Restorative dentistry is the art and science of restoring teeth that were affected by decay, fracture, cracks and other ailments that cause part of the tooth to be lost or missing. The advancements in bonding techniques and esthetic considerations have evolved greatly over the past decade, making even simple fillings made to restore simple cavities a form of art that needs meticulous care and precision to reproduce the shape, size, form and color of the restored tooth.
Branches of restorative dentistry are numerous. We are proud to present the following forms of treatment at Top Dental New York:
1. Dental Fillings
The most modern form of fillings is composite fillings (also known as tooth colored fillings). In the old days, these were only used strictly for front teeth where looks and esthetics are all that matters, and other forms of fillings such as amalgam were used on the back teeth. Nowadays, with the advancement in the quality and strength of the material, it has become the gold standard when filling a cavity, used on both front and back teeth.
Uses of Dental fillings:
- Cavities: cavities formed by decay are replaced with composite fillings to replicate the original shape and color of the tooth.
- Chipped Teeth: Composite fillings can be used to replace chipped parts of the teeth due to trauma or biting on hard objects
- Esthetic Corrections: They can also be used as masking agents to treat minor problems on the cosmetic front, such as white spots or small brown discolorations that could not be treated with other means.
- Composite Veneers: Another use for composite fillings is to cover the entire outer surface of the tooth with a thin shell of the filling, making them white and your smile beautiful.
The procedure goes as follows:
- After numbing the tooth, the dentist would use the drill to clean all the decay from the tooth, and shape the cavity to be able to receive the filling.
- The dentist would then treat the tooth with an acidic gel, and apply a thin clear layer of bonding agent that is responsible for attaching the filling to the tooth.
- The composite filling is then applied in layers, and each layer is subjected to a blue light-emitting device that hardens the material.
- The final layer is carved to the shape and form of the original tooth, and often stains are applied to mimic the color and shade.
- In some cases, the filling could not be completed in one visit (such as when the decay is very close to the tooth nerve). In which case, the dentist would put an isolating material on the endangered areas and cover the cavity with a temporary filling until the next visit.
2. Root Canal Treatment
One of the most common dental procedures is root canal. This happens when the decay has grown so severe that it reaches the nerve (or pulp) of the tooth, causing its inflammation resulting in unbearable pain.
This procedure is quite different than regular fillings and goes as follows:
- After numbing the tooth with anesthesia, the dentist would remove all the decay and the roof of the pulp chamber (this is called gaining access).
- She would then use a specialized set of instruments (called dental files) to thoroughly clean the root canals from the inflamed remnants of the pulp. She would often use lubricants and an irrigation system to ensure complete disinfection of the infected canals.
- The clean canals would then be dried and filled with specialized filling that prevents leakage and bacteria ingression, and the access cavity (that is the opening in the tooth) is then filled with normal composite filling.
- After about a week, your dentist would fit you for a dental crown to protect the tooth from further harm and fracture.
After the procedure is done, expect some dull pain especially on biting and chewing for a few days. This is completely normal due to the cleaning and filling process.
3. Posts and Cores
This type of restoration is needed when the tooth is so destructed by the decay process, that even after the root canal procedure is done, there is no sufficient remaining tooth structure to place a filling or hold a crown in place. Therefore, in addition to the normal filling, a post would be placed inside the root canal to gain additional strength and anchorage for the filling, and also to distribute the biting forces more evenly to prevent the tooth and filling from future fractures. This post is like a small screw, that is inserted into the root canal after removal of a small part of the root canal filling, and shaped to be quite like the canal, being thin and slender, and equipped with means of retentions such as dents and spirals to aid the cement in holding it in place. Posts can be made from metal, but newer ones are made from glass reinforced fiber, that has better strength qualities and better adhesion to tooth structure.
The procedure goes as follows:
- After the root canal procedure is finished, the dentist would use a specialized drill to remove part of the root canal filling, in the same length and width of the post to be placed.
- The post is tried inside the cavity to check for fitness, and xrays could be used to verify proper shape and length.
- Dental cement is mixed and applied inside the canal, and the post is inserted after the cement which is then left to dry.
- A normal composite filling is then placed to replace the missing part of the tooth.
- The tooth is then fitted for a dental crown.
4. Dental Crowns
Dental Crowns are covers or caps that are placed on the tooth to protect it from harm. The most common need for a dental crown is tooth protection after root canal treatment (where the teeth become week and brittle). Other indications for crowns include heavily restored teeth (even if root canal was not done) where the remaining tooth structure is insufficient to hold a normal filling in place, and teeth that have cracks in them.
The crown and bridge industry is also one of the fastest growing and advancing branches of modern dentistry. Crowns can be made of:
- Metal: Older crowns were made of metal that is covered by a thin layer of porcelain for esthetic purposes.
- Porcelain: Newer crowns have no metal in them, and are made entirely of Porcelain (also known as E-Max porcelain) that has sufficient strength to withstand biting forces in addition to being far superior esthetically.
- Zirconium: This material has the strength of metal in addition to being white in color, so combines both qualities of strength and esthetics.
The procedure for fitting dental crowns goes as follows:
- The dentist would first start with a few xrays, and a mold (called and impression) is taken before starting the process.
- After numbing the tooth, the dentist would file off a small part of the tooth (about 1 – 2 mm) so that the crown to be made is not too large and bulky.
- After the preparation is done, another impression is taken and sent to the lab, which uses that impression to fabricate the crown needed to specifications, according to the material of your choosing. This typically takes a few days so in between visits, your dentist would place a temporary crown made of plastic to protect the tooth from sensitivity.
- The lab would then return the finished crown to the dentist, who would then cement it on the prepared tooth using specialized dental cements.
A little discomfort and weird feeling is to be expected until your mouth gets accustomed to the presence of the newly formed crown.