There have been many advances in the techniques and materials that we have available in dentistry today. We maintain a determined vigil on these new technologies and materials to help assure you are receiving the most updated treatment options that are available. Outlined below are some of the many procedures we have available to treat your restorative needs:
For decades, root canals have had less than favorable reputations. This is one arena where technique and technology have made a huge difference. These procedures are designed to allow us to maintain a tooth when the nerve and blood supply have been damaged generally from extensive decay. As seen in the diagrams below, this procedure allows us to remove the effected and necrotic tissue, which was originally the blood and nerve tissue in the canal or inner chamber of the tooth. Once this procedure is completed, it is necessary to place a crown over the tooth to help protect it from fracturing due to the fact the life support for the tooth is now gone. Root canal teeth will get brittle, and the primary reason for root canal failures is the tooth cracking or breaking due to that brittleness.
The first step is removing the decay and accessing the nerve chamber.
The next step is a thorough debridement (cleaning out) of the canals.
Once that is done, the canal is filled with a neutral material (Gutta Percha).
In many cases, a post is placed to allow building up the missing tooth structure.
The final step is placing a permanent crown on the tooth.
There are varieties of dental filling materials available today. In large part, silver mercury fillings have gone by the wayside for obvious concerns. There are still very rare applications where they are far superior to composite (plastic) materials, but these are non-wear areas where mercury toxicity from functional wear is not a factor. The technology of the new composite and hybrid materials (porcelain/composite) is remarkable and has vastly improved the long-term success of these restorations. Below are examples of composite restorations that were done replacing old amalgam fillings.
There have also been tremendous improvements in the permanent crowns. In the past, gold has always been the standard for crowns on molars and non-cosmetic teeth. Over the last five years, that has changed with the development of very strong porcelains such as Zirconium. We can now do all porcelain crowns that are vastly superior to the porcelain fused to metal crowns we utilized for years. The technology has now advanced to the point we can do permanent bridges as well in these all porcelain restorations. The cosmetic results are remarkable because of the natural light transmission that occurs compared to the older porcelain crowns that had a metal substructure that caused them to be very opaque by comparison. The pictures below demonstrate some of these differences.
The development of these new all porcelain crowns have given us a new level of cosmetic accuracy as seen in these comparative photos seen below. Notice the typical darkening at the gum line in the porcelain fused to metal crowns on the left. Also, take note of the vibrancy of the all porcelain crowns on the right.
For many of you who have had difficulty in the past with taking impressions for these procedures, we are happy to share a relatively new scanning technology we have been using for many years. This technology has an unsurpassed level of accuracy and eliminates the need for impressions.
Fixed Bridges have long been utilized for permanently replacing missing teeth. The process involves preparing the adjacent teeth for crowns and fabricating a series of crowns fused together as in the diagram below. Today this approach is generally utilized only when there is inadequate bone available to use an implant replacement. Fixed bridges can be supported by either natural teeth or implants.
Temporary partials can be used for a variety of reasons. The most common is for the immediate cosmetic replacement of a tooth that is missing in the front of the mouth. The advantages are that this is generally the most economical solution and can be done reasonably fast. For many patients, however, these appliances can be uncomfortable and usually only serve for short-term use until a more permanent solution can be completed.
A typical temporary partial is depicted below.
A more permanent removable partial denture will have a custom metal framework that gives it the structural integrity to last a longer time. It is custom made to fit the teeth and generally requires some minor preparations on the teeth that will support the partial. These appliances can also be supported by either natural teeth or implants. These restorations are generally not advised for patients that have periodontally compromised teeth, as the load stresses placed on the teeth from the partial can accelerate the bone loss associated with periodontal disease. The examples below depicts the typical upper and lower cast partial dentures.
Dentures have also undergone tremendous technological improvements over the years. Materials and techniques have made the transition into dentures much easier on our patients as well as providing much more comfortable and long-lasting results. The ability to support complete dentures with implants has profoundly improved our ability to secure a cosmetic, functional, and stable result.
In most cases where dentures are placed at the time of tooth removal, we fabricate a transitional (temporary) denture. This is done so a patient never has to go any length of time without teeth. We call it a temporary because it is designed to be able to be placed over the surgical site that is generally swollen and 5 to 10% larger than the tissues will be after 6 months of healing. The advantage is that this initial denture will be relined at the 6-month mark and will become an excellent backup or emergency denture. At that time, we will fabricate an ideal final denture, which will give us the opportunity to maximize all of the positive aspects of the transitional denture and idealize any things we want to change.
In the cases where implants are being utilized, we will fabricate a metal framework denture that will have the necessary strength to support the greatly improved biting pressure that implants provide.
Below are pictures of both conventional and implant supported dentures.