Dr. Dilek Güvenç DDS, PhD, Istanbul
Posted in Dental Surgery and Dentists, Doctors by Speciality, İstanbul
Dr. Dilek Güvenç DDS, PhD
Dental, Periodontal Surgery, Aesthetic Dentistry
Phone: +90 212 291 39 91
Fax: +90 212 248 24 21
Address: Valikonagi cad. No: 32 Ana Apt. Kat: 6 34367
Nisantasi, Istanbul, Turkey
ABOUT
EDUCATION
* PhD Diploma; Specialist Degree in Periodontology;
İstanbul University, Faculty of Dentistry Department of Periodontology
* DDS Diploma; İstanbul University, Faculty of Dentistry
PROFESSIONAL EXPERTISE
* Treatment of Periodontal Diseases
* Dental Implantology
* Esthetic Dentistry
* Dental Surgery
* Periodontal Plastic Surgery
* Guided Tissue/ Bone Regeneration
AWARDS
*SCI Award, Turkish Society of Periodontology 20th
Scientific Symposium, 29-30 October, Diyarbakır 2010.
*Turkish Society of Periodontology Oral Presentation
Award, Turkish Society of Periodontology 41st Scientific Congress 20-22 May
2011.
SUBMENU
1. AESTHETIC DENTISTRY
2. IMPLANT
3. ORAL and MAXILLOFACIAL SURGERY
4. PERIODONTAL TREATMENT (GINGIVAL DISEASES AND SURGERY)
1. AESTHETIC DENTISTRY
SMILE DESIGN
TOOTH BLEACHING
LAMINATE VENER RESTORATIONS (PORCELAIN LAMINATE)
FULL PORCELAIN CROWNS AND DENTAL BRIDGES ( IPS EMPRESS,
ZIRCONIUM)
1.1. SMILE DESIGN
1.1.1.
WHAT IS SMILE DESIGN?
Smile design consists of all treatment planning aiming to
catch the most aesthetic appearance appropriate to you after evaluation of your
teeth, gingival, lips and whole face together within themselves and in relation
to each other from an aesthetic point of view. Points considered while
analyzing your smile are your tooth form, relation of your tooth with
neighboring teeth ( existence of diastema or crooked teeth), the amount of your
gingival visibility (gummy smile or no visibility at all); after considering
all those mentioned above, a special and individual based treatment is planned.
1.1.2 WHAT ARE SOME SIGNIFICANT POINTS OF SMILE DESIGN?
Main points in treatment planning include:
Gingival Health
Condition of papilla
Zenith points
Gummy Smile (Gum displayed disproportionately when
smiling)
Gingival color (The existence of dark colored gingival
pigmentation)
Phenotype of gingival thickness
Existence of dental restoration
Horizontal and vertical crown dimensions of teeth
Incisal edge harmony of teeth
Smile symmetry
Appearance when resting
Color of teeth
Diastemata (The space or gap between two teeth)
Form of teeth
Sequential position of teeth (dental arch)
Action is taken within specific anatomic borders by
evaluating all these headings as well as the patient’s demands and personal
opinion of the specialist physician. The goal of smile design is to provide the
patient with a younger, healthier and more aesthetic appearance.
1.1.3 WHAT IS GUMMY SMILE? WHAT SHALL I DO IF MY GUM IS
DISPLAYED MORE THAN NECESSARY?
Gummy Smile is the case when gingival display is more
than what is considered ‘aesthetical’ in general while smiling. If there is
such a problem, the decision for the next step is taken after considering the
amount of gingival visibility and periodontal condition of teeth. Among
treatment alternatives are changing gingival position by lifting gum line to
the degree that tissues allow and / or lowering lip to some extent. Both
procedures are minor surgery procedures lasting approximately 30-40 minutes
under local anesthesia.
1.2. BLEACHING
Bleaching includes removal of inborn tooth colors or
those acquired in time. Before this procedure, the patient definitely has to be
checked for gingival diseases, decayed cavities, and extremely eroded dental
surfaces. Those kinds of problems need to be corrected before the bleaching
procedure to be applied in such cases.
1.2.1. WHAT ARE THE METHODS OF BLEACHING?
Bleaching procedure can be applied in three different
ways: at-home, in-office or the combination of both techniques. The most
successful results are commonly possible by the combination technique.
At-home type bleaching technique requires preparing
special elastic plates of tooth lines on lower jaw and upper jaw after
measuring. The bleaching agent is placed on the pockets formed on these plates.
The procedure can be applied by patient in daytime or when sleeping.
In-office bleaching technique requires the procedure to
be carried out by the doctor in clinic. It is possible to get a result in a
shorter period of time because agent concentration is higher than at-home
procedure.
Both bleaching methods ask patients to avoid colored food
and drink both during treatment and the following few weeks.
Both techniques yield effective results; however, one can
benefit from the combination of both if intense coloring occurs.
1.3. LAMINATE VENEER RESTORATIONS (PORCELAIN LAMINATES)
1.3.1. WHAT ARE LAMINATE VENEER RESTORATIONS?
Laminate veneer restorations are solutions with aesthetic
porcelain structures used for changing unpleasant color, form or positions of
front teeth. Furthermore, it is applied in order to protect teeth and prevent
further material loss or avoid coloring as in composite fillings in case of
material losses like decayed / broken tooth.
1.3.2. HOW ARE LAMINATE VENEER RESTORATIONS APPLIED?
Preparation procedure as thin as 0,5-0,8 mm at average is
employed for the application of laminate veneer restorations on the front teeth
surface. It is also possible, in some cases (tooth position in line, gap
between teeth etc.), to restore teeth without erosion.
1.3.3. WHAT ARE THE MOST FREQUENT CASES LAMINATE VENEER
RESTORATIONS ARE USED IN?
Laminate veneer restorations are particularly suggested
as a protective solution in cases of material loss like broken teeth caused by
fillings, tooth decay, erosion or trauma.
1.4. ALL CERAMIC-ZIRCONIUM CROWN AND BRIDGE RESTORATIONS
Metal-supported ceramic prosthesis is light-proof; thus,
the appearance of prosthesis applied teeth is more light-proof and artificial.
Optical features of all-ceramic restorations are semi opaque as in natural
teeth. In all-ceramic restorations, sub-structure is generally composed of
zirconium or toughened porcelain.
ALL-CERAMIC (IPS EMPRESS) CROWNS
These are the restorations backed by toughened porcelain.
Although they are quite aesthetic materials, application technique requires
some specific rules when cutting teeth and planning treatment. This is the most
aesthetic crown prosthesis form for front teeth restorations. For back teeth,
on the other hand, they are not preferred due to their weakness.
ZIRCONIUM CROWNS
Zirconium substructures are formed untouched by
processing blocks. They can adjust to teeth and withstand under stress at
perfect levels. These features provide an advantage of use for back teeth.
However, all-ceramic restorations are more appropriate for front teeth whose
aesthetic appearance is important.
2. IMPLANT
DENTAL IMPLANT:
Today, parallel to medical improvements, life-span has
extended leading to a higher rate of toothlessness as well. The 90% reason for
currently known tooth loss is tooth decay and periodontal diseases (gingival
diseases). Patients are observed to suffer from alveolar bone resorptions
(erosion), atrophy and degenerations related to non-functionality stemming from
long lasting toothlessness and the long use of uncontrolled and inappropriate
traditional prosthesis. Because of this and similar reasons, the aesthetic and
functional success of treatments carried out by traditional moving prosthesis
is generally limited.
WHAT IS IMPLANT?
Implant which closely simulates lost teeth roots consists
of artificial teeth roots which look like a screw or cylinder.
Implants are generated from titanium or other tissue
friendly materials. Implant treatment has two steps. In the first step,
implant, which is the artificial tooth root, is surgically placed into health
jaw bone. The procedure is conducted under local anesthesia without suffering
and generally in a shorter period of time than tooth extraction.
The second step is to fabricate prosthesis upon the
artificial tooth root. Depending on the number of missing teeth and implanted
ones, fixed (like your natural teeth fixed in your mouth) prostheses or
removable (snap attachment) prostheses can be produced.
2.1. WHY HAS IMPLANT BECOME A MORE PREFERRED KIND OF
TREATMENT?
Treatment planning with implants is a rather protective
method. Extraction sockets are considered to be more protective methods
compared to bridge restorations by cutting adjacent teeth or removable
prostheses. Implant treatment also helps to enhance patient’s quality of life
seeing that it is the closest kind of treatment that resembles natural tooth
and it allows the use of fixed prosthesis in mouth.
2.2. WHAT ARE THE ADVANTAGES OF IMPLANTS?
Implants look like your own teeth and make you feel as
they are.
Implants prevent bone loss after tooth extraction since
they are placed into the bone.
Implant is a protective method; unlike bridge prostheses,
implant procedure is carried out with no other teeth involved since implants
are placed in extraction sockets.
In cases like multiple teeth loss or full jaw loss, the
total (denture) and prosthesis fabricated on the implants placed are immovable,
whether partial or total. Holding capacity is at maximum level. Besides, the
prostheses supported by at least 2 and more implants and used in cases like all
jaw loss of teeth cover a rather less surface in the mouth. Thus, the patient
can enjoy his life in a comfortable way.
2.3. WHO CAN HAVE IMPLANTS?
The most appropriate patients to have implants placed are
those with neither periodontal nor general health problems or those with
aforementioned problems under control.
If patient suffers from periodontal diseases or diabetes,
it is adequate to bring illnesses under control for implant procedure.
The part planned for implant needs to have sufficient
number of bones. After tooth extraction, alveolar resorption starts to
increase; therefore, bone loss is prevented by placing implant into the
extraction socket as soon as possible.
THE POINTS TO BE
TAKEN CARE OF BEFORE IMPLANT PROCEDURE
If you smoke very much, you will be asked to refrain from
smoking prior to and immediately after implant treatment and also we expect a
significant reduction in your smoking to at most five cigarettes a day during
the healing phase of dental implant treatment. If you are a diabetic patient
whose disease is not under control, your values will be asked to draw near to
the reference range as much as possible by paying attention to your diet and /
or changing your medicine after consulting your doctor or changing its dose.
THOSE TO BE TAKEN CARE OF AFTER IMPLANTS;
The implant operation creates almost the same effect by
means of a simple tooth extraction on oral tissues.
You may be asked to eat soft and liquid foods in order to
protect implant against overload and reduce the effect of any traumas of
implant wound as much as possible.
It is important to take medicine prescribed by your
doctor on time. As in the aftermath of all surgical procedures, you should not
smoke and drink alcohol as long as the doctor suggests after implant operation.
2.4. HOW LONG IS THE DENTAL IMPLANT PROCEDURE AND WHAT
ARE THE STAGES?
The duration of implant operation varies according to the
number of missing teeth. An average implant operation takes approximately 10
minutes and it becomes less traumatic for the patient than tooth extraction.
However, in case of bone loss, this period of time can increase because of
extra surgical processes applied during operation. Although these procedures
prolong the period, they are painless processes for the patient.
The time to be waited for fusion of the implant
positioned on your jaw bone with the surrounding bone (osseointegration) is
nearly 8 weeks. However, there are cases in which prostheses are immediately
placed as well as the ones requiring a healing time of approximately 4 and 6
months. The factors determining the waiting period is related with existing
volume of your jaw bone the implant will be placed on. After the completion of
this process, a small surgical intervention shapes your gingival by placing a
plate to open implant into inner mouth in the second stage. After 1-2 weeks’
period for gingival shaping, routine
prosthesis procedures are carried out after measuring.
3. ORAL and MAXILLOFACIAL SURGERY
Cyst s tumors caused by mouth and teeth
Cracked teeth and jaws
Extracting or preserving an impacted tooth which remains
stuck in jaw bone
Arrangements made on hard and soft tissues to help
prosthesis fabrication
Genetic (congenital) or jaw face anomalies which develop
later ( cleft lip and palate, the cases in which chewing function and
aesthetics are not proper due to lower or upper jaw position- too far ahead or
back-) are the application fields of mouth, tooth and jaw surgery. In such
cases, a multidisciplinary approach is essential to the evaluation and
treatment of the patient together with an orthodontist.
3.1. IMPACTED WISDOM TEETH OPERATION
These teeth are called ‘wisdom teeth’ as they generally
erupt between the ages of 17-25.
It is the extraction procedure of wisdom teeth (third
molar) generally with problem of eruption in the mouth.
Do all wisdom teeth need to be removed?
It is possible to leave those teeth in the mouth in some
cases. If the wisdom teeth are positioned correctly, bite properly with the
opposite tooth, don’t cause lack of room in mouth and will erupt without
causing crooked teeth, then there is no need for extraction.
Other teeth that may have eruption problems in the
denture are those called ‘canine’. Those teeth can similarly be extracted by
small-scale surgical procedures or, if appropriate, they can be gained through
eruption with orthodontic brackets.
3.1.1. WHY DOES IT BECOME NECESSARY TO EXTRACT WISDOM
TEETH?
Cavity, a small hole formed during tooth eruption, is
positioned at the back of the mouth. Cavities may occur as a result of the
accumulation of food remains since it is difficult to reach that part. This often
threatens the neighboring tooth. If cavity occurs, it is likely to detect
painful situations with these teeth and adjacent tissues as a result of
infection and abscess.
If there is gingival abscess over partially erupted
teeth, infection over that part also spreads to soft tissues, causing intense
pain and swelling. In progressed cases, the difficulty opening the mouth
(trismus) can occur due to the same reason. If the case is even more
progressed, it can spread to cheek and neck through lymph nodes.
Pressure pain; the erupting wisdom teeth may cause
pressure against neighboring teeth and may result in pressure pain in that
part. It may also cause erosion and resorption of adjacent tooth. As a result
of pressure, a slow tooth squeeze or crooked teeth may occur generally on front
teeth in a way patients can realize.
Cyst Formation; before eruption, teeth are found in a
follicle within the jaw bone. Cystic formations may be observed over the
erupting impacted teeth as the surrounding follicle does not resorb. These
formations can grow and cause bone resorption (erosion) and they can weaken jaw
bone, growing and making holes in it. In such cases, broken teeth are often
observed in the jaw bone. Although not frequent, these cysts can turn into
tumors. In order to remove these risks, wisdom tooth removal should not be
delayed.
3.1.2. DOES WISDOM TOOTH HAVE TO BE REMOVED IF IT DOES
NOT HURT?
Even if there is no problem with wisdom teeth, it needs
to be checked and controlled by a specialist doctor with a panoramic film.
During control, the medical necessity decision is given considering factors
such as dental position, existence of an infection and lack of space.
3.2. ABSCESS AND CYST OPERATIONS (APICOECTOMY)
Inability to carry out a fully successful root canal
treatment due to structural flaw in tooth root
Inability to carry out a root canal treatment due to an
irremovable restoration over teeth
If an appliance is broken during root canal treatment and
if the broken appliance has to be taken out,
These are the operations called Apical resection carried
out under local anesthesia related with root apex when the patient still
suffers from pain and the apical lesion continues even after root canal
treatment, or when 1/3 apical lesion of tooth root breaks inside the bone
4. PERIODONTAL TREATMENT (GUM DISEASE TREATMENT)
4.1. WHAT IS PERIODONTAL DISEASE?
Periodontal diseases are the inflammatory diseases
characterized by the destruction of tooth-supporting tissues (alveolar bone,
periodontal ligament and cement) and they develop due to the relation between
microorganisms and genetic features the patient has. The severity and speed of
periodontal diseases vary on individual basis.
WHAT CAUSES PERIODONTAL DISEASE?
The main cause of periodontal disease is bacterial plaque
and it can only be treated by mechanical debridement. Other factors such as genetic, environmental
and systemic can also contribute to the periodontal disease. Among the systemic
factors are diabetes, cardiovascular diseases, epilepsy, Down syndrome, AIDS
and blood diseases.
4.2. WHAT ARE THE SYMPTOMS OF PERIODONTAL DISEASE?
The first sign of periodontal disease, widespread among
people, is bleeding gums. Gums become red and swollen and have bright surface.
Mostly, these signs are accompanied by bad breath, gingival recession,
bleeding, loose teeth or tenderness. Periodontal diseases can affect every
person of all ages at different levels of severity. In most cases, the disease
can proceed without symptoms as the patient does not suffer from any kind of
pain. When the patient undergoes any suffering, healthy teeth with no decays
are also lost as they get loose due to loss of support tissues.
4.3 HOW ARE PERIODONTAL DISEASES TREATED?
The major purpose of periodontal treatment is to ensure
retention of unhealthy teeth which seem hopeless in the mouth. Various
treatment methods are applied according to type and severity of disease. Among
these methods the mainly are: oral hygiene education, tooth surface cleaning,
root planing, and regenerative, reconstructive and mucogingival operations.
What affects treatment planning and its success directly are type and severity
of the disease, patient habits, cooperation between patient and doctor, and
oral hygiene standards. When early diagnosis is accompanied by necessary
treatments in periodontal treatment, the results are precise and patient
satisfaction rate is high. It is worthy of note that restorative treatments
applied on periodontically unhealthy teeth are not successful in aesthetic and
functional terms.
4.4. GINGIVAL RECESSION
Gingival recession is divided into two groups: recession
depending on periodontal disease (periodontitis) and those including a surface
of teeth (vestibular gingival recession). Gum recession depending on
periodontitis (gum disease) can affect all tooth surfaces. Gums recede in
proportion to tooth supporting bone whose height decreases with periodontal
disease. Vestibular gum recession, on the other hand, can be associated with one
surface of teeth involved. Both types of recession can be localized (associated
with at least 1 tooth surface) or generalized (can be associated with one or
more tooth surfaces). Superficial techniques can generally be treated entirely
by means of currently used surgical techniques. However, root surfaces can be
partially covered with gums in the case of progressed gingival recession. When
the bone loss is high, it becomes impossible to cover exposed root surfaces
with gums through the use of modern technologies. Therefore, early responses
may increase the chance for success before the progression of loss.
4.5. PINK AESTHETIC TREATMENT (GUM AESTHETICS)
White and orderly teeth are not always sufficient for a
healthy and beautiful smile. It is important to have gingival health and
aesthetics surrounding the teeth. No matter how orderly teeth individuals with
high lip line have, gingival disharmonies (gingival recession, irregular
gingival forms, extreme look of gums when smiling and dark colored gums) may need
medical intervention both for aesthetic and health reasons in some cases. That
kind of asymmetries can be corrected by simple surgeries. Accordingly, the
patient can have a more healthy and nice smile. A periodontist should be
consulted for the treatment of gingival aesthetics within anatomic boundaries.
HEALTH TOURISM
Professional dental are particularly held out
of insurance range of health policies issued in numerous countries,primarily
those in Europe and The Middle East for economic reasons. Therefore, residents
of those countries tend to visit places where treatment for such special areas
is offered at more reasonable and affordable costs. Turkey is one of the
countries often preferred by people living abroad for medical check-ups and
treatments. Patients who have opted for dental treatment in Turkey can easily
access an increasing number of dentists and benefit from facilities based on
the cutting edge of technology and World standards. During the period you
receive your dental treatment planned and applied by a team of specialised
dentists at our clinic, you can discover historical places and natural beauties
of Turkey as well.
