From braces to beauty

Orthodontic treatment is used to correct misaligned or over-crowded teeth to provide a beautifully straight smile.

It can also help to correct problems with the bite and to improve facial contours.

We offer a full range of orthodontic treatment for both adults and children, including virtually invisible lingual braces and Invisalign™ aligners and ‘self-legating’ braces that radically reduce treatment time.

Who would benefit from Orthodontic treatment?

• Are you teeth noticeably crooked?
• Do you have gaps between your teeth?
• Are your teeth crowded?
• Do you have protruding teeth?
• Do you have a deep overbite?
• Do you have an open bite (where some teeth cannot be brought into contact)?
• Do you have difficulty chewing food?

Dental management also involves facilitating the replacement of missing teeth with dental implants for example.

The correction of an orthodontic problem can be undertaken at any age and adult orthodontic treatment is becoming much more common.

What is orthognathic surgery?

Orthognathic surgery is an operation to reposition the jaws. (Ortho means straighten, gnathia means jaw in Latin). The operation aims to correct imbalances between the upper and lower jaws.

It is not always possible to correct your teeth and how they bite together using only orthodontics. This is because the bones of your face and jaws, in which the teeth sit, may be out of balance with one another. (For example, you may have a larger lower jaw and a normal sized upper jaw). Orthognathic surgery is able to correct larger jaw discrepancies and improve both the bite of your teeth as well as your appearance by altering the shape of the face.

What will happen at the Consultation?

The consultation is a very important part of your treatment. First, it is an opportunity to meet the consultant and team that will be personally looking after you. Your consultant will also establish the diagnosis and take any necessary x-rays or scans needed to assess the complexity of your case. If your condition warrants surgery then this will be explained to you together with any risks and the general recovery time. We only perform jaw surgery if it is appropriate and if the patient wants it to be done. It is rarely essential to carry out this type of surgery.

The surgeon works alongside a specialist orthodontist who has expert knowledge in this type of treatment. Both the surgeon and the orthodontist will formulate a treatment plan to give the best possible result for you.

It is usual for you to need orthodontic treatment as well as surgery. It is important to use braces to move the teeth to make sure that they will meet together correctly after the operation. Usually, fixed ‘train-track’ type braces are fitted about 18 months before surgery. They are worn for up to 6 months afterwards until the teeth are finely adjusted and stabilised. Lastly, there will be a period when a removable retainer brace is worn that holds the teeth in their new position.

How is orthognaphic surgery performed?

When it close to the time for the surgery the surgeon undertakes final planning with the orthodontist in order to accurately move the jawbones to the required position. Often a 3D computer programme is used based on your scans and X-rays.

The surgery may be limited to either the upper or lower jaw or in some cases both jaws (bimaxillary osteotomy).

In the vast majority of cases all surgery is all done from inside the mouth, so there are no external scars. The jawbones are repositioned and secured by tiny plates and screws made from pure titanium, which remain under the gum.

Immediately following the surgery the teeth are not normally wired together. Small elastic bands are placed between the top and bottom braces to guide the teeth into their new bite after a day or so.

Which type of anaesthetic will be used?

Your consultant will discuss the type of anaesthetic appropriate for your case, taking into account your general health and your previous experiences of having dental treatment. Surgery will require a general anaesthetic which will involve admission to a Hospital, meaning you will be asleep during the procedure.

Preparing to have your surgery

Your consultant will explain how to prepare for your procedure. For example, if you smoke, you will be advised to stop as this significantly increases your risk of wound infection, slowing your recovery. Some types of medication you take may also require special consideration.

Any medication you are taking can be continued unless you are specifically instructed otherwise.

Prior to a general anaesthetic, you will be asked to follow fasting instructions, this means not eating or drinking for some hours prior to the procedure. You will be given specific instructions by the hospital prior to your admission date.

During your consultation the consultant will also explain any risks or complications that can arise from treatment and how they can best be avoided or managed. Your surgeon will give you ample opportunity to ask any questions you may have and ensure that you are happy for the procedure to go ahead. If you are then you will be asked to give your informed consent by signing a consent form detailing the procedure agreed and any specific complications discussed.

Recovery from your procedure

Most patients will remain in hospital for 1 or 2 nights and you should probably plan to be away from work for two – four weeks after you are discharged from hospital after the operation. After the operation you will have some swelling and bruising. This will rapidly begin to subside over the first 2 – 3 weeks. For operations on the lower jaw it is fairly common to have some numbness of the lower lip for some weeks or months afterwards. In a very small number of cases a residual area of numbness will remain. This numbness will not affect movement of your lip, only the feeling in it, in a similar way to an injection at the dentist. As with any operation, you will have to take it easy for the first week or two afterwards. You should therefore expect to be off college/ work for at least this length of time. However all patients recover at different rates and your Consultant will advise you taking in to account your individual circumstances

Risks & Complications

This is usually a very safe procedure which is carried out regularly by specialised and experienced clinical staff. Complications in this type of surgery are, fortunately, rare and may not apply to you but it is important that you are aware of them.

These may include:

Numbness – The lips will be numb immediately after the operation, similar to the sensation of an injection of local anaesthetic at the dentist. Very rarely sensation never completely returns. (The lip still looks and moves normally and only exceptionally does it bother patients).

Infection – The tiny fixing plates are usually left in place permanently. In less than 10% of cases the plates may have to be removed if they become infected but this is usually after they have done their job.

Re-adjustment of the bite – In rare circumstances the bite may require adjusting. This sometimes occurs when the patient wakes up from the relaxed state of the anaesthetic and the strong jaw muscles move the bite. Although the bite may only be a few millimetres out of place, a second operation to adjust the plate fixation may be necessary.

Relapse of the operation – With most patients significant relapse is not a problem. However those who are having complicated surgery (movements of 10mm or more in one jaw, patients previously having had a cleft palate, or those with a particularly unusual bite) a relapse can occur. If relapse does occur, it is exceptionally rare for this to be significant. Your Consultant will discuss the risks that are specific to you in detail at the consultation.

Jaw joint problems – if you have pre-existing problems with your jaw joint this may be temporarily worsened after the surgery.

If you have any questions relating to the above then please do not hesitate to contact us.

Early gum disease is very common.  Usually it can be kept under control by regular hygienist treatments and by a good daily oral healthcare routine.  However, if left untreated, it can progress to become periodontal disease, which slowly destroys the gum tissue and bone which holds your teeth in place.  Eventually your teeth can become loose and may fall out or need extracting.  As well as providing preventative services we offer treatment to bring the disease back under control and to help save your teeth from falling out.

Our periodontal treatments include:

• Periodontal assessment
• Preventative periodontal treatment
• Periodontal or gum disease treatment

The aim of restorative dental treatment is to restore teeth to full health and functionality. Typically, teeth can be damaged by accident, decay or other problems.  Treatment may involve the combination of root canal (endodontic) treatments, gum disease (periodontal) therapy and prosthodontic restoration.  The final restorations may range from simple or complex fillings to crowns and bridges or removable dentures supported by either teeth or dental implants.

The restorative treatments we offer include:

• Biomimetic restoration of teeth with either tooth coloured fillings or porcelain veneers and restorations
• Smile make-overs with bleaching and/or veneers depending on treatment needs
• Treatment of discoloured teeth
• Crowns and bridges on teeth or dental implants.  Both conventional and metal-free restorations are provided according to treatment needs
• Root canal treatments
• Gum disease treatments (Periodontal treatment), either surgical or non-surgical
• Dental implants
• Removable dentures
• Rehabilitation of worn or eroded teeth and dentitions

Dental implants are highly realistic, permanent replacement for one or more missing teeth.  They look and feel very natural and enable you to eat and speak with confidence as well as improving the way your smile looks.

The implant itself is a small titanium rod which is precisely set into your jawbone.  Over time the bone and implant bond together forming a strong and permanent base very much like a false tooth root.

Implants can have crowns or bridges fitted on top, replacing one or more missing teeth.  Patients with many missing teeth can be fitted with special dentures, held firmly in place by implants, thus making it much easier to eat and speak without embarrassment.

At Covent Garden Dental Practice we offer guided implant surgery. This involves taking a CT scan of your jaw area so we can ensure that before surgery you have sufficient bone tissue for an implant and can plan the implant placement with pinpoint accuracy.  Where there is inadequate bone tissue we apply the treatment to regenerate the missing bone tissue using a variety of techniques (including bone grafting from other sites) when necessary.

Dental Implant services we offer include:

• Implant placement
• Prosthodontic restoration: Crown,  bridge or denture
• Bone regeneration
• Bone grafting
• CT scan

TMJ (the Temporomandibular Joint) is the jaw joint that allows the jaw to open and close.  This is a complex area and problems that affect the jaw, such as your teeth not meeting together properly, or clenching or grinding your teeth, can go on to create further problems.  If you suffer from difficulty in opening your mouth or pain on opening chronic headaches or migraines, or pain in the neck, shoulder, jaw and ear, we may be able to help.  Treatments are often relatively simple, painless and can make a huge difference to your quality of life.

Our treatments include:

• Occlusal analysis and equilibration treatment
• Bite guards
• Surgical treatment of the TMJ