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Aesthetic aspects have become very important in modern dentistry in recent years. Whereas in the past the focus of dental work was on the restoration of defects, today the prevention of these and the pursuit of a perfect appearance are also at the forefront. Plastic and ceramic fillings, ceramic crowns and veneers that match the color of the teeth help here.

What are veneers?

Veneers are thin, almost transparent ceramic shells. The tooth to be restored is ground to a thickness of just 0.7 mm on the outer surface and shortened by approx. 1 mm at the incisal edge. In exceptional situations, there are now also special ceramics that do not require the tooth to be ground at all if the indication is correct. These ceramics are characterized by a layer thickness of approx. 0.3 mm.

Where can veneers be used for esthetic improvement?

• For unsightly tooth shapes or tooth shades that are too dark
• for anterior teeth with many fillings of different shades
• in the event of damage to the front teeth as a result of accidents
• for small misalignments of the front teeth without additional orthodontic therapy

Advantages of veneers

Most of the tooth structure is preserved, as the veneers, which are individually designed by the dental technician, are bonded to the prepared tooth surfaces using special resins. Veneers do not show any edges on the gums and the transition to the natural tooth is invisible. This achieves a flawless aesthetic result. The functionality of a tooth with a veneer is similar to that of a healthy tooth, it is fully resilient.

Amalgam on everyone's lips

This very ambiguous sentence accurately describes the problem dentistry has been confronted with in recent years. Almost everyone has been introduced to the subject by public discussions concerning the use of this substance as a dental filling material and has been made uneasy to some extent.

The majority of the population even feels directly affected, as amalgam has been used for years without restriction and almost exclusively to fill dental defects. More and more amalgam fillings are now being replaced with other filling materials.

On the one hand, this is for cosmetic reasons, as amalgam is a very dark material and detracts from a "bright white smile". On the other hand, some patients are concerned that the filling, with its composition of different metals, is harmful to their health. Dentists also recommend replacing amalgam for certain reasons. For example, if the filling is oversized, too small or broken. Possible replacements are various types of plastic fillings and inlays in ceramic or gold.

Reasons for replacing amalgam fillings - patient request

Patients themselves want to have their amalgam fillings replaced, either because they do not want dark fillings for cosmetic reasons and value an all-round "white" smile or because they prefer a high to "highest" quality filling therapy.

Some patients are also motivated to replace their teeth by health concerns: on the one hand, they fear that different metal fillings can lead to microcurrents, resulting in health problems. Other patients fear that amalgam is the cause of health problems.

Reasons for replacing amalgam fillings - Dental recommendation

In certain cases, amalgam can also be replaced on the recommendation of the dentist. The reasons for this can be: oversized, too small, broken fillings, fillings without contact to the neighboring or opposite tooth, fillings with caries at the edge or "patched" several times, fillings that are already visible when smiling or in patients who indicate a mercurioscopic idiosyncrasy (strong mercury hypersensitivity).
The replacement of amalgam is carried out with the necessary individual precautions and ranges from the strong use of water with good suction to the application of a so-called cofferdam (elastic rubber protection). Various types of plastic fillings and inlays in ceramic or gold can be considered as replacements.
In some cases, amalgam can be removed using medication.
So what is this material all about?

Amalgam is a mixture of a metal powder and mercury (HG). When a silver-tin-copper powder is mixed with mercury, the result is a malleable paste: dental amalgam. Extensive and intensive mixing of the components is crucial for the properties of the amalgam. The dentist then has 10 - 30 minutes to insert the filling material into the tooth and shape it into the right form for the subsequent bite. After one hour, the filling can withstand a certain amount of stress, after 24 hours it has reached the desired strength.

The advantages of the material are based on the following points

• Overall, a simple, inexpensive and fast filling technique is possible,
• It is versatile and easy to process
• there is no elevated claim in relation to a form of dental defect
• High breaking strength and compressive strength
• Long shelf life and clinically proven

The disadvantages, however, are

• Aesthetically unsatisfactory color scheme
• cannot be used in the anterior region
• Crevice formation, possibility of renewed caries formation
• Discoloration of the tooth
• Indispensability of underfilling
• Health risk to the dentist if not processed properly
• potential allergic and toxic hazards due to additional - albeit low - exposure of the organism to mercury.

Small and minute quantities of mercury (Hg) can enter the body from copper amalgam, and very rarely from precious amalgam. Although there is a risk of Hg, it is not possible to speak of Hg poisoning.

• Copper amalgams should no longer be used
• It is important to process the amalgams correctly in order to keep the Hg release as low as possible; precious amalgams rarely dissolve

Application restrictions

• retrograde root fillings, as the material is in direct contact with the bone tissue
• Build-up fillings under cast crowns, as the contact between two different metals results in electrical conductivity and its consequences

It is not only dark amalgam fillings that look like blemishes in otherwise white teeth and prevent a satisfactory overall esthetic appearance. White fillings can also sometimes appear dark, as they do not become lighter when the natural tooth substance is whitened, but retain their color. The "whiter" the natural teeth are made after filling, the more urgent it may be to replace or treat the fillings. Different procedures and materials can help here:

Composites

Composite fillings are used in the front tooth area, for damage to the tooth necks, or for small to medium-sized fillings in the posterior tooth area. They are gentle on the substance, aesthetically pleasing and cost-effective. They can be completed in a single session and are just as durable for small to medium-sized fillings and almost as durable for larger fillings as the well-known but aesthetically less appealing amalgam. In the anterior region, composite is also suitable for restoring the original tooth shape, for example in the case of accidentally broken incisal edges. These are treated with special composites, whereby a natural appearance is usually achieved by layering several shades. Particularly intensive oral hygiene is extremely important with resin fillings, as discoloration can develop more easily at the edges of the filling. Caries in this area is no more likely to occur than with other filling materials if the teeth (as with other filling materials) are cared for correctly.

Compared to other filling materials (here generally to ceramic inlays), however, composite has shortcomings.

For example, in terms of material abrasion, in contrast to ceramic and gold, and in terms of color stability, in contrast to ceramic, and also in terms of dimensional stability, in contrast to ceramic and gold.

In addition, the costs of plastic fillings in the posterior region are currently only covered by health insurance companies to the same extent as the costs of amalgam fillings. If fillings are made for aesthetic reasons, the health insurance company will not pay anything.

Ceramic inlays

Ceramic inlays lead to the most durable and attractive treatment results for larger defects in the posterior region. Unlike direct fillings, ceramic cannot be processed and finished in the mouth. An impression is therefore taken of the teeth and sent to a dental laboratory, where dental technicians make the "inlays" to fit exactly and match the color of the natural teeth. In a second session, the inlays are then inserted using a tooth-colored composite. Visually, the result is usually so perfect that the tooth appears completely untouched afterwards. Due to their high chewing stability and virtually no material abrasion, ceramic inlays are a very durable but three to four times more expensive solution than composite fillings.

The so-called Cerec procedure enables inlays to be fitted more quickly. The prepared tooth to be restored or the model is photographed with a special camera after the impression has been taken. Based on the data obtained in this way, a computer designs the inlay and mills it out of a ceramic block.

Both ceramic materials and Cerec ceramic blocks in special shades have recently become available for bleached teeth.

Ceramic inlay	Plastic / gold filling	Ceramic front shell

Veneers

Veneers are another very elegant and tooth-friendly way of "optimizing" teeth and fillings. To use them, only a thin layer is removed from the front tooth surface. The delicate veneers are then simply bonded to the discolored teeth. If a veneer is not sufficient to conceal a very dark front tooth, for example, it can also be used in combination with prior bleaching. Veneers not only provide a perfect color design, but also an optimal reconstruction of the tooth shape. This means that lost front tooth corners or tips can be easily replaced by gluing on matching partial veneers.

Picture 1	Picture 2

Picture 3	Picture 4

Figure 1: Initial situation
Picture 2: Final situation
Figure 3: Veneer veneer from the front
Figure 4: Row of teeth with veneers

Photos: courtesy of Olaf v. Iperen

Manual and instrumental FAL and Cadiax

The temporomandibular joint is the most complicated joint in our body. Not only is it a so-called rotational gliding joint, the left temporomandibular joint never changes without the right one when moving sideways. In addition, the left temporomandibular joint moves towards the center. At the same time, the right temporomandibular joint can either not rotate at all or rotate in all directions.
All movements, especially non-physiological ones, can now trigger pain. Either through pressure on the so-called bilaminar zone behind the jaw heads or through irritation when the discus is displaced (so-called "shock absorber" between the jaw joint heads and the jaw joint socket). However, pain can also occur due to the disruption of various other structures of the temporomandibular joint and its surroundings.

In order to find the cause of the patient's pain, a precise diagnosis must be carried out with an accompanying examination and individual questioning.

During the subsequent functional analysis, a detailed examination of the masticatory system is carried out. The results of this assessment are used to decide on the appropriate procedures for pain relief and elimination. Depending on the diagnosis, further procedures may be necessary to determine the cause. The subsequent therapy (e.g. bite splints, stress management due to grinding and clenching, drug therapy and physiotherapy) is tailored to the patient's needs.

Pain in the area of the temporomandibular joints and the masticatory muscles, joint noises (rubbing and/or cracking), restricted movement of the lower jaw and tension in the masticatory muscles are often caused by the teeth. Misaligned teeth, tooth loss, inadequate dentures, poor fillings and grinding and clenching the teeth (stress) can be the cause of discomfort in the temporomandibular joints. Due to the close positional relationship with the ears, pain in the jaw is often perceived as ear pain. In such cases, the ear, nose and throat specialist often cannot find an explanation for the pain. The temporomandibular joints, chewing muscles and teeth form a unit, which is why every diagnosis and, above all, therapy must take all components of this system into account. In principle, the temporomandibular joint should not be considered in isolation, but as part of the whole. This means, for example, that complaints in the temporomandibular joint region may well be caused by a misalignment of the spine or tense back muscles. The same applies vice versa.

Various causes of pain in the temporomandibular joint area

• Joint-related causes such as displacement of the joint disc (cracking when opening the mouth, restricted mouth opening and rubbing noises)
• Osteoarthritis (destroyed joint disc - bone rubs against bone)
• Muscular pain - tension in the chewing muscles due to grinding or clenching of the teeth (caused by stress, missing teeth and incorrect dentures)

Functional analysis

A precise diagnosis with a detailed examination and questioning of the patient is always necessary to find the cause of the pain.

The first step is a functional analysis. This is a detailed examination of the masticatory system. Based on the findings, further diagnostic procedures such as imaging procedures (X-ray, MRI), measurements, etc. may be necessary.

Depending on the diagnosis, various therapies may be indicated, e.g. bite splints, stress management (grinding, clenching), drug therapy and physiotherapy, light grinding of the interfering contacts on the existing teeth through to newly designed dentures.

Manual & instrumental analysis

As far as diagnostics are concerned, manual and instrumental functional analysis must clearly be placed before the above-mentioned imaging procedures.

A distinction is made between manual functional analysis and instrumental functional analysis, as they pursue fundamentally different goals. The aim of manual functional analysis is to find out which structures of the temporomandibular joint are diseased. This is usually done using various pressure techniques in which appropriate pressure is applied to the temporomandibular joint to determine the diseased structures. With the appropriate experience and technique, the finest diseased areas can be localized.

The primary aim of instrumental functional analysis is to observe the way in which the respective temporomandibular joint moves, as there can be considerable differences here. The movement path is either recorded two-dimensionally on paper writing plates using older techniques or the patient's movement is analyzed three-dimensionally using electronic writing instruments and computer support. This is essentially used to program the articulator (also known as the chewing simulator) in order to analyze the movement paths and possibly determine the locations of the damage even more precisely. The Cadiax, IPR and DIR systems should be mentioned here in particular.

Diagram of a chewing simulator (articulator)	The Cardiax facebow in the diagram

If teeth are severely damaged or without a root, it is necessary to strengthen them as they become brittle and porous. If teeth are missing completely or have to be removed, dentures can replace them in their various functions. There are various options for using crowns, bridges or dentures.

Dental prosthetics is the medical specialty that deals with the treatment, care and support of tooth loss or severe damage to the tooth structure. All aspects of treatment are summarized in this statement: biological, functional, psycho-social, material and technological. As a specialist in dentistry and prosthetics, the dentist therefore bears a great deal of responsibility for the patient.

Our treatment always focuses on a patient-centered, preventive approach geared towards the overall health benefit in order to offer the patient the best individual solution. Our practice uses special state-of-the-art equipment and techniques for this purpose.

Crowns and bridges

A tooth with devitalized (killed) pulp becomes brittle and can become discolored. In this case, a crown is fabricated. Crowns are also placed on living teeth if they are severely damaged. The function of the crown is to restore full chewing function and to meet aesthetic requirements. There are metal and all-ceramic crowns, which are intended to improve the aesthetics of the teeth. Natural enamel translucency can be imitated because all-ceramic crowns are metal-free.

The so-called CEREC procedure enables accelerated crown fitting.

The prepared tooth or model to be restored is photographed with a special camera after the impression has been taken.

Based on the data obtained in this way, a computer designs the crown and mills it from a ceramic block.

Both ceramic materials and CEREC ceramic blocks in special shades have recently become available for bleached teeth.

Pin build-up or core insert

If the dental crown is completely destroyed, it is not necessary to extract the remaining tooth root. In this case, a root canal inlay, known as a post, is fabricated. By precisely mimicking the shape of the tooth canal, the root canal inlay allows the chewing load to be distributed between the root and the restored tooth stump, which is then fitted with a crown.

Bridges (bridge dentures)

A bridge can be made of metal-ceramic based on various alloys (both precious metal alloys and special medical biocompatible alloys). Precise, high-quality metal casting makes it possible to make the framework of a bridge-like prosthesis strong and at the same time "light" and "delicate", completely reproducing the anatomical shape of natural teeth. This is an indispensable prerequisite for the prevention of periodontal diseases (inflammation, bleeding, discoloration, painful gums, formation of pathological pockets).

There are now also all-ceramic bridges that are milled from a ceramic blank using the CAD/CAM process.

Removable dentures

Removable dentures are very popular because they are quick and easy to make and only have contraindications in a few cases. If they are only to be worn temporarily, they are made of plastic with hand-bent clasps. If these dentures are to be worn permanently, they consist of a combination of a special metal alloy (model cast dentures) as a base, with acrylic and acrylic teeth or ceramic teeth.

Model cast dentures (dentures)

The use of a metal bar allows the chewing load to be evenly distributed between the mucosa and the remaining teeth. The denture can be made smaller, more durable and more user-friendly. This reduces the time needed to get used to the denture. The retention of a cast denture can take many forms. There are several options: Telescopic crowns, latches, anchors, clasps, hinges and much more.

Telescopic crowns

Attachment to telescopic crowns prevents uneven lever-like tooth loading and subsequent loosening of the supporting teeth. A telescopic crown consists of two crowns. The first crown looks like a metal cap that is placed on the prepared tooth. The second crown is part of the removable prosthesis, which exactly reproduces the shape of the first crown on the inside and the natural tooth on the outside.

Total denture (total removable denture)

Complete dentures are made entirely of acrylic and acrylic teeth or ceramic teeth. The quality of a removable denture depends to a large extent on the quality of the dental materials used.

The way to beautiful and healthy teeth - to keep your own teeth for a lifetime - is through systematic preventive care and maintenance.

Prophylaxis is the most important branch of dentistry. Without it, all other measures are pointless. The biotope of the oral cavity has a far greater influence on general well-being than is generally assumed. The mouth is needed for eating and speaking, and emotions are expressed with it. In addition, the teeth are of great importance for the appearance of the face as they support the lips and cheeks. Healthy teeth are an adornment and they emphasize the feeling of general health.

Diseases of the teeth and gums are widespread. A large percentage of the population is affected. However, dentists can help to prevent the slow and often painful damage to teeth and surrounding tissues. There is little in dentistry that is as proven and undisputed as the effectiveness of preventive measures. From many years of experience with prophylaxis and based on international research results, dentists can offer a prevention program that is successful if consistently adhered to. Even treatment of existing damage to teeth and gums only makes sense if intensive, organized and controlled prophylaxis is carried out.

Possible steps of a prophylactic treatment

1. Initial state before the session
2. Staining the coverings
3. prof. cleaning with ultrasound
4. prof. cleaning with hand instrument
5. Polishing the teeth with a powder jet device
6. Polishing the teeth with polishing paste
7. Floridation of the teeth
8. Treatment goal: clean and healthy teeth

What is the difference between systematic and organized individual prophylaxis and health insurance prophylaxis?

No age limit

Many patients also suffer from tooth decay before the age of 6 and after the age of 18.
Dentists therefore recommend systematic individual prophylaxis for all age groups.

Measures

Dentists know that home dental care is not enough. For this reason, they carry out professional mechanical tooth cleaning as part of systematic individual prophylaxis. Only in this type of prophylaxis treatment can the dentist use fluoride as a medication in the smallest quantity and with the highest degree of effectiveness after professional mechanical tooth cleaning. Scientific findings determine the type and scope of the measures.

Frequency

The frequency and time required for prophylaxis measures depend on the individual needs of the patient and are not limited by health insurance regulations.

Allowance

The available treatment time is calculated individually. Good prophylaxis takes time and patience!

Periodontitis treatment - prevention and care:

Periodontitis (commonly known as periodontal disease) is a disease of the periodontium. Around 80% of all people suffer from this disease. Periodontitis is usually painless and lasts for years. The disease is mainly the result of poor oral hygiene. However, an unbalanced diet that is low in vitamins can promote the development of the disease, as can excessive smoking.

The onset of periodontitis can be recognized by certain symptoms, such as bleeding gums and an unpleasant aftertaste. Periodontitis can be effectively prevented by regular tooth cleaning and treatment of the gums, a varied, healthy diet and an examination at the dentist at least every six months.

Course of the disease

Periodontitis always begins with an inflammation of the gum line surrounding the neck of the tooth (gingival cuff). The disease then progresses and penetrates into the depths of the tooth bed in which the teeth are embedded (alveoli). The retraction of the gums can no longer be stopped and the bone compartments become smaller and smaller. The teeth become loose and interfere with speaking and chewing. In most cases, removal of the teeth can no longer be avoided at this point.

Ultrasonic system PerioScan Photo courtesy of Sirona Dental Systems GmbH

Periodontitis development - early detection

Periodontitis can be recognized by the following signs: the teeth become longer because the gums recede, bad breath develops, the front teeth move and tilt outwards, gaps appear between teeth that were not there before. Early warning signs are an increased tendency for the gums to bleed and an unpleasant "aftertaste".

Periodontitis development - self-help

Periodontitis can be prevented by regular tooth cleaning and treatment of the gums. A balanced, healthy diet also plays a very important role, as does a six-monthly check-up at the dentist. If the gums have a pale pink color, they are healthy. Fine zip-shaped outlets, called papillae, fill the spaces between the teeth.

Inflamed gums become very red in color and tend to bleed. This can be very painful when brushing your teeth.

Preventive tooth brushing - but the right way!

The following is a tooth brushing technique used by many people.

Depending on your age (child or adult), taking into account possible pre-existing conditions and whether you brush with an electric or manual toothbrush, there are individual differences in the optimal brushing technique. We will be happy to explain the right brushing technique for you in a prophylaxis session at our practice.

Teeth should be brushed after every meal (3 times a day) to prevent the build-up of harmful plaque.

The recommended time for tooth cleaning is 3 minutes.

First, the mouth is rinsed thoroughly and the water is pressed through the interdental spaces to loosen the fresh food residue.

The outer surfaces of the teeth are then cleaned first with toothpaste and a toothbrush. With the mouth slightly open, start at the last molar in the left upper jaw. Using light pressure, small circular movements are made on 2 - 3 teeth at a time - approx. 10 times. The toothbrush is then moved a little further forward again. In this way, the teeth are cleaned in small sections up to the right side of the upper jaw. The same procedure applies to the lower jaw. Start at the bottom left of the last molar and do not forget the inner surfaces. Finally, all chewing surfaces are cleaned. Now scrubbing back and forth is allowed. Then rinse the mouth thoroughly again to remove all the food debris. Be careful not to apply too much pressure from the sides when brushing your teeth, otherwise the delicate tissue around the teeth will retract and you will "scrub" the necks of your teeth free. You should brush with a maximum pressure of around 200 grams. It is not the force but the time that is decisive.

1. Cleaning with a toothbrush
2. Cleaning with dental floss
3. Movement sequence inside
4. External movement sequence

There are many other things that should be taken into account. We as the practice team can give you many more tips on prophylaxis.

What should I do when the first signs of periodontitis appear?

The first port of call is the dental practice. Here it can be determined whether it is periodontitis, how severe it is and which treatment steps are necessary.

This is usually followed by a professional tooth cleaning. After a few pre-treatment appointments, the area deep in the pocket is then cleaned. Special hand instruments are usually used here. To support or optimize the treatment result, our practice also uses ultrasound devices, for example, which perform specially defined movements.

1. The Vector™
2. Fig. 2 - 4: The Vector™ in use

In addition to the Soniflex, which performs elliptical movements, the vector system is also used. With this, a powder-liquid mixture is set in ultrasonic vibrations, which gently removes deposits from the tooth root and polishes the root at the same time.

The laser can be used as a further supportive measure. This is able to eliminate or kill bacteria in the gum pockets without additional medication. It can also remove diseased tissue and create the conditions for the gums to grow back onto the tooth (deep epithelialization).

Each laser has its own special area of application. Our practice for innovative dentistry can offer patients comprehensive treatment options because it has several laser systems at its disposal.

The practice uses the "LaserSmile™", the "ezLase™", the "WaterlaseMD™ " and the "Diagnodent™" laser.Advantages of laser applications

Lasers can be used in almost all dental treatment areas.

Laser treatment is characterized by simplicity and speed, lack of postoperative bleeding and edema. No additional bandages are required. As a rule, there are no restrictions regarding eating and lifestyle habits.

• Gentle and effective
• No or less anesthesia
• Less or no bleeding
• The healing process is accelerated
• Less pain
• The vibrations that cause pain and the heat generated by the drill are completely absent.

When a laser is used, the specific wavelength interacts with the molecular structure of the tissue to be treated. There is also a thermal effect, which is more or less noticeable depending on the setting of the laser. The special feature of this procedure is that it can often be performed without anesthesia, which means that there is less or no bleeding and the healing process is accelerated.Areas of application of the different laser types

	The WaterlaseMD™ is the world's leading laser for virtually pain-free dental treatment. The hydrokinetic Er.Cr.:YSSG laser enables the surgeon to make clean and precise incisions and achieve a high ablation rate in hard tissue, which is significantly higher than with conventional Er:Yag lasers - and in a very wide range of indications. In addition, many problems associated with drilling, such as microfractures, which weaken the stability of the tooth, are avoided. In addition to being pain-free, the fillings are also better retained thanks to an optimized surface structure of the tooth and a caries-protective effect.™ By using the WaterlaseMD ™, we as a dental practice rely on a patient-friendly technology!
	The iPlus is the FOLGELASER on the MD with even shorter pulses and therefore increased preparation speed with less sensitivity for the patient. The menu navigation is more intuitive and even patients can understand the settings.
	The LaserSmile™ is mainly used for bleaching teeth and as part of root canal and gum treatment.
	The epicX diode laser is a further development of the ezLase with intuitive operation and higher performance values. The epicX is mainly used in surgical procedures, root canal and gum treatments.
	The EzLase™ is mainly used in surgical procedures, root canal and gum treatments.
	The iLase diode laser is a small, practical diode laser. The iLase is mainly used for root canal and gum treatments. However, it can also be used in other areas.
	The Diagnodent Laser™ is used exclusively for absolutely painless caries detection. It is also impressive in that it detects carious defects that are invisible to the human eye.
	Using dye and laser light, HELBO therapy is characterized by painless and quick application. It is a purely local therapy to destroy the bacteria and fungi that cause inflammation and, above all, has no negative side effects."

Lasers in surgery

Another advantage of using laser technology in dental surgery is that the patient can remain completely stress-free during an operation because they do not see a conventional scalpel. Blood vessels are hermetically sealed with laser radiation at the treated site, ensuring a virtually blood-free incision. Laser treatment can therefore help patients who are prone to bleeding.

Laser beams kill the pathological microflora (bacteria and viruses) in the surgical area, thus reducing the likelihood of postoperative complications.

Fields of application of the WaterlaseMD™

General

• Desensitization

Filling therapy

• Anesthetize
• Working on tooth enamel
• Editing dentin
• Surface etching
• Remove caries
• Cavity disinfection & cavity conditioning

Endodontics

• Disinfection of the root canal
• Treatment of the fistula tract

Prosthetics

• Opening the sulcus before impression taking
• Extension of the clinical crown

Periodontology

• Removal of infected tissue
• Deep epithelialization of the gingival pocket
• Disinfection of the gingival pocket

Surgery

• Opening of abscesses
• Gingivectomy (gum removal)
• Frenectomy (removal of frenulum of lip or tongue)
• Excisions (removal of tissue)
• Herpes treatment
• Aphthae treatment
• Osteotomy (bone processing)
• Vestibuloplasty (visible enlargement of the alveolar ridge)
• Root tip resection
• Coagulation

Implantology

• Determining the implant position
• Fabric cut
• Implant opening
• Sinus floor elevation (opening of the maxillary sinus while protecting the paranasal sinus membrane)
• Peri-implantitis therapy

With the first teeth, it is also time for the first contact with the dentist. This first acquaintance should not only take place when chocolate & co. leave their first traces on the teeth, but the opportunity to gain the child's trust exists much earlier. For example, when a parent visits the practice for a check-up.

Children need very special attention. Not only in their everyday lives and their development, but also during visits to the dentist. The unfamiliar surroundings, the uncertainty of what will happen to them and whether they may experience pain can cause anxiety. They generally experience fear more directly and unfiltered than adults, perceive gestures, moods and behavior even more strongly than the spoken word and feel vulnerable and helpless more quickly.

When talking to children about a visit to the dentist, words such as drill, syringe, holding still, cutting, "soon it will be over" etc. should be avoided at all costs. With regular dental care and oral hygiene, as well as a thoughtful and balanced diet from an early age
 teeth stay healthy and strong for a long time and the first visits can be like "sitting in the dentist's chair on wheels".
When the time comes for treatment, the dentist and the environment are already familiar and there is no need to develop anxiety.

To ensure a positive experience and trauma-free treatment for children, not only dental prophylaxis and child-friendly treatment are important, but also modern and innovative technology.

When using the WaterlaseMD™, water is vaporized using laser energy. The kinetic energy generated can be used like a dental drill without the need for actual drilling. The treatment is virtually painless and anesthesia is therefore unnecessary in most cases, so an injection and the unpleasant feeling of numbness are avoided.

The usually disturbing and frightening vibration of a drill is eliminated and bleeding is very rare, as the treated area is hermetically sealed by the laser beam. In addition, thanks to the high precision with which the laser beam removes damaged tooth areas with pinpoint accuracy, healthy tooth tissue is preserved and better protected.

The laser is therefore particularly useful in pediatric dentistry.

Dear patients

According to surveys, 70% of the population in Germany feel uneasy about going to the dentist, 20% of them are highly anxious and 5% avoid going to the dentist altogether.
These 5% suffer from what is known as dental phobia, which affects millions of people.

The fears are very diverse in origin, with "the uncertainty of what will happen at the dentist" and the trauma experienced as a child during a visit to the dentist being mentioned most frequently.

The resulting fears relate to all potentially painful, invasive procedures, in particular the drill, root canal treatment, the "extraction" of a tooth, but also the injection to eliminate pain.

These patients experience their fears during a visit to the dentist not only psychologically but also physically:
The symptoms range from dizziness, nausea and sweating to a racing heart and circulatory collapse.

So how does an anxiety patient differ from a phobia patient?

Here is a small example to illustrate the difference:
A man drives to the airport, checks in, sits in the plane and flies off. After a while, he sees smoke on the engine, then flames and hears the captain's announcement that the plane is making a stopover due to technical problems. The man is sweating, his heart is racing, his hands are wet, so he is afraid, and justifiably so.

Another man drives to the airport, checks in and flies off. During the flight, he imagines the engine full of smoke and flames and gets wet hands, sweats and a racing heart. This man is scared.

Another man sits in a cab to the airport and imagines the situation on the plane with the burning engine. He also gets wet hands, sweats and a racing heart, whereupon he drives back home and cancels the planned trip. This man has a phobia.

Consequences

Those affected usually avoid all visits to the dentist and live/suffer with the consequences:

• Carious, discolored teeth with sometimes large defects
• Gum disease and bad breath
• Pain, resulting in increased use of painkillers
• Shame, and much more.
• This often results in a severe reduction in quality of life and social isolation for those affected.

General anesthesia

These patients often request treatment under general anesthesia.
This decision is particularly problematic for patients who cannot be completely rehabilitated in one session under general anesthesia or who suffer from chronic diseases. The risks and side effects should also not be ignored.

But what general anesthesia can never do is cure someone of their phobia!
This is not to condemn general anesthesia, but it should only be chosen with caution and under the strictest indication.

Dental phobia is a recognized mental illness and in severe cases can also be treated as such by a psychotherapist.

Sometimes close cooperation between dentist and psychotherapist can lead to an improvement in the condition (treatability) and also to healing.

So how can patient and dentist become a team despite all the difficulties?

• Talk to us openly about your problem so that your dentist and the practice team can adapt to your situation. There are many patients who are highly anxious and you have nothing to be ashamed of!
• Make sure you are fully informed before treatment and discuss with your dentist which treatment steps you feel ready for.
• We take time for you! Our team is experienced in dealing with phobia patients and will guide you through your treatment in a friendly manner.
• If necessary, bring a companion with you who has your trust and will support you.
• Clarify the need for treatment and set yourself goals.
• We offer you low-pain to pain-free treatments with the help of the laser, which works contact-free and without the familiar drilling noise.
• If you have severe pain, contact a dentist you trust as soon as possible. In any case, you can also be helped with gentle methods (including laser treatment).
• With a predetermined treatment plan, you know what to expect and have the opportunity to prepare for it.

An example of the 1st appointment with us:

After you have answered a few questions on our anamnesis form, you will be taken to one of our treatment rooms, where you can sit down and familiarize yourself with your dentist. In other words, you will tell us about the reason for your visit, your expectations and wishes. The dentist will then explain the various treatment options to you, e.g. the use of lasers.

Then the oral cavity is examined using mirrors and blunt instruments (possibly the Diagnodent, a non-contact diagnostic laser) and x-rays may be taken.

Very important: you should never feel that you are at the mercy of others! You have the option of interrupting the treatment at any time and influencing the further course of treatment.

Finally, your dentist will explain the necessary treatments and answer your questions. You can then plan further appointments and their schedule together.

Anyone who dives and many who have flown have noticed that the pressure in the ears changes noticeably. However, this is only an effect that you notice when the environmental conditions change.

The altered pressure is also found in other organs of the body. These body organs also include the teeth and gums, the temporomandibular joint and the facial muscles, i.e. the entire mouth, jaw and facial area.

In addition to pressure and temperature changes, the causes are vibrations and stress. This means that diver and flight dentistry involves, among other things, the special consideration of environmental factors that can occur in certain environmental conditions (in particular: ambient pressure fluctuations).

An influence on the dental, oral and maxillofacial system is particularly possible if there are already pre-existing conditions or therapies that have not taken into account the particular environmental conditions. Various environmental factors must therefore be taken into account when diagnosing complaints in this structure.

Irritated wisdom teeth and teeth with root canal disease are particularly affected. The phase in which the change in environmental conditions occurs is the time when most problems arise.

When flying, the symptoms primarily occur during the climb and landing phase. As the environmental conditions change even more quickly when diving, this is when most problems are to be expected.

Names for such diseases are usually: barodontalgia, dysbarism, aerodontalgia, aerodontopathy, pressure drop disorder, dysbarism.

a pilot's license since 1995	since 1998 Rescue diver (Professional Association of Diving Instructors)

For more detailed information on all topics and, of course, for the individual treatment of your personal concerns, we will be happy to advise you personally!

We have also put together a short dental guide here:

An adult has 28 teeth (+ possibly 4 wisdom teeth).

The dentition consists of 8 incisors, 4 canines and 16 molars.

In order to understand how toothache arises and why you experience it in this way, the tooth is introduced here:

It has a hard shell and a very sensitive core in which its nerves and blood vessels are embedded.

This soft deposit is the pulp. Apart from a small opening to the jawbone, through which the blood vessels run, it is surrounded by the dentin.

Dentin is hard but elastic and can be reproduced for life. In contrast to the outer shell, the enamel.

The root cement covers the tooth from the tooth neck to the root tip. The tooth is embedded in the tooth socket, also known as the alveolus. It is surrounded by the jawbone, which in turn is surrounded by the gingiva, our gums.

The tooth is susceptible to damage or disease. A distinction must be made between diseases of the tooth itself and those of the supporting apparatus.

The most common damage to teeth is caused by bacteria and is commonly known as tooth decay. The bacteria destroy the tooth enamel and eat through the dentin and pulp.

The tooth alerts the entire system via the nerves in the form of pain, but since all the dental nerves are bundled in one large jaw nerve, the exact source of the pain can often only be determined by the dentist.

The preferred focus of disease in the periodontium is the gums. As part of the oral mucosa, it is very susceptible to bacteria and, as a result, to inflammation.

In many cases, bleeding gums (a symptom of mostly harmless gingivitis) and mild "periodontitis" can be eliminated by thoroughly removing the microbial plaque during dental care at home.

In the case of severe periodontitis, the substance of the periodontium is attacked: The gums recede and the teeth become longer and longer.

But it doesn't have to come to that.