Methods of tooth restoration in modern dentistry
Dental restoration methods in modern dental clinics make it possible to completely recreate the shape, color, shine, transparency and light refraction of dental tissue.
I would like to proudly note that teeth restored at the Interdent dental clinic are considered healthy even by dentists from other clinics. What teeth are subject to restoration and what methods of restoration exist? To begin with, it should be noted that teeth that are subject to restoration often require endodontic treatment. Removing inflamed dead pulp residues from the canals, then making a high-quality filling. Without professional root canal treatment, there is no point in proceeding with the actual restoration. The remains of dead tissue, “immured” in the roots or under the roots, will sooner or later make themselves felt by pain or swelling of the gums. Very rarely, a tooth is destroyed in such a way that it needs to be restored with living pulp. In such cases, after a thorough diagnosis, the doctor restores the tooth, keeping it alive. The restoration itself can be single-stage or multi-stage.
When should a tooth be restored?
Teeth are destroyed for many reasons, but the main enemy of teeth is caries, which affects teeth at any age. Most often, caries affects the teeth of those with a sweet tooth, since sweet carbohydrates are a favorable environment for the proliferation of pathogenic bacteria. Over time, bacteria penetrate into the deep tissues of the tooth and form carious cavities in them. Treatment of caries consists of clearing these cavities of dead tissue and filling the tooth. When tooth decay has reached such proportions that it can no longer be restored, the tooth is removed.
One-step restoration
One-stage restoration is a therapeutic procedure, while multi-stage restoration is the restoration of a tooth using an orthopedic method (inlays and veneers). A tooth in need of restoration is significantly damaged, and often, in order to restore the shape of the tooth therapeutically, it is first necessary to install a pin in the root. Pins are available in metal and fiberglass. The latter have little flexibility, which completely prevents root fracture during installation. And they come in white and transparent, which eliminates the influence of their color on the final color of the filling.
Fiberglass posts are more expensive than metal ones, but they are preferable for anterior teeth where esthetics are important. Next, the filling mass is applied layer by layer to the installed pin, like a frame. And this is where the real art begins.
The doctor is not limited in time, because The filling will not harden until it is exposed to the light beam of a gel lamp. But the amount of each layer of material, the sequence of application of different shades, the actual choice of color, and ultimately the modeling depend solely on the professionalism of the dentist. Next, the filling is ground and polished, giving it a final sparkling shine.
Example 6. Restoration of teeth 4 and 5, when only one root remains
In the next total work I would like to highlight the 4th and 5th premolars. In general, the girl’s situation was quite complicated initially at the time she contacted me. Both the lower and upper jaws were restored. Let's look at only the top one.
Front 4 teeth
- these are 1.2, 1.1, 2.1 and 2.2 were entirely made of composite material, under which caries developed. And the teeth we were interested in, 1.4, 1.5, 2.4 and 2.5, were covered with metal-ceramic crowns under which there were metal inlays. Today, such structures are rarely used in advanced dentistry, since the same Cerec technology allows you to achieve excellent results with one module “crown + tooth root”, rather than breaking the structure into an inlay and a crown with an additional adhesive layer. In fact, we place a crown at the root of the tooth with the function of the missing root. There will be a separate example on metal tabs a little later.
So, in the photo below, the crowns were removed, the inlays were removed and carious tissue was removed from teeth 4 and 5, leaving healthy roots
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If only the root remains of a tooth, this does not mean that it cannot be restored. And let this tooth root be pulpless, i.e. dead - such tooth roots feel great in bone tissue and orthopedic structures can be built on them. Using computer technology and 3D scanning, we first restored virtual teeth:
The following photo shows that on one side we place crowns with an inlay function in place of the 4th and 5th teeth, and on the other opposite side we place half-crowns also with an inlay function.
That is, these are single modular designs - veneers with a root part, which are currently the best for the patient
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Installing veneers with the root part allows you to completely recreate an aesthetically beautiful dentition:
The stage of temporary prosthetics, which allows the patient to see his smile, plays an important role in the very process of its new formation, since the patient understands that the main problems with the restoration of the remaining teeth, and in fact the roots of the teeth, are left “far behind”:
After installing crowns and half-crowns and restoring the front teeth, our patient’s smile was transformed beyond recognition, the so-called. wow effect:
The clinical example described above can be viewed in detail HERE.
Restoration with veneers
A veneer is a ceramic or composite “facet” that is attached to the front (front) surface of the tooth with special light-curing cement. Veneers are used to restore mainly the front group of teeth, the color and shape of which are of particular importance. In order to restore a tooth with a veneer, only the front and slightly cutting surfaces of the tooth are ground down within the enamel layer by only 0.5 mm. Naturally, for this purpose the tooth does not need to be depulped (removing the nerve), unless there are other indications.
Then impressions are taken of the ground tooth or group of teeth, the color is determined, and a ceramic or composite “onlay” is made in the laboratory.
Veneer, unlike filling material, does not change color over time and does not lose its shine. Moreover, a veneer, unlike a one-step tooth restoration, has a clearer marginal fit to the gingival tissue, which is important for the prevention of periodontal diseases.
Most Frequently Asked Questions
Is missing a tooth just unsightly or harmful to health?
Violation of the integrity of the dentition has many negative consequences for health.
- Due to lack of load, periodontal tissue and bone quickly atrophy. The risk of other pathological processes occurring in them increases.
- Violation of chewing function entails a number of gastrointestinal diseases. Vitamins, microelements and other beneficial nutrients are poorly absorbed. This weakens the immune system and triggers the aging mechanisms of the body.
- The teeth shift, do not close completely, and an incorrect bite is formed. As a result, the functioning of the temporomandibular joint is disrupted. A person is bothered by headaches, poor sleep, and strange “clicks” in the head and neck.
- A person is embarrassed to smile, talk, communicate with other people. As a result, he withdraws into himself, leads a solitary life, and develops depression.
I urgently need to restore a lost tooth in 1 session - what method do you recommend?
Installing a temporary immediate denture (they are often called “butterflies” due to their unique shape) allows you to restore the dentition in an extremely short time. The prosthesis is made from individual impressions directly in the dentist’s office and is immediately fixed using special fasteners.
- It looks very natural and is completely indistinguishable from real teeth.
- Does not require preliminary grinding of adjacent teeth.
- Prevents tooth displacement and bone atrophy.
- Provides chewing function.
- Comfortable to wear and does not injure gums.
- Has a low cost.
- It will serve you for several months and protect the ground tooth while a permanent prosthesis is being made or the implant is being healed.
What material makes teeth look most natural?
At the moment, zirconium dioxide is considered the most aesthetic material. Only a professional can distinguish crowns and bridges made from it from natural teeth. The material has good biocompatibility, high strength and even some antibacterial effect. Thanks to the translucency characteristic of real tooth enamel, zirconium dioxide dentures look exactly like natural teeth.
Restoration with tabs
Inlays are also made in the laboratory and come in ceramic and composite. The teeth for inlays are processed in the same way as for filling materials, i.e. all carious dentin is removed, a cavity is formed, and then impressions are taken from it and sent to the laboratory. The finished inlay is attached to the tooth in the same way as a veneer. The advantage of inlays over filling material is that inlays do not undergo polymerization shrinkage, i.e. do not shrink in volume like filling material under the influence of a light beam from a gel lamp. Further, when restoring with inlays teeth that are destroyed in the area of the contact surface with another tooth, almost one hundred percent restoration of the contact point is ensured, which is very important for interdental hygiene.
Veneers and inlays are not polished, since they are provided with shine already in the laboratory. Teeth restored simultaneously with composite filling materials must be polished every 6 months due to the fact that the surface layer of the light-curing composite, the structure of which differs from the structure of the enamel, wears out, becomes rough and retains microparticles of food debris and microbes.
Of course, it is up to the specialist to decide whether to restore using filling material or an orthopedic method, but there are situations when the doctor can offer both options for restoring a tooth, justifying all the pros and cons. Naturally, restoration with veneers and inlays is more expensive, but having paid once for quality treatment, you will not have to periodically return to the doctor with the same problem.
How to restore front teeth
It is important to understand what specific problem we are talking about here.
- If a tooth falls out or is removed, implantation is the best option to restore it.
- If only the coronal part is broken, you can consider the option of replacing the front tooth with a crown (with preliminary installation of a reinforcing tab in the root canal).
- If we are talking about chips, cracks, severe destruction of part of the crown, aesthetic dentistry instruments are used. Aesthetic dental reconstruction aims to improve their natural appearance and allows the tooth to be restored even if it is severely damaged. The only requirement is to preserve part of the crown.
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Composite materials for restorations
Performing direct artistic restoration requires the use of reliable, color-stable and durable materials that cannot be erased.
Due to their excellent characteristics, light-curing composite materials are used in dentistry. Photocomposites have excellent adhesion to dental tissue at the molecular level and do not change their position due to the ability to diffuse into enamel and dentin, and at the same time they do not violate the aesthetic perception of the tooth. These materials are applied in very thin layers to compensate for shrinkage due to photopolymerization. If the application technology is followed, a long-term, consistently high-quality effect is achieved.
To most accurately match the material to the mechanical characteristics of the tooth and its color (everyone’s teeth are individual), dentists layer materials of different shades and properties on top of each other. The result is a complete imitation of high-strength translucent enamel.
The strength of photocomposites allows them to be used in the restoration of anterior and chewing teeth that receive maximum load. Many of these materials contain fluoride ions, which helps prevent the development of secondary caries over the entire surface of the filling.
When restoring teeth of irregular shape, their visual contour is often corrected, the corners are smoothed or, on the contrary, sharpened, giving an individual uniqueness to the smile.
The advantage of direct restoration is that all the work will be done in one visit to the dentist (2-6 hours). Modern materials are suitable for closing gaps between teeth, changing their shape, size and color.
Examples of restoration of fifth teeth on the upper and lower jaws
Example 7. A metal tab and caries left only the root of the 5th tooth
A patient came to me with a 3.5 tooth. It was a pulpless tooth - the lower five, it did not have any periapical changes or inflammation in the area of the root apex. The tooth was missing the upper half of the crown part of the tooth. This tooth 3.5 initially had a filling, a metal stump insert was installed in the tooth, quite deep, and a filling was already installed on top. Here's a “puff sandwich”:
As I said in the previous example No. 6, metal tabs are beginning to be used less and less in practice - they have been replaced by modern computer technologies, for example, Cerec. As a result of the atraumatic removal of the metal insert, the bone was preserved, nothing cracked: neither the root nor the remaining bone structure:
The restoration of the bottom five was carried out using Cerec technology in 1.5 hours
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The “crown + root” module fell into place perfectly, the patient was very pleased with such a quick and effective solution to his problem:
Example 8. The top five were completely destroyed by caries. But the tooth root survived
With this example, I want to show you how deep caries can literally “eat” your teeth. And, of course, try to prevent it from developing like this. The patient is a fairly young man who has decided to radically improve his image. This is a laudable decision, but here are the teeth he came to me with:
Caries on almost all teeth. After removing the carious layer, the remains of the teeth appeared in this form:
Please note that in place of the upper tooth 5
There was practically only one root left with a small side wall. In this case, the same technology of tooth restoration using the “crown + root” module and crowns/half-crowns with an inlay function was used. The result of the treatment, as they say, is on the face:
The goal of treatment, according to the patient, has been fully achieved - a brutal Man
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Lack of chewing teeth and impaired digestion
There is a direct connection between the presence of a full set of chewing teeth, bite and digestive organs. Having lost, along with the distant molars, the ability to chew food efficiently, a person significantly limits his diet and provokes the appearance of gastrointestinal diseases. A lack of nutrients will first affect the condition of the skin, hair and nails, and then the general condition of the body. And an overloaded digestive system will respond with the appearance of chronic diseases - gastritis, duodenitis, etc.
Professional dental hygiene
Professional hygiene is necessary before tooth extraction or implantation to reduce the microbial load. In this situation, removal of all dental plaque is also necessary for the treatment of periodontitis and elimination of gum inflammation.
After professional removal of plaque and tartar, the hygienist selected products for independent oral hygiene that will most effectively remove dental plaque and prevent gum inflammation, and taught a technique for brushing teeth that does not injure the gums.
Features of Cerec technology
Cerec root inserts and crowns are made from metal-free materials - it can be ceramic or zirconium dioxide. They can be installed even for allergy sufferers without fear. This technology has completely changed traditional approaches to dentistry.
Now the restoration process is comfortable and takes a minimum of time. In my clinic, the procedure is carried out in several stages.
I would also like to note that only one anesthesia is required and there are practically no errors when creating new teeth. Stages:
- An intraoral scanner determines the boundaries of the damage. This is especially important when only the roots of the front teeth or molars remain. The remaining tissues, antagonist teeth, and closed rows are scanned.
- The information is transferred to a computer, where all the images are combined into an image.
- The program creates a three-dimensional model of the remaining tooth, all defects are clearly visible. Then models of the inlay and crown are created that perfectly replicate the anatomical features of the tooth. Dimensions and shape are calculated accurately. It is determined what kind of restoration is needed.
- The design is made from blanks on a milling module. The elements are being tried on. In rare cases, correction is required. Shade discrepancies or other issues that displease the patient can be easily corrected within a few minutes.
- The completed root inlay fits hermetically to the remaining parts of the tooth, is securely fixed and exactly matches the shape.
Thus, it is possible to quickly restore units if only the roots of the teeth of the lower or upper jaw remain.
