dr.koshy FILLINGS
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Koshys Clinic

Treatments OfferedDental Implants

What is a dental implant?

A dental implant is a small titanium screw that serves as the replacement for the root portion of a missing natural tooth. Dental implants can be placed in either the upper or lower jaws. Due to the biocompatible properties of titanium, a dental implant fuses with the bone and becomes a good anchor for the replacement tooth. Dental implants can be used in solutions for replacing single or multiple missing teeth.

Why dental implants?

There are a number of reasons why you should consider a dental implant:

  • Without the root structure of a natural tooth present, the jawbone can shrink. This shrinkage will make your face look older than it is.
  • There are no loose parts to worry about losing. The dental implant is stable and comfortable. No adjustment is needed after placement. Normally, it will serve its owner for life.

Are dental implants successful?

With more than three decades of clinical experience and over a million patients treated, statistics confirm a success rate of nearly 95 percent for individual Nobel Biocare dental implants*, and even higher for the bridges they support.

* Results based on dental implants and dental bridges remaining and in function over a five-year period.

Who places the dental implants?

In most cases, your dentist can place your dental implant. However, if he or she isn’t familiar with dental implants you can search for local area providers through the Find-A-Dentist search engine found on this website.

How much do dental implants cost?

The fee for tooth replacement with dental implants depends on several factors, including the number of teeth being replaced and the number of dental implants required to support your replacement teeth. Some additional procedures may be required prior to the placement of your dental implants to ensure the long-term health of your dental implants. To obtain a specific fee estimate, it is necessary to have a doctor examine your mouth. After a thorough diagnostic examination, your dentist will recommend the treatment that is best for you.

Will dental implants work for me?

Anyone who is missing one or more teeth due to injury, disease or tooth decay may be a candidate for dental implants. The determining factor is the amount of available bone. Your dentist is the best person to evaluate whether dental implants are a viable solution for you.

Is old age a problem?

Occasionally, older patients express concern that their age may prevent them from enjoying the benefits of dental implants. However, health is more of a determining factor than age. If you’re healthy enough to have a tooth extracted, you’re probably healthy enough to receive dental implants. Certain chronic diseases may contraindicate dental implant treatment. Your dentist will determine if you are a candidate for dental implants after a careful evaluation of your dental and health history.

What are the advantages of dental implants over dentures or a dental bridge?

  • Improved appearance: When you lose the entire tooth - crown and root - shrinkage of the jawbone may cause your face to look older. Dental implants can stop this process. A traditional denture or dental bridge doesn’t.
  • Preserve natural teeth: With traditional dental bridges, teeth adjacent to missing teeth are normally ground down to be used as anchors for a dental bridge. Dental implants often eliminate the need to modify healthy teeth.
  • Permanent solution: There are no loose parts to worry about losing. The dental implant is stable and comfortable. No adjustment is need after placement. Normally, it will serve its owner for life.

Expected Results

How will dental implants affect my life?

Dental implant-supported replacement teeth look, feel and function like natural teeth. This means that you can eat and drink whatever you choose. But most importantly, dental implants often improve quality of life in a very concrete way. People who have felt embarrassed and worried because of their tooth problems are often overwhelmed by what new permanent teeth can do for their self-esteem.

Will my new teeth look natural?

When dental implants are used in combination with modern restorative dentistry, their appearance, comfort and function are very likely to exceed your expectations. Often they are hard to tell apart from your natural teeth.

Will I be able to chew with the same force and pressure I use with my natural teeth?

Yes. Following a brief adaptation period, chewing capacity is comparable to that of natural teeth.

How much time is required for a dental implant placement?

Today, state-of-the-art guided surgical techniques are convenient alternatives to place dental implants and allow you to have the dental implant placed in a single session using keyhole surgery. This new method has significantly simplified the procedure, for both patients and dentists. The major advantage of the guided surgical technique is the minimal amount of manipulation of the soft tissue due to keyhole surgery. This significantly reduces the healing time and the discomfort normally associated with traditional dental implant surgical techniques.

The conventional process can take from three to six months. First, the dentist places the dental implant, which is left for three to six months to heal and integrate with the jawbone. During the healing period, your are given a temporary prosthesis until the permanent crown is put in place.

The procedure chosen depends on several factors, such as your dental health, the number of teeth involved and which teeth are replaced. These factors will also determine the total number of visits to the dentist throughout the treatment period.

Is the treatment painful?

With any surgery, there can be some discomfort. Placing one implant normally causes less discomfort then placing several. Anesthesia and patient sedation are commonly administered to help reduce any discomfort during the dental implant process. Most patients report that they were much more comfortable following the procedure than they had anticipated. Your doctor will prescribe medications to ease any discomfort that may occur. Ask your dentist to recommend another patient who has already had tooth replacement therapy to assess their personal experience.

How will I feel after the treatment?

It is normal to have some bruising and swelling in the gum and soft tissues. But usually the discomfort, if any, is treated with an ordinary painkiller. You should expect to be able to work the next day.

How will I care for my dental implants?

Your new teeth must be cared for and checked regularly, just like your natural teeth. Brush and floss as recommended by your dentist or dental hygienist. See your dentist in six months, or more frequently if so advised.



What are fillings?

Teeth that have been affected by tooth decay (caries or cavities) require a filling. There are many different types of fillings, including:

Dental Amalgams

Dental amalgams, also known as silver fillings, are comprised of a mixture of mercury (45 to 50 percent), and an alloy of silver, tin, and copper (50 to 55 percent). When it is combined with other materials in dental amalgam, mercury's chemical nature changes and it is no longer considered harmful to the body.

Composite Resins

Also know as white fillings, a composite resin is a tooth-colored plastic mixture filled with glass (silicon dioxide) that is used primarily for cosmetic improvements of the smile by changing the color of the teeth or reshaping disfigured teeth.

Other alternatives to restoring damaged or decayed teeth:

Porcelain Veneers - A ceramic material is bonded to the front of teeth to change the tooth's color, size, and/or shape

Crown - A "cap" that covers a cracked or broken tooth, unfixed by a filling, to approximate its normal size and shape

Cast Gold Restorations - This type of restoration is often more costly and may require more than one dental fitting


Root Canal Treatment

What is root canal therapy?

RCT or endodontics is the diagnosis and treatment of inflamed and damaged pulps.

Teeth are composed of protective hard covering encasing a soft living tissue called pulp. Pulp contains blood vessels, nerves, fibers and connective tissue.

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  Normal Anatomy of Tooth Tooth with Infected Pulp and Abscess Formation


The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development. However, it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.

Who performs Root Canal Therapy?

Generally, all dentists receive basic education in root canal treatment, but an endodontist is preferred for Root Canal or endodontic therapy.

An endodontist is a dentist who undergoes a special training for 2 or more years after dental school in diagnosing and treating the problems associated with inside of the tooth.

How does pulp becomes damaged?

Tooth Decay
Deep fillings
Gum diseases
Injury to tooth by accidents.

How  can you tell if pulp is infected?

Most common symptoms are
Tooth ache on biting or chewing or lying down
Oversensitivity of the teeth with hot or cold drinks
Spontaneous pain
Pus drainage

Each individual may experience symptoms differently. Sometimes, however there are no symptoms.

Why do I need Root Canal Therapy?

Without treatment, the infection will spread to the bone around the tooth, making it no longer able to hold the tooth in place.

What is root canal procedure?

First the endodontist will anaesthetize the area by injecting local anesthetic. Then an opening is made in the crown of the tooth and very small sized instruments are used to clean the pulp in the root canal.

  Dr Koshy Dr Koshy
  Cleaning and Shaping
of Root Canal System
Cleaned and Shapped Tooth

After thorough cleaning and shaping of the root canals, they are filled with rubber like material called gutta – percha, which will prevent the bacteria from entering this space again. This completes the endodontic therapy.

Then the endodontist places the crown or other restoration so as to restore the tooth to full function.

  Dr Koshy Dr Koshy
        Obturation of Root Canal System Complete Restoration of tooth with crown placed over the restored tooth


How many visits?

Generally 1 to 2 visits. But treatment time can vary according to condition of the tooth.

Will I feel pain during or after treatment?

Generally comfortable. But for first few days, you might feel sensation especially if pain and infection was present prior to the procedure.

Post operative care

Brittleness – treated teeth becomes brittle. So do not chew or bite on the treated tooth until you have it restored by your dentist. The tooth may become slightly discolored over time.



What is a dental bridge?

A dental bridge is an appliance used to replace one or more missing teeth. These appliances are cemented into place and cannot be removed by the patient.

How is a dental bridge constructed?

As the name of this appliance implies, the bridge is made out of three pieces that fit into the open space in the mouth, "bridging" the gap. Most bridges are made of a pontic tooth (or false tooth), held together by two crowns (a "cap" that covers the tooth, approximating its normal size and shape). This trio is then attached (cemented) to the abutment teeth (the surrounding teeth of each side of the gap).

Who is a candidate for bridges?

Nearly everyone who has one or more missing teeth is a candidate for a dental bridge. However, the difference between proper and improper oral hygiene is, generally, what determines the success of the dental bridge.

What are the different types of dental bridges?

There are several different types of dental bridges. Your dentist or oral health specialist will recommend the most appropriate one for your mouth condition and the location of the missing tooth or teeth.

Traditional Bridge - A pontic tooth (or false tooth) is held together by two crowns (a "cap" that covers the tooth, approximating its normal size and shape). This trio is then attached (cemented) to the abutment teeth (the surrounding teeth of each side of the gap).

Resin Bonded Bridge (also known as a "Maryland" bridge) - This type of bridge involves the pontic (false) teeth being fused together to metal bands, bonded to the back of the abutment teeth with a resin cement. This type of procedure is common when the teeth missing are in the front of the mouth.

Cantilever Bridge - This type of procedure is most appropriate when there is only one abutment tooth on either side of the span.

Oral health care and bridges:

The following recommendations will help to eliminate, or reduce, any oral health problems while your teeth bonded by a bridge:

# Brush your teeth carefully after every meal with fluoride toothpaste and a soft-bristled toothbrush, as food may become lodged causing the gums and teeth to become infected. This may lead to further complications resulting in the loss of the bridge.

# Floss daily. Your dentist, or other oral health specialist, may recommend using a floss threaded for hard-to-reach places between the bridge and its adjacent teeth.

# Have your teeth cleaned every 6 months by an oral health professional.

# Limit your sugar and starch intake, as debris left behind from these types of foods may turn into damaging acids, which, in addition to promoting plaque formation, may also be harmful to teeth and gums.

# Avoid hard and/or sticky snacks. This includes foods such as popcorn, hard or chew candy, caramel, and/or nuts.

Most bridges last 8 to 10 years with proper oral hygiene.



What is orthodontics?

Orthodontics is the dental specialty that focuses on the development, prevention, and correction of irregularities of the teeth, bite, and jaws. Orthodontists also have specialized training in facial abnormalities and disorders of the jaw. A patient may consult an orthodontist after receiving a referral from his/her general dentist -- recommending orthodontic treatment to improve the patient's physical "orofacial" appearance. However, the American Dental Association recommends that every child receive an orthodontic evaluation by the age of seven.

Why choose orthodontic treatment?

Any orthodontic problem may be classified as a malocclusion, or "bad bite." The following problems may be helped or minimized with proper orthodontic treatment:

* misaligned, crooked, or crowed teeth
* missing teeth
* extra teeth
* an overbite
* an underbite
* misaligned or incorrect jaw position
* a disorder of the jaw joint

At what age do braces become appropriate?

Moving and correcting the alignment of the teeth follows the same biological and physical process no matter what the age. However, an adult mouth must overcome already-positioned facial bones and jaw structure. Thus, overcoming most types of malocclusions may require more than one type of orthodontic treatment for adults. In most cases, the ideal age for braces, and other orthodontic treatments, is between 10 and 14 years of age, although, persons of any age can benefit from treatment.

What are the different types of braces available?

Braces, also called fixed orthodontic appliances, generally come in three varieties:

    * brackets, metal or plastic, clear or tooth-colored, that are bonded to teeth

    * lingual-type brackets that attach to the back of teeth, hidden from view

    * bands that cover most of the teeth with metal bands that wrap around the teeth

All three types use wires to move the teeth to the desired position.
Oral health care and braces:

The following recommendations will help to eliminate, or reduce, any oral health problems while your teeth are in braces:

# Brush your teeth carefully after every meal with fluoride toothpaste and a soft-bristled toothbrush, as food becomes easily lodged in the braces.

# Floss daily between the teeth and the braces.

# Maintain every 6 month cleanings by an oral health professional.

# Limit your sugar and starch intake, as debris left behind from these types of foods may turn into damaging acids, which, in addition to promoting plaque formation, may also be harmful to teeth and gums.

# Avoid hard and/or sticky snacks that may be difficult to remove from the orthodontic equipment in your mouth. This includes foods such as popcorn, hard or chew candy, caramel, and/or nuts.



What are dentures?

Dentures replace missing teeth and their adjacent tissues with a removable dental appliance made of acrylic resin and, in some cases, a combination of metals.
What are the different types of dentures?

There are four primary types of dentures:

This type of denture replaces all of the teeth and their adjacent tissues.

Partial dentures act as dental bridges as they "bridge" the gap between a missing tooth or teeth.

Conventional dentures allow a recovery time (usually 4 to 8 weeks) after all of the teeth are extracted before the dentures are placed in the mouth.

This type of denture does not allow a healing period after all of the teeth are removed. The denture is immediately fit into the mouth after all teeth are removed. Additional adjustments in the fitting of this type of denture procedure may be necessary as healing occurs.

Oral health care and dentures:

    * Daily remove and brush the denture carefully with a brush and toothpaste, both specifically designed for denture cleaning.

    * Avoid the use of harsh abrasive cleaners on your denture.

    * Avoid cleaning and/or sterilizing your denture in boiling water, or damage to the denture is likely to occur.

    * If a partial denture is in place, remove it before brushing the natural teeth.

    * Once removed, keep the denture in a safe place, out of the reach of children.

    * Once removed, soak the denture in a proper cleansing solution or water.

    * Have your teeth cleaned every 6 months by an oral health professional.


Teeth Extraction

What are wisdom teeth?

Also called third molars, wisdom teeth usually make their first appearance in young adults between the ages of 15 to 25. Because most mouths are too small for these four additional molars, an extraction procedure, sometimes immediately after they surface, is often necessary.

When should wisdom teeth be removed?

The following symptoms may indicate that the wisdom teeth have erupted and surfaced, and should be removed before they become impacted -- meaning, the teeth have surfaced and have no room in the mouth to grow. However, each individual may experience symptoms differently. Symptoms may include:

* pain
* infection in the mouth
* facial swelling
* swelling of the gumline in the back of the mouth

Most oral health specialists will recommend an immediate removal of the wisdom teeth, as early removal will help to eliminate problems, such as an impacted tooth that destroys the second molar. According to the American Academy of General Dentistry, third molar impaction is the most prevalent medical developmental disorder.
What problems are often associated with impacted third molars?

* bacteria and plaque build-up
* cysts development (a fluid-filled sac)
* tumor development
* infection
* jaw and gum disease

What is involved in the extraction procedure?

Wisdom tooth extraction surgery involves removing the gum tissue that presides over the tooth, gently detaching the connective tissue between the tooth and the bone, removing the tooth, and suturing the opening in the gumline.



What are dental sealants?

Dental sealants are thin, plastic films painted on the chewing surfaces of the back teeth -- molars and premolars -- and are highly effective in the prevention of tooth decay (caries and cavities). Dental sealants are particularly effective on the back teeth, as the back teeth contain more hard-to-reach pits and grooves that serve as a host to food debris and plaque build-up.

How effective are dental sealants?

Because the sealants act as a physical barrier to decay and plaque build-up, in most cases, they provide 100 percent protection -- with the most important variable being how well the dental sealant adheres to the teeth. In addition, research has shown that sealants actually stop cavities when placed on top of a slightly decayed tooth. This action seals off the supply of nutrients to the bacteria that causes the cavity. The dental sealant becomes ineffective when all or part of the bond between the tooth and the sealant is broken.

Who are likely candidates for dental sealants?

Sealants are especially beneficial for children because their newly erupted, permanent teeth are most susceptible to cavities and least benefited by fluoride. However, patients of all ages can benefit from dental sealants.

What does the procedure involve?

The procedure starts with cleaning the surface of the tooth, rinsing the surface to remove all traces of the cleaning agent, and drying the tooth. A solution or gel is applied to the surface of the tooth, including the pits and grooves, to make the surface of the tooth rough. After several seconds, the solution is thoroughly rinsed away with water and the site is dried. The liquid sealant is then applied and allowed to harden.

With proper oral hygiene, sealants may last 5 to 10 years.


Gum Disease

Your Gums Need Special Care

Periodontal disease is an infection of the gums and of supportive tissues surrounding the teeth.  Many people develop gum and tissue problems. The good news is that periodontal disease can be controlled. In some cases, it can even be reversed. Periodontal treatment can make your mouth healthier and help preserve your teeth.

A Silent Disease

You could have periodontal disease and not even know it. That's because periodontal disease is "silent"-it often has no symptoms. This is true even in the late stages of the disease.  Periodontal disease can destroy the soft tissues and bone that support the teeth. But with regular checkups, the infection can be caught early and treated. This offers the best results.

Your Teeth Need A Strong Foundation

In a healthy mouth, teeth fit snugly in place. Their roots are surrounded by a strong foundation of gums and other supportive tissue. This tissue holds teeth firmly to the bone. The supportive tissue also acts as a shocks absorber when you bite and chew. In an unhealthy mouth, periodontal disease may develop; it begins with bacteria infecting the gums. Bacteria can then attack deeper supportive tissues. As these tissues weaken or are destroyed, the otherwise healthy teeth can become loose and fall out.

Bacteria: Invisible Troublemakers

Many kinds of bacteria live and grow in a healthy mouth. They form a sticky, colorless film (plaque) on teeth and gums. As plaque builds up, it appears as a soft, whitish coating. Plaque is always forming .But you can reduce it with proper flossing and brushing. If plaque is not removed regularly, it can harden into tartar (also called calculus). Tartar is a rough yellowish or brown deposit. It needs to be removed by a dentist or periodontist. Bacteria from plaque and tartar can lead to periodontal disease.

Periodontal Disease May Progress

You may have no symptoms alerting you to your periodontal disease. It could be silently damaging the tissues supporting your teeth. Gingivitis, a mild form of the disease, may progress to periodontitis.  This in turn may lead to advanced periodontitis. Early treatment   makes periodontal disease easier to control. It also helps restore the health of your mouth and save your teeth.


If not removed regularly from teeth and gums, bacteria grow out of control. They produce toxins that irritate your gums. Tartar along the gum line forms   a rough surface that attracts more plaque. This adds to gum irritation and swelling. Symptoms may include sore, bleeding   gums or bad breath. The spaces between gum and tooth (pockets) can also enlarge or deepen. Gingivitis can be reserved and does not damage bone.

  Gum Disease Gum Disease



Periodontitis occurs when the infection spreads to the bone. The most common causes are plaque and tartar building up under gum line. This can irritate the gums. If there are symptoms, they may include bright   red gums that bleed easily or shrink back (recede). As ligaments break down, the gums pull away from the teeth. Pockets deepen and fill with more bacteria. Bone starts to be destroyed, and teeth may loosen.

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Advanced Periodontitis

When the infection reaches this stage, pockets deepen and may fill with pus. There may be swelling around the root. Your teeth may be sensitive to hot or cold. Or you may feel pain when brushing your teeth.  As bone losses increases, your teeth may lose so much support that they fall out. Certain teeth may need to be removed   to preserve the health of your mouth.

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Periodontal Treatment: Nonsurgical Options

Nonsurgical treatment removes plaque and tartar. It controls the growth of harmful bacteria and treats conditions that promote gum disease. This treatment may be all you need, especially if your gum problems are found early. Treatment may include replacing worn fillings, which can attract plaque.

Scaling and Root Planing

Scaling is a type of cleaning. It removes plaque and tartar from the teeth at and slightly below   the gum line. Root Planing smooth’s   root surface. Supportive   tissues can then reattach to the tooth surface. Ultrasonic instruments may also be used to keep you free from pain.

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To reduce the bacteria that cause periodontal disease, you may be given antibiotics in pill form. Or you may have antibiotics materials such as gels or chips applied directly to the infected pocket. In some cases, an antibacterial mouth rinse is prescribed to help control plaque.
Gum Disease


Bite Correction

Problem with your bite may increase bone damage and loss. You may be given a bite guard. This is a removable device that fits over upper or lower teeth. It’s used to protect tooth surfaces and relax tense jaw muscles. In some cases, the bite can be adjusted so that teeth meet properly and function better.


If treatment has saved your teeth, but they are still loose because of the bone loss, they may be splinted. This technique connects weak teeth, combining them into a stronger single unit. This makes them more stable, and makes you more comfortable.
Gum Disease

Periodontal Treatment: Surgical Options

Surgical treatment is used for advanced infections and for pockets too deep to reach by scaling and root planing alone. Your doctor uses surgical tools to open your gums and clean the pockets. Your gums may be repositioned to make them easier to keep clean. To   achieve this goal, the gum line often must be lowered. This exposes more teeth.

Flap Surgery

The gum is gently separated from the tooth, creating a flap and access to the infected pocket. Deep deposits of plaque and tartar can then be removed. It also reduces the pocket and the areas where bacteria can grow. Little or no gum tissue is removed.

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Guided Tissue and Bone Regeneration

This helps keep unwanted gum tissue away from the tooth and bone. Ligament fibers can then regrow and bone can reform to better support the tooth.

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Bone Graft

Tiny fragments of your own bone, synthetic bone, or bone from a bone bank are placed where bone was lost. These grafts serve as a platform for the regrowth of bone. This restores stability to your teeth.

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Soft Tissue Graft

Soft tissue is added to reinforce thin gums or to fill in places where gums have receded. A grafted tissue, most often taken from the roof of your mouth, is stitches dissolve or is removed.

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