Dr. Brian Cox Dentistry

Restorative Dentistry

Research has shown that almost everybody has a 95% chance of experiencing some tooth decay. When tooth decay does occur, it is highly important to remove the decay, clean the tooth and repair the tooth with some type of restoration. In addition, lost or missing teeth need to be replaced to protect your overall oral health.

In this section, we will look at the various restorations we can use to protect and restore decayed or missing teeth.

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:

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.

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 might otherwise 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.

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:

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.

Crowns

Protect and keep badly decayed or fractured teeth.

The Problem:

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

The Solution:

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.

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:

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.