Several factors influence the performance, durability, longevity and expense of dental restorations:
- The components used in the filling material.
- The amount of tooth structure remaining.
- Where and how the filling is placed.
- The length and number of visits needed to prepare and adjust the restored tooth.
- The chewing load that the tooth will have to bear.
The ultimate decision about what to use is best determined in consultation with your doctor. Before your treatment begins, discuss the options with your doctor. To help you prepare for this discussion it is helpful to understand the two basic types of dental fillings: direct and indirect.
- Traditional dental restoratives (fillings) include gold, porcelain, and composite/amalgam. The strength and durability of traditional dental materials continue to make them useful for situations where restored teeth must withstand extreme forces that result from chewing, such as in the back of the mouth.
- Newer dental fillings include ceramic and plastic compounds that mimic the appearance of natural teeth. These compounds, often called composite resins, are usually used on the front teeth where a natural appearance is important. They can be used on the back teeth as well depending on the location and extent of the tooth decay. Composite resins are usually more costly than the older silver amalgam fillings.
- Direct Fillings are fillings placed immediately into a prepared cavity in a single visit. They include dental amalgam, glass ionomers, resin ionomers, and composite (resin) fillings. The dentist prepares the tooth, places the filling, and adjusts it during one appointment.
- Indirect Fillings generally require two or more visits. They include inlays, onlays, veneers, crowns, and bridges fabricated with gold, base metal alloys, ceramics, or composites. During the first visit, the dentist prepares the tooth and makes an impression of the area to be restored. The dentist then places a temporary covering over the prepared tooth. The impression is sent to a dental laboratory which creates the dental restoration. At the next appointment, the dentist cements the restoration into the prepared cavity and adjusts it as needed.
A sealant is essentially the simplest form of a filling. It is a plastic material applied to the chewing surfaces of the back teeth (premolars & molars). The sealant resin bonds into the depression and grooves (pits and fissures) on the chewing surfaces of back teeth. The sealant acts as a barrier protecting enamel from plaque and acids.
Sealants work well for all ages – but because the likelihood of developing pit and fissure decay begins early in life, children and teenagers are obvious candidates. However, many adults can benefit from sealants as well.
Sealants are relatively easy to apply. First, the tooth grooves of the teeth are opened with a bur ensuring all food or decay are removed from the tooth’s small crevices. The tooth is then cleaned, primed, bonded and the sealant is ‘painted’ onto the tooth enamel, where it bonds directly to the tooth and is cured with a special light.
Any tooth surface containing sealant will be protected from decay for as long as the sealant remains intact. Sealants hold up well under the force of normal chewing and usually last several years before reapplication is needed. We check the condition of sealants, reapplying them when necessary as part of the regular check-up and oral exam in all patients who have teeth containing sealants.
Crowns are a cosmetic restoration used to improve your tooth's shape or to strengthen a tooth. Crowns are most often used for teeth that are broken, worn, or have portions destroyed by tooth decay.
Crowns are "caps" cemented onto an existing tooth which fully cover the portion of your tooth above the gum line. In effect, the crown becomes your tooth's new outer surface. Crowns can be made of porcelain, metal, or both. Porcelain crowns are most often preferred because they mimic the translucency of natural teeth and are very strong.
Crowns are often preferable to silver amalgam fillings. Unlike fillings which apply metal directly into your mouth , a crown is fabricated away from your mouth . Your crown is created in a lab from your unique tooth impression which allows a dental laboratory technician to examine all aspects of your bite and jaw movements. Your crown is then sculpted just for you so that your bite and jaw movements function normally once the crown is placed.
There's no reason to put up with gaps in your teeth or with teeth that are stained, discolored, badly shaped, chipped, or crooked. Today, a veneer placed on top of your teeth can correct nature's mistake or the results of an injury and help you have a beautiful smile. Veneers are a highly popular solution among dental patients because of their lifelike tooth appearance.
Veneers are thin, custom-made shells crafted of tooth-colored materials (such as porcelain) designed to cover the front side of your teeth. To prepare for veneers, your doctor will create a unique model of your teeth. This model is sent to the dental technician to create your veneers. Before placing your new veneer, your doctor will remove a small amount of your tooth to make room for the veneer.
When placed, you'll be pleased to see that veneers look like your natural teeth and even resist staining. Though veneers are stain resistant, your doctor may recommend that you avoid coffee, tea, red wine, and tobacco to maintain the beauty of your veneer.
If you're missing one or more teeth, you may notice a difference in chewing and speaking. In these cases, a bridge may be used to replace missing teeth, help maintain the shape of your face, and alleviate the stress in your bite.
A fixed bridge replaces missing teeth with artificial teeth, looks great, and literally bridges the gap where one or more teeth may have been. The restoration can be made from gold, alloys, porcelain or a combination of these materials and is bonded onto surrounding teeth for support. Neighboring teeth on each side of the space are prepared for crowns and attached between the two is an artificial tooth called a pontic.
Similar to crowns, bridges require multiple office visits to ensure proper fit.
An alternative to the traditional fixed bridge is a dental implant. An implant attaches artificial teeth directly to the jaw under the gum tissue. A small titanium fixture is used to surgically place the implant in the upper or lower jawbone to replace the root of your missing tooth and provide an anchor for a crown.
One of the biggest advantages of an implant over a bridge is that, like a crown, an implant does not require treatment of the neighboring teeth. It is a free-standing restoration similar to the missing natural tooth.
Although we work toward making it a rare occurrence, there are times when it is necessary to remove a tooth. Sometimes a tooth has so much decay or bone loss that it puts the surrounding teeth and jaw at risk of decay and periodontal disease. If this occurs, we may recommend removal and replacement with a bridge or implant. Infection, orthodontic correction, or problems with a wisdom tooth may also require removal of a tooth.
When it is determined that a tooth needs to be removed, we will discuss whether it should be treated in our office or best treated by one of our specialists. When a determination for extraction has been made, it is important to share any concerns or preferences for anesthesia and sedation that you may have.
Before You Bleach
While many people are satisfied with the sparkle they get from brushing twice daily with a fluoride toothpaste, cleaning between their teeth once a day and the regular cleanings at the dentist’s office – many people want an even brighter, whiter smile. With advances in cosmetic dentistry, there are now a wide variety of products and procedures available to help you improve the look of yours.
First, Talk to the Dentist
If you decide you would like to make your smile brighter, we always recommend discussing it with the dentist before beginning treatment.
Through the consultation we can determine if you might have clinical implications that may have an effect on the bleaching process. Conditions such as leaky filings, chips, exposed roots, and porcelain work (i.e. crowns for veneers, etc.) all may influence the bleaching process.
It is also important to note that whiteners may not correct all types of discoloration. For example, yellowish hued teeth will probably bleach well, brownish-colored teeth may not bleach as well, and grayish-hued teeth may not bleach well at all.
Teeth and gums can become sensitive during the period when you are using any bleaching solution. In most cases, this sensitivity is temporary and should lessen once the treatment is finished. However, whitening processes that contain higher concentrations of the bleaching agent may not be recommended for patients with previous sensitivity.
Once we determine you to be a good candidate for bleaching, we will help you decide which of the available bleaching options is right for you.
Explore the Options
All tooth whitening options contain the same active ingredient -- typically carbamide peroxide as the tooth bleaching agent. The difference between options is in the concentration of the beaching solution, the amount of time and energy involved for the patient, and cost.
Treatment time does directly relate to how long the whitening lasts. Generally, treatments which take a little longer usually last a little longer. Conversely, faster treatments may need to be repeated more often.
All of these whitening options will get your teeth brighter:
- Over-the-Counter Bleaching Products
- Crest Strips Supreme
- Custom-Fit Bleaching Trays
Most over the counter bleaching products are safe and effective if used according to the product instructions. However, due to the rapid growth of this market, we are wary of lesser know bleaching products that might be available in stores or online and which may do harm. As a result, we recommend patients
only use products with the ADA seal of approval
Over-the-counter products good in that they are accessible, relatively inexpensive, safe if approved by the ADA. The disadvantages are longer treatment times and lack of uniformity in bleaching. To achieve quicker results, you may opt for a solution available through our practice.
Take Home Products:
Crest White-Strips Supreme are similar to those sold in drug stores but contain a significantly higher concentration of bleaching agent allowing you to achieve quicker results. Crest Strips purchased from our office are the same cost (per strip) as over-the-counter Crest Strips. Each kit contains 84 strips (compared to 56 strips in retail kits). Crest recommends two, 30-minute applications for three weeks to achieve optimal results.
The advantages to using Crest White-Strips Supreme are that they require no time in the dental chair and they achieve desired results more quickly than store-brand Crest kits. However, since all beaching strips are a ‘one size fits all,’ whitening solution may not hold securely in place, or the strips may not fit crowded or severely misaligned teeth. In addition, like the over-the-counter strips, Crest White-Strips Supreme, may not bleaching uniformly. Finally, some patients also find bleaching strips uncomfortable. In these cases, or if quicker results are desired, we can create a Custom-Fit Bleaching Tray.
Custom-Fit bleaching trays are excellent solution to ensure uniform distribution of the bleaching agent and a higher level of comfort for the patient.
The creation of custom-fit trays requires one office visit to create a mold of your teeth. From the mold, plastic trays are then custom-fit to your teeth. Whitening gel is then placed in bleach trays to fit your teeth precisely – including all the nooks and crannies.
Because custom-fit trays are created from an exact mold of your mouth, trays stay in place very well and most people find them quite comfortable. In addition, we always give patients their personal mold ensuring that if their trays are lost, they need only pay for the tray, not the mold.
Patients who use custom-fit bleaching trays will see results more quickly if used daily, and more slowly if used less frequently. Patients who desire immediate results, or who may not be interested in a daily regiment, should Zoom!
Professional teeth whitening by your doctor is your best choice when you need immediate whitening results. This procedure is called chair-side bleaching and may require more than one office visit. Each visit will take sixty minutes
During chair-side bleaching, the dentist will apply a protective gel to your gums and a rubber shield to protect the oral soft tissues. A bleaching agent is then applied to the teeth. Our office uses the Pola Office+ Whitening System which is the fastest in-office whitening system available.