A wide range of materials are available, from the traditional to the latest resin materials (white fillings)
The recent developments in bonding techniques has made it possible to restore the tooth structures. This has made us more daring in making larger repairs to the teeth that have been undermined due to fractures or caries. The further back in the mouth, the bigger risk of failure of these fillings as the bite force is increasing. Therefore cast restorations might be a better choice in repairing severely damaged molars. Here are some example of repairs to large decays where a crown treatment was not a choice either due to cost or poor prognosis of the tooth.
It is also a fantastic tool to restore the lost tooth substance due to grinding and Para functional habits. This is unfortunately quite common. It is a graduate loss of tooth and often a-symtomatic until it is too late! If it is not treated in good time, it will result in multiple fractures and severe alteration in natural dentition. Here you can see severe wear to the palatal aspect of all upper front teeth. This could have caused multiple fracture of front teeth if not caught on time. All restored with composit(white fillings)bonded to tooth.
Crown and Bridgework
Crowns are used to restore teeth and provide long-term reliable restorations. They can be used to enhance the appearance and strengthen heavily restored teeth. Joined together they may be used to form bridges.
Of course we always try to avoid crowning the teeth. During the procedure of covering a tooth with a complete cast restoration of any kind, the tooth will be drilled to smaller size to create space all round the tooth, an impression is made and sent to the Dental Technician. A cast restoration(e.g full gold crown, various metal crowns or a bonded crown which is porcelain bonded to a inner gold coping) or alternatively a Cad/Cam (computerAidedDesign/ComputerAidedManufacture) is produced by the lab to the full contour, shade and then cemented in place.
Advantages of providing the tooth with a crown, is to shape the heavily undermined tooth to natural, functional, esthetical product which can sometimes be impossible otherwise.. Also posterior teeth following root canal treatment are advised to be crowned or onlayed to cover the cusps to avoid vertical split through the root (6 times higher risk for vertical fracture than a non-root treated tooth). Root filled teeth are much more fragile than teeth with natural blood supply.
Disadvantages are the increased cost, time in the chair and also possible irritation to the pulp due to drilling. The nerve(pulp) can die in a small percentage of teeth following a crown preparation(this is not entirely due to drilling but the fact that these teeth have already been through a tough time prior to crown preparation).
Here is one of those occasion(from left to right) where a rootfilled tooth has had a vertical fracture due to lack of cuspal coverage but luckily could be restored with a crown retained by a cast gold post, only using the palatal root after other roots were lost due to fracture.
Fixed braces and removable appliances can be used to straighten teeth. Cosmetic braces are also available. In some cases expansion plates are used for children as a prevention of overcrowding in adulthood.
Prevention of Gum Disease
Gum disease is the most common cause of tooth loss in adults. It can be prevented and successfully treated if caught in early stages. By working closely with you, your dentist can show you ways to prevent the progress of this disease and provide you with treatment that is best suited to your particular needs. The old age saying of prevention is better than cure is most certainly correct in this instance.
Restoring the missing teeth with placing implants, has been around since late 60;s. It was introduced first by Professor Branemark (Swedish orthopaedic surgeon) and has not stopped evolving since then. It has created a revolution in the way we are thinking and fundamental base of restorative dentistry. Basically, the implants act as manmade tooth roots providing the supports in a similar fashion to the teeth supporting or retaining conventional crowns or bridges. The main advantage is replacement of teeth with a fixed and strong solution, which can withstand the forces of mastication equal with natural tooth. All this is done without involving adjacent teeth hence no biologic cost as such. Disadvantages are length of treatment (can take months from beginning to end), need for surgery and cost. Implants can be immediately placed at the time of extraction of he tooth but it is imperative not to have residual infection in the area, basically the tooth to be extracted should not have acute infection. That still does not mean that a tooth can be connected to it! In order to immediately load(connecting a crown on the implant) the implant, the fixture (the titanium screw) should have certain stability (good bone quality). If the initial stability is poor at the time of surgery, the placement of the tooth has to be delayed for at least 12 weeks! The cost of implant treatment remains quite high, due to high component fee, materials and dental technician fee in comparison with other dental treatment. Also the need for higher qualification/training for operators (dentists). Here is an example of this;
Absence of the maxillary lateral incisor(%2 in population) creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and a consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and to the teeth, including the presenting malocclusion and the effect on the occlusion, are considered. This review considers the possible options: no treatment; orthodontic space closure with canine modification; space maintenance and replacement of the missing tooth with denture, bridge (adhesive and conventional), or implant.
Implant restorations have become a primary treatment option for the replacement of congenitally missing lateral incisors.
In this case, both maxillary laterals were missing. After initial consultation, we agreed with patient to replace the missing laterals with implant retained single crowns.
After careful radiological examination, and clinical measurements, the right size of implants were decided. The implants were placed in the gap during a short surgical session, and covered.
Finally the crowns were constructed following impressions, and fitted in place. These porcelain crowns are best to be protected against natural tooth clenching with a bite guard.