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.
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, crowns are the only alternative.
Crowns
Protect and secure badly decayed or fractured teeth
The Problem:
- Badly decayed teeth
- Fracture/broken teeth
- Need to protect and strengthen teeth
The Solution:
A crown (sometimes called a cap) covers the tooth and restores its original shape, size and strength. Once the tooth is prepared for the crown an impression is taken and sent to the dental lab. The lab makes the crown out of porcelain, gold or a combination of the two materials and returns it to the office. Your temporary crown (worn while the lab makes the real crown) is removed and the final crown is cemented to your tooth.
Advantages:
Crowns are strong allowing them to protect and secure the remaining tooth structure. Crowns can be used to improve cosmetics and to straighten crooked teeth.
Disadvantages:
Healthy tooth must be reduced to fit a crown and the initial cost has to be considered.
Alternatives:
If you are saving the tooth the only alternatives would be to place a temporary crown knowing that a permanent crown will be done later when your circumstances allow for it. Another alternative to buy so time would be to do a crown build-up and follow up with the permanent crown within six months.
Fixed Bridges
A great way to replace missing teeth that is not removable
The Problem:
- A missing tooth or teeth
- Stabilize teeth from shifting into an empty space
- Desire to improve chewing ability
- A more permanent solution than removable partials
The Solution:
A bridge is simply crowns joined together to replace one or more teeth. It is generally anchored over the tooth on either side of a missing tooth. An artificial tooth, called a “pontic” replaces the the missing tooth. The bridge is cemented onto/over the anchor.
Advantages:
Fixed bridges are not removable and they look, feel and chew like real teeth. Bridges stabilize the bite and prevent teeth from shifting.
Disadvantages:
The two primary disadvantages are the adjacent teeth must be prepared to anchor the bridge and they cost more than removable options.
Alternatives:
Teeth can be replaced with dental implants or removable partials.
Root Canal Therapy
Protect and keep a sick or dying tooth
The Problem:
- Infected or sick tooth due to decay, injury and too much dental treatment
- Tooth pain from contact with hot and/or cold liquids and food
- Pain from pressure or biting down
- Spontaneous pain
- Danger of infection with swelling and drainage
The Solution:
Inside a tooth is a space that contains the nerve and blood supply for the tooth. When the pulp becomes infected due to decay or injury to the tooth, the pulp must be removed the tooth. The tooth canals are cleaned out and shaped like a funnel and then sealed or caulked from the root tip up.
Most teeth that have had root canal therapy need to be protected a crown (see crown section.) Root canal teeth are usually weaker because much of the tooth has been removed due to decay, existing filling material and the opening to do the root canal. A crown secures the tooth and prevents the tooth form cracking under biting pressure.
Advantages:
Root canal therapy saves teeth that would otherwise need to be removed. Done properly the success rate is about 96%.
Disadvantages:
Disadvantages: Root canal therapy adds cost and time to save your tooth.
Alternatives:
The only real alternative is to remove the tooth and then you may have to consider how to replace the missing tooth. Your ability to chew will suffer, your teeth may start to move and now you could be looking at a dental implant and crown or bridge to fill the space.