Restorative dentistry includes all basic restorative treatments in dentistry. It consists of removing the soft decayed part of a tooth and replacing the lost tooth structure with a high quality, tooth coloured material. The aim of restorative dentistry is to make the tooth look like new and to restore a natural image.
Amalgam Fillings
We do not make use of silver amalgam fillings in our practice. There is no research indicating that amalgam fillings are dangerous to your health, apart from some allergic reactions to the surrounding tissues. There is however a tendency in the dental community to remove all amalgam fillings and replace them with modern, aesthetic restorative materials. Certain European countries have banned the use of amalgam by Dentists. Our aim is to work as conservatively and aesthetically as possible.
Before we can start any restorative treatment, we need to do a thorough examination as explained in our dental examination section. This will aid us in making an accurate diagnosis and deliver the correct form of treatment.
Let’s take a look at some forms of pathology and how they can be treated:
Primary Caries
This is active decay where the tooth structure has been damaged by bacterial micro-organisms. It can be detected by probing the affected area with a sharp instrument, or with an x-ray showing decay in between teeth that cannot be seen clinically.
The decay feels soft on probing and the tooth is usually pain free, but may present with slight sensitivity to cold.
It is important to make sure that the nerve is not infected. If the nerve canal system is infected, the tooth needs to be root canal treated before we can restore it. Primary caries not involving the nerve canal can be treated with a direct resin composite filling or a CEREC/CADCAM inlay or onlay.
Secondary Caries
This refers to active decay around an existing filling or crown. We see this very often with old amalgam fillings where creeping has occurred. Creeping is where the filling moves away from the margin of the cavity, causing bacteria to leak into this area and form decay.
Again, we need to make sure the nerve is not involved and restore the tooth with a resin composite filling or a CEREC/CADCAM inlay or onlay.
In a case where the secondary decay surrounds the margin of an old crown, there will be redness on the gum surrounding the tooth. Restorative dentistry will then involve the removal of the crown, along with the decayed tooth structure. The crown is then replaced with a new, full porcelain crown.
Erosion
This happens when the tooth is attacked by acids in the oral cavity. The acids cause saucer shaped lesions on the outer buccal surfaces of the teeth.
We see this in patients who enjoy high sugar gas cold drinks, acidic fruit juices and patients with reflux problems. These teeth tend to be very sensitive to cold substances. If the erosion is minor with minimal sensitivity, the problem can be treated by placing a desensitising resin material to reduce the sensitivity and enhance re-mineralisation of enamel in the affected area. If the lesion is advanced, we need to replace the lost tooth structure with a small resin composite filling to stop the expansion of the lesion.
Attrition
Attrition is a problem where the patient has a tendency to grind his teeth. The technical term is Bruxism. These patients present with wear facets on their teeth and may even complain of headaches, facial muscle pain and spasm.
We treat these patients by restoring teeth with high levels of attrition and constructing a grinding plate or bite plate. This will prevent future damage to teeth.
Abrasion
Abrasion refers to the damage caused by using excessive force during tooth brushing. Abrasion causes wear on the outer buccal surfaces of the teeth, and these teeth tend to be very sensitive to cold substances.
If a patient does complain of cold sensitivity, we treat the tooth with a desensitising resin material and instruct the patient to use a toothbrush with soft bristles, less force and a circular brushing technique.
If the lesion is advanced, we need to replace the lost tooth structure with a resin composite filling to stop progression of the lesion.
Fractured Teeth/Fractured Filling
First, we need to rule out the possibility of the nerve canal system’s involvement in the tooth. If the tooth is healthy, and minimal tooth structure is lost, we can replace the lost tooth structure with a resin composite filling or a CEREC/CADCAM overlay or onlay. If there is a substantial loss of tooth structure, the tooth should be treated by placing a full porcelain crown.
Resin Composite Fillings
Resin composite fillings are by far the most common restorative procedures carried out in our practice and it’s a very conservative method of treating a damaged or decayed tooth. Resin composite fillings consist of resin and filler particles. We make use of different types of materials, depending on which area in the mouth we are treating.
Resin composite fillings with a high resin content and low filler content, tend to be more aesthetic, but they do shrink more than high filler composites and we limit their use to small fillings. We use high resin, low filler composites to treat small lesions on anterior teeth where aesthetics are important, and we make use of low resin, high filler composites for big posterior restorations, where aesthetics are less important. These fillings are still aesthetic, but tend to shrink less on hardening with a curing light.
The procedure starts by removing all decayed tooth structure with a high speed drill. A phosphoric acid etch material is placed inside the prepared cavity to roughen the surface of the cavity. The acid etch is removed with water and the cavity is gently blown with air to remove excess water. A bonding agent is then placed to cover the entire surface of the cavity. This is the glue that binds the filling to the tooth.
The bonding agent is gently blown with air to remove the excess solvent, and then light cured with a UV curing light for 10 seconds. We can now place our resin composite filling material. As explained above, these fillings tend to shrink on curing, causing them to pull away from the walls of the cavity. We combat this by placing the filling in small increments, curing with the Ultraviolet light for 20 seconds before we place the next increment. Once the cavity is completely filled, we light cure the filling for 40 seconds. We can now check that the filling is out of the occlusion, and then polish.
We do find these fillings to be cold sensitive for the first two weeks after placement, but the teeth should settle down during this time. This is caused by the acidic etch used to roughen the surface of the cavity. The acid tends to dry the tooth structure, leading to sensitivity. However, if the pain persists after two weeks, please contact us. The filling may be high and in the occlusion, causing pain on biting.
If the pain persists after our restorative dentistry process, we will redo the filling for you – free of charge.
For more information about restorative dentistry, please get in touch.