There are a variety of filling materials available today. The challenge is to determine the best and most appropriate material for the procedure and to recognize the weaknesses and strengths of the materials. There is no one material that will fit all needs.
One of the most common and easily recognized fillings is the silver or amalgam filling. These fillings have been used successfully for decades. They are durable, predicable, and cost effective. The drawback is that they are not attractive when they can be seen in a smile. To date, there is no scientific evidence that there is any health risk related to silver fillings. A study published in The Journal of the American Dental Association, (February, 2008) studied a group of 507 children age 8-12 beginning in 1997. The study followed the children based on using silver fillings vs. white fillings and evaluated the neurological impact on the developing children. The conclusion of the study was: “This study fails to show that exposure to mercury in childhood as a consequence of treatment with silver/amalgam restorations is associated with a higher frequency of NSS’s (neurological soft signs) in childhood and adolescence”. The study further states: “This study results show clearly that children exposed to elemental mercury from dental amalgam, do not differ from similar children without amalgam exposure in terms of gross and fine neurological development”.
Composite fillings are tooth-colored fillings that are often as natural as the original tooth. These fillings are generally preferred in areas that are visible in your smile and may be used to replace existing silver fillings that are not pleasing in your smile.
The composite fillings are one of the most basic cosmetic treatments that we provide. When used properly, they will provide years of service. Because of our ability to bond to tooth structures, more conservative/smaller preparations are often possible.
The use of these bonded materials is limited to areas that can be isolated from moisture during placement. Moisture contamination will lead to leakage and premature failure. These materials are not intended for areas of high stress or areas with a high potential for recurrent decay. A Formal Caries Risk Assessments help us to identify high risk patients.
Resin Modified Glass Ionomer
Resin Modified Glass Ionomer (RMGI) materials have been developed areas of damage that must have an esthetic appearance, but that may not be reasonable to restore with composite materials due to location or inability to protect from moisture contamination. These materials have a self-adhesive property, and they release fluoride to aid in decay prevention. They lack durability for high function areas, but they do work very well as build-up materials. There are occasions that these RMGI materials may be used in conjunction with traditional composite materials.
The materials are natural in appearance and a material of choice for affected root surfaces in cosmetic areas.
Generally, a crown covers most of or all of the tooth similar to a thimble. This reduces the stress on teeth. Crowns may be placed to protect teeth, reshape teeth, or change the appearance of a tooth entirely.
Crowns may be made of porcelain, porcelain fused to a gold alloy, or full gold. The design of the crown is dependant on the location and the stress that will be applied to the crown. There is no magic material. The design of the crown should be determined based on the patient’s individual circumstance.
Crowns are often used to rebuild teeth back to their normal shape and/or a brighter color. The quality of the newer porcelain materials and the skills of our Certified Dental Technicians allow the placement of crowns that are virtually undetectable.
Veneers are thin porcelain or ceramic facings that are bonded to the front and top of the teeth. Veneers are an excellent means for modifying the shape and color of your teeth. Discoloration, minor rotations, developmental irregularities, and gaps between teeth are just a few of the applications for veneers.
Veneers are one of the most realistic and lifelike restorations that we provide. They have good strength and resistance to stains.
Veneers bonded to enamel have been available since the mid-80’s and are based on work by Simonson et al. The early veneers were completely bonded to enamel. Studies of the restorations show a high success rate over 10-15 years.
More recent and more aggressive designs for veneers have resulted in removal of much of the enamel resulting in the bond being made to the more unstable internal dentin of the tooth. De-bonding and fractures of veneers are more common with the aggressive preparations. The predictability of the veneer is based on the quality of the bond to the tooth. The more enamel that is retained, the better the bond strength to the tooth.
There is a considerable amount of talk in the media about “no-prep veneers” or “ultra-thin veneers”. Again, there is no magic material, but the use of no-prep veneers is limited to cases that already have small teeth, need space closure between adjacent teeth, or teeth that do not have dark discolorations. For treatments that involve several teeth, it is possible to use several different materials and techniques based on the teeth to be treated. A combination of full coverage crowns along with veneers on other teeth is not uncommon.
Fixed Bridges or Fixed Partial Dentures are a method of replacing missing teeth with a replacement that is cemented to existing teeth or dental implants. The obvious benefit is that the restoration stays in place and does not move when eating. This is one of the most life-like replacements for missing teeth that we have available. The number of teeth replaced by a Fixed Bridge depends on the number and location of support teeth or implants available and the quality of the supporting bone.
Dental Implants have changed the way that we look at replacing missing teeth.
The current dental implants and the implants that have been the workhorse of implantology for 25 years are basically a threaded titanium screw with an internal thread design. The screw acts as the root of a missing tooth. We are able to attach other components to the implant by way of the internal screw threads that will support a single crown, serve as abutments for a fixed bridge, or stabilize a partial or full denture.
Research has shown that the placement of dental implants following removal of natural teeth helps to preserve the remaining bone. Many patients who lost their teeth at an early age have experienced such excessive bone loss as to render them as dental cripples. Dental implants may provide a means of restoring a significant amount of comfort and function to these individuals.
Our practice has been working with our surgical specialists for 25+ years to provide implant solutions for the replacement of missing teeth. The procedures may be very straight forward such as the replacement of a single missing posterior tooth or as complex as replacing all of the teeth in an arch with an implant supported denture or bridge
The use of implants is well documented over the past 25 years with success rates well above 90% in healthy individuals. “At Risk” patients are those who are uncontrolled diabetics, heavy tobacco users, alcoholics, or any condition that results in impaired healing.
Collaboration and planning the implant procedures is critical to the success of treatment.
Removable Partial Dentures
Removable Partial Dentures (RPD’s) are one of the most versatile methods for replacement of teeth in an arch. As the name implies, this is a removable replacement that is stabilized by the remaining teeth. A properly designed removable partial denture will replace single or multiple teeth and act as a stabilizing influence on the remaining teeth.
The teeth retaining the partial should be prepared to properly support the partial denture and the partial denture must also be well adapted to the soft tissues to support the teeth. There are fitting steps that allow very accurate adaptation to the gums that result in very few if any sore spots.
Partial dentures may have porcelain teeth or plastic/acrylic teeth. The porcelain teeth should only chew against other porcelain partial denture or complete denture teeth. The porcelain teeth are so hard that they will wear natural teeth and normal crowns. Plastic teeth are subject to wear unless the chewing surfaces are protected by gold or metal chewing surfaces.
Removable Partial Dentures are often a very good alternative to dental implants when costs or a lack of bone make the use of implants difficult.
Implant Stabilized Removable Partial Dentures
Dental implants may be used to stabilize conventional removable partial dentures. When critical support teeth are missing or are lost, implants may be used as a replacement.
A common application is to use implants to support the posterior portion of a Removable Partial Denture.
Complete dentures are a method of replacing all of the teeth in one or both jaws. The loss of all of the natural teeth is sometimes unpreventable due to trauma, disease, or personal circumstances. Upper dentures depend on suction between the denture and the roof of the mouth and the remaining ridges that once supported the natural teeth for their retention.
The dentures may be designed and fitted to replace the missing teeth to a very natural appearance. The lower denture is much more difficult to adapt and the historical difficulty in wearing a complete lower denture was one of the early driving forces in the development of dental implants. Studies show a significant loss of chewing function and bite force with conventional completed dentures.
We follow the techniques developed by Dr. Earl Pound and that have been expanded and taught by Dr. Jack Turbyfill for the development and fitting of complete dentures. Theses techniques result in a very well adapted denture that is custom designed based on individual facial features.
The myth of the “Facelift Denture” being something extraordinary or new is not true. The concept of putting the denture teeth in the proper position to support the soft tissues of the face and at the correct vertical opening have been taught by Dr. Pound and Dr. Turbyfill since before World War II. The process demands steps to verify the proper support and function prior to the final delivery of the denture.
Complete upper dentures are often seen with a few lower teeth remaining. The remaining teeth in the lower may be the difference between a stable lower removable partial denture and an unstable lower denture that may lead to the need for dental implants. The following patient is a good example of a well-designed upper denture and lower removable partial denture.
Implant Retained Complete Dentures
A lower denture can be one of the most difficult adjustments that a dental patient will ever face. The longer a denture is worn, the more bone is lost, and the more unstable a denture becomes. Ill-fitting dentures can accelerate bone loss and result in difficulty wearing even an upper denture
Much of the early research in dental implants was directed toward helping patients who could not eat properly with “false teeth”. A dental implant is a special titanium screw that is placed into the bone of the jaw. The bone grows to and adheres to the implant. This is a process called osseointegration. The links below have good consumer sections:
Once the implants have healed, a denture may be fabricated that will snap onto or screwed down to the dental implants and hold the denture very still.
In recent years, techniques have been developed that can allow a complete denture to be screwed down to the implants on the day of implant placement.
Once screwed to place, the denture cannot be removed for 3-6 months depending on the quality of the patient’s bone. Once healing is completed, the surgical denture becomes an emergency appliance and a new screw retained denture is fabricated with a metal frame for strength.