Tooth Replacements and Restorations

Definition

A tooth restoration is any artificial substance or structure that replaces missing teeth or part of a tooth in order to protect the mouth's ability to eat, chew, and speak. Restorations include fillings, inlays, crowns, bridges, partial and complete dentures, and dental implants.

Purpose

Restorations have somewhat different purposes depending on their extensiveness. Fillings, inlays, and crowns are intended to repair damage to individual teeth. They replace tooth structure lost by decay or injury, protect the part of the tooth that remains, and restore the tooth's shape and function. Bridges, dentures, and implants are intended to protect the shape and function of the mouth as a whole.

Precautions

Some patients are allergic to the medications used for local anesthesia in dental restorations. In addition, many people in the general population are afraid of dental work. Most dentists in present-day practice can help patients with this specific fear.

Description

Fillings

Fillings are restorations that are done to repair damage caused by tooth decay (dental caries). Tooth decay occurs when microorganisms in the mouth convert sugar from food to acid, which attacks the tooth. The acid forms cavities that start in the hard outer surface of the tooth (the enamel) and may extend inward to the pulp, which contains the tooth's nerves and blood vessels. Left untreated, tooth decay may lead to inflammation and infection that may cause toothache and perhaps more serious complications.

To stop the decay process, the dentist removes the decayed portion of the tooth using a high-speed drill or an air abrasion system, shapes the cavity walls, and replaces the tooth structure with a filling of silver amalgam, composite resin, or gold. The filling is placed in the cavity as a liquid or soft solid. It sets within a few minutes and continues to harden over the next several hours. Silver amalgam is commonly used to fill cavities on the biting surfaces of the back teeth, because it is strong enough to withstand the tremendous pressures exerted by grinding and chewing. Composite resin is typically used to fill cavities in front teeth and any other teeth that are visible when the patient smiles, because its color can be matched to the tooth surface. Gold as a filling material is far less common, but is being increasingly used. Although it is more expensive and less easily applied, it does not trigger the sensitivity reactions that some patients have to silver amalgam.

Inlays

An inlay resembles a filling in that it fills the space remaining after the decayed portion of a tooth has been removed. The difference is that an inlay is shaped outside the patient's mouth and then cemented into place. After the decay is removed and the cavity walls are shaped, the dentist makes a wax pattern of the space. A mold is cast from the wax pattern. An inlay, usually of gold, is made from this mold and sealed into the tooth with dental cement.

Crowns

The crown of a tooth is the portion that is covered by enamel. A restorative crown replaces this outer part to protect the tooth. This protection becomes necessary when a tooth cracks or has its entire structure weakened by decay. As with a filling or inlay, the dentist first removes the decayed portion of the tooth. The tooth is then prepared for a crown. It may be tapered on the outside edges to a peg, reinforced with a cast metal core, or rebuilt with both a cast metal core and a post. A wax impression of the prepared tooth and the teeth next to it is made. The new crown is made to fit this mold. The crown may be made of gold or stainless steel alone, metal with a veneer of tooth-colored porcelain or resin, or of porcelain or resin alone. The finished crown is then placed over the prepared tooth, adjusted, and cemented into place.

Bridges

Bridges are a type of restoration that is done when one or more permanent teeth are lost or pulled. The resulting gap must be filled in to prevent the remaining teeth from shifting. If the other teeth shift, they will affect the patient's bite (occlusion), which sometimes produces pain in the jaw joint. As the teeth move and become crooked, they also become more difficult to keep clean. The risk of tooth decay and gum disease increases, increasing the likelihood that additional teeth will be lost. A bridge is inserted to prevent this risk. Bridges are nonremovable appliances of one or more artificial teeth (pontics) anchored by crowns on the adjacent teeth (abutment teeth). The abutment teeth carry the pressure when the patient chews food.

Partial dentures

A partial denture is similar to a bridge in that it fills a gap left by missing teeth with artificial teeth on a metal frame. A partial denture is removable, however. It attaches to a crown on the abutment tooth with a metal clasp or precision attachment. A partial denture is primarily used at the end of a row of natural teeth, where there is only one abutment tooth. The pressure exerted by chewing is shared by this abutment and the soft tissues of the gum ridge beneath the appliance.

Complete dentures

Complete dentures may be worn when all of the top or bottom teeth have been lost. A complete denture consists of artificial teeth mounted in a plastic base molded to fit the remaining oral anatomy. It may or may not be held in place with a denture adhesive.

Implants

Dental implants are a means of securing crowns, bridges, and dentures in the mouth. A hard plastic or metal fixture is implanted through the soft tissue into the bone. Over time, the bone grows around this fixture, firmly anchoring it. The exposed end of this fixture is covered with a crown and may serve as a stable abutment for a bridge or denture.

Preparation

Before a restoration is placed in the mouth, the dentist removes all traces of decay and shapes the remaining tooth structure for the restoration. Fillings are the only restoration created within the tooth itself—the others are made up in a laboratory using a model of the tooth structure. Thus, a filling may be placed in a single dental visit, while the other restorations usually take several appointments. Temporary crowns and dentures are put in place after the tooth is shaped until the permanent restoration is delivered by the laboratory.

Aftercare

Fillings

Fillings need time to harden for several hours after being placed, so the patient should chew food on the opposite side of the mouth for the first day.

Dentures

A partial or complete denture may take several weeks of getting used to. Inserting and removing the denture will take practice. Speaking clearly may be difficult at first—the patient may find it helpful to read out loud for practice. Eating may also feel awkward. The patient should begin by eating small pieces of soft foods. Very hard or sticky foods should be avoided.

Patients with dentures must work on good oral hygiene. Specialty brushes and floss threaders may be used to remove plaque and food from around crowns and bridges. Dentures should be removed and brushed daily with a specially designed brush and a denture cleaner or other mild soap.

The patient should see the dentist for an adjustment if there is any discomfort or irritation resulting from a restoration. Otherwise, the patient should see the dentist at least twice a year for an oral examination.

KEY TERMS

Abutment tooth— A crowned tooth that stabilizes a bridge or partial denture.

Bridge— An appliance of one or more artificial teeth anchored by crowns on the adjacent teeth.

Complete denture— A full set of upper or lower teeth, mounted in a plastic base. Dentures are also called false teeth.

Crown— A protective shell that fits over the tooth.

Dental caries— A disease of the teeth in which microorganisms convert sugar in the mouth to acid that erodes the tooth.

Enamel— The hard outermost surface of a tooth.

Filling— Dental material that occupies the space remaining within a tooth after the decayed portion has been removed.

Implant— A fixture with one end implanted into the bone and the other end covered with a crown, often to serve as a stable abutment for a bridge or denture.

Inlay— A filling that is made outside of the tooth and the cemented into place.

Occlusion— The way upper and lower teeth fit together during biting and chewing.

Partial denture— A removable bridge that usually clasps onto only one abutment.

Pontic— An artificial tooth.

Pulp— The soft innermost layer of a tooth that contains its blood vessels and nerves.

Risks

Restoration procedures typically require local anesthesia. Some people may have allergic reactions to the medication. A very small number of people are allergic to one or more of the metals used in a dental restoration. In most cases, the dentist can use another material.

Normal results

A well-made restoration should feel comfortable and last a relatively long time with proper care. Artificial dental restorations only approximate the original tooth, however. A complete denture will never feel as comfortable or work as well as natural teeth. It is better, therefore, to prevent the need for restorative dental work than to replace teeth. Restorations are expensive, may require many appointments, and still need careful cleaning and attention.

Resources

ORGANIZATIONS

Academy of General Dentistry. Suite 1200, 211 East Chicago Ave., Chicago, IL 60611. (312) 440-4300. 〈http://www.agd.org〉.

American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. (312) 440-2500. 〈http://www.ada.org〉.