RESTORATIVE
DENTISTRY
Fillings
Dental amalgam is the traditional silver-colored filling we are all familiar with. Although there is mercury in dental amalgam, once it is combined with the other materials in the amalgam filling its chemical nature is changed rendering it harmless. Research into the safety of dental amalgam has been carried out for over a century and to date, no trustworthy controlled studies have found a connection between amalgam fillings and any medical problem. While composite (tooth colored) fillings are becoming more popular, amalgam fillings represent the most durable and long-lasting form of filling available (apart from gold fillings which are more expensive).
Today, because we are much more conscious of our smile, we can choose a natural looking alternative - the composite or tooth-colored filling. A composite resin is a tooth-colored plastic mixture filled with glass (silicon dioxide) first introduced in the 1960s. Originally only used for front teeth because of their softer nature, modern improvements to their composition make them generically suitable today.
The main advantage of composite fillings is there aesthetic appeal. The main disadvantage is their life expectancy. White fillings have always been considered less long lasting than silver amalgam fillings but there are now new materials available with properties comparable to silver amalgam, and these are proving to be very successful. The life expectancy of your composite filling can depend on the depth of cavity and its position in the mouth and your dentist is best positioned to advise you on the appropriate material to use in each circumstance.
Root Canal
Root canal treatment (also called endodontics) is needed when the blood or nerve supply of the tooth (known as the pulp) is infected through decay or injury. If the pulp becomes infected, the infection may spread through the root canal system of the tooth. This may eventually lead to an abscess. If root canal treatment (RCT) is not carried out, the infection will spread and the tooth may need to be taken out. The aim of the treatment is to remove all infection from the root canal. The root is then cleaned and filled to prevent any further infection.
Root canal treatment is a skilled and time-consuming procedure. Most courses of treatment can be completed in one visit, but sometimes in more difficult cases will involve two or more visits.
By procedure, the infected pulp is removed. Any abscesses which may be present, can also be drained at this time. The root canal is then cleaned and shaped and filled with an inert material called Gutta Percha that seals off the canals and prevents further infections. The alternative to Root Canal treatment is to have the tooth out. Once the pulp is destroyed, it can’t heal and it is not recommended to leave an infected tooth in the mouth. Although some people would prefer an extraction, it is usually best to keep as many natural teeth as possible. Afterwards, a crown is necessary on a root canal tooth to prevent breakage of the tooth, and premature loss.
Crowns and Bridges
A crown is an artificial restoration that fits over the remaining part of a prepared tooth, making it strong and giving it the shape of a natural tooth. A crown is sometimes known as a ‘cap’. Crowns are an ideal restoration for teeth that have been broken, or have been weakened by decay or a very large filling. A crown could be used for a number of other reasons, for instance:
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you may have discolored fillings and would like to improve the appearance of the tooth
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you may have had a root filling (root canal) which will need a crown to protect it
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it may help hold a bridge or denture firmly in place
Crowns can be made of a variety of different materials and new materials are continually being introduced. Some of the most popular options are:
Porcelain bonded to precious metal: this is what most crowns are made from. A precious metal base is made and then porcelain is applied in layers over it.
Porcelain crowns: these crowns are made entirely out of porcelain and are not as strong as bonded crowns, but they can look very natural and are most often used for front teeth.
All-ceramic crowns: this modern technique offers a metal-free alternative, which can give the strength of a bonded crown and the appearance of a porcelain crown. Therefore it is suitable for use in all areas of the mouth.
The dentist will prepare the tooth to the ideal shape for the crown. This will involve removing most of the outer surface, and leaving a strong inner core. The amount of the tooth removed will be the same as the thickness of the crown.
Once the tooth is shaped, the dentist will take an impression (mould) of the prepared tooth, one of the opposite jaw and possibly another to mark the way you bite together. The impressions will then be given to the dental technician, along with an appropriate shade and other information needed for the crown to be made. In a few weeks, the crown will come back from the lab and will be inserted. When the dentist is happy with the fit and appearance of the new crown it will be fixed in place with special dental cement or adhesive. The cement forms a seal to hold the crown in place.
A bridge is a restoration designed to replace missing teeth. It is made by putting crowns on the teeth at either side of the space, and then joining these two crowns together by placing a false tooth in the space. This is all made in the laboratory and then the pieces are cemented into place with special adhesives. The bridge can’t be removed. Bridges are usually made of a precious metal. If the bridge will show, porcelain is then bonded to the base. Sometimes, there are other non-precious metals used in the base for strength. Although a bridge may seem expensive it will last many years. It will also improve your appearance and bite. A bridge uses the considerable skill of the dentist and technician, and in this way, it’s similar to ordering a piece of hand-made jewelry. The materials are also expensive so it’s fair to say a bridge will not be the cheapest treatment you have ever had.
Dentures
A denture is an appliance which is worn to replace lost or missing teeth to enable you to enjoy a healthy diet and smile with confidence. A complete or full denture is one which replaces all of the natural teeth in either the upper or lower jaws. A partial denture fills in the spaces created by lost or missing teeth and is attached to your natural teeth with metal clasps or devices called precision attachments. The base of a denture is called a plate and can be made of either acrylic (plastic) or metal. The teeth are normally made of acrylic and can be made to match your natural teeth. This is especially important in the case of partial dentures. Dentures can be made to closely resemble your natural teeth so that little change in appearance will be noticeable. Modern dentures may even improve the look of your smile and help fill out the appearance of your face.
Even with full dentures, you still need to take good care of your mouth. Every morning and evening, brush your gums, tongue and palate (roof of your mouth) with a soft–bristled brush. This removes plaque and stimulates circulation in the mouth. It is vitally important that partial denture wearers brush their teeth thoroughly every day to prevent tooth decay and gum disease that can lead to further teeth being lost. Dentures are very delicate and may break if dropped. When cleaning dentures it is recommended that you do so over a folded towel or sink of water. When you are not wearing your dentures, they should be stored in a container containing enough water to cover them.
Like natural teeth, dentures must be brushed daily to remove food debris and plaque. Brushing helps prevent dentures becoming stained and helps your mouth stay healthy. There are special denture cleaning brushes available but a soft bristled toothbrush can also be used. Avoid using hard-bristled brushes which can cause damage. The use of an effervescent denture cleaner will help remove stubborn stains and leave your denture feeling fresher. Over a period of time, dentures will need to be relined or re-made due to normal wear or a change in the shape of your mouth. Bone and gum ridges can recede or shrink causing jaws to align differently. Loose dentures can cause health problems, including sores and infections not to mention discomfort. A loose or ill-fitting denture can also make eating and speaking more difficult. It is important to replace worn or poorly fitting dentures before they cause problems.