Restorative
It encompasses “restoring” everything from the tiniest of new cavities to a full-coverage crown to save a tooth that has been seriously structurally compromised.
It also includes replacing teeth that are lost or replacing part of a broken tooth.
Technology continues to provide new materials and techniques for restoring teeth. Dr. Johnson emphasizes techniques that provide for the most conservative way of making a tooth look and
feel like the original.
Below is a review of the techniques and materials used
to offer optimal restorative dental care:
Restorative dentistry is tooth-centered treatment.
Restoring Permanent Teeth with major structural loss:
With greater structural loss, the emphasis becomes one of the
restoration containing the tooth instead of the tooth containing the restoration. Despite significant structural loss in these cases, the same
rules of conservatism apply to preserve as much tooth structure as possible. With these restorations we have more options as to materials.
Gold is still around although is being used less and less. Porcelain, Composite, and Zirconia based restorations make up the bulk of what is done. Considerations are made for what opposes the restoration as well as how much tooth structure remains to attach to.
Restoring baby teeth with decay:
Combining new materials that self-adhere to the tooth, ozone to sterilize the cavity after removing decay, and a gentle, minimally invasive approach, most cavities can be restored without any anesthesia (no shots). By using ozone to sterilize them, some cavities don’t need to be “restored” at all, which results in less overall cost. The material we use is kind to tooth structure and contains no BPA.
Restoring Permanent Teeth with minimal decay or structural loss:
Combining ultra-conservative techniques, air abrasion, ozone, and biomimetic materials allows us to restore decay and defects in teeth so conservatively that rarely do we need to put the tooth to sleep.
Restoring Permanent Teeth that have had root canal therapy:
No one seems to agree on this one as the long held belief that a tooth that has a root canal filling is more brittle than a “live” tooth. Despite lack of agreement, we focus on enhancing the structural strength of the tooth utilizing the latest in internal reinforcement and bonding components together.
Removable denture with the missing teeth
on it.Fixed “Bridge” that attaches to teeth adjacent to the missing tooth space.
Dental Implant that replaces the root structure within the jaw bone itself.
Replacing missing teeth-
the options:
Restorative
Restorative dentistry refers to the area of dental treatment that deals with damaged, decayed, abnormal, or missing teeth. Though this includes periodontics, prosthodontics and implants, these are discussed separately (below). Fillings and crowns are the most predominant restorative procedures.
Fillings
Dr. Johnson provides composite fillings, also commonly referred to as "tooth colored" or "invisible" fillings. Though clearly appearing on x-rays, when looking at the tooth, the filling is indistinguishable from the tooth (see image). Aside from esthetic reasoning for using composite material instead of amalgam ("silver") fillings, composite mimics natural tooth structure better than any other filling material. Placing composite fillings requires less natural tooth structure be removed and avoids the "graying" effect that silver fillings can create.
Cracked Amalgam Filling
Restored with Composite
Crowns
The tooth needs a restoration that will satisfy the need to make it whole again. Because of the extent of damage to the tooth, it needs a "Crown". This restoration is designed to return the tooth to its original size, shape, bite, and strength. Due to technological advances, there are a variety of types of "Crowns". The following list is in order of the most desirable (also more expensive) to the least desirable (also less expensive).
1. Fiber Reinforced Resin Crowns (Sculpture):
Combining new materials that self-adhere to the tooth, ozone to sterilize the cavity after removing decay, and a gentle, minimally invasive approach, most cavities can be restored without any anesthesia (no shots). By using ozone to sterilize them, some cavities don’t need to be “restored” at all, which results in less overall cost. The material we use is kind to tooth structure and contains no BPA.
2. All Ceramic Crowns (OPC):
These are similar to the Resin Crowns except not as strong and require more tooth removal.
Their superior esthetics makes them the choice for "capping" or "veneering" front teeth.
3. Porcelain fused to Metal Crowns (PFM):
These have been the standard tooth colored crown for more than 25 years. They are strong and durable, but esthetics is average at best due to the metal underneath the porcelain. These tend to leave a dark line at the gumline unless the edge is buried deep under the gum. The gums prefer tooth structure instead of crown edges, so when possible, they are avoided. The combined thickness of the metal and porcelain make this the most destructive restoration in terms of tooth structure removal, but they are a necessity when the crown must extend under the gumline.
4. All Gold Crowns:
These have been the standard for more than fifty years where appearance is not an issue. They are strong, durable, relatively conservative, but not very esthetic in today's world. If looks aren't an issue, probably the best value in restorative dentistry.
Bonded ceramic or resin inlays and onlays:
Both functional and esthetic alternatives to metallic restorations.
Because they bond to the tooth, they strengthen weakened teeth and reduce the potential for fractures that lead to the necessity to have a crown placed. This could reduce long term dental costs. In addition, because these restorations bond to the tooth, they usually require significantly less tooth destruction than conventional non-bonded restorations. Thus they are more conservative. This results in a less invasive procedure and a reduced potential for tissue irritation caused by crown margins placed below the tissues. Thus these restorations are not only highly esthetic, but beneficial to your long term oral health.
Where applicable (based on degree of decay and amount of remaining tooth structure),
there is also another option called
"bonded inlay" or "bonded onlay".
Prosthodontics & Implants
Both address the issue of missing teeth but in very different ways:
Prothodontics deals with replacing missing (either lost or congenitally) teeth through the use of bridges and partial or full dentures. Bridges adjoin to adjacent teeth to replace one or a couple missing teeth. A partial denture is used when several teeth are missing and a full denture when all teeth are missing. With any of these, the crown portion of a tooth is artificially recreated to fill the gap of missing teeth
Implants are surgically placed into the bone to recreate the root of a missing tooth. This is the preferred method for replacing a missing tooth. An implant abutment extends into the oral cavity and provides retention for the crown (or denture) to be placed. The implant is provided seperately by an oral surgeon who works in conjunction with the dentist.
