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A Decade of Excellent Service

Congratulations to Angela our practice manager/receptionist who celebrated her tenth year anniversary with us.

We are fortunate to have Angela being so committed after so many years of service; she even knows the patient’s voice on the phone before she speaks to them! She is also celebrating with a week away in Queenstown this time instead of her travels to Australia recently. Well done Angela.




 

Dental Sterilisation Room Renewal

As a practice a top priority is our comitment to the highest standard of cleanliness and sterilisation.

To this end we have just completed a total renewal of the Dental Sterilisation Room including the renewal of the W & H Lisa Autoclave steriliser. This ensures that we more than meet the guidelines recommended by the code of practice of the New Zealand Dental Council.


Renewed Sterilisation Room

New Lisa Autoclave Steriliser

Ultrasonic Cleaner

Grinder to prepare study materials for diagnostic Wax Up

Breast Cancer Week

This year staff were dressed in pink as a way of showing awareness and support for breast cancer week and we also helped by raising funds for the New Zealand Breast Cancer Foundation.

Dr Gar Duen Wongs Presentation on Aesthetic Dentistry

Aesthetic Dentistry
www.morrowstreetdental.co.nz Dr Garduen WongBDS,BSc(Hons)

Sapphire Clinic



Dr Garsing Wong, graduate of Auckland University in 1991 with a Bachelor of Medicine & Surgery. Dr Wong is the Censor for the New Zealand College of Appearance Medicine and an Examiner and Lecturer for the College of Urgent Care Physicians.

Introduction:

The Story behind this blog was that Dr Garduen Wong was invited to present his work "The Synergy of Appearance Medicine & Cosmetic Dentistry" at the NZ College of Appearance Medicine Annual Scientific Conference on 19-22 Sept 2012, Queenstown. After lots of encouragement from Margaret and Garsing, Garduen finally compiled this blog, to enable patients to see how Aesthetic Medicine and Dentistry can give optimal results for his patients.




Dr Garduen Wong B.D.S. (Otago) BSc.(Hons) Newmarket Dental Care 18 Morrow Street ( Parking Opposite 277 Newmarket Westfield Shopping Centre ) Ph: 09 524-8399 www: morrowstreetdental.co.nz



Occlusal Vertical Dimension increased, colours changed. Note the improvement of facial height & fullness of the lips. Patient now has a good foundation for appearance medicine


ENHANCE YOUR BEAUTIFUL SMILE



Porcelain teeth have significantly improved smile line by changing the shapes & colours. Treatment time to completion 2-5 months, depends on complexity & patients wishes.


Patient declined orthodontics for protrusive teeth & had mild tetracycline staining. Treatment completed in 3 months.


Teeth colours changed, length of teeth increased & improvement on buccal corridor. Teeth follow soft tissue architecture of the lips.


Improve smile by lengthening teeth with composite restorations, which is more conservative treatment compared to porcelain veneers or crowns.


Patient concerned with diastema (Spaces in between teeth) colours & sizes of teeth. Lava 3M zirconium crowns made. Again patient declined orthodontics.

Improved smile with changes in colours, shapes and the amount of teeth displayed. Also wished to have more translucency to teeth shapes to give a more "life like" & natural appearance. ( See following page )


Left Photo - Medium Smile displays 20% to 80% teeth showing. Right Photo (Top) - Low Smile displays maximum of 20% teeth showing. Right Photo (Bottom) - High Smile displays 100% teeth showing & gum tissues.



Replacing amalgam restorations with crowns, heavy toothbrush abrasion was present, hence the decision for crowns as opposed to porcelain inlays.



Bridge treatment 16^^13 ( 4 units with stress-breaker ). We were able to improve the occlusal plane & colours significantly.


Bridge constructed to replace 2 missing maxillary teeth, patient declined dental implant option. Also bridge constructed 35^37 mandibular teeth.46 Temporary composite crown.
 

Left Photo - Completed case with porcelain bridge. Top Right Photo - Discoloured lateral tooth. Bottom Right Photo - Temporary Bridge in place.



Before and after Photos. Patient wished to have natural colour look to match remaining teeth. Treatment is not completed at this stage, will need to improve the buccal corridor.

Trauma resulting fractured tooth from accident, restored with composite resin. Fissure Sealants & Gold Inlays for longevity of restorations.



Toothbrush abrasion on maxillary 22,23,24 & mandibular 34,35 replaced by composite. This prevents further sensitivity of hot/cold & possible further risk of endodontic treatment

Occlusal Vertical Dimension increased, colours changed. Note the improvement of facial height & fullness of the lips. Patient now has a good foundation for appearance medicine.


New Acrylic Dentures made with dental implants & locators to improve retention.

Treatment Planning Sequencing

Dental Clinical Examination including dental radiographs OPG, BW & PA's Clinical Photos, Study Models & Diagnostic Wax Up if necessary. 2) Referral to dental hygienist & address pain symptoms if any, triage of preventive aspects e.g. avoid root canal therapy if possible, caries, maintenance, finally cosmetics. Shapes, colours, treatment options & time parameters discussed. 3) Occlussal analysis to avoid dentition collapse, periodontics, food impactions & optimal ease for oral hygiene. Sequencing, phasing treatment discussed. 4) Partial dentures, bridges or dental implants to replace missing teeth, get optimal occlusion, avoiding bruxism/attrition & complications discussed. 5) Longevity of treatment using long term materials such as porcelain and gold, good contours & shapes to make oral hygiene easier for patients. 6) Maintenance by seeing dental hygienist on a regular basis, usually 6 monthly or less if patients have periodontal issues.



Before & After treatment photos showing completed case. Improved with colours, shapes, increased length/height of teeth & buccal corridor. Time of 3-6 months to complete treatment, depends on treatment required.



Study Models taken, then diagnostic wax up made, trial smiled before we started on definitive treatment.(Temporary crowns with increased OVD/height) Crowns used for 6 weeks to ensure colour, heights & phonetics correct before next step



Colour selection, canine guidance build up on 13 to increase OVD in composite, then crowns with gold occlussal 15,14,13 and E-Max crowns on anterior maxillary teeth. ( OPG Radiograph on completed case )


Patient had tetracycline staining & caries due to reduction of saliva flow resulting from radiotherapy for naso - pharyngeal carcinoma. Porcelain Crowns and Composite Veneers. The patients left upper lateral incisor positioning was improved.


Diagnostic Wax Up to Change teeth shapes & length of teeth / Before & After Treatment. This is planned & discussed with patient before we commence treatment.


Facial collapse due to early lost of teeth prematurely, dental implants can prevent bone resorption, see bone levels on page 29 & 32 - following case (Dental radiograph thickness of mandible in comparison to this)


Dental OPG Radiograph with 2 x Astratech dental implants & intra oral photos. Surgical Placements of dental implants carried out by Dr Richard Longbottom.

Astratech Dental Implant Analogues on Stone Models & in mandible. With -/F & Locators under denture for improved retention.


  PIB (Prosthetic Implant Bridge  6 x Dental Maxillary Implants. Also 6 x Dental Mandibular Implants (Porcelain Bridges & Crowns)



Maxillary implants x 6 Nobel Biocare & Multiunit abutments, ( PIB ) Articulated PIB (Prosthetic Implant Bridge). Dental OPG radiograph of completion. A titanium frame was constructed & attached with prosthetic screws.



Bridges x 2 (Implants 37^^34, 42^32, 46 & 47 ) Gold Abutments & Porcelain teeth made. Gutta Percha placed over abutment screw access cavities.


Before treatment & completion of treatment.We decided to make the three mandibular incisors not completely straight to give a more authentic & natural appearance. Titanium frame fabricated & attached with prosthetic screws.(Nobel Biocare)


Stages of Single Dental Titanium Implant Straumann Fixture ( Before & After ) Titanium Abutment used & then Crowned.



From Left: Before with fractured 21, Stage with fixture registration coping & Completion. Straumann Dental Titanium Implant with Ti Abutment, then crowned.Surgical placement by Dr Michael Danesh-Myers.


Dental Implants to replace terminal dentition with periodontal disease. Dental implants placed by Dr Richard Longbottom ( Astra & Straumann ) EVERY FACE TELLS A STORY......

Disclosures of Dr Garduen Wong Other Information

Previously postings at Auckland Hospital, New Zealand Defence Force, Accident and Emergency Clinics in Remuera and Takapuna, General and Cosmetics in Newmarket.

Member of the following Associations:

ITI (International Team for Implantology), NZDA (New Zealand Dental Association) New Zealand Society of Endodontics (Inc), NZACD (New Zealand Academy Cosmetic Dentistry) & NZIMID (New Zealand Institute Minimal Invasive Dentistry)

Presentations at following Conferences:

NZCAM ( NZ College of Appearance Medicine ) - Synergy of Dentistry & Medicine ! ADA Fiji Conference - Orthodontics & Restorative Dentistry for Optimal Results ! ADA Seminar Brisbane Australia - Cosmetic Dentistry Complications. ! NZDA Meeting Colorado USA - Dental Implant Prosthesis & Complex Full Mouth Reconstructions


Garduen Wong, graduated from Otago University NZ in 1986. Initially started working in Auckland Hospital then in Newmarket in 1991. Areas of interest are oral preventive dentistry, Cosmetic Dentistry & Aesthetic dental implants. Outside interest includes history, philosophy, photography,Tai Chi & Cycling. He is married with one adult son who is at university.
 


Gold Inlays stand the test of time.

Dr Clarence Tam - Replacing Amalgam Restorations

I get daily requests from my patients asking whether it is wise to replace their old amalgam fillings. Their concerns typically revolve around having mercury in their body and the long-term systemic effects from this. A secondary concern is esthetic, and how these fillings deteriorate their confidence when smiling.

If patients want to replace amalgams for esthetic reasons, normally this is okay. The danger is when you have a really deep filling in the tooth that already represents a high risk of needing a root canal - in these cases, sometimes, it is better to leave something that is seemingly stable than remove it and provoke a potential inflammatory response.

It is no secret that amalgams are metals. Metals expand more than tooth structure (they have a higher co-efficient of thermal expansion) and thus over time, this cyclical fatigue may cause teeth to crack definitively or show hairline fractures (which may propagate - most scarily into the nerve). In these cases, I do recommend removal of the offending amalgam filling as well as the leading edge of the crack. This is the first, most conservative step. If symptoms continue, sometimes full crown coverage or root canals are required. In modern dentistry, we are trying to prevent this from happening to you. Early-detection is key.

The recent earthquakes in Wellington is a key example. Cracks are seen as dangerous in certain support structures - the council and individuals have the choice of reinforcing or eliminating these cracks before a catastrophic failure, however due to budget often these "risks" of doing little or nothing is taken. You will never grow your teeth back again. Let's try to identify problems before they become catastrophic.

Mercury: If an amalgam filling is intact and there is no evidence of cracks or tooth weakening, I will tell my patients to "leave it alone." I don't like to fix "what ain't broke." In fact, mercury levels are highest at the time of amalgam filling placement and removal. In the middle plateau, the amalgam level drops to an insignificant, menial level. You probably consume more mercury from the seafood you eat every week. Is the risk of increased mercury vapor when the amalgam is drilled out greater than the benefit? Always look at benefit:risk ratios, especially when it comes to your health.

Make good choices, and see you at the practice.

New Zealand College of Appearance Medicine

Conference - 19th - 22nd September 2012 - Queenstown

Topics presented by Dr Gar Duen Wong

  1. Complications of Cosmetic Dentistry
  2. Synergy of appearnce medicine and cosmetic Dentistry
Dr Gar Duen Wong BSc (Hons), BDS
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