Today the majority of fillings both on anterior and posterior teeth are composite or “white fillings”. There are a few reasons for a shift away from amalgam or” silver fillings”. These include:
Cosmetic reasons with the majority of people preferring the colour match of the white fillings.
A more conservative filling. Due to the bonding properties of white fillings, we can remove less sound tooth structure. As a result this does not weaken the tooth as much and reduces the chance of later tooth fracture. The size of the area of decay is relevant in determining the size of the filling and early detection is more important than ever.
Teeth with larger cavities would be better restored with ceramic crowns or overlays.
A restoration free of mercury and heavy metals.
It is also important to be aware that composites also contain chemicals. They are more technique sensitive, take longer to place and are more expensive than amalgam restorations. It is important for all patients to determine for themselves the type of restoration with which they would be more comfortable. Clinical circumstances will also play a role in determining the best restoration required.
CROWN AND BRIDGEWORK
Crowns are laboratory made restorations used to protect a weakened tooth from fracturing further. They completely surround the prepared tooth. They are usually recommended in the following situations: Root treated teeth, heavily restored teeth and can also be used to improve the cosmetics of teeth, matching the shape and colour of the existing teeth. Crowns are manufactured from many different materials including:
All porcelain – used when appearance is critical
Zirconia – high strength dental crown material with excellent aesthetics
Gold or other metal – used only on the very back teeth when space is limited.
Porcelain fused to metal – when strength and aesthetics required.
Bridges are used to replace missing teeth. The teeth adjacent to the missing tooth/teeth are prepared for crowns. The bridge is manufactured in one piece and is cemented onto the prepared adjacent teeth.
These have become the optimum treatment solution to replacing single or multiple missing teeth. Implants also provide a functional and aesthetic solution to people who are having problems with loose dentures or failing crowns or bridges.
The loss of a tooth causes an obvious space/gap, loss of bone in the area of the extraction, as well as movement of the other teeth which affects the bite and muscle function.
The benefits in implant placement is that it may prevent this loss of bone, movement of surrounding teeth and fill the resultant gap/space all with no involvement/damage of the adjacent teeth.
Implant treatment involves 2 stages:
– the first stage involves the surgical placement of a titanium fixture in the correct position in the jaw, once the bone integrates with the implant, then the second stage of treatment can occur.
– the second stage involves placing a crown on the implant.
* I refer patients from my practice to have this very important first stage treatment performed by a specialist periodontist in Hobart.
Dentures are certainly still a cost effective treatment in many cases. They can be aesthetically pleasing, maintain the stability of the mouth and improve chewing function. Dentures can be partial, replacing several missing teeth, or complete, replacing all the teeth. Partial dentures can be made on a chrome cobalt or an acrylic resin framework. Levels of satisfaction with a denture are variable. Patients with complete dentures may require the use of implants to improve the stability.