Dentistry Today

Penggantian gigi tiruan

2008-04-13T17:45:00.005+08:00

Penggantian gigi tiruan
Oleh Hafizah Iszahanid
hafiza@nstp.com.my

PANJANG implan menyamai akar gigi asal. Implan dibuat daripada titanium, boleh sebati dengan tulang dan berfungsi sebagai penambat gigi.

PERNAHKAH anda terfikir untuk menanam gigi baru bagi menggantikan gigi yang rosak? Tidak kira sama ada kerosakan itu disebabkan kemalangan atau penyakit, inovasi bidang pergigian menjanjikan anda boleh memiliki senyuman menawan dengan susunan gigi yang sempurna.

Presiden Persatuan Pergigian Implan Malaysia, Dr Firdaus Hanapiah, berkata implan gigi bukanlah kaedah baru, sebaliknya ia sudah diperkenalkan sejak 1960an.

Beliau berkata, implan gigi bermaksud penggantian akar gigi tiruan dan ia dirintis oleh Prof Per-Ingvar Brånemark dari Sweden.

Katanya, Brånemark mendapati implan yang dibuat daripada titanium boleh sebati dengan tulang dan berfungsi sebagai penambat untuk gigi.

"Titanium yang bertindak sebagai implan dimasukkan ke dalam tulang gusi. Kini asas penciptaan Brånemark diperbaharui dan terdapat pelbagai jenis implan gigi yang boleh dipilih oleh pesakit," katanya.

LUBANG implan selepas gigi dicabut (gambar kiri). PROSES penanaman implan.

Berbanding dengan alternatif rawatan pergigian yang lain, implan gigi lebih kuat dan lasak. Ia juga berfungsi hampir menyamai gigi asal. Oleh itu, ia adalah jawapan kepada masalah kehilangan gigi kekal.

Dr Firdaus berkata, implan bukan saja boleh dipasang secara sendiri tetapi ia juga digunakan sebagai sokongan kepada kaedah pergigian terdahulu seperti jejambat gigi (bridge) atau bertindak menambah kestabilan gigi.

Selain itu, katanya ia juga boleh berfungsi mengurangkan masalah tisu gusi.

"Ada beberapa jenis implan dan antara yang popular ialah implan menyerupai akar (root shape implant) dan implan satu keping (one-piece implant)," katanya.

IMPLAN yang sudah ditanam, tetapi belum dipasangkan gigi (gambar kiri). GIGI selepas proses implan.

Dr Firdaus berkata, implan gigi tidak sama dengan gigi palsu, sebaliknya, implan yang diperbuat daripada titanium bertindak sebagai akar kepada gigi yang hilang. Ia akan ditanam dalam gusi sebelum gigi yang diperbuat daripada porselin dilekatkan di atasnya.

Katanya, selain bergantung kepada keadaan gigi pesakit dan kekuatan tulang bawah gusi, ada kalanya proses meletakkan implan dan gigi dilakukan beberapa bulan atau hari selepas gigi dicabut.

Selepas implan ditanam, katanya pemasangan gigi akan dibuat beberapa ketika selepas itu dan sekali lagi ia bergantung pada kekuatan tulang bawah gusi pesakit.

Bagaimanapun, Dr Firdaus berkata, bagi pesakit yang memiliki tulang bawah gusi yang kuat, prosedur membabitkan penanaman dan pemasangan implan dan gigi dengan kadar segera boleh dilakukan. Kaedah ini dikenali sebagai implan pasang segera (immediate loading procedure).

Secara umum, pada peringkat antarabangsa, ada beberapa tempoh masa diberikan bagi menanam implan selepas gigi dicabut. Antaranya:

Implan pasang segera selepas gigi dicabut

Pemasangan implan yang tertunda selepas gigi dicabut (Delayed immediate post-extraction implant placement) yang memakan masa antara dua minggu atau tiga bulan selepas dicabut.

Pemasangan implan lewat (tiga bulan selepas dicabut)

Pesakit kadang kala tidak mahu menunggu lama untuk memasang implan selepas gigi dicabut, justeru implan pasang segera menjadi pilihan.

Prosedur ini membolehkan implan ditanam dan gigi terus diletakkan di atas. Prosedur ini banyak bergantung kepada beberapa faktor antaranya tulang gusi yang kuat untuk menampung implan dan porselin. Jika tulang gusi tidak kuat, ia tidak boleh dilakukan.

Dr Firdaus berkata, tulang bawah gusi berfungsi untuk memegang implan dan jika tidak kuat atau nipis, ia tidak boleh menampung porselin sekali gus menyebabkan pecah.

"Kalau tulang bawah gusi memang tidak kuat, ia diperbaiki dengan menambah kekuatan tulang menggunakan tulang sintetik yang diambil daripada rahang atau pinggang pesakit," katanya.

Bagaimanapun, katanya bukan semua gigi boleh diganti dengan implan pasang segera. Hanya gigi yang tidak memiliki gigitan yang kuat contohnya gigi depan saja boleh melalui prosedur ini.

Katanya, prosedur penanaman implan tidak terhad kepada satu gigi saja. Malah, seseorang itu boleh memasang sehingga 11 implan dalam satu masa.

"Implan memiliki kekuatan yang sama dengan gigi asal. Ia boleh bertahan lama selagi kita menjaganya seperti mana penjagaan gigi biasa. Plak juga tidak mudah lekat kerana ia diperbuat daripada porselin, jadi ia licin," katanya.

Dr Firdaus berkata, jika hanya satu batang gigi saja yang ingin diganti, prosedur implan satu keping menjadi pilihan.

"Biasanya, implan ini dipasang jika hanya satu batang gigi saja yang rosak atau ia berulang kali berlubang yang tidak boleh dibetulkan atau gigi hanya tinggal tunggul. Selalunya, prosedur ini menjadi pilihan mereka yang kemalangan jalan raya atau mengalami rahang pecah,"

Mengenali proses implan

Diagnos atau imbasan seluruh gigi perlu dibuat bagi mendapatkan ukuran. Ini bagi mendapatkan ukuran panjang implan yang akan ditanam. Panjang implan adalah berdasarkan panjang akar gigi yang akan diganti. Biasanya akar gigi orang dewasa adalah antara lapan hingga 15 milimeter (mm) dengan lebar antara 3.3 mm hingga 6 mm.

Pesakit akan dibius menggunakan jenis bius setempat dan prosedur memasukkan implan mengambil masa 10 minit. Proses ini tidak menyakitkan. sementara gigi belum dipasang, satu alat khas dipasang bagi menutup permukaan implan. Gigi (crown) akan diletakkan di atas implan dalam masa dua bulan setengah (minimum).

Kekurangan alternatif lain selain implan

Secara tradisionalnya kehilangan gigi akan digantikan dengan gigi palsu. Bagaimanapun, gigi palsu tidak membolehkan pemakainya menggigit dengan kuat, mudah patah dan pecah.

Satu lagi rutin gigi palsu yang mesti dipatuhi, ia perlu dibuka sebelum tidur bagi mengelak jangkitan.

Selain gigi palsu, alternatif yang ada adalah jejambat gigi (bridge) masalahnya, gigi di sebelah kiri dan kanan perlu dibetulkan bagi memudahkan proses menyangkut bridge. Masalahnya gigi yang elok juga perlu dipotong.

INFO: Siapa yang boleh menggunakan implan gigi?

Secara umum, mereka yang boleh memilih prosedur ini adalah;

Kehilangan sebatang atau lebih gigi.

Memiliki tulang bawah gusi yang kuat atau boleh melakukan prosedur graft tulang.

Berhadapan dengan trauma yang menyebabkan gigi rosak, patah atau mengalami penyakit kekurangan gigi sejak lahir (hypodontia)

Memiliki tisu mulut yang sihat

Tidak berhadapan dengan masalah kesihatan yang boleh mengugat proses penyembuhan tulang.

Dental Implants - Letters in The Star

2008-02-19T03:14:00.009+08:00

On February 13, 2008 The Star published a Letter to the Editor by MEDICAL DOCTOR that contained many misconceptions about dental implants. This letter and the responses it had evoked are reproduced below so that the public can be corrected of any misconceptions and have a more accurate picture of dental implants.
~ Azlan Adnan

Wednesday February 13, 2008

Dental visits a pain in the pocket

ACCORDING to statistics, about 10% of people who are 55 years and older will begin to lose their teeth. Whatever the cause attributed to each individual, age is the single biggest factor.

Because of our ageing population, the number of people who would become edentulous would be a substantial number. The market is huge.

Many old folks are at the mercy of dental surgeons, especially the ones who now describe themselves as implantologists.

Many of them wear doctor’s coats, carry stethoscopes and insist on being called doctors. They charge by the tooth for every implant. Current prices range from RM7,000 to RM9,000 for the implantation of a tooth. This does not include the cost of the replacement parts, surgery, X-rays, etc.

Hence, for about four to five teeth to be implanted in the average elderly person, the price can come up to RM45,000. This is more than the cost of a complex angioplasty, bypass operation, or a hip replacement.

There seems to be no regulation to control these prices. It is a free market, with dentists, specialists, as well as GPs competing and charging whatever the market can take.

Most older people are poor and have to depend on their relatives. And few family members want to pay these exorbitant charges.

Government specialists, curiously, do not provide teeth implants for most of these unfortunate victims. If they do, it is to learn the technique before leaving government service.

While the cost of private medical care is now regulated and there are guidelines provided by the MMA, implantology is a wide open field with no control. Even the Malaysian Dental council has not tried to exert any control.

The patients who cannot afford implants are given cheap dentures or a mix of implant and a bridge (if they can afford the latter).

Having watched the implantation procedure, I think this is really a simple procedure, most of the time done under direct vision. There are no special tools required.

Most surgically trained medical GPs should be able to learn this procedure very quickly. There will, of course, be some difficult cases which can be left to the specialists.

Dental surgeons, whether specialists or GPs, work in a very narrow field of the human body. From experience, I have learnt that they know little or nothing about the wider spectrum of medicine.

The number of antibiotics they are familiar with is very few. They ask for a history of diseases that the patient may have but do not know how to assess how bad these diseases are or how they should be treated.

They have no idea about emergencies that may occur with surgery or with drugs.

They do not know anything about cardiopulmonary resuscitation.

Because of these weaknesses, I would suggest the following remedial actions:

> The Malaysian Dental Council should investigate and control prices in this dog-eat-dog business. They must impose some discipline to care for poor old people.

> The dental surgeon who calls himself an implantologist should give a written bill to the patient before he starts treatment. He should list all his immediate charges as well as charges for subsequent visits.

> It should be possible to train technicians to do single implants. These technicians should be licensed and also given guidelines on charges. Prices would come down in a free market once you increase the supply.

> Medical emergencies during a dental implant are rare but can happen. Hence it should be mandated that an anaesthetist should be on standby during any implant or surgical procedure done by a dentist.

> The dentist should buy and place in his clinic emergency equipment. This would include a defibrillator, a heart monitor, a pulse oxymetre and an ECG machine.

> The implantologist should be certified, which means going before a panel of peers who will verify if he has the knowledge and skills to perform large volume implantation.

MEDICAL DOCTOR,
Kuala Lumpur.

~~~~~<<<*>>>~~~~~

Thursday February 14, 2008

Get your facts right, doc

MEDICAL Doctor in his letter “Dental visits a pain in the pocket” (The Star, Feb 13) does not even know the duties of a dental surgeon and a dental technician.

A dental surgeon graduates with a “Bachelor of Dental Surgery” degree and is conferred with the title Doctor while a dental student studies anatomy, physiology, biochemistry, dental materials, pathology, microbiology, pharmacology, medicine, surgery and all other dental subjects in a dental college.

The RM7,000 to RM9,000 fee is still cheap for a single dental implant. The cost to set up a dental surgery with implantology varies from RM500,000 to RM1mil or more. The material costs and laboratory charges are equally high.

The procedure for doing a dental implant is not simple. It is a high precision procedure and needs lots of training before the dental surgeon can provide such treatment. It is not just a case of cut and fix.

All dental surgeons providing dental implant treatment have undergone intensive training and attended courses and meetings like the latest Osstem Meeting 2007 at KLCC on Nov 25 last year.

Here are my replies to some of the suggestions raised in the letter:

> The Malaysian Dental Council together with the Health Ministry have set the range of dental charges for basic dental treatment under the Private Healthcare Facilities and Services Act. Dental specialist charges have not as yet been imposed.

> All dental surgeons providing dental implants and any other dental treatment quote the treatment charges prior to starting the treatment and patients are forewarned of any other charges that may occur during the procedure should any deviation of treatment arise.

> Technicians are not surgeons. They only fabricate the implants, crowns, bridges, dentures and splints in their laboratories.

> All dental surgeons doing dental implants are fully aware of any medical emergencies that may arise and are well prepared for it. So far, not a single emergency has occurred for a dental surgeon to require a defibrillator, a heart monitor, a pulse oxymeter or an ECG machine.

> Should such a need arise, the dental surgeon will either call for medical help or take the patient himself to the nearest medical centre.

> A dental surgeon providing dental implant treatment has attended courses and is proficient in his expertise. Not all dental surgeons provide dental implant treatment.

Medical Doctor should get his facts correct before alarming the public unnecessarily. If you cannot afford an expensive car, you should buy a cheaper car according to your budget.

The Malaysian dental surgeons are doing a very good service to the public.

DR JASPALL SINGH,
Vice-President,
Malaysian Private Dental Practitioners Association, Kuala Lumpur.

~~~~~<<<*>>>~~~~~

Saturday February 16, 2008

What a dentist can do only a dentist can do

I REFER to the letter ‘Dental visits a pain in the pocket’ (The Star, Feb 13). The dental treatment charges in Malaysia are well regulated by the Medical Practice Division, of the Health Ministry under the Private HealthCare Facilities and Services Act 1998 (Act 586).

This act is well supported by Malaysian Private Dental Practitioners’ Association and Malaysian Dental Association.

Dental practitioners’ in the private sector whether they are GPs or Specialists are well trained in this aspect and are supposed to adhere and practise dentistry according to these guidelines.

The healthcare clients (new terminology for patients) have their own rights. Under the Act, they have all the rights to know about the charges and treatment procedures.

If they do not feel satisfied with the dentist, there is the “Grievances Mechanism” in clinics to address the issue under the Act.

The writer also said that the dental surgeons were not well versed in drugs.

The second year of dental course covers pharmacology.

In fact, dental surgeons can treat Upper Respiratory Tract Infection (sore throat) that is a common disease treated by medical practitioners.

The third year covers subjects of general surgery and general medicine.

The syllabus clearly shows that dental surgeons are on par with their medical counterparts.

Another accusation by the writer is that implantologists are not well trained and medical GPs can place implants.

This is a joke!

My sincere advice to him is, please look at your backyard.

There are a lot of illegal and incompetent medical practitioners. Try to rectify that.

We have our own professional body to regulate competency.

In conclusion, I feel the writer was wrong in all his statements and figures.

He was too emotional in expressing his opinion and created an increase in dental phobia among dental patients.

One important phenomenon that everyone must realise is that: “What a dentist can do only a dentist can do.”

Dr NEDUNCHELIAN VENGU,
President,
Malaysian Private Dental Practitioners’ Association.

~~~~~<<<*>>>~~~~~

Monday February 18, 2008

Cheaper to do dental implants here

AS A practising oral implantologist, I read with alarm and concern the polemic “Dental visits a pain in the pocket” (The Star, Feb 13).

To clarify matters and to set the record straight, I would like to address certain inaccuracies that were unfortunately passed off as facts:

> To qualify as an oral implantologist requires vigorous practical and theoretical grounding on par with medical doctors: a five-year basic degree in addition to a further two to four years of specialisation.

During the course of the training, many modules are identical to those undertaken by medical students, including management of medical emergencies and performance of cardio-pulmonary resuscitation (CPR).

> The current prices of implants in Malaysia range from RM5,000 to RM9,000, which is substantially lower than those in other countries. For example, implants in Singapore easily cost in excess of S$6,000 (RM13,662); in the UK, more than £2,500 (RM15,788); in the US, more than US$2,500 (RM8,050).

In fact, many foreign patients of mine have performed multiple dental implants in Malaysia specifically due to the equivalent level of professional competence but at a fraction of the price back home.

> Implants are not necessarily the final word in tooth restoration (even though the procedure ranks as the best among the options available in terms of comfort, function and aesthetics).

In the interest of cost, cheaper options such as dentures and bridges are available. On this note, no right-minded dental practitioner will force a patient to have implants done if affordability is an issue.

> The Malaysian Dental Association does provide a list of recommended fees for dental implants. However, as the writer pointed out, it is a free market; therefore each patient has the right to find the practitioner that he is most comfortable with.

> Government specialists have been providing dental implant services for some time now at lower rates compared with private fees. The writer seems to be ignorant of this fact.

> The implantation procedure is not as simple, nor as straightforward, as claimed by the writer.

As stated in the foregoing points, an oral implantologist has to undergo lengthy clinical and hands-on training to become an expert in the field.

There are many serious complications and adverse effects that can arise should the procedure be done incorrectly: for example in the case of guided bone regeneration procedure, sinus lift and bone harvesting.

I hope I have clarified some of the misconceptions that the writer has generated in his letter.

AN ORAL IMPLANTOLOGIST,
Petaling Jaya, Selangor.

~~~~~<<<*>>>~~~~~

Saturday February 23, 2008

Implants cost too much

I REFER to the letter Cheaper to do dental implants here in The Star, Feb 18. Implants in Malaysia costs between RM5,000 and RM9,000. Let us say it is RM7,000 on the average, which is the equivalent to 7,000 cups of coffee or three months' pay of a government medical officer’s salary here.

In Britain, it is £2,500 which is about 1,500 cups of coffee there or less than a month's salary of a government medical officer.

In the United States, it is US$2,500, which is about 1000 cups of coffee there or much less than a month's salary of a government medical officer. In Singapore, it is S$6,000, which is about 2000 cups of coffee there or less than a month's salary of government medical officer.

A baby delivery by Caesarean section here - which includes general anaesthesia and few days stay in a private hospital - would cost less than a tooth implant in Malaysia.

So dental implants here are among the most expensive in the world.

Suggesting other alternatives like dentures and bridges is like telling a patient with a bone fracture not to have nailing and plating and just to have plaster casts, as it will heal anyway.

Just as there is government control over food items and other products, there must be a price control over dental procedures. Dental health must be available and affordable to the rakyat of Malaysia.

As can be seen from above, a reasonable charge for an implant would be around 1,500 cups of coffee or RM1,500 by comparing the different prices of several countries. A root canal should not cost more than RM300 and crowns not more than RM300.

Technicians here should be taught to perform implants as there are other more difficult procedures that are also done by technicians. For example, there are midwives doing a good job with examinations, investigations and the delivery of babies.

Ultrasound and echo (for heart patients) are done by technicians, medical assistants are doing examinations, investigations and treating patients while dental nurses are doing fillings and extractions. In addition, anaesthetic assistants are giving general anaesthesia in rural areas.

Medical doctors should be taught to do implants as they have basically learnt all that the dentists have learned such as oral anatomy, physiology, pathology, bone regeneration, bone harvesting etc.

In my rural posting I was taught to extract teeth and do fillings. Implants have now become a common part of dental procedures, just as root canal treatment.

If there is a shortage of oral implantologists then we should recruit medical doctors. I am sure doctors here will fulfil their Hippocratic Oath to serve the public.

Dentists are also bound by Hippocratic oath to serve the public.

ANOTHER DOCTOR
Kuala Lumpur

~~~~~<<<*>>>~~~~~

Sunday February 24, 2008

Dental implants have the best bite

THE ideal standard of care for replacing teeth is not a denture or even a bridge anymore, but dental implants.

Dental implants are now used to replace missing teeth, stabilise loose dentures, straighten teeth and rehabilitate patients who have lost parts of their jaw and face due to cancer or accidents.

We refer to the letter “Dental visits a pain in the pocket” (The Star, Feb 13) and wish to express our sadness over the misconceptions of a colleague whose profession we highly respect and admire.

Dentists or dental surgeons are part and parcel of the healthcare providing medical profession and work hand in hand for the betterment of our patients.

We do empathise with his concern for the older members of the population who due to inadequate dental care in the past now require dental implants.

However, the main cause of teeth loss in older people is not aging as stated by medical doctor, but gum disease.

This means that a healthy adult who takes proper care of their teeth and gums will enjoy a full set of teeth for life.

Hardly 10% of dentists practice implantology and also because implants are all imported and costly, the cost of providing the service is still relatively expensive.

Research and development of dental implantology took a lot of time, effort and expenditure on the part of university researchers and implant manufacturers.

The cost of training is still very high because it involves highly trained lecturers, logistics and material costs.

Implantology is not as simple as it looks.

Such treatment can range between simple to highly complex procedures that involve bone grafting, gum grafting, specialised imaging, detailed planning and a thorough understanding of occlusion which may take years of experience to understand and successfully manage.

Special dedicated tools, equipment and materials are needed in implantology.

Dental implantology usually does not incur any more trauma than an ordinary extraction of a tooth, and therefore does not require any extra safety measures that are not already in place in all dental clinics.

Dental implants have helped countless people around the world to enjoy their food again. They are the best replacement for lost teeth.

Though expensive currently, the price will keep coming down due to free market forces.

Like in all professions, some dentists charge more and some less. Find one you can afford.

After all, dentists here in Malaysia are highly trained and yet are still among the most affordable in the world.

The cost for dental implants in Malaysia is one of the lowest in Asean.

This has led many from overseas like Australia, Europe, America and Japan coming to Malaysia to enjoy the benefits of dental implantology at international standards and yet at half the price or less in their home countries.

Dental implantology has placed Malaysia on the map as a major destination for health tourism in this region.

DR FIRDAUS HANAPIAH & DR CHOW KAI FOO,
President and Honorary Secretary,
Malaysian Oral Implant Association (MOIA).
Affiliate of the Malaysian Dental Association

~~~~~<<<*>>>~~~~~

Monday February 25, 2008

Dental implants an expert’s job

WE REFER to the ongoing discussion on dental, medical and healthcare costs in Malaysia. In Implants cost too much (The Star, Feb 23) oral implants were likened to treatment for bone fractures.

Comparing the cost of dental implants to the local price of a cup of coffee does not make sense. This is because a major cost of a dental implant is the cost of the imported prosthesis itself.

More than just the cost of materials, oral implantology is a multi-stage multi-disciplinary treatment procedure. The surgical component (i.e. the placement of the implant within the bone) is performed by the implantologist/oral surgeon.

In fact, we invite interested medical surgeons to equip themselves with the proper training and accreditation that enable them to perform this surgical procedure.

The demand for oral implants is far higher than what dentists in this country can cope with. Having well-trained medical surgeons to help out in the surgical process will be a welcome bonus.

The next step involves designing an artificial tooth over the implant. When a patient requests an implant, this tooth component is the one he or she will see and use every day.

Therefore, this stage is best carried out by a dentist properly trained in treatment planning, dental occlusion, function and aesthetics.

Based on the dentist’s exact specifications and detailed instructions, the prosthesis (tooth) is custom-made in the laboratory by a dental technician. Finally, this prosthesis is precisely attached to the implant.

Function and cosmetics are examined clinically. This multi-stage, multi-disciplinary approach is important to ensure that each stage is done by an expert in that field, to ascertain the best possible treatment outcome.

The dental implant of today is by no means the ultimate replacement for missing teeth. Further research and development (R&D) is required.

Currently, essential/basic dental treatment like extraction, pain relief, fillings, scaling, and infection management are already affordably priced. These procedures are cheaper than most medical surgical treatment.

We are working towards a time when dental implants are no longer an optional luxury but a common affordable treatment alternative, just as cars were once exclusive to the rich but are now commonplace.

We can achieve all this and more only with the understanding and cooperation of our medical colleagues and the public.

Who knows, with support from all parties and sufficient funds for R&D, the option of replacing a missing tooth with a new one grown from stem cells may soon be available.

DR FOO CHI CHEAN,
President – Malaysian Academy of Cosmetic Dentistry.

DR MELISSA FOO SUYIN,
Oral & Maxillofacial Surgery Department, Hospital Sungai Buloh.

~~~~~<<<*>>>~~~~~

Monday March 3, 2008
Why dental implants are costly

I WRITE in response to opinions expressed on dental implants in letters to The Star on Feb 13 and Feb 23.

I wish to inform the concerned persons that the practice of dental implant placement is a recognised procedure carried out by dental practitioners (dental surgeons) who have undergone the required training.

It is worthy to note that dental implants are fabricated abroad and imported and thus remain costly and the procedural cost of implants may vary from practitioner to practitioner in the private sector.

Government dental specialist clinics provide implants as well, but case selection often favours functional purposes.

Should there be any dissatisfaction over treatment provided by dental practitioners, complaints can be channelled to the Malaysian Dental Council, which regulates the profession.

In addition, the Malaysian Dental Association and its affiliate bodies are dental bodies which are also able to address issues related to dentistry.

DATIN DR NORAIN ABU TALIB
Senior Director of Oral Health
Ministry of Health Malaysia
and Registrar, Malaysian Dental Council

Confessions of a procrastinator

2008-01-25T19:42:00.000+08:00

A procrastinator explains how it feels after finally having gone to the dentist:

Sometimes it is only when the niggling pain goes away that you realise just how irritating and distracting it had become.

A sore tooth can sit for weeks just beneath the threshold of consciousness before you finally decide to do something about it, and you leave the dentist full of optimism, hope and love for all humanity now that you can think clearly.

Well, like a man who bangs his head against a brick wall because it feels so good to stop, I've finally given up procrastinating and visited my dentist.

And life is good.

The toothache has been sorted. The ringing in my ears has stopped. I can breathe freely and that sharp pain whenever I bend over sideways has finally cleared up. I can be at peace whenever and wherever I want to be, and life is good.

Dental schools in Malaysia

2008-01-18T15:46:00.000+08:00

University of Malaya Faculty of Dentistry
Prof. Dato' Dr Ishak Abdul Razak, BDS (Malaya), DDPHRCS (England), MSc (London), PhD (Malaya)
Dean, Faculty of Dentistry
University of Malaya
50603 KUALA LUMPUR
Malaysia
Tel: +603-7967 4800 / 4801, +603-7956 5143 (Dean's DL)
Fax:+603-7956 1607 / +603-7967 4809
Emails: queryfq@um.edu.my, dekan_dental@um.edu.my

Universiti Kebangsaan Malaysia Faculty of Dentistry
Professor Dr Ghazali Mat Nor
Dean, Faculty of Dentistry
Universiti Kebangsaan Malaysia
Jalan Raja Muda Abd Aziz
50300 KUALA LUMPUR
Malaysia
Tel: +603-4040 5799 / +603-4040 5700 (Dean's DLs)
Emails: dkfdent@dental.ukm.my, ghazali@medic.ukm.my
http://pkukmweb.ukm.my/~FPerg/MALAY/laman%20utama.html
http://www.ukm.my/english/fgigi.htm

Universiti Sains Malaysia School of Dental Sciences
Assoc. Prof. Dr. Hj. Abdul Rashid Hj. Ismail
Dean, School of Dental Sciences
Universiti Sains Malaysia
Kampus Kesihatan
16150 KUBANG KERIAN
Kelantan, Malaysia
Tel: +609 766 3700
Fax: +609 764 2026
e-mail: dental@kb.usm.my
http://www.kck.usm.my/ppsg

Universiti Teknologi MARA Faculty of Dentistry
Prof Dr Mohamed Ibrahim Abu Hassan, BDS (Malaya) MDSc (Leeds), PhD (Bristol)
Founding Dean, Faculty of Dentistry
Universiti Teknologi Mara
40450 SHAH ALAM
Malaysia
Tel: +603-5543 5802, +603-5543 5801 (Dean's DL)
Fax: +603-5543 5803
Email: mibrahim@salam.uitm.edu.my
http://www.dentistry.uitm.edu.my

AIMST University School of Dentistry

AIMST University Semeling Campus:
Senior Professor Dr Frederick Charles Smales, BSc Dunedin, BDS Newcastle, PhD London, FDSRCS England and Edinburgh, FHKAM (Dental Surgery), FCDSHK (Periodontology)
Dean, School of Dentistry
AIMST University
Jalan Bedong - Semeling
08100 Bedong
Kedah Darul Aman
Tel: +604-429 8000 / 8038
Fax: +604-429 8007 / 8008 / 8009
Email: chooseaimst@aimst.edu.my

KL Office:
AIMST University
No. 10-1st Floor
Jalan SS15 / 8
47500 Subang Jaya
Tel / Fax : +603-5636 3688
http://www.aimst.edu.my/facultiesn/facultiesdetails/denintro.asp

Penang International Dental College (campus is under construction in Kepala Batas, Bertam, Penang)
Administration Office:
Dr S. Sharavanan, MBBS., M.D., (Radiology)
Pro-Chancellor – VMU, Salem, India.
Managing Director and Chief Executive Officer – PIDC
Suite 3A-05, Block-E
Phileo Damansara 1
Jalan 16 / 11, Off Jalan Damansara
46350 Petaling Jaya
Selangor Darul Ehsan., Malaysia
Tel: +603 7665 3333,
Fax: +603 7665 3323
E-mail: info@pidc.edu.my
Website: http://www.pidc.edu.my

International Islamic University Malaysia Kulliyyah of Dentistry
Dean, Kulliyyah of Dentistry
International Islamic University Malaysia
P.O Box 141
25710 KUANTAN
Malaysia
Tel: +609-571 6441 / 6444
http://www.iiu.edu.my/prospective/faculties.shtml#faculties

Universiti Sains Islam Malaysia (USIM) Faculty of Dentistry
Dean : Dato’ Dr. Wan Mohamad Nasir bin Wan Othman
Secretary: Ms. Firdaus binti Alwi
Assistant Registrar: Mr. Mohd Azli bin Mohd Nizah
Faculty of Dentistry
Islamic University of Malaysia
Level 13, Tower B, MPAJ Building
Pesiaran MPAJ, Jalan Pandan Indah
55100 KUALA LUMPUR
Malaysia
Tel: +603-4289 2566
Fax: +603-4289 2408
e-mail: ddwan818@admin.kuim.edu.my
http://www.kuim.edu.my/english/index.php?option=com_content&task=view&id=96&Itemid=85

Prevention is better than cure

2008-01-18T01:01:00.000+08:00

Prevention is vital to avoid tooth decay

To ensure you look after your teeth properly, you should routinely spend at least two minutes every morning and night and after meals brushing and flossing your teeth.

Controlling what you eat can help reduce your risk of tooth decay, too. Limiting your intake of sugary and starchy foods helps to prevent tooth decay and the need for dental treatment. Some of the bacteria in our mouths love the sugars and starches found in foods. They turn these into acid, which causes decay.

Help your children brush their teeth twice a day and after meals, and take them for regular check-ups at the dentist. Also, cut down the amount of sweet snacks your child is allowed (including acidic fizzy drinks). Luckily in Malaysia, our water supply is fluoridated, so it is not necessary to take fluoride supplements.

Why have a dental check-up?
Get in the habit of seeing your dental surgeon as often as they recommend, so that complicated and unpleasant treatments can be avoided. Most problems could be detected early, helping you steer clear of extensive treatment. There are good reasons besides toothache, for seeing your dental surgeon. They can often diagnose and prevent diseases of the tongue, lining of the cheeks (mucosa), palate and jawbones. As well as checking gums for disease, they may also spot the first signs of oral cancer (although only about seven percent of cancerous tumours occur in the mouth).

Your dental surgeon will give you a personal recommendation of how often you should have a check-up. Current guidelines recommend that for under-18s check-ups should be between 3 and 12 months, and for adults between 6 and 18 months.

This will:

• Ensure your teeth and gums are in good shape
• Allow the dental surgeon to remove any plaque which contributes to cavities and gum disease
• Enable the dental surgeon to spot serious oral health problems early when they can be treated successfully
• Enable you to learn how to brush and floss your teeth properly
• Build your confidence if you’re nervous, as you’ll get to know your dental surgeon and know what to expect at each visit

Oral Health Survey of Malaysian Adults 2000
According to the results from the Oral Health Survey of Malaysian Adults 2000, less than half of those surveyed cited making a dental visit within the last two years, and more than 50% of them did so only because they had dental problems.

Only about 13% made self-initiated ‘preventive visits.’

Only about 60% of those with problems of the oral cavity perceived a need to see a dental surgeon. In fact, about 50% of those with problems of the oral cavity did not make a dental visit within the last two years, the large majority perceiving their dental problems as ‘not being serious enough.’

It is pertinent to note that cost of treatment was not a barrier to dental treatment for a large majority of Malaysians; dental fees in Malaysia being among the lowest in the Asia Pacific region.

Public dental facilities seemed to rate quite highly by a substantial number of those surveyed. More than half of subjects attended a public facility, yet if given a choice of facilities, more than two-thirds would actually prefer to use a public facility.

The reasons for preference of public facilities were ‘reasonable charges,’ ‘good facilities and equipment’ and ‘convenient location.’ Those who chose private facilities did so mainly because of the ‘short waiting time’ and ‘convenient hours.’

Government poll results
Another poll asking “Where do you go for your dental treatment?” conducted by the Oral Heath Division, Ministry of Health found that 49% of Malaysians frequented Government dentists, 36% went to private dentists and an amazing 15% avoided dentists at all costs!

Afraid of the dentist?
Many people feel anxious at the prospect of seeing the dental surgeon and, for some, their fear prevents them from visiting for years. However, most practices are sympathetic and various methods of help are available.

Why we’re afraid
An unpleasant experience in the past may be the cause of the anxiety. Other common concerns include fear of injections, the anaesthesia not working, concerns about unnecessary treatment and anxiety about cross-infection.

Fear of the Fee
It’s not always fear of physical pain that makes people anxious about a dentist’s visit; in many countries, particularly the USA and UK, it’s also fear of the fee. As dentist Robert E Kroeger explains in his book How to Overcome Fear of Dentistry:

Because many fearful patients have not visited a dentist in 5-10 years or longer, they may have memories of dental fees from their last dental visit many years ago. When they are informed of the current fees for treatment, they experience ‘sticker shock’. The dental phobic may need some time to accept that his or her mouth deserves the best dentistry and that may cost a substantial amount.

There are ways to lessen this trauma to the back pocket. In Europe, the British, Germans, Austrians and Swiss are taking dental holidays in Hungary and Poland, where dentists charge a third to half of Western prices for similar quality dentistry performed with the latest high-tech equipment.

Americans with rotten teeth can take their families on a dental excursion to Costa Rica where you can shop and sightsee between visits to US-trained dentists who charge a fraction of the prices elsewhere.

The good news for Malaysians is that we have some of the lowest dental fees in the Asia Pacific region. So much so that dental tourism is fast gaining ground as an industry here in Malaysia with patients coming from Singapore, Indonesia and even as far away as Australia, Europe and Ecuador for affordable world-class dental treatment.

What can be done?
Don’t be embarrassed about expressing your concerns and talk to your dental surgeon. If you haven’t been for a while, you may wish to contact a number of practices first and explain your concerns over the phone.

If you need treatment, ask plenty of questions and make sure you understand exactly what will happen, which should help you to feel more in control. You may also wish to take a friend or relative with you for support.

If the thought of a long treatment session is worrying you, discuss it with your dental surgeon and work on a coping strategy, such as a hand signal if you need to take a break for a few moments.

Sedation
Fear of dentists is not a uniquely Malaysian experience. In 1998, the American Dental Association found that over 23 million Americans delay dental care solely out of fear. All of these dental patients have some sense of nervousness when it comes to going to the dentist.

Sedation provides an option for these patients who want to get their teeth fixed but are fearful of the process. Sedation ~ the use of anesthesia during dental procedures ~ may diminish the fear in these patients, but will not obliterate the pain.

The candidates for sedation have one or more of the following characteristics:

Dental anxiety
Dental phobia
Inability to control movements due to conditions like Parkinson's Disease or cerebral palsy

There are several different methods of sedation as applied in dentistry. Dentists may choose to use only one, or, several of the following methods in combination:

Nitrous oxide
IV sedation
Oral sedative

Dental Implants

2008-01-14T23:51:00.000+08:00

Tooth extraction is quite common due to poor dental health and gum disease. Leaving the missing tooth space empty may not sound too serious, but the consequences of not filling in the space from the missing tooth can include:

The teeth adjacent to your missing tooth can change position to fill the gap;
The loss of your missing tooth’s root can cause your jawbone to shrink, making your face appear prematurely older; and,
A missing tooth in the front of your mouth can affect your smile and your self-confidence.

In many situations, a dental implant is the most pleasingly aesthetic solution for replacing the missing tooth. An all-ceramic dental crown or dental bridge, secured to a dental implant, provides a complete and beautiful solution for improving your smile. A dental implant takes the place of the missing tooth’s root and helps prevent the above consequences.

What are dental implants?
Dental implants are artificial teeth roots that are surgically anchored into the jawbone. Most implants today are endosteal implants— these are surgically implanted directly into the jawbone. Usually made of titanium alloy, they are securely positioned into the jawbone beneath your gums. Once in place, they allow your dental surgeon to mount prosthetic (replacement) teeth (called crowns or dentures) onto them.

Once the surrounding gum tissue has healed, a second surgery is needed to connect a post to the original implant. Finally, an artificial tooth (called crown) is attached to the post individually, or grouped on a denture.

In “flapless implant” surgery, however, this second surgery is unnecessary as the crown is fitted immediately. This surgical procedure is also known as immediate loading.

A removable full denture secured by two implant-borne clip-in retainers: even one or two implants dramatically increase the stability. Photo Credit: Straumann

A single replacement tooth called a crown is finally affixed onto an individual dental implant. Sometimes, when many teeth need to be replaced, a group of artificial teeth called dentures are affixed onto two or more dental implants.
How do dental implants work?
Because implants securely fuse to your jawbone (by a biological process medically known as osseointegration), they provide extremely stable support for replacement teeth. Crowns and dentures mounted to implants won't slip or shift in your mouth — an especially important benefit when eating and speaking. This secure fit helps the dentures — as well as individual crowns affixed over implants — feel more natural than bridges or conventional dentures.

For some people, ordinary bridges and dentures are simply not comfortable or even possible due to a number of reasons such as poor ridges, sore spots or gagging. In addition, ordinary bridges must be attached to teeth on either side of the space left by the missing tooth. A distinct advantage of dental implants is that no adjacent teeth need to be prepared or ground down to hold your new replacement tooth/teeth in place.

To receive implants, you need to have healthy gums and adequate bone mass to support the dental implant. You must also commit to keeping these structures healthy. Meticulous oral hygiene and regular dental visits are critical to the long-term success of dental implants. Usually a course of antibiotics is prescribed when an implant is placed to prevent the occurrence of infection. It is important to take and complete this course of antibiotics to avoid complications due to infection.

Dental implants are usually more expensive than other methods of tooth replacement but the many advantages of dental implants far outweigh this added one-time investment in your oral health.

How long do dental implants last?
Dental implants generally last a lifetime ~ certainly between ten to twenty years ~ depending on the location of the implant in the mouth and on patient compliance with oral hygiene and dental visits. Because molars are used for grinding food, they receive more stress than other teeth. Due to this heavy wear and tear, the crowns on these implants typically do not last as long as those located at the front of your mouth.

In general and barring complications, dental implants that are carefully chosen and placed by your dental or oral surgeon can be safely regarded as a one-time investment in a permanent dental solution that also provides accompanying psychological and social benefits.

Are you a good candidate for dental implants?
Patients must undergo a medical evaluation to determine whether the implant placement procedure poses any health risks, and whether any factors exist that may affect the healing capacity of either their bones or their associated soft tissues.

Who can receive dental implants?
Patients who are medically fit to participate in a general oral surgical procedure.

Who should carefully consider dental implants?
Patients who have medical or other conditions that may interfere with the healing process of either their bones or soft tissues (e.g. connective tissue disorders, steroid therapy, bone infections, cigarette smoking) must carefully evaluate, with their dentists, the potential risks and benefits of using dental implants.

Precautions for implant treatment
Dental implants should not be used in patients that have inadequate amounts of bone to permit placement of implants in sufficient size and numbers to support their biomechanical loads. Mechanical failures, including fatigue fracture of implants, prosthetic screws, and/or abutment screws, may occur if dental implants are insufficient in size or number to support their biomechanical loads, or are not properly positioned. To reduce the risk of overload or fatigue failure, dentists must place the implants and design prosthetics to accommodate the physical or medical conditions of their patients, such as bruxism (i.e., grinding or clenching of teeth) or unfavourable jaw relationships.

Further information:
More information about dental implants may be obtained from the Malaysian Oral Implant Association (MOIA):
http://geocities.com/malaysian_oral_implant_assn

The Phenomenon of the inciDental Tourist

2008-01-14T23:16:00.000+08:00

It all began in the UK
British dental patients are flocking abroad to avoid long queues for access to dentists back home. Cheap flights and bargain prices for treatment are additional incentives.

Some dentists in England and Wales are reporting they have to turn away National Health Service (NHS) patients because local health authorities have run out of money to pay them. The dentists blame changes in government policy introduced in April 2006 designed to improve access to NHS dentists and make fees fairer. However, many dentists were unhappy with their new terms and conditions and it is estimated that some 2,000 dentists (one in 10) consequently left the NHS.

As a result, in that year alone more than two million Britons were unable to get dental treatment, so it is no surprise some are resorting to extreme measures to care for their teeth.

Many dental tourism agencies have mushroomed in the UK offering cut-price treatment combined with a holiday break. Prices are so much lower in Eastern Europe that it is economical for patients from the UK to fly out, undergo surgery, take in a sight seeing tour and return home. Besides dental tourism agencies, British patients are increasingly using the internet and budget airlines to seek out cheaper alternatives to private dentistry at home.

Flocking to Poland and Hungary
To do the same dental treatment in a private dental practice in Great Britain would be three to five times more expensive than in Warsaw. Polish dentists are expecting a boom - the number of dental tourists is expected to increase by 20% in 2008.

Dentists in Hungary are used to dealing with foreign teeth. Austrians, Germans and other Europeans for decades have been crossing the former Iron Curtain to get their teeth fixed, often at jaw-droppingly low prices, literally for a fraction of the price at home. A dental industry has emerged in towns along the border and an estimated one in three Austrians now use Hungarian dentists. The emerging market of British patients is concentrated on Budapest due to its accessibility by three budget airlines.

The Americans join in
Now, a small but growing number of Americans, prompted by soaring medical costs and dwindling insurance benefits at home, are following suit of the Austrians, Germans and British. They're contributing to the rising popularity of dental tourism, a relatively young trend, but part of a fast-growing global phenomenon in which travelers, typically from wealthier countries, visit less-developed nations for dental care mixed with vacation — all at cut-rate prices.

The price factor
One 52-year-old patient’s dilemma was that her teeth were falling out due to a hereditary gum disease and she did not want dentures. She was told the alternative was to have dental implants done privately which would have cost her £52,000 in the UK.

"No way could I afford £52,000," she lamented. Eventually she found she could get the same treatment for £16,500 in Budapest - a 3,360 km round trip that took 12 hours. "It just seems so stupid to get in the car and drive all the way to Luton and catching a flight for a check up and going to another country but I had no option.”

Another patient was quoted £17,000 by a private practice in Edinburgh for root canal work, four implants and 12 crowns. A British dental tourism agency arranged his treatment in Budapest for around £7,000.

Most of British patients who go abroad for dental treatment need extensive work done: bridges and implants, which are not usually available on the NHS. However, with NHS dentists becoming increasingly scarce - just four for every 10,000 people in England - clinics in Hungary are expecting more patients who need routine work such as crowns.

A single dental implant - a metal screw placed into the jaw bone to hold a replacement tooth or bridge - costs £1,000 - £2,000 at a dentist's in north London. In Hungary, they're putting them in for £580. The same London dentist charges more than £800 for root canal treatment and a crown. In Budapest, the price is around £250. Even with the cost of flights, accommodation and return visits, the savings are considerable.

How can they keep costs down? “One reason: the manpower is very cheap,” says a dentist who moved his practice to Hungary five years ago from his native Germany. There, he says, most of the cost goes to lab technicians and salaries. Here, he uses the same materials, pays his staff better-than-average wages and still makes a bigger profit.

A word of caution
The British Dental Association (BDA) urged those thinking of traveling abroad for treatment to be cautious. They warned that if any complications develop when patients are home they may find local dental surgeons reluctant to take on responsibility for extensive treatment that was done another dentist, particularly one overseas.

As for calibre of care, the American Dental Association similarly offers caution. The concerns are not for the quality of dentistry received... but for the patient when it comes to long-term follow-up and possible complications. The term 'buyer beware' is very much in play here, as you may have fewer options after treatment if you feel it has not gone well.

That is one of the potential problems, finding aftercare in the home country for treatment that was done abroad. However, many patients are not worried about that as they are confident in the quality of the work they have received and believe the effort involved in traveling abroad is less stressful than the inconvenience of waiting for treatment in the UK.

All's well that ends well
Dentistry and tourism seem an ideal match. Patients are delighted, for example, to get all of their work done in one fell swoop. And once the major part was out of the way, stopping back for brief fittings left ample time for sightseeing.

Dental Caries

2008-01-14T22:44:00.000+08:00

What are dental caries?
Tooth decay, known technically as dental caries, is one of the most common health complaints in the world.

It is a disease of the teeth that affects individuals of all ages, although it is particularly common in children and young adults.

Dental caries affect individuals of all ages, although it is particularly common in children and young adults. Photo Credit: Nobel Biocare

Its incidence has been fueled by an increase in sugars in the diet, and poor dental hygiene. Dental caries occurs when the tooth enamel is destroyed.

Decay begins at the tooth's hard external surface, and may advance to internal structures of the tooth including the dentin and pulp. The earlier decay is treated, the better chance of saving the tooth.

What causes tooth decay?
The bacteria that are normally present in the mouth change the food (primarily sugars and starches) we eat into acids. Over a period of time, the bacteria and acids form a sticky deposit called dental plaque that clings to the teeth.

Tooth decay is caused by dental plaque that collect, in particular, around the gum line, the edges of fillings and the grooved surfaces of the teeth. Plaque is made up of food debris, saliva and the bacteria that are normally present in the mouth. If plaque is allowed to collect over time it will harden into a substance called tartar. Both tartar and plaque contain acids which, over time, can dissolve away the protective, hard enamel coating of the tooth, resulting in holes or cavities.

Most cavities slowly form over a period of months, or even years and are usually painless, but they can grow very large, and damage the much softer internal structures of the tooth such as the dentin and the pulp, which is found at the core.

If left untreated, cavities can lead to a serious complication such as the development of a tooth abscess - the build up of pus resulting from a bacterial infection of the centre of the tooth. Infection may spread out from the root of the tooth and to the bones supporting the tooth. Tooth infection can kill the nerve and blood vessels of the tooth, and ultimately the tooth itself.

Plaque and tartar also irritate the gums, and lead to a gum disease called gingivitis. Children's teeth primarily decay in the grooves. In addition to the grooves, older adults decay in other areas, including the roots of the teeth, which may be exposed as a result of receding gums.

What are the symptoms?
The most obvious sign of tooth decay is toothache, particularly after hot or cold foods or drinks. However, pain may not be present until decay has reached an advanced stage.

Pits or holes may also be visible in the teeth.

Most tooth decay is discovered at an early stage during a routine check up.

Is diet a factor?
Yes, sugar and starches (such as candy, cakes, cookies, milk and fizzy soft drinks) are responsible for much of tooth decay, but sour or acidic foods (such as lemons and fruit juices), also contribute to decay because they change the pH (acidity level) in the mouth. Eating a diet rich in sugar and starch therefore increases the risk of tooth decay, and sticky foods can be a particular problem because they are more likely to remain on the surface of the teeth.

Frequent snacking also increases the amount of time that acids are in contact with the teeth.

In the absence of good oral hygiene, it doesn't take long for damage to begin. The acids generated by the breakdown of food stuff in the mouth can begin to attack the tooth enamel within 20 minutes of a meal.

How do you prevent tooth decay?
The best way to keep your teeth in healthy condition is to ensure that you clean them regularly to get rid of any plaque build up. Eating nutritious foods and visiting the dentist on a regular basis will also help prevent cavities.

Dentists provide these guidelines for preventing tooth decay:

• Brushing your teeth at least twice a day. Using a toothpaste containing fluoride is recommended as this provides the teeth with added protection from the effects of acid.
• Cleaning between the teeth daily with floss
• Rinsing out your mouth after eating sticky foods
• Eating well-balanced meals and limiting snacking
• Visiting the dentist on a regular basis for check-ups and cleanings
• If brushing is not possible, the next best thing is to rinse the mouth with water to neutralize the acids and change the pH level in the mouth, which may curb tooth decay.

How often should you visit your dentist?
It is also important to have a regular check up at the dentist - most dentists suggest once every six months to a year for a cleaning and a thorough examination. You should never hesitate to consult a dentist if you experience any problems or need emergency care.

How is tooth decay treated?
Unfortunately, even good oral hygiene does not prevent decay as the bacteria congregate in areas inaccessible to brushes and floss. Therefore regular visits to the dentist are important so that your dentist can remove the inaccessible plaque and tartar using a technique known as scaling.

Once the structure of a tooth has been damaged by decay, there is no way to repair it. However, if decay is picked up at an early stage its progression can be blocked. Decayed material can be removed, and replaced with a restorative material known as a filling.

If the decay is more extensive, then another option is a crown. The decayed or weakened area is removed and repaired and a covering jacket - the crown - is fitted over the remainder of the tooth.

If the nerve in a tooth has died, either from decay or a blow, then a dentist will consider root canal work. This involves removing the centre of the tooth, including the nerve and blood vessel tissue. The root is then filled with a sealing material, and the process is completed with a filling or, possibly, a crown.