Dentistry uses a very wide range of procedures (over 180 procedures in the average dental office) to manage different types of problems on the hard teeth or soft tissues. When repairing the teeth, there are 5 procedures that are most commonly used to restore shape, color and function, with any number of additional procedures added on depending on the situation. We are going to focus on those 5 primary procedures in this blog to help improve understanding.
These procedures are discussed in order of increasing damage or tooth structure loss:
- Fillings
- Crowns
- Bridges
- Implants
- Dentures
Fillings
Cavities are caused by loss of the hard minerals in an area of a tooth, leading to eventual collapse of that area. This is caused by the acids bacterial produce as they eat the leftover carbohydrates in our mouth.
Unfortunately, cavities do not get better on their own. Once enough hardening mineral (hydroxyapetite) is lost, the tooth has to be surgically treated and repaired or the problem will gradually progress until the tooth has to be removed.
Treatment process:
1) Damaged tooth structure and bacteria is removed.
2) Tooth is treated with anti-bacterial solution to kill bacteria in the microtubules of remaining tooth structure.
3) Tooth is chemically treated to help it bond to filling material.
4) Filling material is dispensed as a paste into the area of missing tooth structure. Your dentist will shape the filling material and then shine a specialized light at the material to bond it to the tooth and harden it.
5) The filling material is shaped and polished so it fits with the opposite teeth when you bite together. Now the bacteria are sealed out, the tooth can return to its normal function, and it should look nice and new !
Crowns
Fillings are designed to solve small to medium sized problems (cavities, broken tooth structure, etc). Once a problem reaches a certain size, or if there are fractures in the tooth structure indicating that the tooth is breaking apart, a more involved procedure is needed to save the tooth long-term.
Crowns are basically a 'tooth hat' made of porcelain. They look just like natural teeth and are shaped to hold what is left of the tooth together. This allows us to save even severely damaged teeth for many more decades.
Treatment process:
1) Damaged tooth structure and bacteria are removed, just like the first steps of a filling.
2) A special type of filling is placed where the tooth structure is missing. This helps us get the ideal shape to help hold the crown in place after our next step.
3) The entire tooth above the gumline is reshaped so that we can place the new porcelain tooth hat overtop and end up with a tooth that is the same size as the original tooth.
4) A very precise putty picture is taken of the reshaped tooth. This is sent to a dental crown laboratory, where your beautiful new crown will be custom made. This customization includes color, shape, fit, etc. Everything that is needed to return the tooth to ideal shape, color and function.
5) A temporary plastic crown is made and cemented in place to cover your tooth until the permanent porcelain crown returns from the dental lab.
6) Once the permanent porcelain crown arrives at our dental office, the temporary plastic crown is removed and the permanent porcelain crown is fine tuned to fit perfectly, then cemented in place.
Your dentist will give you instructions as to how to take care of your crown to get maximum life out of your new 'tooth hat'.
Bridges
When a person has to have a tooth removed, the missing tooth leaves a large space that can have a lot of potential consequences beyond just how it looks.
One way to fill that space is a bridge. Each tooth on either side of the space is prepared for a crown (see above). When the dental laboratory is making the two crowns, they attach a fake tooth that perfectly fills the space between the two crowns, creating a dental bridge.
Once this bridge is cemented in place, the fake tooth fills the space of the missing tooth.
Bridges are an excellent way to fill spaces where teeth are missing, but they must have a few things to be an option.
1) Healthy strong teeth on either side of the space.
2) Patient with excellent teeth cleaning skills (or willing to learn them). Tooth structure that supports the bridge can get cavities again if the teeth are not kept extremely clean.
3) 1-2 missing teeth maximum in the space intend to fill. Larger bridges that replace many teeth have a much shorter lifespan.
Implants
Dental implants involve the surgical insertion of a small, threaded titanium post into the jaw bone (similar to a screw) that serves as a replacement for a missing root. Once the area around the screw heals from surgery, a connector is added, then a crown is placed on top—which looks and feels just like a natural tooth.
Unlike crowns and bridges detailed above, implants do not require shaving or any alteration of the natural surrounding teeth. Implants are a lengthy process, as each stage must be done separately to allow healing time. First is the surgical procedure to insert the screw, followed by a pause of four to six months for healing before adding the crown.
According to the American Academy of Dental Implants, these are extremely common, with more than 1 million people treated each year and another 150 million who are candidates due to missing at least one tooth.
Dentures
Dentures are our last fall back position. Though not as ideal as natural teeth or implants, when we are missing all of our teeth, this is the final option.
Dentures are a plastic device that covers your gums and has fake teeth attached. This provides teeth like replacements for esthetics, and to a moderate degree, for chewing.
No matter how perfectly made, dentures never function as well as natural teeth, so this is never our first choice if there are still healthy teeth to restore or use as support for other types of devices we can use to fill spaces with missing teeth.
Treatment process:
1) Once all the diseased or broken tooth structure is removed, 6 weeks minimum of healing must occur so that the bone and gum tissues are stable and no longer being remodeled by the body.
2) Putty impressions are taken of the gum covered ridges (where your teeth used to be anchored) and adjacent soft tissues.
3) Over multiple additional appointments, the denture laboratory and dentist construct a denture to best fit over those tissues and fit with the opposing teeth or denture.
4) The denture is delivered to the patient, and then over the next few weeks to months refinements are made to make the denture more comfortable and stable for chewing.
Dentures can be more thoroughly fixed in place by attaching them to implants. For most people this is ideal on the lower jaw as dentures are much more prone to lifting off of the lower jaw and making it difficult to chew.
The ADA offers additional insight on dentures, including proper care following the procedure.
If you are in need of a caring team to help you fix your teeth, please give us a call at (530) 533-7545. We would love to serve you.