Restorative tooth - Types & Procedures

Restorative dentistry plays a vital role in preserving oral health and restoring the natural function and aesthetics of teeth. It encompasses a variety of procedures tailored to address dental issues such as decay, trauma, and tooth loss. From repairing cavities with dental fillings to replacing missing teeth with implants or bridges, restorative dentistry aims to enhance both the appearance and functionality of the smile. By utilizing advanced techniques and materials, dentists can effectively rehabilitate teeth, improving chewing ability, speech, and overall dental health. Whether you require minor repairs or extensive reconstruction, restorative dentistry offers personalized solutions to help you achieve optimal oral wellness and a confident smile.

What is restorative dentistry?

Restorative dentistry involves a variety of dental procedures designed to repair or replace teeth that have been affected by decay, trauma, or other dental issues. These treatments range from filling cavities and performing root canals to placing dental implants using dental equipment. The main objectives of restorative dentistry are to restore the functionality of teeth for proper chewing and speaking, as well as to improve their appearance. Depending on the individual's needs, these procedures may focus on enhancing oral health, restoring dental aesthetics, or achieving a balance of both. Each treatment is customized to address specific dental conditions, ensuring patients regain optimal dental function and maintain a natural-looking smile.

How to Perform Dental Restorations – Procedure

Step 1: Preparation

• Diagnosis and Treatment Planning: Evaluate the patient's dental condition and determine the need for restoration.
• Shade Selection: Choose the appropriate composite shade using a shade guide under natural light.

Step 2: Tooth Preparation

• Isolation: Use a rubber dam to isolate the tooth and ensure a dry working field.
• Cavity Preparation: Remove decay and shape the cavity using high-speed rotary instruments, ensuring smooth and rounded internal angles.

Step 3: Etching and Bonding

• Etching: Apply phosphoric acid etchant to the enamel and dentin for the recommended time, then rinse and dry.
• Bonding: Apply the bonding agent according to the manufacturer’s instructions. Light-cure the bonding agent for the recommended duration.

Step 4: Composite Placement

• Incremental Layering: Place the composite resin in increments (2 mm or less) to ensure proper curing and minimize shrinkage.
• Sculpting: Shape each layer using appropriate instruments, ensuring anatomical contours and occlusal contacts.

Step 5: Curing

• Light Curing: Use a curing light to polymerize each composite layer. Follow the recommended curing time for each increment.
• Final Cure: After the final increment is placed and shaped, perform an additional curing cycle to ensure complete polymerization.

Step 6: Finishing and Polishing

• Initial Finishing: Use fine diamond burs and carbide finishing burs to refine the restoration’s shape and remove any excess material.
• Polishing: Employ polishing discs, strips, and pastes to achieve a high gloss finish that mimics natural enamel.

Step 7: Post-Operative Care

• Check Occlusion: Verify and adjust occlusion using articulating paper.
• Patient Instructions: Provide care instructions to the patient to ensure the longevity of the restoration.

What are the types of dental restoration?

There are two types of tooth restoration:

Non-esthetic direct restoration materials encompass materials like amalgam and direct filling gold. Amalgam, according to G.V. Black, is an alloy that includes mercury and other metals, forming a durable filling material. Direct filling gold, as described by Sturdevant, consists of gold restorative kit materials compacted directly into prepared cavities.

Esthetic direct restoration materials include composite resin, glass ionomer cement (GIC), resin-modified GIC, and compomers. Composite resin, per Skinners, is a polymeric material reinforced with filler particles and bonded with a coupling agent. Resin-modified GIC combines the benefits of glass ionomers and composite resins, hardening through light curing. Compomers represent a newer class of dental restorative materials designed to combine the advantages of composites and glass ionomers.

Indirect restorations or Intracoronal restorations such as inlays and onlays play crucial roles in dental care.

An inlay is a restoration crafted outside the mouth from materials like gold or porcelain, then cemented into a prepared cavity. Class II gold inlay covers the occlusal and proximal surfaces of posterior teeth, preserving cusps.

An onlay on the other hand, encompasses both intracoronal and extracoronal aspects, capping all cusps of a posterior tooth. It serves to reinforce teeth weakened by decay or previous dental work.

Dental Fillings: The most frequently used dental restoration, fillings can be made from gold, silver amalgam, or tooth-coloured composite resin materials to repair decayed or damaged teeth.

Crowns: These tooth-shaped "caps" cover a tooth to restore its shape, size, strength, and appearance. Crowns can also hold a bridge in place or cover a dental implant.

Implants: These are metal posts inserted into the bone socket of a missing tooth. A crown is then placed on the implant, serving as a replacement tooth root and tooth.

Bridges: Designed to "bridge" the gap left by one or more missing teeth, bridges are false teeth anchored by crowns on either side and permanently cemented in place.

Dentures: Removable replacements for missing teeth and surrounding tissues, dentures are made of acrylic resin, sometimes combined with metal attachments. Complete dentures replace all teeth, while partial dentures are used when some natural teeth remain, secured by metal clasps attached to the natural teeth.

Veneers: These are natural-looking, tooth-coloured shells that cover the front surface of one or more teeth. Veneers can improve the appearance of small or short teeth, and they can bring a uniform look and colour to discoloured, cracked, or chipped teeth. As a cosmetic procedure, veneers are generally not covered by dental insurance.

Dental Bonding: Similar to veneers, dental bonding can enhance the appearance of cracked, discoloured, or chipped teeth. Bonding involves applying a composite resin to the tooth to repair the damage. However, bonds are not as durable as veneers, which means additional restoration procedures may be necessary if a bond chips. Bonding is sometimes considered a cosmetic procedure, so it’s important to check with your dental insurance provider to see if the procedure is covered under your plan.

Inlays and Onlays: When a cavity are too large for a filling but too small for a crown, your dentist might recommend an inlay or onlay. These custom restorations are designed to fit into your natural tooth structure like puzzle pieces and are permanently bonded into place by your dentist. Inlays and onlays are similar, with inlays filling the area between the cusps of your teeth, while onlays extend to cover at least one cusp.

Root canal therapy: A root canal procedure is necessary when a cavity penetrates deep into a tooth, exposing the soft pulp inside. It is also often required following an injury or due to infection within the tooth. During the procedure, the dentist removes all the soft pulp from inside the tooth and root canal, cleans out the infection, and fills the interior with a composite material similar to that used for cavity fillings. This process prevents future infections and preserves the tooth.

Advantages & Disadvantages of Dental Restorations:

Benefits of Restorative Dentistry:

• Helps in maintaining and improving overall oral health.
• Enhances the ability to chew food properly.
• Relieves pain caused by dental issues.
• Lowers the risk of potential dental problems down the line.
• Improves the aesthetic look of your smile.

Disadvantages of Dental restoration:

• Dental restorations can be expensive, especially for procedures like implants and veneers, which may not be fully covered by insurance.
• Some patients may experience increased sensitivity to hot or cold after a restoration.
• Restorations like fillings and bonding may wear down or break over time, requiring replacements.
• There is a small risk of infection during or after a restoration procedure.
• Certain materials used in restorations, such as metals in crowns, may cause allergic reactions in some individuals.
• Post-procedure discomfort ranging from mild soreness to more significant pain is possible.
• Restorations may not perfectly match the natural colour of teeth and can stain over time.
• Regular maintenance and good oral hygiene practices are necessary to prolong the life of restorations.
• Every dental procedure carries risks, including nerve damage, prolonged bleeding, or reactions to anesthesia.

Dental Restorations - Best Practices and Tips

Proper aftercare and long-term maintenance are crucial for preserving the results of dental restoration procedures. Maintaining your new smile is manageable with dedication to these care tips:

Regular Dental Appointments:

• Schedule bi-annual visits or more frequently if advised.
• During these visits, the dentist will assess the condition of your restoration, make necessary adjustments or repairs, and monitor overall oral health.

Oral Hygiene Practices:

• Brush at least twice a day.
• Floss daily.
• Use an oral rinse twice a day.
• These practices help ensure the health of your natural teeth and gums while keeping your restoration strong and preventing colour changes.
• Patients with removable restorations should clean them properly and follow dentist instructions to avoid bacterial contamination and maintain durability.

Limit or Cease Tobacco Use:

• Tobacco can damage dental work, including fillings, crowns, and implants, and deteriorate gums and natural teeth due to nicotine sensitivity.
• Tobacco slows blood flow, causing gum tissue to die, which can make it difficult or impossible to support certain restorations like bridges and implants.

What to Do if Your Dental Restoration is Damaged:

• Contact your dentist immediately if your restoration is damaged, even if the damage seems minor.
• Small cracks or other issues can be larger than they appear, and a dental examination, possibly including X-rays, is necessary to assess the true extent of the damage.
• Patients with restorations like implants, crowns, veneers, and fillings need prompt attention, while those with removable restorations, such as dentures, may require a new set.

Risk & Complication in Dental Restorations:

• Some sensitivity or general discomfort may occur after a procedure.
• In rare cases, there could be an infection or an allergic reaction to the metals used.
• Dental restorations like crowns might chip or become loose. Ignoring deep cavities or delaying treatment can lead to the need for root canal therapy or tooth extraction.

Who needs restorative dentistry?

Restorative dentistry is essential for individuals who have experienced dental issues such as cavities, tooth decay, cracked or chipped teeth, missing teeth, or structural damage due to injury or wear. It is also beneficial for those seeking to improve their oral health, functionality, and aesthetic appearance of their smile. By restoring teeth through procedures like fillings, crowns, bridges, implants, and bonding, restorative dentistry helps individuals regain dental function, alleviate pain, prevent further damage, and enhance their overall quality of life.

Restorative dentistry encompasses a variety of procedures aimed at repairing and replacing teeth affected by decay, trauma, or other dental issues. From basic fillings and crowns to advanced treatments like implants and veneers, these procedures restore dental function and enhance smile aesthetics. They help alleviate pain, improve chewing ability, and reduce the risk of future dental problems. Although dental restorations can be costly and may require maintenance over time, they offer significant benefits in maintaining oral health and achieving a confident smile. Regular dental visits and good oral hygiene practices are essential to prolong the longevity of dental restorations.