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RESTORATIVE DENTISTRY Restorative Dentistry is the part of dentistry which is involved in the repair and/or replacement of damaged of missing teeth. There are many methods available to patients today, depending on the specific needs of the patient. For small to moderate sized areas of decay or damage, composite resin fillings are an excellent choice to restore teeth. For larger areas of damage, the options include inlays, onlays, porcelain veneers and crowns. When teeth are missing or require extraction, possibilities for restoration may include bridges, implant supported crowns, removable partial dentures, removable complete dentures or a combination of these treatments. Composite resin restorations [fillings] are used to restore portions of a tooth that have been damaged [primarily by tooth decay] to proper form and function. These are tooth-colored [white] fillings that are bonded to the tooth to provide a seal between the tooth and the filling. The composite fillings are quite strong and wear resistant when used appropriately. Depending on the location of the decay and the size and placement of any existing fillings, a filling may include one, two, three or more surfaces of your tooth. Any time that decay is in-between your teeth at least a two-surface filling is required in order to restore the tooth. In the case of a tooth that has a great deal of missing tooth structure, a more extensive treatment [such as a crown] will be required to prevent further future damage to the tooth. Composite resin restorations may be used to repair teeth in all areas of the mouth when adequate tooth structure remains to support the restoration. In cases where inadequate tooth structure remains, a more extensive restoration is indicated. The use of these materials allows for much more conservative preparation [the removal of less tooth] of the teeth that require restoration, providing a better long-term treatment prognosis. After removal of all damaged areas of the tooth, the tooth is treated with an acidic solution for approximately fifteen seconds to microscopically roughen the tooth. After this solution is rinsed off with water, the tooth is gently dried of excess water and a bonding agent is placed on the tooth. A very bright light [called a curing light] is used to harden the bonding agent, creating the seal between tooth and filling. The filling material can now be placed on the tooth and hardened with the curing light. After the filling is placed, the dentist verifies that the filling fits properly in your bite and now your filling is done! While there are generally few complications, which arise from the placement of a composite restoration, the most common ones include the need for a bite adjustment and temporary cold sensitivity. In rare instances, the placement of the restoration [usually, but not always, associated with deep cavities or teeth that have fillings previously placed and removed] may cause what is called a pulpitis, which is an inflammation of the pulp tissue [blood vessels and nerves] inside the tooth. For more information on pulpitis and its treatment[s] visit the page on Endodontic Treatment. Alternative treatment options for composite resin restorations include not
treating the tooth, delaying treatment, a crown, an inlay or onlay, an amalgam
restoration, or extracting the tooth. The adverse
effects of non-treatment and delaying treatment include possible
pain, infection, increase in size of the decay resulting a need to implement a
more extensive treatment plan, bone loss, and/or tooth loss. Amalgam restorations have no proven
adverse health effects to patients, but advances in dental materials have
allowed composite restorations to approximate amalgam in strength and wear
resistance. When used appropriately, both materials are suitable restorative
options, however, composite resin has the benefit of bonding to the tooth
structure, where amalgam cannot. The extraction of the tooth may lead to many
potential complications including bone loss, shifting of teeth in both upper and
lower jaws, loss of chewing ability, loss of support of facial muscles and
structures [leading to a "sunken" facial appearance], and difficulty
in speaking. A crown is a restoration which covers the tooth, restoring the original shape and function, while protecting the tooth from future fracture and damage. A crown may be made of several different materials, and there are advantages to each possible selection. A full gold crown has been traditionally considered the standard by which all other crowns are judged. The advantages to a gold crown include excellent wear qualities, a track record of longevity in use, and being highly friendly to the tissues of the body. A porcelain-to-metal crown has the advantage of being tooth colored while having a metal substructure to help strengthen the tooth and help prevent fracture of the porcelain. An all ceramic crown can replicate the shading of teeth very naturally where esthetics [how the crown looks] are very important. An all ceramic crown may only be used after careful consideration of the specific location of the tooth and the stresses that it will encounter. Continuing advances in dental bonding technology continues to allow for greater flexibility in the use of all-ceramic bonded crowns. The first step in the creation of a crown is referred to as preparing the tooth. Using precision diamond covered instruments, a uniform thickness [approximately 1-2 millimeters] of tooth is removed from the entire exterior surface. When sufficient preparation is completed, an impression [mold] is made of the tooth needing the crown and the teeth the crown will chew on, so that the laboratory can make an accurate replica of the tooth. Your bite will be recorded in a rubbery material as well. When all of this is done, a provisional crown will be made for your tooth of either plastic or metal, and cemented temporarily. It is very important that you return for the definitive crown, as the provisional crown will not adequately protect your tooth from the stresses generated in your mouth for an extensive period of time. After the crown is completed in the laboratory, the dentist will try the crown in your mouth, make any necessary adjustments, and cement the crown onto the prepared tooth. In some circumstances, there is insufficient tooth structure remaining to provide an adequate preparation for the crown. In these cases, a crown build-up [or possibly a post and core, in the case of a tooth that has had a root canal] will be required. A crown build-up is a separate procedure from a crown, but can often be completed at the same time as the crown preparation. See below for a more complete description of a crown build-up. Complications from crown placement are infrequent and include the need for bite adjustment and in the case of a tooth that has not been treated endodontically, a pulpitis may occur. For more information on pulpitis and its treatment, see the Endodontic Treatment page. Treatment options for a crown include
non-treatment, delayed treatment, placement of a large composite resin
restoration, an inlay or onlay, or extraction of the tooth. Adverse consequences
of non-treatment or delayed treatment include possible pain, infection, increase
in size of the decay resulting a need to implement a more extensive treatment
plan, tooth and/or root fracture, bone loss, and/or tooth loss. A crown
build-up involves the placement of
a large amount of bonded composite material in the damaged portion of the tooth
to provide a foundation for a definitive restoration [like a crown]. A crown
build-up may be used on either an endodontically or non-endodontically treated
tooth. In the case of an endodontically treated tooth that has sustained
extensive loss of tooth structure a prefabricated
post may be placed in one or more
of the canals to aid in the retention of the core build-up. In certain
instances, the creation of a custom cast
core by our dental laboratory may
be required for a successful result. In the case of an endodontically treated
tooth, the determination about which treatment option is appropriate will be
made after the root canal is completed. In each case, the determination will be
based on which option will give the patient the best long-term result while
conserving tooth structure and restoring proper form and function to the tooth.
When an extensive treatment plan is formulated, and a lengthy period between
endodontic treatment and definitive restoration exists, it may be necessary to
remove the temporary filling and perform a crown build-up or post and core to
prevent the leakage of saliva, bacteria, and food into the tooth which may cause
the root canal to fail. A crown build-up or post and core is not designed or
intended to function as a definitive restoration for extensive periods of time,
therefore, it is very important that the crown is placed on the tooth as soon as
your treatment plan allows to prevent complications [which may include cusp or
root fracture]. A bridge is a treatment option that allows the replacement of a missing tooth or teeth. In order to use a bridge to replace a missing tooth, there must be a sound tooth remaining on either side of the space that the missing tooth previously occupied, known as abutment teeth. The abutment teeth must be in a state of periodontal health, with adequate bone structure remaining to support the tooth and the restoration. These teeth may or may not have required root canal treatment or restoration in the past. The procedure for the fabrication of a bridge is virtually identical to the preparation for an individual crown. The abutment teeth are prepared for crowns, with all abutment teeth being oriented in a parallel direction. After taking appropriate impressions, bite registrations and fabricating a provisional restoration, the laboratory fabricates the final restoration. Crowns are created for the abutment teeth, and pontics [false teeth] are created to fit between the abutment teeth. Complications associated with the placement of a bridge are similar to those of crowns. One problem associated with bridges is the accumulation of plaque underneath the false teeth of the bridge. This requires an increase in oral hygiene in the area, using specific oral hygiene aids. There are several options available for
the materials used in the fabrication of the bridge, including a full gold
bridge or porcelain fused to metal bridge. Please see the section on crowns
for further details. New dental technology shows great promise for the creation
of a metal-free bridge that is adequately strong to withstand the forces of
chewing. The removable partial denture, commonly called a partial, is a prosthetic device that allows the replacement of multiple missing teeth. A partial denture replaces some, but not all of the teeth in a jaw. In order to be a candidate for a partial denture, there must be a sufficient number of teeth that the denture will attach to and these teeth must have adequate bone support and tooth structure. If there is inadequate support for the denture, a partial denture may result in the premature loss of teeth in question. Partial dentures are generally feel more secure in the mouth than complete dentures, but both types of dentures require some "getting used to." In order to fabricate a partial denture, small preparations are made on the teeth that the denture will be attached to. Impressions of the mouth are taken and then the metal frame of the partial denture is made at the laboratory. This frame is tried in the mouth to check the accuracy of the fit, and then it is returned to the lab for the placement of the replacement teeth and final processing. After the completed denture is placed in the mouth, it often requires adjustment of the fit and/or bite. These adjustments may require one or more return visits to the dentist. Alternatives to removable partial dentures include not having dentures made
at all, fixed partial dentures [bridges] and implant-supported crowns and/or
bridges. However, the implants and bridges may not be appropriate for all
patients. Failure to replace missing teeth may lead to bone loss, shifting of
teeth in both upper and lower jaws, loss of chewing ability, loss of support of
facial muscles and structures [leading to a "sunken" facial
appearance], and difficulty in speaking. Complete removable dentures are what might be considered the restoration of last resort. A complete denture is used to restore the function of a patient who is missing all of the teeth in one or both jaws. A complete denture is a prosthetic device that attempts to replicate the appearance of natural teeth while allowing the patient to chew food and speak as naturally as possible. Many patients have a hard time adapting to dentures, but it must be remembered that a denture is an artificial replacement for a body part, not dissimilar to an artificial limb. Every denture patient must be willing to spend the time and effort to learn to adapt to their new prosthesis. Just a patient that recently received an artificial leg would not expect to be able to run a marathon immediately, a denture patient should not expect to be able to eat "just like I did when I had all of my own teeth." Even if you have both upper and lower complete you will need to visit your dentist at least once a year to maintain the dentures and evaluate your dental health. It is very important that denture patients be examined on a regular basis, at least once a year, to evaluate their oral health. Without routine examination, it is impossible to diagnose and treat any number of oral conditions, both common and rare, that a denture patient may present. The most common problem is a persistent, chronic fungal infection under a denture. Many times the patient is unaware of the infection due to the slow growing nature of the organism. Much more rare, but far more serious, is the occurrence of cancer in the oral cavity. According to the American Cancer Society, between 3 and 3.4% of all cancers diagnosed in the United States in any given year will be cancer of the oropharyngeal area. Unfortunately, oral cancer has a relatively low survival rate over five years of 31 to 54%. Even more distressing is that approximately 18% of oral cancer patients will develop secondary oral cancer lesions within one year of treatment [this rate was nearly doubled for patients that did not quit smoking after diagnosis]. Nearly 20 percent of the patients with oral cancer will develop another cancerous lesion in the upper respiratory tract, upper gastrointestinal tract, or breast. One reason that oral cancer is so lethal is that it is often not detected in an early stage due to the patient not receiving routine dental care. The bone that remains in the jaws after teeth are extracted is the foundation upon which the denture is supported. Over time, this bone gradually goes away without the stimulation that teeth provide. As this bone changes [or "remodels"] the dentures do not fit as well as they once did, and subsequently, they begin to move around in the mouth. This creates irritations on the gum tissue that is underneath the denture. These irritations can cause outgrowths of tissue, as the gums attempt to protect themselves, and these growths can become traumatized and raw. In rare cases, these raw and irritated areas may become cancerous. |