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The Times Raconteur Supplement Monday 20th Feb

Minmally Invasive, Oral Health conscious, High Tech Cosmetic Dentistry

New Cosmetic Dentistry As seen in ‘The Times Raconteur Supplement‘ Monday 20th Feb

I’m excited.

For years I’ve been banging on, extolling the virtues of a philosophical approach that puts Cosmetic Dentistry and Healthy Dentistry in bed together – often in the face of a seemingly increasingly agressive approach being driven by our Atlantic cousins.

I’ll explain.

If you were to have followed my musings over the years you will know that I am inclined to be kind to both patients and their teeth. Our emphasis at Winning Smiles is pain free dentistry (eg use of the wand) and tending to try and enhance the natural tooth (eg Alignment, Bleaching and Bonding or ‘ABB’ rather than wall to wall enamel destruction and shed-loads of porcelain veneers).

These treatments are not only better for the teeth, they are better for the patient experience, better for their pocket! More ‘Gentle’ in every way!

So for me to read in the National Press that they have dedicated a whole supplement to Gentle, Healthy Cosmetic dentistry, well it’s music to my ears [grist to your mill? – ed].

As the title page of ‘Raconteur’ (linked above) says: previously ‘Cosmetic Dentistry’ was all about grinding miles of enamel off teeth to make room for great big ultra-white porcelain veneers – and this aggressive approach continues today. But clearly the New Wave is on the ascendent and the old way of doing things is being replaced by a more health conscious, gentle approach.

Sadly there are still well known clinics in well known parts of London encouraging patients to spend ‘A grand a tooth’ on that ‘Perfect Smile’:

A 2nd Opinion

Only last week a young lady of 20 came to me for a 2nd opinion. She smiled broadly at me to reveal a perfect set of straight teeth albeit for one upper central incisor which was grey…’I’ve been told I need 10 veneers’ she confided. On further investigation it was revealed that she had had an ‘E-consult’with a West London Clinic who had advised her that to get a perfect smile she needed 10 veneers at a grand each.

Needless to say, she is coming to us to have a single EMAX crown fitted to the grey front tooth after we have internally bleached it. The colour matching will take a while and will probably involve re-shading that crown a couple of times to get it to blend seamlessly with the natural teeth.

Matching a single front tooth to its natural neighbours is one of the hardest things to do.

I wonder how many times people have been recommended to fit 6, 8 or 10 veneers because the dentist finds it easier than the alternative. At best, a lazy approach, and it does all make you wonder sometimes.

But veeners will always match each other, won’t they?! (it’s hard to do sarcasm written down)

Shaping and restoring teeth to their former glory:

  • Better for teeth – tick
  • Better for patient – tick
  • Less expensive – tick
  • More challenging (and therefore more rewarding) for the dentist – tick

That’s our kind of dentistry!

Instant Veneers – as seen on Jeremy Kyle

I never thought I’d say it, but the Jeremy Kyle show had quite an impact one day last month on our dental practice.

Thanks to a recent programme featuring new cosmetic dentistry techniques and ‘instant’ veneers, our phone rang off the hook all day. Who’d have thought the show would have that much influence!

You’ve probably heard of porcelain veneers, they’ve been around for quite some time.  They’re the reason so many celebrities have perfect teeth and bright, white smiles.  Simon Cowell, Miley Cyrus, 50 Cent, Katie Price and Hilary Duff are all rumoured to have got themselves a set of veneers – and at a celebrity price.  A full set of porcelain veneers can cost thousands, and yes, we do still fit these when the occasion demands it.

However, ‘instant’ or ‘composite’ veneers, at a fraction of the cost, put a fantastic smile within the reach of the rest of us, which I guess is why Jeremy Kyle’s show provoked such as response.  But then, a dazzling smile, a more confident and youthful look – it’s a service that was always going to be popular, if only people knew it existed!

Immediate veneers before and after picture

The flexibility of this new material does mean that Instant, or Immediate Veneers are the modern answer to crooked teeth, staining or gaps between teeth.  They are fitted quickly and easily over your existing teeth in just one visit to the surgery, and there’s no need for your own teeth to be filed down (as with porcelain veneers) so it’s pain-free too.  Yes, really.

If you think that sounds too good to be true – we thought that too, but there really isn’t a downside to this. Instant veneers do look great, they are long lasting, and easily repaired if chipped. The cost is just £350 per tooth, which is about half the price of the porcelain method.

When choosing instant veneers our main piece of advice is to find an experienced composite dentist. I know, we would say that, but not all dentists follow the same career path.

It is different, because whereas porcelain veneers are made in a lab by a technician, instant veneers are shaped by the dentist in the surgery so your dentist needs to have a good eye and a little artistic flair!

“Keep smiling – it makes people wonder what you’ve been up to.” Author unknown.

How do you find a busy dentist?

We have just posted a description of the kind (of) dentist that we are seeking to join us at the Winning Smiles dental practice.

The dentist vacancy has been created by a steady increase in patient numbers over the last couple of years. And the only way we can continue being able to serve more people whilst still giving patients the time they deserve, is to find some help. We’re nothing if not logical around here.

So if anyone reading this knows someone special in the field of dentistry, if you would be kind enough to point this job out to them, then we would be very grateful. We feel we should ask because we know that special people are always busy and aren’t always looking for a new role at exactly the time the perfect opportunity comes up!

We’ll update you on our search when we have some news.

The Winning Smiles Team.

The top three reasons why I like Damon System braces, by Almarie Odendaal

Almarie Odendaal is the new orthodontist at Winning Smiles and is an expert in fitting braces using the new Damon System.

Almarie Odendaal, new Winning Smiles Orthodontist

Almarie Odendaal, new Winning Smiles Orthodontist

Here are the top three reasons why Almarie thinks Damon braces are a great treatment to choose if you need a full brace:

1. Damon braces typically provide excellent results in a shorter treatment time than conventional braces, and patients have to make less appointments.

2. Using the Damon System means that it’s very rare that a patient will need to have any teeth extracted, and they won’t have to wear any headgear during treatment.

3. Patients are a lot more comfortable during treatment.

Damon braces use a new passive slide mechanism to maintain the shape of the archwires within the bracket.
This allows the wires to move freely and reduces friction and binding, so your teeth can move quickly and comfortably. Other types of braces use elastic ties or active clips that bind archwires in place, this results in friction, making treatment slower and less comfortable. Elastics ties also attract a lot of plaque and so Damon System braces are also a lot easier to keep clean.

Almarie Odendaal, joined our team in June. Almarie qualified as a dentist from the University of Pretoria in South Africa in 1993. She is a member of the British Orthodontic Society, the Faculty of General Dental Practice and the British Dental Association.

You can book a consultation with her by dropping us a note via the form on the web site, or call us on 08000 90 10 60.  Consultations are currently FREE!

Alignment, bleaching and bonding vs teeth veneers

Or the story of how three techniques (alignment, bleaching and bonding), when skilfully combined, can save you money and give you better results than just one (wall to wall teeth veneers)…

Before alignment, bleaching and bonding

Before alignment, bleaching and bonding

After alignment, bleaching and bonding

After alignment, bleaching and bonding

Alignment Bleaching and Bonding vs Wall to wall teeth veneers

Here in Essex, Cosmetic dentistry is evolving. A decade ago when decent porcelain veneers came along cosmetic dentists were very keen on placing lots of veneers – in 2010 there are still a lot of veneers being placed by cosmetic dentists, but here at Winning Smile we believe that the Age of the Veneer is on the wane.

A colleague of mine Dr Tif Qureshi ( recently addressed the profession with his ‘evolved’ concept of Cosmetic Dentistry – updated to reflect the progress in dental knowledge and treatments within the profession and changing attitudes among our patients. Tif brought the Inman Aligner to the UK from the States and combines this brilliant little brace with 2 other treatments to produce significant dental transformation without the need to grind away good teeth as is the case with veneers.

Tif’s concept is called ABB: ‘Alignment, Bleaching and Bonding’


Using the inman aligner the front teeth can be lined up orthodontically in as little as 10 weeks


The cosmetic dentist’s best friend – professional teeth whitening to noticeably ‘lift’ the colour of all the teeth


The addition of cosmetic filling material (like our Italian HFO system) where necessary to add the finishing touches.

Here at Winning Smiles we have been using the bleaching and bonding techniques for years and Michael Fennell one of our orthodontists has been doing the straightening. We are no strangers to these ideas. But Tif has put a label on it for us, and we think people will be hearing of this costmetic dental technique a lot more.

As always my regular readers will notice that I like to bullet point the pros and cons

ABB Advantages over Teeth Veneers

  • No grinding off of the front surfaces of the teeth
  • No porcelain veneers that can fracture easily and begin to lose their looks after a few years – ABB simply enhances your own teeth
  • Cost – ABB costs around £2000 at Winning Smiles, 6-8 veneers cost £3600-£4800!
  • ABB is one hit: veneers usually need to be replaced every 10 years or so (think of the cost implication of that)
  • ABB is kind to the teeth – occasionally a veneered tooth will need a root filling because the nerve reacts badly to the grinding process

Disadvantages of ABB vs Veneers

  • Very badly discoloured teeth or teeth with lots of visible fillings may be better treated with crowns or veneers
  • Teeth that have always been the wrong shape (eg too small, or misshaped) usually benefit from veneers/crowns despite the drawback
  • ABB will take on average 12 weeks – veneers can be done in 2-4 weeks
    Jodie Marsh lookalikes need porcelain veneers for that level of whiteness

Are false teeth now history?

How old, dodgy dentures have given way to beautiful, permanent replacement teeth

Truly transformational: the full arch titanium/acrylic fixed implant bridge:

before treatmentafter treatment
Times (they are) a changing.  I’m actually not listening to Bob Dylan as I write this, but times are definitely changing in the world of UK dentistry, and where dentures are concerned, the change is accelerating.

20 years ago if you had lost all your teeth, false teeth or ‘falsies’ were your only option. Cheap and cheerful, available free on the NHS…and utterly hopeless as a functioning pair of teeth. Some of them looked ok and even stayed in when you were talking, sometimes!

20 years ago dental implants were in their infancy, only a few brave dentists with hugely rich patients ventured into such unchartered territory..

Fast forward 10 years and things had changed dramatically:

10 years ago if you had lost all your teeth (or a complete top or bottom set)  then it was possible to find a few dentists with the ability to replace a whole set of top or bottom teeth – but the costs, although vaguely affordable for those with serious property equity, were still somewhat eye-watering. A full set of porcelain teeth needed 10 implants to support them and each tooth was lovingly crafted – the dental technician would spend days or even weeks making them.

Some dentists realised that there must be ‘another way’ and started to use fewer implants to fix dentures in place: the implant-denture was born. The beauty of the implant denture is that instead of needing 10 implants to hold a complex custom made porcelain bridge in place, with the extra support that the implant denture gained from resting on the gums, the implant dentists could use fewer implants to hold these teeth in place:

Result! Dentures that stay put and can be used for eating most food without any fear of them falling out when discussing the latest episode of the Simpsons [Grandpa should have implant-retained dentures by now surely? -ed]

The only problem with implant retained dentures is that in patients’ eyes they are still dentures! They need to be removed for cleaning purposes every night….and no matter how well they stay in with their super-duper implant-connectors, they still have the ‘false teeth’ label.


Enter the new era of ‘full arch’ implant dentistry [full arch: aka a top set, bottom set or complete set of implant-teeth].

Combining the ease of construction of implant-dentures with the satisfaction of having a set of fixed teeth that really feel like your own, without resorting to using 10 implants at a time and without the days and weeks of painstaking construction time at the dental lab… has become possible to completely replace a top set, bottom set or both for a rather less eyewatering fee than those huge ceramic bridges….


This has been made possible by using digital scanning/CNC technology to produce titanium ‘backbones’ with micro-tolerances that are screwed into place on as little as 4 implants for a full set.

Top quality acrylic teeth are then firmly attached to the titanium backbone and the full arch titanium/acrylic fixed implant bridge is complete.

How do they look? The photographs speak for themselves.

Why precision 3D X-ray images are essential for safe and successful dental implant surgery.

It should be fairly obvious that in order to fit dental implants safely and successfully, you need to have a skilled and experienced surgeon. But did you know just how much the procedure also relies on having incredibly precise 3D images of the jaw bone? These are the X-ray images that allow the surgeon to plan the exact position and placement of an implant and they make sure that:

-the implants don’t ‘hit’ any vital structures during insertion (like arteries and nerves)
-the implants are placed so that the final implant crown or bridge ends up in the right position in the mouth

So what are the consequences of getting this wrong?

-a numb lip (possibly forever)
-a haemorrhage during surgery
-teeth ending up in the wrong place and looking ‘goofy’!

At Winning Smiles we know how crucial this precise 3D imaging of the jaw bone is. That’s why we use the latest Specialist Dental CT scanner to produce 3D images of the jaws before surgery. These machines provide superb high resolution, high definition images. Armed with this level of information we have safely and successfully fitted around 600 dental implants in the last few years.

And because the new generation of ‘cone beam’ dental CT units work with a radiation dose many times below that of hospital CT Scanners, they are not only more convenient (the whole procedure can be carried out here at our clinic), but they are also much safer.

So if you’re looking for safe, convenient, successful implant surgery… can rest assured that that all comes as routine for you here.

An example screen grab from our Specialist Dental CT Scanner

An example screen grab from our Specialist Dental CT Scanner

How long do Dental Implants last

The truth about Peri-implantitis….(which in English means HELP, my implants are failing!!)

I recently had a new patient consultation with a chap who had had a quote for implant work at another practice. Nothing extraordinary about that I hear you say….except that

he had been told – your implants will last a lifetime

Which prompted some immediate questions from me, like for instance

  • who’s lifetime, the dentist, the patient or the implant?!
  • who’s going to guarantee those implants for a life-time?

Because it’s all very well making longevity-promises to people but without a back-up plan and some ‘what-ifs’ in the

contract, those promises start to sound rather hollow!

Here’s what we do at Winning Smiles to ensure that our implants survive for the longest time possible

Having the right attitude helps!

  1. Admit that implants can and do fail both short term and long term (denial is indefensible, see above)
  2. Keep abreast of the latest evidence-based studies on what causes implant failure and what the best failure avoidance strategies are recommended – (Like the European Forum on Peri-implantitis held in London in January 2010)

Having a clear, well defined follow up protocol for each and every implant patient, tailored to individual needs eg

  • – Regular implant-hygiene sessions with our implant-trained hygienists
  • – Bi-annual inspections (x-rays when indicated) with the implantologist
  • – Hygienists trained to carry out our screening protocol for signs of early problems (eg the beginning of peri-implantitis)

Giving patients the right information

  • Peri-implantitis leads to implant failure if undetected (or not looked for – head in sanditis)
  • 15% of implant patients will suffer from some form of peri-implantitis (from recent long term studies in Europe)
  • Patients who have lost their teeth from gum disease have a much higher risk of losing implants
  • Patients who don’t manage to keep plaque off the implants also at higher risk
  • Patients who smoke have a much higher risk of peri-implantitis and implant failure
  • Patients don’t know when they haver peri-implantitis because it doesn’t hurt, right up until the implant tooth falls out!

But look on the bright side!

  • we detect problems early using our screening protocol
  • we can treat them easily in the early stages
  • late stage treatment is more complex but still possible

And most of all, as with teeth, as with implants: keep them clean, stay off the fags and please please turn up for routine checks

and maintenance…..implants are not fit and forget…

To: Our dental implant page

Pain Control and Dental Implant Surgery Part I

It is quite common that patients who are considering, or about to undergo dental implant surgery to be in the dark when it comes to predicting how much pain to expect.

pain control questions for dental implants

We hope this will help understand the implications from

a) the surgery itself
b) during the recuperation period immediately post-surgery (ie the next week or two)

And although at Winning Smiles we always encourage new implant patients to have a chat with patients who have had the whole ‘implant experience’, most patients won’t actually take us up on that offer – even though our previous implant patients are usually very happy to talk about it!

So I thought it might be useful to pen a broad classification of what pain and trouble you might expect from our implant procedures here at Winning Smiles. All implant surgery is not the same, so I have divided it up a bit (with a note on sinus surgery/bone grafts at the end)

1) Simple implant surgery ie 1-2 implants, no ridge splitting, no sinus work, no grafting

No need for sedation unless you are a nervous patient

Pain during surgery: none

Recuperation period: 2 days, mild soreness around gums, most patients will go back to work next day without the need to take even an aspirin.

2) ‘Middle of the road’ cases ie 3-4 implants or 2 implants with ‘extras’ like sinus surgery/sinus ‘tap up’/simple bone grafting/ridge expansion

Sedation recommended

Pain during surgery: none! (No, really!)

Recuperation: 3-10  days. Mild to moderate soreness around gums, mild  swelling. Individual patients respond very differently in these cases.

For some patients it is very easy and they get only minor post-op soreness. At the other end of the spectrum a few patients will have to take painkillers for a few days and may bruise (in fair skinned patients the bruising can be quite noticeable).

3) Complex cases ie a whole upper jaw/lower jaw, 4-16 implants, ‘block’ bone grafts, etc

Sedation strongly recommended

Pain during surgery: none

Recuperation: 7-14 days. Moderate soreness around gums, moderate swelling, pain killers for the first week. Bruising can be quite widespread in fair skinned patients (ladies – buy concealer before you come!)

4) Sinus surgery:

no pain during surgery, little or no pain afterwards with mild swelling. Bruising on fair skinned patients.

5) ‘Block’ bone grafts – where we take bone from the chin or lower jaw and screw it into place somewhere else (often upper front area)

Ok, again we would expect no pain during the surgery but considerable soreness/bruising and some swelling for 1-2 weeks afterwards.

Similar to ‘complex’ cases above, it’s not something we enjoy doing to patients but in some cases the only way forwards – and they do work very well.

This is a lot of detail, but we find people would rather know these things up front, rather than find out after the event.

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Dental Bridges or Dental Implants

A video!

Andrew explains the pros and cons of the implants vs bridges argument and why he generally prefers to use dental implants to replace missing teeth these days. This is the blog about dental bridges referred to in the video.

Length: 1 minute 50 seconds.

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