This offer is only available with Dr Vicki Chan, our newest team member, and with our hygienists, Reem and Sarah! Offer is open till Sept 2013!

Yes, that’s right, NOT Dental Associates’ fees (we are a beautiful PREMIUM practice based in the middle of Auckland’s gorgeous Viaduct harbour) but the average fee as charged by Auckland dentists!

Why do it this way? So you know that you are receiving a discount based on a PUBLISHED fees list based on dentists’ fees all over the Auckland region. Now THAT’S value! We also provide FREE parking here for all our patients, in conjunction with WILSON PARKING (Pakenham St East).

*Premium Heraeus-Kulzer CAD teeth used on all our dentures.
** New Zealand labs are used for all our work, we DO NOT send our work overseas. Dental Associates is proud to support local businesses and industries wherever possible.

For more procedures and average fees in Auckland, look here: http://www.healthysmiles.org.nz/assets/pdf/Feessurvey2010.pdf

Super Gold Card Members – enjoy 15% off the average AUCKLAND fee for a procedure.This offer is only available with Dr Vicki Chan, our newest team member, and with our hygienists, Reem and Sarah!  Offer is open till Sept 2013! Contact us now to ask about our Super Gold Card discounts. Phone: 09 3651565 Fax: 09 365 1575 email: info@dentalassociates.co.nz In addition to EFTPOS, VISA, AMEX we also accept GEMVISA and QCARD:

]]> http://dentalassociates.co.nz/super-gold-card-discounts//feed 0 http://dentalassociates.co.nz/root-canal-treatment/ http://dentalassociates.co.nz/root-canal-treatment/#comments Sun, 10 Jun 2012 23:53:10 +0000 adrian http://dentalassociates.co.nz/?p=459 Why do I need root canal treatment?

Root canal treatment is normally offered when a tooth has been damaged by an accident or by decay; and the tooth’s pulp chamber has been exposed; the tooth often displays symptoms of pain and discomfort, which may be accompanied by an infection or abscess.

Are there alternatives?

You can choose the following alternatives to root canal treatment:

1. Extract the tooth, and choose no replacement.
2. Extract the tooth, and replace with a denture, bridge or implant.
3. Extract the tooth and orthodontically close the space (rare option and not always possible).

What is root canal treatment?

In the most simple sense, root canal treatment will clean out the insides of a tooth, and seal it off; a filling or restoration is then placed on the tooth to protect and/or strenghten it.

During the cleaning stage, the nerves and blood vessels are removed and the tooth is medicated; the root canal (or nerve tunnel) is bored out and widened. This phase often provides nearly immediate relief from pain and infection. Small stainless steel or nickel titanium files are used in a “reaming” fashion to clean out the soft tissues within the pulp and root tunnels.

At the sealing stage, the tooth’s root tunnel (the root canal)  is filled with a soft material, usually a natural substance called “guttapercha”, which is inert and biocompatible. Some dentist will use a synthetic sealant which has the same properties.  This stage also normally sees the tooth restored with a filling.

Is root canal treatment always successful?

No, but the success rate is very high. In large scale Delta Dental Study of over 1.6 million patients who had root canal treatment, 97% had retained their teeth 8 years following the procedure, with most complications, such as re-treatment, need for root-tip surgery or extraction, occurring during the first 3 years after the initial root canal treatment. Rotstein I., Salehrabi R. (December 2004), “Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study”, Journal of Endodontics 12 (30): 846–50

The key factors affecting the success of root canal treatment are:

1. The use of a rubber dam.
2. Thorough cleaning of the tooth and anti-bacterial treatment.
3. Timely crowning of a tooth after root canal treatment to prevent fracture.

It is important to understand that failure of root canal treatment and loss of a tooth may NOT indicate a deficiency in treatment or treatment error but may be a factor that is OUTSIDE the control of your dentist.

ROOT CANAL RETREATMENT success rates are, unfortunately lower.

What are the known risks and complications?

Accessory or “extra” canals. During the treatment of the tooth, we expect to find 1, 2, 3 or 4 canals, depending on the size of tooth, however, nature sometimes imparts more than the “expected” number of root canals AND/OR these extra canals are very narrow or branch off the main canal deeper within the tooth. This can mean that the extra canals are NOT thoroughly cleaned and filled or missed altogether. This may cause a reinfection of the tooth.

Fractured files. Root canal treatment is carried out using fine stainless steel and/or nickel titanium files. Every care is taken to ensure that these files do not catch or bend; however, in extremely fine or constricted canals files can break leaving a small metal piece in your tooth. All our files are sterile and biocompatible or inert, and will not cause a reaction, but a fractured file means that the root canal cannot be thoroughly cleaned and sealed.

Fractured roots. Root canal treatment results in a tooth structure that may be brittle and prone to fracture under loading. This may lead to a hairline root fracture and reinfection of the tooth. Some root canal treated teeth will need posts placed into the root tunnel to help strengthen the eventual filling placed, and these may also cause root fractures.

Fractured tooth. Once root canal treatment is completed, the tooth normally needs a very large filling or restoration, if the tooth is not crowned in a timely manner, parts of the tooth may fracture after loading leading to loss of the tooth. Not all root canal teeth need crowns and your dentist will advise you on the need for a crown.

Cracked teeth. The prognosis is favourable if the fracture does not enter the root however the presence of a crack in the tooth may influence the long term success of root canal treatment and the future behaviour of the crack is not predictable.

The risks of endodontic treatment include but are not limited to - discomfort after treatment; fracture of roots;  damage to or loosening of crowns and their foundations; separation of instruments; perforation of roots; blockages of the roots (natural or  procedural) that may prevent treatment and treatment failure. If a complication were to occur during your treatment, your dentist may discuss the need to refer you to an Endodontist (specialist dentist).

Root canal treatment Finance Treatment can be expensive, especially if a crown is needed after completion of root canal treatment, so we offer up to 18 months interest free finance (credit criteria applies). Phone +64 (9) 365 1565 Fascimile +64 (9) 365 1575 info@dentalassociates.co.nz In addition to EFTPOS, VISA, AMEX we also accept GEMVISA and QCARD:

]]> http://dentalassociates.co.nz/root-canal-treatment//feed 0 http://dentalassociates.co.nz/invisalign/ http://dentalassociates.co.nz/invisalign/#comments Tue, 13 Mar 2012 21:53:27 +0000 adrian http://dentalassociates.co.nz/?p=191 Have you always wanted straight teeth but couldn’t bear the idea of wearing braces?Straightening teeth without wires? Impossible, you say?

Well no, Invisalign is a radical “new” way of straightening teeth without the use of traditional braces – that is no brackets and wires, just a clear plastic mouthguard, called an “aligner” is used. No more teasing about wearing “train tracks” or being called “metal mouth”.

Invisible braces

Invisalign, from Align Technologies, a US orthodontic company, moves teeth using a series of clear mouthguards – each mouthguard varying in shape just enough to nudge your teeth into position. A computer scan is made from moulds of your teeth that your dentist takes, this scan is then used to construct a series of mouthguards – used to straighten your teeth.

Each mouthguard is worn for 2 weeks before swapping up to the next set. The best thing is, you get to take these off when your eating or when you’re at the special social event. The mouthguards have to be worn most of the day and night but can be removed periodically. A usual course of treatment may last for up to 18-24 months. Invisalign is perfect for people who want straight teeth but don’t want the inconvenience of wearing braces.

More information here, on Invisalign’s website.

Invisalign affords you the chance to have straight teeth WITHOUT braces (although may not be suitable for all patients, an initial assessment is necessary) at a cost that is only slightly more than braces.

Invisalign Treatment Costs Initial consultation $105. If you are a suitable InvisAlign patient, treatment starts from $7995, and can be financed, interest free over 18 months, or up to 36 months with interest (credit criteria applies). Phone +64 (9) 365 1565 Fascimile +64 (9) 365 1575 info@dentalassociates.co.nz In addition to EFTPOS, VISA, AMEX we also accept GEMVISA and QCARD:

]]> http://dentalassociates.co.nz/invisalign//feed 0 http://dentalassociates.co.nz/new-patient-special/ http://dentalassociates.co.nz/new-patient-special/#comments Sun, 12 Feb 2012 20:19:27 +0000 adrian http://dentalassociates.co.nz/?p=142

Reem Ibrahim BHSC(AUT) HygienistSarah Xia BOH (Otago) Hygienist

Usual cost $460 but for the month of May,  this will cost all new patients $199. Finding a new dentist is often hard work. We’ve made it easy with our New Patient Special!“Quality Takes Time”, so if you are looking for a new dentist pop on in for a 90 minute appointment with either of our two dentists,  Adrian or Vicki,  and get: a thorough check of your teeth and gums, under digital magnification – normally $105 a set of screening digital bite wing radio-graphs AND a digital panoramic x-ray - normally $185 your teeth thoroughly cleaned by one of our two hygienists – normally $150 a hygiene take home pack – valued at $20 a full treatment plan for more recommended work if needed.

“Dental Associates – one of the very few companies to score full marks on TV3s TARGET (2011). Come in to see us now and see why!” In addition to EFTPOS, VISA, AMEX we also accept GEMVISA and QCARD:

]]> http://dentalassociates.co.nz/new-patient-special//feed 0 http://dentalassociates.co.nz/composite-veneers/ http://dentalassociates.co.nz/composite-veneers/#comments Wed, 28 Dec 2011 02:02:37 +0000 admin http://da2.mental.co.nz/?p=116 Composite veneers – a viable (and cheaper) alternative to porcelain veneers? It would seem, watching TV these days, that any makeover would be incomplete without dental work to “straighten and brighten” the smile. Is just me, or are the SURGEONS themselves looking a tad made-over as well? Smile reconstruction is normally achieved by the use of porcelain veneers – fine, thin pieces of porcelain overlaid on top of dental enamel. Working with porcelain is expensive and it is not uncommon for treatment plans to exceed the $10,000 mark. Is there an alternative? Well, happily, there may be, in some cases. Composite, has been the restorative workhorse of dentistry for quite some time. The word “composite” refers to the ingredients used to make this material – a combination or “composite” of resins and fillers to achieve life like tooth colours, strength and wear resistance. Many of you would already have composites in your mouth – it’s what your dentist would use for “white” or “tooth coloured” fillings. Newer generations of composite materials allow for very lifelike colours and translucencies making these fillings nearly invisible to the untrained (and occasionally, trained!) eyes. If the required modification to tooth colour and alignment is not extensive, then composite veneers – a thin layer of composite instead of porcelain – could be utilized to improve both alignment and colour of teeth. Costs are, in almost all cases, markedly less than what the same treatment would cost if carried out using porcelain.

There is a catch though (isn’t there always). A huge advantage of porcelain restorations is that they are fabricated in a laboratory – the restorations can be tweaked and adjusted to a very high degree. Colour, shape, characterizations (e.g. white spots) can be easily introduced into these restorations, and modified till things look as you want them to. Composite veneers have to be done “on the fly” so to speak, with the veneers sculpted in the mouth. The procedure is very technique sensitive and moisture control is very important, as moisture from saliva (or your breath!) can affect the bonding of these veneers to the tooth. The downside from all this is that a set of eight composite veneers can sometimes take up to three hours to place, sculpt and finish; the upside is that it often costs a fraction of the cost of porcelain.

Aside from costs, there are a number of advantages to this procedure. There is little need to remove tooth structure so the procedure is nearly always reversible. Secondly, composites can often be repaired, so if a fragment breaks off, it can often be invisibly fixed, something that cannot be done with porcelain. There are also drawbacks. You nearly always end up with teeth that are slightly thicker than your natural ones as composite is “added” on the surface of your teeth. It is also often very difficult to mask discoloration on very dark teeth with composite, although opaqueing agents can help with this. Composite is not has hard wearing as porcelain so these restorations will need yearly polishing to maintain their luster and surface gloss.

How long will these veneers last? I would suggest that 7 years would be a decent amount of time before either replacement or refurbishing is needed. In refurbishment, a new layer of composite may be overlaid after thinning the original veneer.

If you are considering these, be sure to ask your dentist if he or she is experienced in doing these and if he or she is comfortable doing these – some dentists aren’t and they can be fiddly things to do. If you are considering either porcelain or composite and would like whiter teeth, you may have to consider having your teeth whitened before embarking on the placement of these restorations as composite/porcelain WILL NOT WHITEN!

These veneers are NOT suitable if you have issues with clenching and grinding your teeth, and there are other concerns that you would affect the suitability of these in your mouth. You should discuss this with your dentist.

Adrian Tan practices from his Viaduct rooms where he focuses on aesthetic and surgical dentistry. He’s a member of the New Zealand Academy of Cosmetic Dentistry and the American Academy of Cosmetic Dentistry. He makes regular small contributions to the IRD, whilst the rest of his income goes to supporting his two small dogs.

PATIENT P :: 8 composite veneers and 1 porcelain crown were placed here. The crown is the lateral incisor on the left. These took me 4 hours to complete, 3 hours to place and an hour a week later for final finishing. The teeth were bleached before starting.You can see that the shape of all the teeth were recontoured in composite, and the teeth further back were “built up” to show more tooth and to create a more “youthful” looking smile. PATIENT R :: Patient here had spaces between his front teeth that he found unsightly, he really didn’t want to go through the trouble of wearing braces, although these were initially offered to him as a treatment plan. We opted for composite veneers as I didn’t really want to cut MORE tooth structure away for crowns. An IVOCLAR/VIVADENT video. Courtesy of Dr Markus Lenhard, Heidelberg, Germany

]]> http://dentalassociates.co.nz/composite-veneers//feed 0 http://dentalassociates.co.nz/why-is-my-dental-treatment-so/ http://dentalassociates.co.nz/why-is-my-dental-treatment-so/#comments Wed, 28 Dec 2011 02:00:28 +0000 admin http://da2.mental.co.nz/?p=113 “Why did one dentist recommend I have 8 crowns, a bleach and numerous white fillings when another one said that all I needed was a clean?”Sound familiar? You may have heard this common perplexing query OR have had the same query yourself. You may also wonder why one dentist would charge one fee for a filling, whilst another dentist would charge markedly more!

There’s no simple answer to this and surprisingly enough it is not always – “he’s trying to rip you off”! In dentistry, as in many other professions, there are many ways to skin a cat. Apologies to all cat lovers out there!

(The dog isn’t mine, but belongs to a hygienist in the US – it’s a funny picture though!)

Take for example the number of filling materials that can be utilized for restoring a cavity – amalgam, zinc phosphate cement, glass ionomer, composite, composite/glass ionomer hybrid, gold, CEREC milled porcelain (chair-side milling) and laboratory fabricated porcelain. The porcelains themselves are further divided into all-ceramic, with zirconia or alumina cores, ceramic with metal cores; the metal cores then can be divided into precious or non-precious metal – you get the point, I assume.

All of these materials are suitable for replacing missing tooth structure, the CHOICE, of which material you would use would depend on the environment (acidic, clean/unclean, prone to decay), maintenance habits (regular attender, once every 10 years), cost that can be afford (beer budget?) and patient wants (just slap something in there mate, I have a pub crawl to go to).

If given a choice I would probably place gold restorations into every back tooth that needed a large filling because this material lasts, but the cost would be prohibitive and patients have an aversion to gold fillings because of their appearance. Similarly, in an acidic mouth, with poor patient oral hygiene, placing composite fillings and expecting them to last the distance is probably wistful thinking.

In addition to the TYPE of material being used, there’s also an option in the MEANS of placing the filling. As a dentist I have a choice of using standard diamond drills, or powder abrasion units, or even lasers. All these tools can be used to prepare a cavity for a filling. Consider this though – a standard dentist’s drill would cost between $1000-$3000, but a laser would cost $120,000! Clearly, this would impact on the cost of provision of treatment. Dental chairs also range from $17995 to as much as $129,995! You can easily kit up a dental surgery to start drilling away for as little as $50,000, but you can also kit the same surgery up to the tune of a cool $500,000.

Another factor would be the number of assistants, I regularly work with 2 assistants allowing me to work more efficiently, improve my service level and greatly increase the cross-infection control of my clinical area – that is, one assistant would focus on assisting me, and the other would control the environment making sure that surfaces are kept contaminant free. This allows greater patient focus, and certainly better care. The overall service to the patient is increased, as I’m seldom rushed to complete treatment, but clearly increases the cost of treatment.

Perhaps the most ethereal factor in this whole process is the “reasonable standard of care” – what is considered “reasonable” by one dentist may not be the same as another.

Let me give you an example here, my patient base has certain “expectations” in terms of what is the minimum required, and in many cases would not balk at a case fee of many thousands of dollars. Once you’ve have worked in an environment such as this for some time, you make a gradual shift in your perceptions for “reasonable care” towards the more definitive, longer term, higher quality and MORE EXPENSIVE treatment options – someone going into Tiffany’s in New York is probably not looking for a bargain!

However, a good way to get the treatment that you want is to be honest and upfront about what your budget is. Many treatment plans can be modified to suit any budget, and in many cases these alternatives will give you many years of good use before needing replacement. The key here is COMMUNICATION with your health provider.

Clearly, the other thing that has to be said here, as it’s probably on everyone’s mind, is that more expensive treatment is not necessarily better treatment. You need to build a rapport with your health professional, be they your dentist or your doctor, this is the only way that they can understand you as a person and be better able to customize your treatment plans to who you are. By building a relationship with a patient as a person, the dental professional can better see the WHOLE picture and not just focus on the tooth!

See your dentist regularly – don’t be a stranger!

Dr Adrian Tan is a regular contributor of small amounts of money to the largest New Zealand charitable organisation – the IRD. He also works hard at his practice on Auckland’s beautiful VIADUCT harbour, so he can keep his two dogs in the manner to which they are accustomed.

A patient and I were having a bit of a laugh the other day (well, he was laughing at me, although he swears it was with me), when I presented a quote for a not-too-sizable amount to offset the effects of years of dental deterioration. That said, the laughter resounded even more when I suggested that no matter what we do, the work envisaged would only have a lifespan of about 10 years.

“Who’d spend X much dollars on something that would only last 10 years, doc?”

“Well, they are called men, Bob (lets call him Bob), and they’ll spend 10X on cars that they replace every 5 years.”

“Oh, come on doc,” spluttered Bob, “I use my car everyday …”

Hmm, okay, so Bob somehow manages not to use his teeth everyday. For the rest of us unluckier souls, there is the problem of how to maintain a dentition that is heavily filled and in a steady state of wear and tear.

The “gold standard” would certainly be the replacement of these worn out restorations with gold fillings or crowns, as these types of restorations last the very longest. However, there is a bit of resistance when you suggest this as most people seem to have an aversion to gold teeth – most say that they remind them of their grandparents. I must say, though that never having known my grandparents, I nearly rushed out to get gold teeth to see if I could inspire any latent childhood memories of the oldies.

There is however, a slightly less costly way to restore both the appearance and function of your teeth, without spending the average GDP of a small tropical country – as long as you are willing to accept slightly weaker restorations that won’t last as long.

Dental composites, or plastics, have been around for a great many years, with light cured composites (when it seems like your dentist is sticking what sounds like a hair-dryer in your mouth) making their first appearance in the 1970s. Although very technique sensitive, composites when placed appropriately in the right places can confer great strength and function to teeth, albeit for a shorter amount of time.

How much shorter? Depends on the studies you read, practically, I expect my composites to last 5-7 years, up to 10 years if my patient has extremely good oral hygiene. As you would expect, if neglect leads to tooth structure loss, it would also lead to loss of restorations. Some composite restorations struggle to last 2-3 years, if care is not taken to keep them clean.

Composites offer a good alternative to the porcelain veneers that you keep hearing harped on about on just about every TV makeover program. Porcelain offers fantastic aesthetics and strength, and last a goodly amount of time. However, should your porcelain veneers fragment, fracture or fall off, there’s no repairing them and replacement is often the only option. Composite veneers do not have the high gloss of porcelain or the translucency but in many cases can look nearly as good as their porcelain cousins. Additionally, you can repair and repolish composite WITHOUT removing the entire restoration.

Composite veneers are often carried out in two steps: an initial preparation, application and shaping of composite to the teeth, and then a follow-up polish appointment. In many cases these types of veneers can be placed without gross preparation of the surface of the teeth. However, they WILL feel thicker than porcelain in some cases.

Cost wise they compare favourably with porcelain, often costing about 50% of the cost of porcelain veneers and restorations. Not every dentist is comfortable placing multi-unit composites as unlike laboratory made restorations, a composite veneer or restoration is to dentistry what live-action theatre is to movies – you get one go at it! So make sure you discuss this with your dentist and are comfortable that HE/SHE is happy to do them.

“So Bob,” I winced, “Let’s talk about your teeth that you don’t use every day.”

The laughter is still ringing in my ears.

Adrian Tan is a general dental practitioner practicing near the water in Auckland’s beautiful Viaduct Harbour! I’m only describing it thus as it’s really cold down here at the moment and this description makes it sound like summer. When it’s warmer. He has two small, grumpy dogs that sometimes greets patients at his reception. He’s a member of the New Zealand Academy of Cosmetic Dentists, and the New Zealand Dental Association. He makes small, regular contributions to the IRD, a New Zealand based charitable organization for the redistribution of dental incomes.