Dental Treatments Information

Restorations

A dental restoration or dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. It is also lost intentionally during tooth preparation to improve the aesthetics or the physical integrity of the intended restorative material. Dental restoration also refers to the replacement of missing tooth structure which is supported by dental implants.

Treatments

 

Silver Fillings

An inexpensive way to restore a small amount of tooth decay.

The Problem:

A small amount of decay on a portion of a back tooth.

The Solution:

A silver (or amalgam) filling is a mixture of approximately 50% silver/tin alloy and 50% mercury. After tooth decay is removed and cleaned, this gray colored material is packed into the tooth and shaped.

Advantages:

Silver fillings have been used for more than 125 years. Their biggest advantage is that they are quickly placed, making them relatively inexpensive. They are also relatively durable.

Disadvantages:

Silver fillings do not bond (stick) to the tooth structure. This requires the preparation to be “undercut,” creating a chamber that is smaller at the surface of the tooth and wider inside. This undercut keeps the filling from falling out of the tooth.

The problem is that the creation of this undercut requires the removal of more healthy tooth structure than is necessary. This weakens the tooth and predisposes it to fracture when biting into hard items. Since fillings will break down from normal wear, they will eventually need to be replaced, and this will require the removal of even more healthy tooth structure.

Though silver fillings contain some mercury, current studies indicate what appear to be no measurable health risks to patients. However, we do know that mercury is a highly toxic material that can cause neurological and kidney disease. Adults and children have even been warned to limit the consumption of certain types of fish that carry high levels of environmental mercury. Even if there are no direct risks to patients, the extensive use of mercury in fillings may have a long term environmental impact.

Alternatives:

Composite (white) fillings are an excellent alternative, limiting the removal of healthy tissue and posing no known environmental risk. In cases of extensive decay, inlays/onlays or crowns are a much better restoration.

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Composite Fillings

The clear alternative to traditional mercury fillings.

The Problem:

  • Decay on a portion of any tooth.
  • Desire to replace old-fashioned mercury (silver) fillings.
  • Desire to maintain a white, beautiful smile.

The Solution:

A composite filling is a tooth colored quartz-like material. After tooth decay is removed and cleaned, this tooth colored material is layered into the tooth. Each layer is hardened or cured with highly intense visible light, and the final surface is shaped and polished to match the tooth. The final restoration is virtually invisible.

Advantages:01_fillings_tomlinson

Composite fillings are more than just attractive. They are environmentally non-toxic because they use no mercury. They are stronger because they bond directly to the surface of the tooth. They protect the tooth from fracturing because they don’t require the severe “undercut” (removal of healthy tooth structure) of a mercury filling.

Disadvantages:

The initial investment in a composite filling is higher than that for a mercury filling. This is due to the fact that the composite material is more expensive and the restoration is more difficult and time consuming to place. However, this initial higher investment is offset in the long run by the health benefits and reduced likelihood of restoring potentially fractured teeth.

Alternatives:

Inlays/onlays are sometimes good alternatives to composite fillings, offering excellent long term durability. In cases of extensive decay, inlays/onlays or crowns are the only alternative.

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Inlays and Onlays

An excellent way to restore teeth with small to moderate decay.

The Problem:

  • Any level of decay on a portion of any tooth.
  • Need for a long-term, durable restoration.
  • Desire to limit the amount of healthy tooth structure removed.
  • Need to strengthen and reinforce tooth.

The Solution:02_inlay_tomlinson

Decay is removed and cleaned from the tooth and a highly accurate impression or mold is made of the prepared surface. This mold is used to create a model of the tooth which is then sent to a special laboratory that will create a gold or porcelain (tooth colored) restoration called an inlay or onlay. The inlay or onlay is then cemented into the prepared surface of the tooth.

An inlay covers only one or two surfaces of the tooth and is used to restore a small amount of decay. An onlay actually covers one or more cusps (the chewing surface of the tooth.)

Advantages:

Inlays and onlays are incredibly strong due to the fact that they are created in a laboratory. This protects the tooth from fracturing and actually strengthens the tooth. In addition, inlays and onlays fit almost perfectly into the prepared surface of the tooth, reducing the size of the seam between the restoration and the tooth. This helps keep decay from eventually occurring under the restoration.

Inlays and onlays require the removal of only decayed areas of the tooth, leaving more healthy tooth structure intact. This can help prevent the expense of root canal therapy in the future.

Disadvantages:

Due to the fact that they are crafted in a laboratory, inlays and onlays require a greater initial investment than regular fillings. However, in the long run, inlays and onlays are a better investment than fillings due to their extremely long life and highly accurate fit. Gold inlays and onlays generally have a greater long term durability than porcelain inlays and onlays.

Alternatives:

In cases of extensive decay, crowns are the only alternative.

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Crowns (Caps)

The Problem:

  • Badly decayed teeth.
  • Fractured Teeth.
  • Need to protect and strengthen teeth.

The Solution:04_crown_tomlinson

A crown (often called a cap) covers the tooth and restores it to its original shape and size. Decay is removed and cleaned from the tooth and a highly accurate impression or mold is made of the prepared surface. This mold is used to create a model of the tooth which is then sent to a special laboratory that will create a gold or porcelain (tooth colored) crown. The crown is then cemented onto the prepared surface of the tooth.

Advantages:

Crowns are incredibly strong due to the fact that they are created in a laboratory. This protects and strengthens the remaining tooth structure. In the hands of a skilled dentist, a crown will fit almost perfectly onto the prepared surface of the tooth, reducing the size of the seam between the crown and the tooth. This helps keep decay from eventually occurring under the crown.

Crowns should be placed before the tooth is so decayed that it may fracture. This can often help prevent the expense of root canal therapy in the future. It can also prevent the possibility that a fractured tooth may need to be removed, requiring the expense of a bridge or implant to replace the missing tooth.

Disadvantages:

Crowns are excellent restorations and have few disadvantages. They are highly durable, but they will eventually need to be re-cemented or replaced due to normal wear.

Occasionally, a tooth may still need root canal therapy after being crowned. However, this indicates that the interior of the tooth was already sick (infected) and would have eventually needed root canal therapy anyway.

Alternatives:

In the event that a tooth is so decayed or fractured that it needs to be removed, the best alternatives to a crown are bridges and implants that replace the missing tooth.

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Fixed Bridges

A great way to replace missing teeth.

The Problem:

  • A missing tooth or teeth.
  • Potential bite and jaw joint problems from teeth shifting to fill the space.
  • The “sunken face” look associated with missing teeth.
  • Desire to improve chewing ability.
  • Desire for a more permanent solution than dentures.

The Solution:06_fixed_bridge_tomlinson

A bridge is a single appliance that is generally attached to two teeth on each side of the space where a tooth is missing. An artificial tooth attached in the middle of the bridge fills in the gap where the missing tooth was. The teeth on either side of the gap are prepared for crowns (see crowns) and a highly accurate impression or mold is made of the prepared area. This mold is used to create a gold or porcelain (tooth colored) bridge in a special laboratory. The bridge is then cemented onto the prepared surface of the teeth, effectively creating the appearance of a “new” tooth.

In some instances, a resin-bonded bridge may be used. In this case, the two teeth on each side of the gap are not prepared for crowns. Instead, the bridge consists of a false tooth with metal brackets on the back of each side of the gap. The brackets are attached to the backs of the real teeth on each side.

Advantages:

Unlike dentures, a fixed bridge is never removed. It is stable in the mouth and works very similar to natural teeth. By filling the gap and stopping the movement of other teeth, a fixed bridge is an excellent investment, providing better chewing ability, heading off jaw joint problems and saving money that would otherwise might be spent on future dental treatment.

Disadvantages:

Fixed bridges are excellent restorations and have few disadvantages. They are highly durable, but they will eventually need to be re-cemented or replaced due to normal wear.

Alternatives:

In the event that the use of a fixed bridge is not feasible, the best alternative is a dental implant.

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Dental Implants

An excellent way to replace missing teeth.

The Problem:

  • A missing tooth or teeth.
  • Potential bite and jaw joint problems from teeth shifting to fill the space.
  • The “sunken face” look associated with missing teeth.
  • Desire to improve chewing ability.
  • Desire for a more permanent solution than dentures.

The Solution:07_implant_tomlinson

A dental implant is an appliance used to replace the roots of teeth. The implant is surgically attached to the jaw bone and an artificial tooth is attached to the top of the implant, creating a natural looking, undetectable replacement for the missing tooth. In the event that more than one tooth is missing, several implants may provide a base for a series of artificial teeth known as a fixed bridge (see fixed bridges.) Implants can even be used to secure a full set of removable dentures for people who have no remaining natural teeth. This can greatly improve chewing ability and reduce the risk of choking.

It generally takes about six months for the surgical implant to heal before the final installation of the artificial tooth or teeth can be finished.

Advantages:

Dental implants with artificial teeth are the closest thing to regrowing your natural teeth. They are strong, stable, durable and virtually undetectable. By filling gaps left by missing teeth, implants can provide better chewing ability and head off jaw joint problems. They are far superior to removable dentures.

Disadvantages:

Dental implants are excellent, state-of-the-art restorations and have few disadvantages when compared to alternatives such as dentures. However, dental implants do require surgery and time to heal, and they are initially more expensive than dentures or fixed bridges. These disadvantages are offset by the ease of use, saved time and long term health benefits of implants.

Alternatives:

Dentures are a poor alternative to dental implants. However, in some cases, where finances are a primary concern, dentures are the only alternative.

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Root Canal Therapy

Protect and keep a sick or dying tooth.

The Problem:

  • Infected or sick tooth due to decay or injury.
  • Chronic tooth pain from contact with hot and cold liquids.
  • Pain from pressure or biting down.
  • Danger of infection spreading.

The Solution:08_pulpotomy_tomlinson

Inside each tooth is a pulp chamber that contains the nerves and blood supply for the tooth. When the pulp becomes infected due to decay or injury to the tooth, the pulp must be removed from the center of the tooth and the canals of each root. Once the infected pulp is removed, the remaining chamber is filled with a rubber-based material to seal it off.

All teeth that have had root canal therapy must be protected with a tooth-like artificial covering known as a crown (see crown section.) This is because teeth that have had the pulp removed are more susceptible to fracture.

Advantages:

Root canal therapy is an excellent way to save a tooth that would otherwise die and need to be removed.

Disadvantages:

If a tooth is sick, there are no disadvantages to root canal therapy. On rare occasions, however, root canal therapy may need to be redone to ensure that all of the infection has been removed.

Alternatives:

The only real alternative is to remove the sick tooth. However, this will require a dental implant or bridge to fill the empty space and prevent the shifting of surrounding teeth. These solutions will ultimately cost more than the root canal therapy, and they will never equal the quality of keeping your natural tooth.