Restorative Dentistry

Replacing Missing Teeth

The goal of replacing missing teeth is to preserve natural teeth as much as possible. Replacing missing teeth with a dental implant, bridge, full or partial denture helps promote dental health as well. Filling in empty spaces in the mouth can help prevent cavities in the remaining teeth because odd-shaped gaps are vulnerable spots for plaque-causing bacteria to build up. Missing teeth also put extra stress on your remaining natural teeth because you don’t have as much surface area to chew with.

The types of bridges may vary, depending upon how they are fabricated and the way they anchor to the adjacent teeth. Conventionally, bridges are made using the indirect method of restoration. However, bridges can be fabricated directly in the mouth using such materials as composite resin. A bridge is fabricated by reducing the teeth on either side of the missing tooth or teeth by a preparation pattern determined by the location of the teeth and by the material from which the bridge is fabricated. In other words, the abutment teeth are reduced in size to accommodate the material to be used to restore the size and shape of the original teeth in a correct alignment and contact with the opposing teeth. The materials used for the bridges include gold, porcelain fused to metal, or in the correct situation porcelain alone. The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. When restoring an edentulous space with a fixed partial denture that will crown the teeth adjacent to the space and bridge the gap with a pontic, or “dummy tooth”, the restoration is referred to as a bridge.

Virtually all dental implants placed today are root-form endosseous implants, i.e., they appear similar to an actual tooth root and are placed within the bone. The bone of the jaw accepts and osseointegrates with the titanium post. Osseointegration refers to the fusion of the implant surface with the surrounding bone. Prior to the advent of root-form endosseous implants, most implants were either blade endosseous implants, in that the shape of the metal piece placed within the bone resembled a flat blade, or subperiosteal implants, in which a framework was constructed to lie upon and was attached with screws to the exposed bone of the jaws. Dental implants can be used to support a number of dental prostheses, including crowns, implant-supported bridges or dentures. They can also be used as anchorage for orthodontic tooth movement. The use of dental implants permits unidirectional tooth movement without reciprocal action.

Dentures (also known as false teeth) are prosthetic devices constructed to replace missing teeth, and which are supported by surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable; however there are many different denture designs, some which rely on bonding or clasping onto teeth or dental implants. There are two main categories of dentures, depending on whether they are used to replace missing teeth on the mandibular arch or the maxillary arch.

Orthodontics

Orthodontic treatment often improves facial appearance and occasionally is performed for solely cosmetic reasons; it is used primarily to correct health problems and to ensure the proper functioning of the mouth. Properly aligned teeth, which close together correctly, simplify oral hygiene and enable children to chew their food efficiently. Orthodontic treatments provide straightened teeth that are rotated, tilted, or otherwise improperly aligned, correct crowded or unevenly spaced teeth, corrects bite problems and aligns the upper and lower jaws.

By applying constant gentle pressure in a specific direction, braces can slowly move teeth through the supporting bone to a new position. Springs and wires put pressure on teeth in order to straighten them. The pressure causes bone in the jaw to dissolve in front of the moving tooth as new bone grows behind the tooth. Braces and other appliances may be removable or fixed and are made of clear or colored metal, ceramic or plastic. Removable appliances are often plastic plates that fit into the roof of the mouth and clip onto a tooth.

Fixed braces exert more pressure than removable braces and can achieve more complex movements. They consist of wires and springs that are held in place by small brackets glued to the outside surfaces of the incisors and sometimes the premolars. Lingual braces have brackets bonded to the back of the teeth. Bands encircling the molars also can be used for attachments. The wires, springs, and other devices attached to the brackets or bands put pressure on the teeth, gradually shifting them into new positions. The nickel-titanium wires are very light, and some are heat-activated. These are very flexible at room temperature and actively begin to move the teeth as they warm to body temperature. Elastic bands sometimes connect the upper and lower teeth to create tension.

Appliances used to direct jaw growth and development in growing children and adolescents include:

Headgear and Herbst appliances can significantly reduce protrusion of the four top incisors and enable the growing lower jaw to catch up with the upper jaw, eliminating swallowing problems.

Crowns

A crown is a type of dental restoration which completely caps or encircles a tooth or dental implant. Crowns are often needed when a large cavity threatens the ongoing health of a tooth. They are typically bonded to the tooth using dental cement. Crowns can be made from many materials, which are usually fabricated using indirect methods. Crowns are often used to improve the strength or appearance of teeth. While unarguably beneficial to dental health, the procedure and materials can be relatively expensive.

The most common method of crowning a tooth involves using a dental impression of a prepared tooth by a dentist to fabricate the crown outside of the mouth. The crown can then be inserted at a subsequent dental appointment. Using this indirect method of tooth restoration allows use of strong restorative materials requiring time consuming fabrication methods requiring intense heat, such as casting metal or firing porcelain which would not be possible to complete inside the mouth. Because of the expansion properties, the relatively similar material costs, and the aesthetic benefits, many patients choose to have their crown fabricated with gold.

Fillings

A filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. It is also lost intentionally during tooth preparation to improve the aesthetics or the physical integrity of the intended restorative material. Dental restoration also refers to the replacement of missing tooth structure that is supported by dental implants.

Dental restorations can be divided into two broad types: direct restorations and indirect restorations. All dental restorations can be further classified by their location and size. A root canal filling is a restorative technique used to fill the space where the dental pulp normally resides.