Monday, October 26, 2009

The question for dental implant.

Patient ask :

I heard from internet sources that dental implants last forever. A friend of mine had an implant done a few years ago and now it’s loosening. The dentist says my friend has poor hygiene. If implants last a lifetime, why is it that poor hygiene can cause it to loosen?
Admin answer :

Dental implants MAY last a lifetime. Their durability is dependent on several factors. True, implants don’t decay, but like natural teeth, the gums and bone surrounding an implant can get infected due to poor oral hygiene.

Chronic inflammation “melts” away the bone holding the implant. Even with very good oral hygiene, some of the older designs of dental implants have microgaps inherent in the system which trap bacteria and cause chronic inflammation, giving rise to bone resorption even with good oral hygiene.

With better knowledge nowadays, dentists are less likely to use systems which have microgaps. Still, inflammation and bone resorption will set in if implants are not properly maintained.

Sunday, October 25, 2009


About Teeth whitening, have you ever wondered why almost every hunk or babe in the TV series Baywatch had such glistening white teeth? Well, of course no one would have paid too much attention to Pamela Anderson’s teeth, but the worst kept secret in Hollywood is, they all had their teeth bleached. That pearly white, “starry” smile used to be called the Hollywood smile. And it used to cost thousands of US$. Not anymore. The Hollywood smile has descended to the realm of mere mortals. Not only is tooth whitening readily available in dental practices all over the developed world, the cost for the procedure, like the US$, had come tumbling down.

The Bleaching Conspiracy?
The moment tooth whitening became a mass market thing, something unfortunate happened. Marketing efforts by various manufacturers of dentrifices churned out an array of relatively cheap whitening gels, pastes and liquids which gave consistently poor results. One TV ad even said that with their product, nobody would ever need to pay their dentist hundreds of dollars for whiter teeth. Hardly any one of those products is still being sold in Singapore. Why were these products ineffective? Because the strength of peroxide (the active ingredient in bleaching gels) in them is too low. Meanwhile, at the dentist’s office, fanciful “laser whitening” procedures were performed. These procedures seemed to work very well, but within days, the teeth started yellowing again. In the end, they only worked marginally better than the OTC products but cost many times more.

Back in the good old days (20 years ago) dentists were taught that only non-vital, root canal treated teeth could be bleached. In those days, we would open up the pulp chambers of non-vital teeth, place hydrogen peroxide into the chamber and then, heat up the potent solution with a hot instrument. The whitening effect came fast and was very effective. Every science student can tell you that heating up hydrogen peroxide will cause it to decompose into oxygen and water. It’s the heat that speeds up the process and release whitening oxygen into the microscopic pores in the inside of the teeth.

Then, vital bleaching hit the market not long after I first started practising. Suppliers started telling us that even vital teeth which have not been root canal treated can be bleached with peroxide gel applied on the outer, non-porous surface of the tooth. It didn’t sound probable, but the “magic light” suspended our disbelief.

Fanciful light equipment like plasma arc lights, LED lamps, lasers etc burned holes through many a dentist’s pocket. It turned out that many dentists have either forgotten their basic sciences or somehow decided to go along with the suppliers’ marketing strategy. Light does not activate peroxide decomposition. Not plasma arc light and definitely not LED light which is cool. It’s heat that does it, so perhaps laser does work, but we can’t use heat on vital teeth or we’ll kill them. As far as bleaching is concerned, a safe, non-heat-generating light is a useless light.

Not only were some of these equipment bulky and expensive to rent, the hype generated by aggressive marketing tactics resulted in unrealistic expectations on the part of both dentists and their trusting patients who have paid about S$900 to S$1200 for mediocre results.

Tooth whitening with carbamide peroxide has been around for almost as long as I've been practising dentistry. However, very few dentists had their bleaching products flying off the shelves. I was curious enough to have tried out a wide range of products, encountered almost every kind of tooth discolouration and after countless complaints and praises, I more or less figured out some of the realities of tooth whitening. It’s not magic. It works for the majority of people but the degree of whitening varies from individual to individual. It doesn’t work for just anybody. Maybe that’s why not every lifeguard you see below is smiling. And the expensive, fanciful equipment are a big rip-off.

Thursday, October 22, 2009

Cost of tooth whitening @ my clinic

Cost of tooth whitening at my clinic starts from $400 for a customised DIY tooth whitening kit. Come for impression taking and wait for just one hour to collect the kit. No second visit required.

9 applications, can be completed in 4.5 days if you do it twice a day, one hour each time. The bleaching trays are super thin and virtually invisible, so you can wear them on your way to work or while you're watching TV.

Why save bad teeth?

Controversial topic, but definitely worth discussing. I’ve often come across patients keen on saving teeth which are virtually hopeless. Of course, there will be dentists out there who are willing to take on these cases. Most of these cases are extremely challenging, prone to failure and expensive. Should these teeth still be saved? I think the patient needs to make a very well-informed choice and come to a decision accepting responsibility for the outcome.

There will be some successes in salvaging one of these “hopeless” cases, but neither practitioner nor patient should be carried away by all the hype in “new technology”. Take a look at the case below. The best option for this patient (and I would do it for my own mother) is to extract those 3 lower front teeth abd replace them with implants. But there are patients and dentists out there who would take up the challenge save those teeth. It’s OK as long as everybody understands the outcome and long-term stability of such measures.

Why Save Bad Teeth? Dental ‘Heroics’ Unnecessary And Failure Prone
29 Aug 2009

For years, it was common practice for dentists to perform repeat root canals and other procedures to save teeth compromised by extensive decay, gum disease and bone loss. Today, the American Academy of Implant Dentistry (AAID) said times have changed and patients should forego prolonged dental heroics to save failing teeth and replace them with long-lasting dental implants.

“There really is no justification for undergoing multiple endodontic or periodontic procedures, and enduring the pain and financial burden, to save a diseased tooth,” said John Minichetti, DDS, speaking for the AAID. “The days are over for saving teeth till they fall out. Preserving questionable teeth is not the best option from both oral health and cosmetic perspectives.”

Losing a tooth is an emotional decision and patients must clearly understand the oral health and cosmetic implications of preserving questionable teeth. Even though patients often resist losing natural teeth, in many cases the best outcomes occur from extracting them and inserting implants, which look and function like natural teeth.

“Our patients expect restorative dental procedures to make their smiles more attractive and long- lasting. In most cases, implants deliver the best results, as the ultimate goal is to achieve an esthetic and functional restoration for years to come,” said Minichetti.

Published studies have shown there is a higher failure rate of root canal procedures vs. dental implants. In some cases, root canals fail because abscesses occur, and oral surgery is required to clean out the infected area.

Minichetti noted that a recent study published in the Journal of Oral Implantology showed that single-tooth dental implants are 98.5 percent successful after seven years and there was no discernable bone loss in almost all the implant sites. First-time root canals fail 5 percent of the time, according to the American Academy of General Dentistry, and at much higher rates in repeat procedures. Further, endodontic surgical re-treatments, according to published studies, have success rates ranging from 37 to 87 percent.

Saving compromised teeth in the esthetic zone with periodontal treatments also can have unfavorable cosmetic results, according to Minichetti. “Periodontal procedures to save decaying natural teeth can require raising the gum line and exposing teeth roots to anchor a new crown,” he said. “The crown needs something to hold onto, so you have to push the gum tissue up with unfavorable cosmetic impact.” He noted that patients should always ask the dentists how their smiles will look if they chose to save a questionable tooth in the esthetic zone with a periodontal procedure.

Source: American Academy of Implant Dentistry

Tuesday, October 20, 2009

The food Kingdoms

Not long after Kaelyn Ong gave a not so flattering review for the cakes and desserts at a shop at Joo Chiat called Obolo in her popular food blog, she received an email from the folks at Obolo telling her to remove the posting or run the risk of being sued.

Sued? For what? For not liking their cakes and telling others about it? It doesn’t take an legal expert to see that Obolo may have been a bit ahead of itself. We haven’t heard Stephen Speilberg suing movie reviewers who said unflattering things about his work. Yes, J.K. Rowling has sued people for plagiarism, but I’ve never heard her sue any reviewer or hater who didn’t like Harry Potter. What about Governor Arnold Schwarzenegger? Has he sued anybody for laughing at his acting and his not so intellectual movies? Why are our local cake shops behaving like some of our local politicians then?

Maybe I’ve already answered my own question. But unlike the pitifully tenacious politicians at the receiving end of endless lawsuits, Miss Ong drew a tide of supporters on her side. Obolo was blasted for its bullying tactics. Everyone was calling for a boycott.

So why did Obolo do such a silly thing? Because they thought that as a young undergrad, Miss Ong would get frightened, give in to their threats and do as told? Well, that might have worked with me when I was Miss Ong’s age. But times have changed. Miss Ong’s defiance spoke volumes of the youngsters today. You can’t push them around anymore.

But then again, something didn’t and won’t really change. In spite of all the bad publicity, Obolo is unlikely to suffer much. That’s my prediction. Why? Because foodies are cheap. The endure rudeness, arrogance and profiteering from “good” hawkers just to get their fix. And just before I wrote this blog entry, I was at a noodle stall at Lucky Plaza. I ordered a chicken noodle and it took them ages to deliver. It’s only when i stared angrily at the other customers who got their food before me that they bothered to explain the cause for the delay - by shouting across 4 tables. When my food finally arrived, they didn’t even bother to apologise. In spite of such rudeness and arrogance (and their food is not exactly great), the stall still sees an enless stream of customers. Courtesy and good service are not criteria for success in this food business here. Every successful stall swarming with customers and long queues probably sees itself as a little kingdom and the hawkers running them act like kings.

I dare now imagine how I would be treated if their soy chicken were a bit more tender and their gravy a little more flavourful. The photo below is not taken at the stall I patronised. The last thing I want is to advertise for them.

Monday, October 19, 2009

Dental Implant Charges @ Dental Clinic

Sleeping implants $300 cash $900 Medisave.

Implant placement + abutment placement + porcelain fused to metal crown using Osstem®/Dentium® implants S$3000 (S$900 payable with Medisave)

Mini implants + porcelain fused to metal crown for lower front teeth S$2500 (not Medisave claimable)

Full ceramic (zirconia) crown using Osstem®/Dentium® implants S$4000 (S$900 payable with Medisave)

Multiple unit PFM bridge (4 implants, 10 teeth) S$14,000

Multiple unit PFM bridge (6 implants, 12 teeth) S$18,000

Implants for denture support S$2500 each (minumum 2)

Additional Procedures (applicable to some cases only)

Bone grafting procedure to thicken ridge using Biogen® or Synthograft® S$500-S$1000

Internal sinus lift procedure using Biogen® or Synthograft® S$500

Sinus Grafting procedure using Biogen® or Synthograft® S$1000

Additional soft tissue graft using Alloderm S$300-S$800 (depending on size)

Saturday, October 17, 2009

Another feed back from our patients

This two patients did treatment with us and I accidently found our patient's feed back from Thanks Valley Yong and Mangoes.

Below is what I got from revahealth webpage.

From : Valley Yong,

"Of course I will go back"

Valley Yong, from Malaysia.
Were you pleased with the treatment?

My wisdom tooth surgery was done by Dr. Chan. It costs me $450. Well, I think this is a reasonable price.

Would you recommend the clinic?

The assistants is very polite and gentle.

Would you return for further treatment?

Of course i will go back to visit him. I have appoitment with Dr. Chan every six months.



100% Communication

This review has been verified by

From : Mangoes,

"I will recommend the clinic to my friends"

Mangoes, from Singapore.
Were you pleased with the treatment?

Scaling and Air Polishing + Teeth Whitening

Would you recommend the clinic?

Yes, of course, I will recommend to my friends.

Would you return for further treatment?

I will go back to see dr. Chan every six months.


Teeth Whitening

Treated By

Treated by Dr Chan Joon Yee in Singapore

by :

Information About Dental Implants

A dental implant is an artificial tooth made from titanium for replacements missing teeth.
But how much do you know about the implants?

Different implant systems or brands have different connections and configurations, but most of them have similar components or parts. The part that is often called the implant or the fixture, is the titanium screw that you see on the left.

The first stage of implant surgery is always to place the fixture into the bone. Obviously, the implant practitioner cannot just drill into the jaw bone blindly. He/she must look at xrays and determine a safe region in the jaw to place the fixture without perforating bone and causing any damage to vital structures.

After a hole is drilled in the jaw bone, the surgeon selects an implant of appropriate length and diameter and then proceeds to drive the implant into the bone. If bone width and quality are good, the implant will present good initial or primary stability. Implants which have gained good initial stability even before they have fused with the bone have a 98% rate of successful integration.

After implant placement, a healing period must be allowed. For the lower jaw, this is usually 2 months. For the upper jaw, it is usually 3 months. For bone grafted implants without good initial stability, it may take 6 months or more.

Once the implant practitioner is quite certain that the fixture has integrated with the bone, he/she will proceed to the next stage of implant restoration.

If the surgeon is confident of the bone quality and done a one stage surgery, an abutment can be directly connected to the implant. If the implant fixture has been covered with gum during the surgery, it must first be surgically exposed before the abutment is connected.

After connection of the abutment, it will be obvious that the implant is present even though it is hidden beneath the gums. The abutment projects from the gums and forms a pillar of sorts for the fabrication of a crown. There are many ways in which the restoring dentist can prepare the crown. The simplest and most straightforward method is to take an impression of the abutment and then cement a crown over it. Another method is to build the crown into the abutment itself and screw the crown-abutment complex into the fixture. These crowns are screw-retained instead of being permanently cemented.
Cemented crowns are can be very economically fabricated, but once permanently cemented, there is no turning back. Screw-retained crowns and bridges can be removed by the dentist for periodic maintenance. However, they are more costly to produce.

In an ideal situation, the crown covers over all the metal of the abutment. This situation is not always sustainable. Metal may be exposed due to wear or to bone resorption after several years.

Tuesday, October 13, 2009

What is bone grafting?

When a patient goes for dental implant consultation, a topic that frequently pops up is the issue of bone grafting. What is bone grafting and why is it so important? Our natural teeth are supported by bone. Once teeth are lost, the bone loses its purpose and function. The result is resorption. Anybody who has lost all his teeth will have sunken lips and cheeks. Unfortunately, implants also need good bone in order to stay firmly embedded in our jaws. For individuals who have lost their teeth for a long time, the bone is often not ideal for implant surgery. To solve this problem, dentists use a technique called bone grafting.

How is bone added to one’s jaws? The procedure is a surgical one. The dentist must first separate the gums from the underlying bone and then place a matrix over the exposed bone. This matrix will form a framework for the bone cells to build on. Grafting materials may be divided into the following categories.

1. Autografts are “real bone” taken from a donor site to be transplanted on a receptor site in the same individual. As it is the patient’s own bone, there is no chance of rejection. This sort of bone represents the gold standard for grafting materials. The most obvious disadvantage is that you’re robbing Peter to pay Paul. Instead of just one surgical site, there are now 2 sites. The pain/morbidity is often increased.

2. Allografts are materials derived from another individual of the same species. The donors are people who have pledged their organs before their death to better the lives of other others. Of course, bones from dead people must be thoroughly sterilised before they can be used on living people. After grafting, this sort of material is eventually replaced by the host bone.

3. Xenografts are much more often used used than allografts. These materials are processed from animal bone. Cows and horses are the usual sources. Like allografts, they are thoroughly sterilised. They are very safe and no known case of mad cow disease arising from bone graft has been reported. With time, the grafted animal bone will also be converted to host bone.

4. Synthetic Bone can be made from coral, ceramics or different forms of calcium phosphate. The obvious advantage is the safety from cross infection. Rejection is not a serious concern, but synthetic bone will never be completely resorbed and replaced by host bone. Particles of synthetic bone form a matrix around which the host bone will grow. The grafted area will always contain synthetic bone particles embedded in host bone.

How much does it cost for taken out wisdom tooth?

How much does it cost for taken out wisdom tooth?
If you want to remove wisdom tooth we charge from $450 and above, it depends on the position on your wisdom tooth.

Many patients call up and ask me how much my dentist will charge them for wisdom tooth surgery. If you already done with your X-ray , you can refer to the photo as below.

May I know it there any extra charges?
No, This charges is already included x-ray, medicines, gauze, mouth wash and when you come back for remove stitches.

Can I use my medisave for wisdom tooth surgery?
Yes, most of our patients can claim full amount from the medisave.

If I don't have medisave , what should I do?
Our clinic accept cash, net , visa , amax and diners club.

Do I have pay deposit or payment if I go for wisdom tooth surgery?
No, you no need to pay deposit just bring you Ic along before you are going for surgery.

Can I use my husband medisave?
Yes, you can use your spouse and your parents medisave. But if you need to use your spouse or your parents medisave please bring them come a long with you and his/her Ic .

Is very painful or not? I am very scared .
If your very scared/nervous of pain you can required for GA (general anaesthetic) but you have to pay extra $650/hour.

Monday, October 12, 2009

Can you tell us , what's the difference?

This yoga instructor has been very self conscious about her less than perfect smile. Take a close look and you'll see what's the difference?



Looking good starts with a great smile today!

This yoga instructor has been very self conscious about her less than perfect smile. Take a close look and you'll see why.

Her problem is quite obvious. Her left central incisor is somewhat elongated.
There is also quite a big gap between her left incisors.

The obvious solution is to trimmed down the elongated teeth after root canal treatment.

The gap is even more obvious now that the teeth have been trimmed shorter.

Note also that the two central incisors are not in alignment. We recommended 3 emax crowns for this patient.

Here are her finished emax crowns. Note the vast improvement. However, the patient finds her right lateral incisor a bit short and sunken.

To create some semblance of symmetry, bonding was done to prop up the lateral incisor and also to lenghten it.
Here are the results. The lateral incisor looks good for the moment, but bonded teeth may stain or chip over time.
A veneer would be ideal for that bonded tooth.

Which dental implants brands is suitable for you? (2)

Osstem Implant
Osstem implant made in Korea.
The cost about $3000 - $3500.

Friday, October 9, 2009

Grinding teeth

For those who think that "grinding teeth" is a simple task. These are just the norms and guidelines for standard crown preparations. Variations to the norms must be creatively made by the dentist in non-standard cases . When it comes to bridges, there is an added element of alignment that has to be taken into consideration. Dentistry is not just about "grinding teeth".

Thursday, October 8, 2009

The risky wisdom tooth sugery cases.

Not directly related to cosmetic dentistry, but we often get referrals from orthodontists to remove wisdom teeth.  Most wisdom tooth surgeries are uneventful.  However, due to anatomic variations, vital structures may sometimes get in the way of the surgeon.

Nerve injury will then be a possible risk. Check out this article and learn how to assess your own risk from your x-ray.

Wisdom teeth can be troublesome. The last teeth to erupt in the mouth, they often end up half buried, hitting against the next tooth or even lying down horizontally. A variety of problems will follow when these teeth fail to erupt properly. Some “deviant” wisdom teeth can trap food and cause bad breath. That’s not all. If these food traps are not properly cleaned out, decay and gum infection will follow.

Ouch! That sounds painful already, but left untreated, wisdom teeth can cause even more painful damage. Many people end up losing the next tooth. Some suffer from recurrent gum boils. In most cases, the best and perhaps only treatment is the surgical removal of that “deviant” tooth.
Different kinds of impaction will require slightly different techniques. In practically all cases, the gums will need to be cut. Next, the bone surrounding the tooth may need to be trimmed away. For the simple cases, the tooth can be removed at this juncture. If the tooth is angulated against the tooth in front, s further step is necessary. The tooth needs to be divided into 2 or more parts. The deeper and more angulated it is, the more bone needs to be trimmed and the tooth may also need to be further divided into smaller parts.
Needless to say, some wisdom teeth are more difficult to remove than others. The degree of difficulty and the risk often depends on the depth of the impaction, the angulation relative to the next tooth, the curvature of the roots, the quality of the patient’s bone, any medical condition, oral hygiene and even the attitude of the patient.
Surgical intervention is never a perfect cure. Complications can occur and it may not be because of the dentist’s lack of skill or care. Prolonged bleeding and infection are relatively easy to manage. Much more difficult to manage, would be nerve damage and prolonged numbness.

The xray above shows a high risk, difficult operation which I’ve successfully performed recently. The risk of nerve damage or paresthesia depends very much on the anatomic location of the nerves relative to the wisdom tooth. The closer the nerve to the tooth, the higher the chance of nerve damage during surgery. The dentist will be able to assess the risk of nerve damage to the inferior alveolar nerve from your xray. This nerve runs in your lower jaw bone and hence, its entire course in the bone is almost always visible in a panoramic xray. If your dentist uses digital xrays, you may bring a thumb drive to copy the file and see for yourself where the inferior alveolar nerve lies.

I’ve traced out the course of the nerve in the above patient for you just in case you can’t see or identify it. If the nerve is close by, it would mean that the chances of nerve injury will be high. If the tooth is not giving any problems, leave it alone. If it’s troubling you or if it is necessary to remove it for orthodontic treatment, then you must weigh out the risk versus benefit. To do that, you must be aware of the consequences of nerve damage.
1. Feeling of numbness of the lip and chin even after the anesthesia has worn off.
2. Drooling.
3. Inability to hold food at one corner of the mouth
This has to be one of the trickiest wisdom tooth surgery I’ve done. Nevetheless, I was cautious and made sure that the nerve was not cut. After surgery, the patient above suffered loss of sensation on the left side of her lip and chin. The numbness recovered partially after a few days. Near complete recovery was felt after 2 weeks. The nerve was probably just slightly displaced during the surgery.

Check out this other xray. This surgery took me more than one hour. Technically, it was more difficult than the other surgery you saw earlier. However, the nerve seems somewhat further. Do you know where it is?

It’s been traced out for you in the xray above. After the anesthesia wore off, this patient experienced a loss of sensation on her left lip just like the other patient. However, this patient recovered fully in just 2 days. The nerve was obviously just minimaly disturbed.
Thankfully, I have not encountered a single case of permanent nerve damage in almost 20 years of private practice. Many patient’s who have undergone a particularly difficult or risky surgery would experience prolonged numbess for a day or two. Some recovery after a week or two. The majority would have recovered after a month. The longest a patient ever took to recover from numbness under my care, was 6 months.
Looking at these figures, nerve damage certainly doesn’t seem as frightening as it sounds. Nevertheless, it is important to note that even in the hands of the most skilled and experienced practitioner, something unexpected can happen. If your xray looks anything like those above, you should do a risk assessment with your dentist to determine if you would like to go through with it.
Having said that, the majority of wisdom tooth surgeries (over 98%) heal uneventfully. Note that these two cases are atypically complicated.

Friday, October 2, 2009

Wisdom tooth

The wisdom tooth is the third molar.  Most people have one in each quadrant of the mouth but some people also have four wisdom teeth  - two in the upper jaw and two in lower jaw.  However, it is not uncommon to find individuals with less than 4 wisdom teeth. 

Because this tooth usually erupts when the person is about 16 - 21 years of age, it is called the wisdom tooth. In reality, the tooth is often non-functional or even problematic. 

When there is insufficient space in the jaw for the tooth to emerge fully, the wisdom tooth may get trapped under the gum and bone. Partial eruption makes the tooth susceptible to gum infection which may result in recurrent bouts of pain and swelling. Left alone for long periods, chronic gum infection can lead to fibrous growths or cyst formation.

In certain cases, the tooth may be slanted against the next tooth - the second molar. The resulting gap between the two teeth traps food and promotes bad breath as well as decay.

This OPG  X-ray depicting four impacted wisdom teeth, you can see two wisdom teeth in the upper jaw and two wisdom teeth in the lower jaw.  In this case for the upper no need required surgery but for the lower one required surgery anywhere if  you are Singaporean or Singaporean PR   the total of this surgery  you can use your  medisave for both of this surgery. (Full amount, No need cash, No need deposit required )