A tooth restoration is any artificial substance or structure that replaces missing teeth or part of a tooth in order to protect the mouth's ability to eat, chew and speak. Restorations include fillings, inlays, crowns, bridges, partial and complete dentures and dental implants.
Restorations have somewhat different purposes depending on their extensiveness. Fillings, inlays and crowns are intended to repair damage to individual teeth. They replace tooth structure lost by decay or injury, protect the part of the tooth that remains and restore the tooth's shape and function. Bridges, dentures and implants are intended to protect the shape and function of the mouth as a whole.
Fillings are restorations that repair damage caused by tooth decay (dental caries). Tooth decay occurs when microorganisms (bacteria) in the mouth convert sugar from food to acid, which attacks the tooth. The acid forms cavities that start in the hard outer layer of the tooth (enamel) and may extend inward to the dentin and eventually to the inner most layer the pulp chamber, which contains the nerves and blood vessels. Left untreated, tooth decay may lead to inflammation and infection that may cause toothache and perhaps more serious complications.
To stop the decay process, the dentist removes the decayed portion of the tooth using a high-speed drill or an air abrasion system, shapes the cavity walls, and replaces the tooth structure with a filling of composite resin (tooth colored), silver amalgam or gold.
Fillings work well to restore the tooth when only a small to moderate amount of the tooth structure has been lost. However, when a tooth has suffered more extensive damage, there may not be enough tooth structure left to hold a filling in place without the risk of breaking the tooth.
When a tooth needs more than a filling but less than a crown, we may recommend an inlay or onlay. With today’s advancements with Cerec CAD/CAM technology these custom made restorations can be fabricated and placed in one appointment. When a stronger more durable material is needed, an inlay may be used to fill in the grooves between the cusps of the biting surface of the tooth. An onlay is more like a crown because it covers both the grooves and one or more cusps. It is usually recommended when much of the tooth structure is still healthy and strong but one or more cusps need to be replaced.
The crown of a tooth is the portion that is covered by enamel. A restorative crown replaces this outer part to protect the tooth. The protection becomes necessary when a tooth cracks or has its entire structure weakened by decay. As with a filling, inlay, or onlay, the dentist first removes the decayed portion of the tooth. The tooth is then prepared for a crown. It may be tapered on the outside edges to a peg, reinforced with a core buildup and /or post and core. The traditional method of creating a crown uses a wax impression of the prepared tooth and the teeth next to it. The new crown is made to fit this mold. The crown may be made of gold or stainless steel alone, metal with a veneer of tooth-colored porcelain or resin, or porcelain or resin alone. The finished crown is then placed over the prepared tooth, adjusted and cemented into place. The new CEREC CAD/CAM technology allows us to take a digital intraoral image of the prepared tooth, design and mill a porcelain crown in one visit. This reduces your time in the dental office and the need to wear the temporary crown while your permanent crown is being fabricated.
Bridges are a type of restoration that are done when one or more permanent teeth are missing or extracted. The resulting gap must be filled in to prevent the remaining teeth from shifting. If the other teeth shift, they will affect the patient’s bite (occlusion), which sometimes produces pain in the jaw joint. As the teeth move and become crooked, they also become more difficult to keep clean. The risk of tooth decay and gum disease increases, increasing the likelihood that additional teeth will be lost. A bridge is inserted to stabilize the bite. Bridges are non-removable appliances of one or more artificial teeth (pontics) anchored by crowns on the adjacent teeth (abutment teeth). The abutment teeth carry the pressure when the patient chews food.
Dental implants are the closest restoration that can be provided to replace a missing tooth to function and feel like a natural tooth. Dental implants are a means of securing crowns, bridges and denture in the mouth. A hard metal anchor (usually titanium) is surgically placed into the jawbone. In approximately 4 months, the patients bone grows around the implant, firmly anchoring it in place. Then the exposed end of the implant is covered with a crown or it may serve as a stable abutment for a bridge or denture.
A partial denture is similar to a bridge in that it fills a gap left by missing teeth with artificial teeth on a metal frame. However, a partial denture is a removable appliance. It attaches to a crown on the abutment tooth with a metal clasp or precision attachment. A partial denture is primarily used at the end of a row of natural teeth, where there is only one abutment tooth, or when there are multiple teeth to be replaced in the same arch. This abutment and the soft tissues of the gum ridge beneath the appliance share the pressure exerted by chewing.
Complete Dentures may be worn when all of the top or bottom teeth have been lost. A complete denture consists of artificial teeth mounted in a plastic base molded to fit the remaining oral anatomy. It may or may not be held in place with a denture adhesive.
DELAYING RESTORATIVE TREATMENT
Tooth decay NEVER goes away on its own. Decay that is present in the enamel (hard outer surface) of the tooth generally grows slowly. However, if the decay reaches the dentin (soft inner layer) it grows more rapidly, allowing bacteria to infect the pulp chamber (location of nerves and blood vessels) of the tooth. When this happens, most patients will experience pain in varying degrees from mild to severe. You will need a root canal treatment to save the tooth, followed by a core buildup and crown placement. This is why we recommend treating the tooth as soon as possible. Not only does delaying treatment add costs to restoring the tooth, it causes additional trauma to the tooth
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