Restoration

FILLINGS

When teeth have been affected by decay, your dentist will remove this decay, and will need to restore the missing tooth structure to prevent further decay, and return the tooth to function.

Restoration

There are two main options for fillings on back teeth; amalgam or dental composite.


Amalgam

Amalgam is a filling material made up of silver, tin, mercury, and a little copper. It has been used for over 125 years in dentistry.

Amalgam Advantages
Amalgam is relatively inexpensive to place, is very durable, and will restore a tooth predictably even in the presence of moisture or other contaminants. It has excellent longevity (up to 90 years survival has been documented). It is common to see amalgam restorations last 25 years and longer in clinical practice.

Restoration

Amalgam Disadvantages
The main disadvantages are its poor appearance, and its mercury content.

Mercury is a toxin, and this is a concern.

If you wish to have your amalgam fillings replaced because of concerns about mercury, please talk to your dentist, as there are protocols to follow to reduce your exposure during this procedure. This includes removal under a rubberdam (so you can not ingest any fragments),  Oxygen delivered via a mask, and nutritional or vitamin support.

Changing silver fillings to more aesthetically pleasing tooth coloured ones can often be done in one or two visits, quite comfortably and safely.

In my experience most people who have had their amalgams removed for health reasons report improvement of symptoms for a wide variety of problems from chronic fatigue to unexplained skin conditions. It is important to understand however, that responses to treatment are variable. There is a large amount of evidence indicating that dental amalgam is a safe dental material for the vast majority of the population.

Mercury exposure to people from amalgams is at such a low level that the effects are negligible. The amount of mercury exposure is similar to the amount taken up from your body by eating fish once a week. It is uncommon for people to have an allergy to amalgam fillings.


Dental Composite

The introduction of dental bonding over 50 years ago has revolutionised dentistry. It is possible to bond or ‘glue’ white fillings in to teeth.

Composite advantages
Practically invisible, these white fillings can aesthetically replace lost tooth structure. They have the ability to seal the tooth to prevent future decay, and can even strengthen weakened teeth a little. No extra tooth structure usually needs to be removed so the smallest possible filling can be placed. Many composite fillings are so small, and they seal the tooth so well that they can almost be considered as micro-surgery.

Tooth coloured fillings are used as an aesthetic alternative to silver amalgam fillings. Direct composite resin or porcelain inlays are the treatment of choice where the unsightly nature or simply the mercury content of the fillings is a concern.
 

Composite disadvantages
Composite fillings take longer to place, and are more technique sensitive, so are more expensive than amalgam.

While small to medium composite fillings last extremely well, there is an overwhelming body of evidence that indicates that large white fillings in back teeth usually last 1/2 to 2/3rds the length of time that similar amalgam fillings would last.
White fillings tend to chip, fracture and wear faster than amalgam.

If a large restoration is required, talk to your dentist about other alternatives such as overlays/inlays or crowns


Crowns

A dental crown or dental cap is a custom made restoration that covers a tooth with sustained significant loss of structure. They are analogical to being a thimble capped over your finger.

Benefits
Protects severely damaged teeth, or teeth weakened by decay, large fillings or root canal therapy from fracturing. Teeth with large fillings tend to flex as you chew on them causing stress fractures. They are an excellent way to improve the long-term prognosis of weak teeth.

Covers discoloured teeth and irregularities in teeth so improving cosmetic appearance

  • Restores tooth weakened with large decay or filings
  • Restores and maintains natural bite
  • Restore your smile

Types of Dental Crowns
There are three basic types of materials for dental crowns:

  1. All Porcelain
  2. Porcelain fused to metal crowns
  3. Gold Crowns

All Porcelain crowns give the most ideal aesthetic results in areas where very high strength is not required. These crowns have ideal optical qualities that mimic natural teeth, but are reinforced to have high strength to protect the weakened teeth.

All porcelain before and after

Porcelain fused to metal crowns have tooth coloured ceramic on the outside to give natural appearance, and a band of strengthened gold on the inside for optimal durability. Best used in areas where high strength and beauty are important. They are the most common crowns used.

Porcelain Fused to Metal Crown Before and After

 

Gold dental crowns are the most durable and offer the most precise fit. Gold crowns cannot chip or fracture like porcelain crowns. In addition, the preparation of the tooth is less, as they are very strong in thin section.

 


Onlays/inlays

Onlays or inlays are a way of restoring and protecting teeth that have suffered extensive damage from decay, failing fillings, fracture, or wear.

Unlike crowns (which require all surfaces of the tooth prepared), onlays and inlays are quite conservative. Usually all that is required is removal of any fillings and decay, and removal of a limited amount of tooth structure to allow covering of any weak part of the tooth.

Onlays/inlays can be made of reinforced plastic, porcelain, or gold.
Plastic and porcelain have unrivalled appearance. Bonding them to tooth structure strengthens teeth, reversing the effects of decay and wear in a conservative manner. Giving the tooth similar physical properties as an untouched tooth

 Porcelain onlay before and after.

Gold overlays have unparalleled durability, wear resistance and fit. There is no other restoration that can match golds long-term predictability in areas where aesthetics are not an issue. The high strength in thin section allows the most conservative preparation of teeth. It is the dental material most likely to still give good service lasting upwards of 30 years.

 

Cerec Restorations

It is possible to achieve very strong, highly aesthetic ceramic inlays, onlays and crowns in one visit. Cerec 3D is a highly sophisticated CAD-CAM system that produces durable, well fitting ceramic restorations in one visit. These bonded porcelain restorations allow weakened teeth to mimic the physical properties of untouched teeth.

Click for further information about Cerec


Dental Bridges

A bridge is a custom-made false tooth or teeth that is permanently placed between two healthy teeth, filling in the area left by a missing tooth or teeth. The bridge is held in place by crowns placed on the healthy teeth on each side of space to be filled.

Picture of posterior bridge

Benefits of Dental Bridges

  • Restores your ability to properly chew and speak
  • Maintains the shape of your face
  • Distributes the forces in your bite properly by replacing missing teeth
  • Prevents remaining teeth from drifting out of position
  • Helps preserve the natural function and position of the teeth
  • Restores and maintains natural bite


Types of Dental Bridge Materials

As for crowns, there are three basic types of materials for dental bridges:

  1. Porcelain fused to metal dental bridges
  2. All porcelain dental bridges
  3. All metal dental bridges (Gold)


The all porcelain dental bridges and porcelain fused to metal (PFM) dental bridges are tooth coloured bridges. PFM dental bridges are usually used to restore back teeth where the forces of chewing and grinding are strongest. All porcelain dental bridges are the most aesthetic and are used almost exclusively for front teeth where the need for strength is not as critical. Gold dental bridges are the most durable and offer the most precise fit.


Bridges without tooth preparation

It is often possible to replace missing teeth without cutting down the supporting teeth for crowns. These are called Maryland, or Resin retained Bridges.

Resin Retained bridges can give you a vibrant smile, without causing any damage to healthy supporting teeth.