Advanced treatments
What advanced dental treatments are available?
Catford Dental offers vital pulp therapy to keep a damaged nerve alive, digitally planned smile design, clear aligners and professional whitening. Each is planned from scans and photographs so the result is agreed before treatment begins.
What is vital pulp therapy?
Inside every tooth is the pulp — living tissue carrying the nerve and blood supply. When decay or a fracture reaches it, the conventional response is root canal treatment: remove the pulp entirely, disinfect the space and fill it.
Vital pulp therapy asks a different question first. If the pulp is inflamed but not yet dead, can it be kept? The exposed tissue is treated directly with a bioactive material that seals it from bacteria and encourages the tooth to form its own barrier of hard tissue underneath. The tooth is then sealed with a bonded restoration.
The point of keeping the pulp is not sentimental. A tooth with a living nerve stays hydrated, keeps its sensation, and does not become the brittle, hollowed structure that a root-treated tooth eventually is. It also keeps root canal treatment available as a later option if the pulp does not settle. The reverse is not true — once the pulp has been removed, it cannot be put back.
When can the nerve be saved, and when can it not?
It depends on the state of the pulp, and that is a clinical judgement made partly before treatment and partly with the tooth open in front of you.
The favourable picture is a pulp that is inflamed rather than infected: pain that comes with cold or sweetness and settles within seconds, a tooth that has not been keeping you awake at night, and healthy bone visible around the root tip on a radiograph. When the pulp is exposed during treatment, bright red bleeding that stops within a few minutes suggests tissue that is still healthy enough to recover.
The unfavourable picture is a pulp that has already been overwhelmed. Prolonged throbbing pain, pain that wakes you, pain that lingers long after a cold drink, swelling, a tooth that no longer responds to testing, or a dark area at the root tip on a radiograph all point to tissue that is dying or dead. Bleeding at the exposure that will not stop says the same thing. In that situation, keeping the pulp is not a conservative choice — it is a failed one that leaves infection sealed inside the tooth.
Nor is the decision permanent at the moment it is made. A tooth treated this way is reviewed over the following months, and a proportion will still go on to need root canal treatment. That possibility should be explained to you before you agree, not afterwards.
Vital pulp therapy is not always possible, and no dental professional can promise in advance that a nerve will survive. Where the pulp is already dead or infected, root canal treatment or extraction is the correct treatment and delaying it risks the infection spreading.
What is digital smile design?
It is a planning method, not a treatment. Photographs of your face and smile are combined with a digital scan of your teeth so that a proposed result can be designed and shown to you before any tooth is touched.
That matters because cosmetic work is unusually easy to get wrong in a way that is only obvious afterwards. Tooth proportions, where the edges sit relative to your lip, how much tooth shows when you speak, whether the midline matches your face — these are judgements that are far easier to make on a screen, with you in the room, than on a tooth that has already been prepared.
The practical consequence is that the conversation happens first. You see a proposal, say what you do and do not like about it, and the design is adjusted. Only once the intended result is agreed does the plan work backwards to establish what is actually needed to achieve it — which is sometimes less than the patient expected, and occasionally more.
How do clear aligners work?
Clear aligners are a series of removable, transparent trays. Each one is shaped slightly differently from your current tooth position, and wearing it applies gentle, continuous pressure that moves teeth a small distance. You move through the series in order, and the teeth follow.
They are made from a digital scan of your mouth, so the whole sequence is planned before the first tray is fitted. They are removed for eating and cleaning, which avoids most of the dietary restrictions and hygiene difficulty of fixed braces.
The trade-off is that they only work while they are in your mouth. Aligners typically need to be worn for most of the day and night, and a patient who takes them out frequently will not get the planned result. Retention afterwards is also not optional — teeth drift back towards where they started unless they are retained.
Aligners suit mild to moderate crowding, spacing and alignment problems. More complex bite discrepancies, significant jaw size differences and some rotations are better handled by fixed appliances or by an orthodontic specialist. An assessment establishes which category you are in before anything is ordered.
Clear aligners move teeth; they do not repair them. Decay and gum disease must be treated before orthodontic movement begins.
What does professional whitening involve?
Whitening lightens the natural tooth by using a peroxide gel to break down staining within the enamel and dentine. It is done either in the practice or with custom trays made to fit your teeth for use at home, and it is the least invasive way to change the appearance of teeth because it removes no tooth structure at all.
Two things are worth knowing before you start. Whitening does not change the colour of existing fillings, crowns or veneers, so restorations in the front of the mouth may need replacing afterwards to match. And discolouration that comes from inside a tooth — an old root-treated tooth, or staining laid down while the tooth was forming — responds differently from ordinary surface staining and needs assessing separately.
Temporary sensitivity during and shortly after whitening is common and settles. Existing decay, leaking fillings and untreated gum disease should be dealt with first.
How is a treatment plan put together?
An examination first, with radiographs and usually an intraoral scan, so that the state of every tooth is established before anything is proposed. Photographs are taken where appearance is part of the concern.
From that, the options are set out with what each one commits you to — how much tooth structure it uses up, what it makes harder later, and what happens if you do nothing for now. The sequence usually runs the same way: settle anything painful, treat active decay and gum disease, then restore, then align, then whiten, then replace any front restorations that no longer match.
Where more than one approach is reasonable, you should be told so rather than presented with a single plan. If a treatment is being recommended, it is fair to ask what the conservative alternative would be and why it was not chosen.
Common questions
Can vital pulp therapy help me avoid a root canal?
Sometimes. If the pulp is inflamed but still healthy, treating it directly with a bioactive material can keep the nerve alive and avoid root canal treatment. If the pulp is already dead or infected, it cannot, and root canal treatment is the correct option.
Does vital pulp therapy regrow the nerve or the tooth?
No. It keeps living pulp tissue alive and encourages the tooth to seal itself off with a layer of hard tissue. It does not regenerate a dead nerve, and no dental treatment regrows a tooth.
How long do clear aligners take?
It depends on how far the teeth have to move and how consistently the aligners are worn. Mild crowding may take a few months; more extensive movement takes considerably longer. An assessment with a scan gives an estimate specific to your teeth.
Will whitening damage my enamel?
Professionally supervised whitening at appropriate concentrations is not known to damage enamel. Temporary sensitivity is common and settles. The greater risk is with unsupervised products used on untreated decay, leaking fillings or inflamed gums.
Is digital smile design a treatment on its own?
No. It is a planning and communication method. The design shows what a proposed result would look like; the treatment that delivers it may be whitening, aligners, bonded restorations, veneers or a combination, and is agreed separately.
What do these treatments cost?
Cost depends entirely on how many teeth are involved and what each one needs, so a figure quoted without an examination is not a real quote. Ask for a written estimate after assessment, and ask what your medical aid is likely to cover.