Lepow Dental Associates
Our Dental Services: Family 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.
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.
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.
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.
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 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 to add a partial or implant.
Veneers
Completely reshape your teeth for a beautiful, white smile.
The Problem:
- Stained or discolored teeth
- Unsightly gaps between front teeth
- Chipped teeth
- Rough or jagged edges on front teeth
- Teeth that are too small or large in proportion to rest of the mouth
- Crooked teeth
- Worn teeth
The Solution:
A porcelain laminate (often called a veneer) is a thin shell of porcelain that covers the front of each tooth. They bond directly to the front of the tooth, similar to the way artificial fingernails work. Each porcelain laminate is a work of art, carefully crafted in a laboratory to fit your individual smile.
Advantages:
In the hands of a highly skilled dentist, porcelain laminates can provide you with an incredibly natural, beautiful smile. They are virtually undetectable and can dramatically improve your appearance. They are durable and long-lasting when compared to other cosmetic treatments.
Disadvantages:
Although they are highly durable, porcelain laminates are not permanent. Well crafted laminates will last many years, but will eventually need to be replaced.
Alternatives:
Porcelain laminates are an excellent investment. However, they are not appropriate for teeth with excessive decay. In those cases, porcelain crowns are the only alternative. In the event that you desire only to improve tooth alignment, orthodontic treatment may be another alternative.