding academic achievement and the Irish Dental Council award for being the top student throughout the clinical course.
Dr Joey Donovan
General Dental Surgeon
BDS (Ireland)
DClinDent (Orthodontics) (Ireland)
Dr Joey Donovan graduated with an Honours Bachelor’s Degree in Dental Surgery and subsequently, a Doctorate in Clinical Dentistry in Orthodontics from the National University of Ireland. He was also awarded a Diploma of Membership in Orthodontics from the Royal College of Surgeons in England. His practice is limited to orthodontics, including clear aligners, growth modification appliances, as well as traditional metal, self-ligating and ceramic braces. He is particularly keen on interceptive treatment for younger children and adolescents.
Dr Reuben How
General Dental Surgeon
BDS (Otago), MClinDent (Orthodontics),
M Orth RCS (Edinburgh)
Dr Reuben How graduated from the University of Otago, New Zealand with a Bachelor of Dental Surgery in 2000. He pursued a Master's degree in orthodontics at the University of Edinburgh, followed by further certification from the Royal College of Surgeons, Edinburgh. Dr Reuben was previously involved in undergraduate and postgraduate teaching at the Universiti Kebangsaan Malaysia (UKM). His area of special interest is in both the biomaterial as well as functional aspects of clear aligners, and the use of micro-implants in the management of complex orthodontic cases
Available Dental Services
General Dentistry
Dental hygiene is an essential part of your well-being, as infections from teeth and gums can affect your general health and quality of life. Prevention begins from childhood and regular check-ups, teeth cleaning and daily home care reduce the risk of cavities and gum disease.
At Precious Dental, we offer a wide range of general and specialised dental services for you and your family, as part of our holistic approach to total health. This includes routine cleaning, fillings, root canal treatment and extractions. Our team also manages more extensive treatment such as teeth alignment with clear aligners, cosmetic dental procedures, crown and bridgework, gum treatment, dental implants and wisdom teeth surgery.
Children's Dentistry
Introduce children to dentistry early to give them a positive start to dental care. Your child's first tooth appears at around 6 months and can quickly decay without proper home care or supervision. Bring your child for a check-up between ages 1 and 2 as all their milk teeth will already be in place before they reach 3 years of age. At age 6 the permanent teeth will emerge and replace the milk teeth progressively. As your child grows, it is also important to assess jaw development and plan for braces if needed.
Scaling & Gum Treatment
Scaling is the term used by dentists to remove the hardened deposits that form on your teeth. These deposits, known as “calculus” or “tartar”, form when the natural calcium in our saliva mixes with the bacteria in our mouth and food debris. Starting off initially as a soft mix called “plaque”, it hardens over time and becomes difficult to remove, causing our gums to bleed and teeth to become shaky. At that point “root planing” is required. This more focused procedure to remove the hardened deposits on the root surface below the gum margin is commonly referred to as gum treatment.
Dental Fillings
Fillings are specially selected dental materials used to fill cavities or defects in teeth as the result of either tooth decay or damage by excessive force. Different types of materials including metals, composite resins, porcelain and zirconia have been used. As the strength, durability, biocompatibility and aesthetic properties are vastly different, the choice of filling material depends on clinical and patient factors including cost. The decayed portion is first removed and the remaining tooth structure then prepared by shaping the cavity and refining the margins before inserting the filling.
Root Canal Treatment
Root canal treatment is the procedure which removes the injured or infected tissues from within the central core of the tooth, known as the pulp chamber and root canals. This is then followed by disinfecting and reshaping the canals before sealing them off from the rest of the body using an inert material and cement. Unlike fillings or crown which repair tooth structure, the objective of root canal treatment is to stop pain and infection. As the canals are fine and require careful manipulation, the use of a special microscope to ensure adequate visualisation during treatment is useful.
Wisdom Teeth Extractions
Wisdom teeth are the last teeth to erupt in our mouths and only appear between ages 16-24 years of age. As most of our jaws do not have enough space for it, they often do not come fully through and are not functional and may cause pain and infection. The term used to describe this situation is that the teeth are “impacted” and the resultant infection is termed “pericoronitis”. In most cases, a surgery is required as the tooth is usually partly covered by the overlying gum and partially buried within the jawbone.
Mouthguards, jaw pain and headaches
Mouthguards are plastic shields which fit over your teeth to act as a cushion or shock absorber in order to protect your teeth from injury. While most understand the need to wear these protective guards during contact sports, damage to our teeth also occurs slowly over time as a result of either habitual clenching of our teeth during the day, or subconscious grinding of our teeth when we are sleeping. This habit, termed bruxism, will over time cause damage and pain to our teeth and jaw joints and may even lead to frequent headaches.
Cosmetic Dentistry
A smile is the first thing you see when you meet a person. In this day and age, how we look is important for our social life and confidence. It is not merely about vanity, but it also affects our personal and professional aspirations and relationships. The shape and proportion of our face is affected by the position of our teeth which provide support for our lips and cheek. In addition, correct alignment, angulation, shape, size, proportion and colour of our teeth provide the balance and harmony which is the essence of facial aesthetics.
We can straighten our teeth through the use of braces or clear aligners and whiten our teeth through the use of various bleaching agents. If our teeth are decayed, badly discoloured, or if a faster solution is required, we can consider the use of veneers and crowns to attain a more ideal result, especially if our expectations are high. In addition, care must be paid to the health, level and symmetry of our gums. Whether you wish to whiten your teeth, change their shape, size or alignment, re-sculpt your gums or adjust the bite, we are committed to helping you gain the look you wish for.
Laser Teeth Whitening
Our teeth get discoloured over time especially if we consume coffee, tea and red wine. We can reverse this by applying a special gel to our teeth and leaving it to bleach or whiten over time. This can be done at home using a custom-made mouthguard. The effects are usually seen after 2 weeks. Alternatively, it can be done in the clinic using a laser or blue LED light or laser over one or two sessions, each lasting an hour or less. Laser teeth whitening takes the least time to achieve a satisfactory result. If the stains are very deep or dark, porcelain or zirconia veneers or crowns may be required.
Porcelain Fillings
Porcelain fillings are made from strong and natural looking ceramic material which are long-lasting and biocompatible. In combination with accurate scanning and computer processing technology, it can be made within hours, provide a better fit and require the dentist to trim less of the remaining tooth structure when compared to conventional crowns. It can also be made to match the colour of the surrounding teeth. The use of new generation cements which are adhesive and radiopaque allow better bond with the remaining tooth and allow dentists to check the fit and seal of the crown.
Veneers
Veneers are thin tooth-coloured shells which are custom made to fit over the front surface of a tooth to improve the shape, size, colour or alignment of the underlying tooth. They can be made of a variety of materials such as composite, porcelain or zirconia. While they are done mainly to improve aesthetics, they can also be used to repair front teeth which have fractured or have large fillings. Veneers are also preferred by many when compared to crowns as much less of the tooth is trimmed resulting in less sensitivity.
Dental Crowns
Dental crowns are customised shells made from various dental materials to fit over cracked or broken teeth in order to rebuild them to its original form. In the past, metal or gold was often used but in today's age of social media, tooth-coloured materials such as porcelain or zirconia which are strong, yet aesthetic is the popular choice. They are also known as “caps” and besides protecting teeth that are weak, can also be used to change the shape, size and colour of teeth for cosmetic dental purposes.
Clear Aligners & Braces
Clear aligners is a method of straightening crooked teeth without using traditional braces. It utilises custom made sheets of thin plastic which fit over the teeth like a mouthguard rather than metal brackets and wires to apply a controlled force on teeth which are out of position to push them back into proper alignment slowly over time. Each aligner is made to move the teeth incrementally back into position and is worn for about 2 weeks before changing to subsequent aligners until the teeth reach their planned final position. Of the many types available in the market, the best known is Invisalign®.
Teeth & Gum Reshaping
In addition to a well aligned set of teeth, the shape, size and proportion of teeth as well as gum contours and symmetry also contribute to a pleasing smile. The size of our natural teeth may sometimes be either too large or too small, and the shape may appear too bulky, or conversely too sharp. In addition, excessive gums may also show when we smile and if the gums which show are at a similar level
Implant dentistry is regarded as the preferred form of tooth replacement as it allows a permanent fixed alternative to removable dentures and functions like your own teeth. It is comfortable, feels natural and allows you to enjoy your food better. With new surgical techniques and intra-venous sedation, it is now a much simplified and almost painless procedure.
Implants & Teeth Replacement
Dental Implant Surgery
Teeth serve an important role in our daily lives as it affects our speech, our ability to eat well and the way we look. Its loss through disease or trauma sets in motion the loss of underlying bony support resulting in tooth loss. This in turn affects support for our lips and cheek leading to a more aged appearance. Failure to replace missing teeth often leads to the opposing teeth overgrowing and the adjacent teeth tilting resulting in areas of food trapping which in turn may result in gum disease tooth decay.
Implant Crowns & Bridges
Implant dentistry is a 2-step procedure in which the implant is placed at surgery and the replacement tooth connected after bone healing 4-6 months later. The term prosthodontics refers to tooth replacement and can be either a single crown connected directly to the implant, an “implant bridge” to replace 2 or more missing teeth or even an “implant denture” to replace the full set of teeth when mounted on 4 or more implants. The term “implant overdenture” is used when the replacement denture is supported mainly by gums and underlying bone rather than by the implants placed.
Same Day Teeth Replacement
Losing a tooth, especially one of our front teeth can be very distressing for most patients. In addition to the effect on appearance and confidence, it affects our speech and on the long-term, the gums and the supporting jawbone will also shrink. A common request from our patients is to get a replacement for their missing tooth immediately, hence the advent of protocols for "same day teeth replacement". This could be done by partially loading the implant on the day of the surgery, or more commonly by using the adjacent teeth as temporary supports.
Bone Grafts & Regeneration
A bone graft is a procedure where bone is transferred to an area which is deficient in order to create the bulk necessary to place an implant. Bone graft material can either be harvested from near the implant site, or processed from synthetic or other calcified sources. (for example, specially processed cow bone). They serve as the supporting framework in areas of missing bone. Whatever the source, even if it is your own bone, the body would then initiate its healing process and remodel the graft material into fully functional bone.
Dental Bridges
A dental bridge is a long-term replacement for spaces between teeth as the result of tooth loss. The teeth on both sides of the gap are prepared to support a framework on which new teeth are mounted. This is then fixed in position using a special cement and does not need to be removed at night, unlike removable dentures. Dental bridges are also more stable, comfortable and aesthetically pleasing than dentures. Bridges can be used on natural teeth or dental implants. Bridges last on an average between 7-10 years though some may last for up to 15 years or more.
Dentures
Dentures or “false teeth” are a simple and low cost method of replacing missing teeth. They are classified into partial and complete dentures based on whether any teeth remain in the mouth to support and retain them while in use. Prefabricated teeth are attached to a plastic base which may be strengthened by a metal mesh or base and are held in place by wires which grip lightly to the sides of remaining teeth. If all teeth have been lost, the denture will have to rely on a close fit with the gums and soft tissue of the mouth to produce a “suction” effect to keep it in position.