Restorative Options

At Alstonville Dental, treatment is customized for each patient, according to the individual’s circumstances. There are a number of materials and techniques that we can use to restore teeth to optimum health and function. Restorations can either be placed directly into the tooth and adjusted in the mouth, or made indirectly (outside of the mouth) and then bonded/cemented into position.

Direct Materials

  1. Composite resin (tooth coloured ‘white’) fillings can be placed directly into your teeth.

Composite resin fillings are tooth coloured fillings that are made of a plastic material mixed with a filler, and are suitable for small to medium sized fillings. Due to economic reasons, this material may sometimes be used on larger restorations at the patient’s request, understanding the limitations and weakness of the material. It is inserted into the cavity in a paste form and set hard with a special light.

Advantages:

  • More cosmetic looking than many of the alternatives – a variety of shades are available;
  • Can be placed very conservatively avoiding more drilling for the preparation of the tooth.

Disadvantages:

  • In larger fillings, composites can wear out sooner than alloy or porcelain materials. They also may fracture more readily;
  • Some food and drinks may stain composites. They can be polished over time however;
  • A tooth filled with composite may be sensitive for some time after the procedure. This is because the material shrinks when it sets. It is important that the setting (polymerization) process is done carefully to minimise shrinkage, which can place stresses within the tooth;
  • Food can become jammed between the teeth if the contact point between the teeth is not tight enough. It is quite an art to achieve a good contact point, as composite fillings cannot be packed into a cavity with the same pressure as metal/alloy fillings.
  1. Glass Ionomer restorations.

These are tooth coloured restorations that create a chemical bond /union with the tooth as they set. They are not as physically strong as composite resin, so are often used for restoring surfaces where the forces are less, such as roots. They do have a fluoride base, which can be recharged every time we brush, helping to remineralize and protect our teeth. Unfortunately they are prone to acid erosion if they are not cleaned well or subjected to repeated acid attacks, through diet or ill health.

  1. Amalgam alloy restorations.

This is the older, traditional filling material for posterior (back) teeth, which has been serving patients and the profession well for many years.

Advantages:

  • They do not take as long to place as white fillings;
  • They can be more durable and stronger than composite fillings;
  • Over time, corrosion products are produced which seals the microspace between the filling and the cavity, helping to seal out bacteria.

Disadvantages:

  • Not as cosmetic as tooth-coloured restorations;
  • Not as environmentally friendly as some alternatives;
  • Medium to large sized amalgams can weaken a tooth over time and lead to fractures and cracks especially for those that brux (grind and clench) and chew heavily on their dentition.

Indirect Restorations

For larger sized cavities and extensively fractured teeth it is often better and easier to make the new restoration out of the mouth. This saves a lot of time adjusting and polishing the restoration inside the mouth, as well as being able to use stronger materials and achieve a more perfect shape, colour and contact points between the teeth.

Traditionally these restorations were made using an extremely accurate impression of the mouth which was sent to a laboratory to fabricate the final restoration. A temporary crown or filling was used by the patient until the new restoration was ready to be cemented into place.

Recent advances in CAD/CAM (Computer Aided Design/Computer Aided Milling) technology and digital scanning within your mouth means that a high percentage of cases can be now done on the same day. The use of high strength all ceramic materials (Lithium disilicate e.max) means that restorations are biocompatible, durable, use more minimally invasive preparations and are very aesthetic.

Indirect Materials

  1. Gold alloy restorations.

Dental gold alloy is a well proven, corrosion free, strong and durable material for inlays, onlays and crowns. It is very strong in thin section, which is often needed towards the back of our mouths. It is gold in colour and the material cost is relatively high.

  1. Non precious alloys.

These can be used in similar situations to alleviate the cost of the gold. They are metallic in appearance, but can be bonded into the tooth and are very strong.

  1. Porcelain.

Older feldspathic porcelains were the mainstay of our profession until more recent advances. They were strong in compressive forces, weak to impact forces, had excellent aesthetics but were abrasive to opposing teeth.

  1. Zirconia.

Newer lithium disilicate porcelain (e.max) is much stronger (360-400 Mpa of flexural strength), has good aesthetics and is gentle on the opposing tooth. It can also be fabricated using CAD/CAM and can be bonded into the tooth to produce biomimetic type restorations.

A new high strength ceramic. Initially the colours were very opaque, but with evolution of the science they are now quite aesthetic.

  1. Porcelain fused to metal crowns.

The gold standard of care for many years, giving the precise fit and strength of gold alloy with the aesthetics of porcelain to make it look lifelike. However, in some situations the metal frame can make the restoration look opaque.

  1. Mixture of porcelain and resin blocks for CAD/ CAM restorations. These can be milled and then bonded into the tooth.

Indirect Restoration Types

Onlays and Inlays

Advantages:

  • Strength is the major advantage. Onlays are bonded directly over or into the tooth and can increase the overall strength of a tooth;
  • They can be a good alternative to a crown and they conserve tooth structure;
  • They are durable;
  • They do not shrink as they are placed and have a lower incidence of post-operative sensitivity.

Disadvantages:

  • They are more expensive than direct fillings due to the high quality materials required to manufacture them and the precision required for their fitting;
  • Occasionally they can de-bond or fracture. Some peoples bites are heavier and stronger than others. Accidental biting on a stone or ice can cause a crack to initiate, and over time a piece can suddenly flake away.

Crowns are often required when the existing tooth structure has been lost or compromised. A crown assists with holding the filling and tooth together.

Crowns may also be used when teeth are severely discoloured and this cannot be addressed with tooth whitening or veneers.

They are also used:

  • When a tooth is severely fractured;
  • Following root canal therapy. These teeth almost always require a crown as they have lost a great deal of tooth structure from previous fractures, decay, or the root canal process and are furthermore prone to fracture.
  • As an anchor for a bridge to replace a missing tooth.

Alstonville Dental does not send any work offshore. We use handpicked local and national technicians and laboratories using quality materials.

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