A black line at the gumline or a tooth that looks fake because of a flat, bright un-natural color or a tooth that is too bulky compared to the adjacent teeth are sure indications of a crown that is an esthetic failure. With appropriate materials, procedures, and skill lifelike crowns will blend in naturally with adjacent natural teeth.

What Causes the Dark Line?

The dark line is associated with an old porcelain crown. The dark line originates from the edge of the crown where the porcelain and the metal meet at a knife-edge at the gum line. At the knife-edge, a very thin amount of the metal always shows. One of the illusionary techniques dentists have used was to hide the thin dark line under the gum line. Over time, the gum tissue would recede and expose the dark line. In some patients the dark line would show through the gum and make it appear dark as well.

How Do You Get Rid of It?

The only way to eliminate the esthetic problem is to replace the crown. The most beautiful crown for a tooth is, without question, all-porcelain or all-ceramic. With porcelain fused to metal crowns, there has to be an opaque layer put over the metal to block out its color. This makes it impossible to have a translucent restoration that mimics the translucency of natural teeth. Only with pure porcelain or pure ceramic can you have such translucency. And these three basic categories of crowns for front teeth: bonded all porcelain, extra strength all porcelain, or porcelain fused to metal.

Bonded all porcelain - It is made entirely of porcelain or other ceramic material. Now the type of porcelain used for crowns for teeth by itself is not very strong. The way a cosmetic dentist will handle this is he or she will bond the crown to the tooth, thus giving it plenty of strength to function.
This type of crown has the nicest appearance. It mimics the appearance of nature to the point where it is difficult to tell that it is not a natural tooth. An all porcelain crown costs more than a porcelain fused to metal crown. And while an all porcelain crown is strong enough for front teeth, it may not be strong enough for some back teeth in some patients with an extra strong bite.

Extra strength all porcelain - There are some new ceramic materials that have extra strength - so much so that they don't have to be bonded. However, they aren't as esthetic as the bonded all porcelain crowns. Some brand names of crowns that are this type are Procera crowns, InCeram crowns, Cercon Zirconia crowns, Lava crowns, and Cerec crowns. While they don't have an opaque metal core, most of them have an opaque white core, so they aren't as esthetic for front teeth. They don't tend to develop the dark black line at the gumline that porcelain fused to metal crowns do, but they can still reveal a sharp color difference where the crown meets the tooth. They also tend to be a little more abrasive on the opposing teeth that chew against them.

Porcelain fused to metal - This style of crown is referred to as a porcelain fused-to-metal crown because it uses tooth-colored porcelain on the outside and it uses metal under the porcelain for strength. A black line at the gumline of a crown is caused when the underlying metal framework supporting the porcelain shows through. A properly done crown with an acceptable margin should have no black line. They tend to have a very fake-looking opacity, and they will tend to get a black line at the gumline after a few years. This line may not show when the crown is first placed but shows later, as the gum recedes. But porcelain fused to metal is substantially stronger than the all porcelain crown. Further if ever you need a crown discuss all the possible options and get more natural smile. Like to seek a consultation , contact our dental office.
Dr. Vinod Chandel MDS. (Prosthodontics) AIIMS New Delhi
Advanced Dental Care,Prosthodontic and Implant Centre
SCO 157/1 Sector 37-C, Chandigarh
Phone no. 2691001, 09815131898

Dental implants have revolutionized Dentistry, making it possible to replace a single tooth or all teeth in as little as an hour or two.
Computer Guided dental implants can improve your appearance, restore your smile and confidence, and allow you to eat the foods you like, without worrying about your teeth. Computer guided implant placement allows us to create an exact replica of your jawbone on our computer screen. This allows us to see all the structures such as nerves and sinuses. Thus, we can safely avoid the structures when planning and ultimately placing the implants. With the conventional method of placement the measurement is taken from a flat or one dimensional x-ray. This leaves us guessing in the other two dimensions.
Quick And Convienent
We all lead very busy lives in this day and age. Using computer guided treatment drastically reduces the amount of visits to the dentist. At the completion of the surgery you will be able to function immediately with your new teeth.
No stitches or incisions – Immediate Function
We all know that pain and recuperation are always a big concern. With computer guided placement there are no stitches or incisions. This conservative approach drastically diminishes pain and healing time.
Three Methods of Implant Denture Replacement
1. Mini-Implant Dentures - "Snap In" Dentures
This type of implant denture is an economic alternative for those who cannot afford conventional implants or the available bone is too sparse for conventional implants.
• Mini-implants can are used even when there is very little bone structure.
• Although this is a great alternative mini-implants may not last as long-term as conventional implants.
• Mini-implants cannot change the tightness or holding power of the denture as can conventional implants.
• A snap down denture is still a denture, meaning it still rests upon the gums.
• Although the chewing force achieved is much better by adding the snap down implants, it is still much less than your natural teeth.
• When economics is a major concern this method is the best choice.
2. Conventional Implant Dentures - "Snap In"
This type of denture is very similar to the mini-implant snap down denture. There are several fundamental differences.
• There is an abundance of documented research that shows these implants to have long term stability.
• The holding power of the snaps used can be adjusted to be weaker or stronger by switching out the retentive inserts.
• The larger diameter makes for a stronger implant.
• The cost is more than the mini-implant solution
• There must be adequate bone structure.
3. Implant Bridge Dentures
This by far is the best solution if you want to chew as well as you did with your natural teeth. This type of implant replacement does not rely on your gums for support. The entire bridge/denture is supported solely by the implants.
• The bridge/denture is permanently attached to the implants.
• There is no need for removal.
• They are brushed and flossed similar to your natural teeth.
• The chewing power is similar to your natural teeth.
• The cost is considerably more than the other two solutions
• There must be adequate bone
Dr. Vinod Chandel MDS. (Prosthodontics) AIIMS New Delhi
Advanced Dental Care,Prosthodontic and Implant Centre
SCO 157/1 Sector 37-C, Chandigarh
Phone no. 2691001, 09815131898

There is a certain feeling each of us has when we look into the mirror and feel really confident about our appearance. It "sets the mood" for our day or social function. Simply stated, our personal confidence can dramatically affect our lives.

Unfortunately, missing teeth, medically known as edentulism, keeps many people from "feeling their best". Edentulism not only affects your self-confidence, but also has a dramatic impact on the quality of your life.

Edentulism may limit your choice of foods and therefore your nutrition and general health.
Can make you feel isolated either socially or on the job.
Can effect relationships with loved ones.
Also leads to bone loss making the "fitting? of traditional dentures difficult or impossible
If not treated, partial edentulism, that is missing some of your teeth, can place stress on the remaining teeth requiring them to "do more work". This can lead to further tooth loss.
For years the best solutions for missing teeth were bridges, removable partial or full dentures. For centuries man has endeavored to find a more natural replacement for missing teeth. Modern, space age materials have allowed that quest to become a reality. Todays dental implant is possible because of these materials combined with years of research and clinical trials. The dental implant is truly the most natural solution for missing teeth.

But what exactly is a dental implant?

Implants are artificial tooth root that is made titanium, which is placed into your jawbone to hold a replacement tooth, or bridge closest is shape and size to the natural tooth root. After application of anesthesia, your dentist will expose the area of the jawbone to be implanted and prepare the bone to accept the implant. The number of incisions and bone preparations depends upon the number of implants (and teeth) being placed. The implant is carefully set into place and the gums are closed with several stitches. The healing period usually varies from as few as 3 to 6 months or more. The bone grows in and around the implant creating a strong structural support. When healing is complete, your implant is uncovered and an extension is attached onto which your new tooth or teeth are attached. Implants restore proper chewing function and so you can enjoy food.

You feel confident that your replacement teeth won?t move or loosen.
You regain the closest thing to the look, feel and function of your natural teeth.
Forget about unsightly partial denture clasps, which place damaging pressure on remaining natural teeth.
Eliminate irritated and painful gums.
Improve your speech by eliminating or reducing the "fullness" of full or partial dentures.
Replace missing teeth with the look and feel of natural teeth without having to "cut down" healthy teeth.
Dental implants help stop the progressive bone loss and shrinkage of your jawbone by "mimicking" the roots of natural teeth.
Dental implants are clinically proven with a success rate in excess of 90%.
Clearly dental implants are one of the finest treatment options dentistry has to offer. With their ability to improve the quality of your life and health it's easy to understand why they have become the accepted alternative to traditional methods of replacing missing teeth.
Dr. Vinod Chandel MDS. (Prosthodontics) AIIMS New Delhi
Advanced Dental Care,Prosthodontic and Implant Centre
SCO 157/1 Sector 37-C, Chandigarh
Phone no. 2691001, 09815131898

How to Make a Hospital Hospitable

Every hospital should have a plaque saying: There are some patients whom we cannot help; there are none whom we cannot harm.
Arthur Bloomfield

Hospitals can provide a secure refuge when you are seriously ill, remember that hospitals can be scary places! For one thing, the very fact that your doctor wants you to be admitted into hospital means that he thinks you are quite ill, and this in itself can generate considerable anxiety! Even worse, hospitals can be very unfriendly places. Not only do hospitals strip you of all your dignity (having to wear a half-open hospital gown which barely covers your body properly does not do much good to your ego!), but also they subject you to painful routines and humiliating rituals performed by a retinue of strangers. Moreover, you could be woken up at any time of the day, (or night), deprived of your privacy, forced to eat unpalatable food, cut off from friends and family, and denied a lot of the independence which you take so much for granted in daily life. Also, remember that hospitals can be dangerous to your health as well! Hospital-acquired infections have become increasingly common (since a number of sick patients are gathered together under one roof); and errors and mix-ups are not unusual at all, especially in India, where the paramedical staff is often poorly trained.
The first rule, therefore, is try to stay out of hospital as far as possible! However, if there is no choice, there is a lot you can do to improve the quality of your hospital stay.
The first step is selecting a hospital. Often, you may have no choice in this regard. For example, your surgeon may operate at only a particular institution. Or your employer may have entered into a contract with a particular hospital, so that if you want your hospital expenses to be covered by your company, you may have to be admitted only to this hospital. However, if a choice is available, then how do you select the best hospital? Basically, hospitals fall under the following categories:

1. Private large hospitals. These are large (200-bed plus) institutes, which offer all medical facilities (including pathology, radiology and blood banking) under one roof. While such hospitals often attract the best medical specialists, and many have a developed a reputation for providing excellent medical care, they can be very expensive. Unfortunately, they are also usually very impersonal, and you are often just "the patient in bed number 423". Also, the red tape in these places can be considerable. These hospitals tend to overuse medical technology, which can prove to be a major disadvantage while treating common problems. However, these hospitals should be your first choice if you are suffering from a complex or rare problem, or if you require major surgery.

2. Private small hospitals/nursing home. These are small facilities (containing 10-20 beds), which are usually run by a single doctor, or a small team of doctors, in order to provide care for their own patients. They are very popular, because they are relatively less expensive and provide patients with personalized care and attention. However, you should be aware of the fact that many of these facilities may not meet basic standards, because of the lack of governmental rules and regulations. Many of these places are poorly equipped (for example, a doctor may set up a cardiac monitor at the patient’s bedside, and call the bed an " intensive cardiac care unit”!); the staff may be medically unqualified and poorly trained; and they may not posses the infrastructure (e.g. blood bank facilities) to cope with complex problems. On the whole, well-run nursing homes are a good choice for treating simple problems (e.g., simple surgical procedures).

3. Public hospitals. These are large hospitals run by the government. While they may posses excellent medical staff, since many of them are often attached to medical colleges, their equipment, however sophisticated, often does not function, due to a paucity of funds. Often, basic standards of hygiene may be lacking in these places. Nevertheless, they can provide excellent medical care at highly subsidized rates and are a good choice for emergencies (since they are well-equipped to handle trauma and emergency cases, and will not turn patients away) and for certain complex problems, since some of the departments in these hospitals can be centers of excellence.

CHOOSING YOUR ROOM
During a stay in the hospital, several options are available as to room choice. Depending on insurance coverage or personal preference, a patient may stay in a private room, a semi-private room or a ward. Private rooms may be deluxe (with amenities comparable to a five-star hotel in some hospitals) or first class, and offer the advantage of much needed peace and quiet. A major plus point is that your friends or relatives can stay with you; after all, you need to have someone who can look after your best interest when you in a hospital bed! In a semi-private room, curtains are put up around each bed that allow for some privacy, but the bathroom is usually common for the occupants. A ward is a hospital room that is large enough to accommodate several beds. Each bed may be curtained off during examination for privacy, but you are otherwise fully exposed to all passersby. However, the charges are much less than those of a private room.

LOOKING AFTER YOURSELF
Nobody likes to be in the hospital – and it’s especially difficult if you have to be hospitalized for a long time. Some ideas which can help you to keep yourself from becoming bored, depressed or lonely if you have a long hospital stay include the following: keep a journal; write letters to family and friends; do activities such as needle point, sewing, knitting; listen to a radio; talk with other patients; read a book; do puzzles and word games; play computer-games; surf the internet on a laptop.
Hospitals can be dehumanising places to be in, so try to personalise your surroundings as far as possible, by surrounding yourself with objects you enjoy, such as books, a radio, games and puzzles. Try to arrange for food from home, if at all possible – hospital food have a deservedly bad reputation. It’s also a good idea for you to have your mobile/cell-phone with you, in case an unforeseen emergency crops up during your hospital stay.
It’s useful to ask for help from family and friends – request them to come and visit you. Most people will be glad to oblige – and remember to return the favour if someone you know is in hospital. If you like, you can ask them to bring food or fresh fruit that is not served in the hospital, so you can look forward to eating something appetising . And don’t forget to look at the upside – you get served breakfast in bed!

MEDICAL RECORDS: TO SEE OR NOT TO SEE?
Although your medical chart affixed to your bed is legally the property of the hospital, you should be aware of what kind of information is recorded on it. If you have any doubts, ask your doctor for an explanation. The chart should contain the following details:
• Your medical history (in the form of a synopsis).
• Results of all laboratory tests.
• Doctor’s order sheet: (1) daily list of medications to be taken, (2) special treatments or testing, (3) dietary restrictions, and (4) scheduled diagnostic procedures.
• Notes on surgery performed: (1) name of operation; (2) anesthetic used; (3) the names of the assisting staff; and (4) whether or not blood was transfused.
Don't be surprised if you encounter resistance when you ask to see these records! Many physicians and hospitals still don't believe that these records belong to you, or even that you should have access to them. As with any argument, there are two sides of this one too. The most commonly voiced concern is that patients may misinterpret the records, and become confused or unnecessarily frightened by the information they contain. Further, physicians and hospitals are concerned about their malpractice liability being increased if patients are granted unlimited access to their records, and some fear that records will not be kept with the same degree of honesty if patients were to have direct and unlimited access to them. Patients, on the other hand, want to know what is in their records - after all, the records are about their body! They also believe, quite correctly, that they can store their x-rays and records more reliably than anyone else. The ideal situation is one where you and your physician go over the records together, with your physician explaining the information, and you knowing that you can ask any question and get a clear and honest answer.

The Hospital Routine
An average day in a hospital can be divided into five categories. They normally involve the following:
1. The patient’s activities such as laboratory tests (often done early in the morning), treatments or scheduled surgeries, visiting hours and rest periods.
2. Nursing observations, which include monitoring and charting your vital signs (pulse, blood pressure, temperature, urine output) on a frequent basis; as well as evaluating your physical and emotional needs. A good nurse is worth her weight in gold!
3. Doctor’s visits. Doctor’s rounds may occur at various times during the day, and the resident doctor or assistant will often visit you early in the morning. Your personal doctor may come to see you, and this visit is often the high point of the day for the patient. Unfortunately, the doctor is often in and out of the room so fast, that you may not get a chance to clarify your doubts. Please request your doctor to sit down, so that you get some more time to talk to him. It’s a good idea to "prepare" for these visits, by having a list of questions you need answers to.
4. Medications which can begin before breakfast and continue throughout the day and night as prescribed by the doctor. Intravenous lines (IV fluids) require more frequent nursing attention.
5. Meals, which are normally brought by orderlies three times daily. A nighttime drink or snack may also be available.

WHO’S WHO AT THE HOSPITAL
In a hospital one finds so many people walking around in white uniforms that patients become easily confused as to who does what! While it’s the normal procedure for all the staff to wear name tags that identify who they are and what their positions are, a general understanding of the hospital staff can be beneficial.
Physicians
1. Medical Students: They are found only in teaching hospitals (attached to a medical college), and are trying to learn as much as possible. They cannot actually treat patients by themselves, but a kind and understanding student can often spend a lot of time with you and explain what’s going on.
2. Residents: They are doctors who are receiving specialty training in a particular medical field such as surgery or medicine.
3. Doctor: The doctor who admitted you to the hospital.
4. Consultants: They are specialists, and your doctor may ask them to examine you to provide expert advise or a second opinion.
Nurses
Nurses are the ones who really take care of you when you are in hospital, and their responsibilities include: (1) taking and charting your vital signs (such as temperature, pulse and blood pressure); (2) taking care of your wound; (3) carrying out your doctor’s orders; (4) giving you your Nurses spend much more time with patients than doctors do, and will often be your primary contact with your medical caregivers. They can also teach you to care for yourself when you go home.
Additional Hospital Staff
1. Orderlies or nurse’s aides assist in moving patients to the x-ray room or to other specialized testing rooms and help in a non-medical capacity.
2. Occupational Therapists assist disabled patients in performing their routine activities.
3. Physical Therapists assist patients in developing the strength and the ability to become and remain mobile through exercises, massage and other treatments.
4. Respiratory Therapists help with the use of specialized equipment to treat breathing disorders.
It is very helpful to know someone on the hospital medical staff (an "insider") with whom you can really communicate. This individual may be a nurse, a technician or a social worker. Request this person to act as your advocate in order to help you get the medical care you need and want – a medical "insider" who is on your side can be very useful when you are in hospital!

HOW TO BE A COST-CONSIOUS HOSPITAL PATIENT
Hospital bills can add up to huge amounts very easily, and you need to be aware of what steps you can take to save your money! The basic rule is simple: avoid an unnecessary stay in the hospital! The hospital should never be viewed as a place to get a good rest. Consider the following pointers:
• Consult your physician and, whenever possible, select outpatient services. By avoiding an overnight stay at a hospital, substantial savings can occur. Many routine laboratory tests and scans can be done for a lesser cost as an outpatient.
• As an inpatient, stay only for the prescribed time that is necessary. If it’s peace and quite you need in order to recuperate, a hotel may be a better bargain.
• If you need surgery, ask your doctor if this can be done on a day-care basis, so that you don’t need hospitalisation.
How to keep your hospital bills down
• Be an intelligent and informed patient – ask questions, to make sure that all the medical procedures you are advised are truly necessary.
• Take out a medical insurance policy when you are healthy – this can be very helpful in case you do fall ill.
• Hospital bills can be huge, and they need to be carefully analysed to look for errors. Don’t assume that just because it’s generated on a computer that it’s accurate – billing errors are amazingly common, and you need to actively look out for them. Insist on a receipt whenever you pay your hospital bills.
• Beware of duplication of tests. Be sure to ask the doctor about what blood tests, x-rays and medical procedures you will need to undergo in hospital.
• Checkout times should be strictly followed. Be sure you know when precisely you need to leave and stick to your schedule; otherwise, you’re likely to be charged for an extra day’s stay.
• If your health problem isn’t an emergency, avoid being admitted to a hospital on a weekend. No one likes working on weekends, and testing will usually not take place until Monday.
• Discuss your financial concerns with your doctor. Many doctors and hospitals can and do reduce their fees for patients who have problems with payments. Also, remember that you will get exactly the same quality of medical care in a first class deluxe room in a private hospital, as you will in the General Ward – but you will end up paying more.
Remember, that sooner or later, you or a family member will have to spend some time in a hospital. If you are well-prepared, you can make sure you will survive your stay in style – so that you can show off your surgical scar to all your friends at the next party!

Surgery for Low Back Pain?

Every one of us who never had backache must consider themselves very lucky as it has been reported that LBP affects as much as 70-90% of the adult population at some point of time.
The good news is that only one fourth get recurrence or progression to longstanding LBP. The person who has been suffering from LBP for a long time seeks solace at any cost even if it means undergoing a major operative procedure. But nowhere the role of operative treatment of any disease has been as controversial as in low back pain.
What I am trying to tell you is not a substitute to the opinion of a well informed doctor but it may help you to arrive at a correct decision pertaining to your individual condition.
There is insignificant correlation between back pain and the findings on different imaging studies. An overdependence on the diagnosis of disc herniation occurred with early use of MRI that show disc herniations in 20% to 36% of normal volunteers. This incidence increased to 76% of asymptomatic controls when they were matched to a population at risk for work-related lumbar pain complaints.
Severe nerve compression demonstrated by MRI or CT correlates with symptoms of distal leg pain; however, mild to moderate nerve compression disc degeneration or bulging, and central stenosis do not significantly correlate with specific pain patterns.
Lumbar MRI scans of 67 asymptomatic patients and found that 20% of those younger than 60 years of age had herniated disc, which were also present in 36% of those over the age of 60 years. Asymptomatic abnormalities were found in 57% of those 60 years of age or older. Lumbar disc degeneration was found in 35% of those from 20 to 39 years of age and in 100% of those over 50 years of age.

If you have been considering surgery for LBP here are certain things to consider before making a decision.
If the pain is mainly in your back with no or minimal radiation with no other abnormality other than a disc bulge reconsidering surgery would be better.
Appropriate treatment for what can be at times excruciating pain generally should begin with evaluation for significant spinal pathology. This being absent, a brief (1 to 3 days) period of bed rest with institution of painkillers and rapid progression to an active exercise regimen with an anticipated return to full activity should be expected and encouraged. Generally, patients treated in this manner improve significantly in 4 to 8 weeks. Diagnostic studies, including roentgenograms, often are unnecessary because they add little information.
Structural abnormalities do not always cause pain and diagnostic injections can help to correlate abnormalities seen on imaging studies with associated pain complaints. In addition, epidural injections can provide pain relief during the recovery of disc or nerve root injuries and allow patients to increase their level of physical activity. Because severe pain from an acute disc injury with or without radiculopathy often is time-limited, therapeutic injections help to manage pain and may alleviate or decrease the need for oral analgesics.
Surgical treatment can benefit a patient if it corrects a deformity, corrects instability, or relieves neural compression, or treats a combination of these problems.
There have been various studies comparing the long term results of operations for LBP ranging from microscopic discectomy to circumferential fusion.
Both the surgeon and the patient must realize that disc surgery is not a cure but may provide symptomatic relief. It neither stops the pathological processes that allowed the disc prolapse to occur nor restores the back to a normal state. If you have a prolapsed disc on the much coveted MRI examination, to conclude that a removal of disc will bring total relief from pain may not be true for everyone.
Disc surgery with fusion of the affected spinal segments definitely provides relief from pain arising from instability but may also increase the motion strain on adjoining segments thereby increasing the chances of degeneration at these levels.
The patient must practice good posture and body mechanics after surgery. Activities involving repetitive bending, twisting, and lifting with the spine in flexion may have to be curtailed or eliminated. If prolonged relief is to be expected, then some permanent modification in the patient's lifestyle may be necessary.
This does not mean that chronic LBP patients are doomed to suffer. The most important aspect in treatment of such patients lies in education of the patient pertaining to his problem and to mutually manage the condition with medicines, life style modifications, structured exercise programs with constant supervision and surgical intervention in cases that would definitely be benefited.
The question that “Is surgery for LBP a solution to a problem or itself a problem” still remains unanswered not only in the minds of patients but also the people responsible for treating Low Back Pain.
Dr Sameer Agarwal can be reached at International Medical Center.