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-symptomatic 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 composite (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 need to 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, aesthetical 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.
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