Sometimes despite our best efforts dental problems can’t be avoided and when this happens one of the following treatments may be required:
- Tooth coloured restorations
- Replacement of metal/amalgam restorations
- Treatment of cracked cusp syndrome
- Ceramic inlays and onlays
- Ceramic crowns and bridges
- Root canal treatment
- Dental implants
Tooth Coloured Restorations
This procedure involves the direct application of a colour-matched composite resin to replace lost tooth structure. Adhesive resin is chemically bonded to the remaining tooth structure and cured with a LED light. These restorations are highly aesthetic and utilize nano-filler technology, making them virtually indistinguishable from natural tooth structure. Modern nano-filled dental resins are highly polishable and wear resistant. Being adhesively bonded they can be minimally invasive, allowing the preservation of as much natural tooth structure as possible. (Minimally Invasive Dentistry)
Replacement of Amalgam
Out-moded metal amalgam fillings rely on mechanical undercuts into tooth structure to retain the restoration. The seal between the metal filling and the tooth surface is created by the formation of a silver oxide layer. Amalgam restorations have poor aesthetics and are often replaced for this reason. Large amalgam fillings in back teeth can also contribute to tooth cracks and cusp fractures.
Cracked Cusp Syndrome
Cusps on the biting surfaces of back teeth are important for efficient chewing. When food is being chewed they flex very slightly under the biting force. With time this continual flexing may cause fine cracks to develop. These cracks are usually confined to enamel and are of little significance. However, cracks that extend further into the dentine core of a tooth can illicit a painful response when chewing.
The condition is more prevalent in heavily restored back teeth. The compromised tooth may pain when biting down but often it is the release of the bite pressure that triggers the response. Hypersensitivity, especially to cold or sweet foods are often noted.
Diagnosis of CCS can be challenging and time consuming. Invariably radiograghs do not pick up the problem. Tests can involve applying gentle selective pressure to any suspect cusps to see if sensitivity exists, investigating for cracks with intense light and magnification or detecting areas of excessive bite force using micron thin articulating/bite paper.
Initial treatment may involve removal of an existing restoration so the crack can be visualised internally. The problematic cusps can then be trimmed down, covered and supported with a restorative resin. In the longer term a ceramic onlay or crown may be indicated to prevent further crack propagation and to help seal against bacterial infection.
Fortunately the vast majority of cracks do not reach the internal pulp (nerve). But if this does happen a root canal filling may be required.
Excessive loads on teeth through grinding and clenching (bruxism) can cause CCS. In these cases wearing a protective occlusal splint at night can prevent further problems.
Ceramic Inlays and Onlays
Ceramic restorations are usually chosen because of their superior strength and enhanced aesthetics when compared to direct placement of composite resin restorations. In addition, existing restorations with poor aesthetics can be replaced with ceramic inlays and onlays as part of a "smile makeover".
An inlay is usually a laboratory fabricated indirect restoration that is cemented in a prepared tooth cavity. An onlay is similar except it incorporates a replacement for lost tooth cusps and corners. It is cemented on where a cusp has fractured off or is too weak to support a traditional filling. Onlays allow for the conservation of remaining sound tooth structure.
Ceramic inlays and onlays are advantageous because of their superior resistance to occlusal/bite forces, precision of fabrication only possible out of the mouth (CAD/CAM), proper contouring for better gingival health and improved lustre for ease of cleaning.
Ceramic Crowns and Bridges
Ceramic crowns are a prosthetic replacement for a natural anatomical tooth crown that has been compromised by decay, trauma, erosion, wear or that has suffered cracking or cuspal fracture.
Root Canal Treatment
Nerve damage to the Root canal can be caused by: cracks, decay, heavy grinding, gum disease.
Treatment involves the replacement of the infected nerve or pulp tissue with a special type of filling. The treatment is performed over a number of appointments, with the infected tissue being removed and the nerve chamber shaped to fit the filling, which is used to seal the nerve chamber to prevent infection. As this treatment removes living tissue the tooth will over time become brittle and it is recommended you have a crown fitted to prevent fracture.
Replacing a missing tooth
If nothing is done to replace an extracted tooth, the surrounding teeth will over time start to tilt and drift. This can lead to serious problems. Missing teeth can lead to: decay, gum infection, bite collapse and further loss of teeth. Treatment for missing teeth include: denture, dental bridge or dental implant.
Dentures are a removable plastic or metal base that sits over the gums to which plastic teeth are attached. They are an inexpensive , however some patients do find them uncomfortable and notice a significant reduction in their ability to chew food..
A bridge is a non-removable ceramic false tooth positioned between crowns that fits over the teeth. The bridge also offers the advantage of strengthening the adjacent teeth and feels natural in the mouth. Despite being more expensive, most patients find dental bridges more beneficial compared to dentures.
A titanium screw is embedded into the jaw bone and a ceramic false tooth is then attached. This is the most expensive tooth replacement treatment, however, it is also the best cosmetic and longest lasting option available.