Silver Amalgam Restoration:
Much of the dentistry that we do is simply to repair or replace previously done dentistry which is no longer serviceable. Here is an example of some old silver amalgam restorations which, as you can see, have fractured.
Ideally, these restorations would be best replaced with gold, or a ceramic material, however for economic reasons the patient elected to simply replace them again with amalgam. Although they will likely discolor with time, these new restorations should provide many years of successful function.
Incidentally, the grey background that you see is a rubber dam, which is used to aid in isolation and provide better visibility for the dentist during the restorative procedure. It protects the patient from inadvertent injury from aspiration or swallowing debris or restorative materials.
Severe Decay Restored with Composite Resin Bonding
In many restorative procedures, we are trying to achieve an optimum esthetic result, and therefore must choose materials that are tooth-colored. Our options typically consist of composite resin (plastic) materials, ceramic, or metal reinforced ceramics. This case is an extreme example of severe decay which was restored using composite resin bonding.
This patient’s limited resources prevented her from using ceramic crowns which would have been far better from the standpoint of strength, cosmetics, and potential longevity, but the use of composite at least buys her some time until she is able to proceed with a more permanent solution.
The dark spot on the patient’s right lateral incisor is from a metal post placed in the root which was necessary after the tooth had been treated with a root canal filling. As the next case demonstrates, the use of a ceramic restorative material would have prevented this compromise.
Aged & Discolored Restorations with Ceramic Crowns
This picture shows several aged and discolored composite restorations. These old fillings are quite large when viewed from the back of the front teeth. A heavy coffee drinker, this patient wished to have a long term solution to the chronic problem of staining which is an inherent weakness in composite technology.
The solution was found in the use of all ceramic crowns, which are extremely resistant to stain and color change.
Notice that we were also able to correct the slight mal-alignment of the lateral incisors. This is one of the great advantages of full coverage crowns.
The following case demonstrates the extreme edge of orthodontic correction with restorative dentistry. We can do a certain amount, but beyond that limit it is best to engage the expertise of an orthodontist.
We were able to accomplish this realignment only because the roots were very nearly in ideal positions. It can be risky to use restorative dentistry to correct severe orthodontic problems. We were fortunate here.
Replacement of Central Incisor:
Perhaps the greatest esthetic challenge that any dentist can face is the restoration of a single central incisor. There are so many factors which must be addressed to achieve an acceptable result, including but not limited to shape, color, optical properties of the restorative material, and soft tissue health. This young man had a previously restored central incisor using technology from the 1960’s which involved a plastic facing on a gold core. As you can see, the plastic has worn away revealing much of the underlying structure.
The replacement was done with an all-ceramic material. Note the exact mirror-image of the replacement to the natural incisor. Also note the subtle variety of colors in the natural tooth and the ceramic. Lastly, note the health of the gum around the crown.
Silver Amalgam Fillings Replaced With Cast Gold
When function and longevity are the primary considerations in replacing previous dentistry, we prefer to use a material that will withstand functional stress. By far, the best material is cast gold. Cast gold never breaks, and its wear characteristics are closer to that of natural teeth than any other restorative material. Hence, gold is ideal when opposing natural dentition. These teeth have old silver amalgam fillings which are beginning to show their age.
This patient elected to replace these restorations with cast gold. In addition to covering and protecting weak cusps, gold can be finished very precisely to enamel cavity margins to reinforce the natural tooth structure, and minimize further breakdown and leakage. Another advantage is that with gold, the remaining tooth structure doesn’t tend to darken as with silver amalgam.
Below is another example of molars reinforced with cast gold. This type of conservative approach allows the cusps to be reinforced to prevent or repair fractures without having to cut away sound tooth structure near the gumline. This is a tremendous help in maintaining periodontal health
Restoration After Wear and Breakdown of Front Teeth
Unfortunately, wear doesn’t always occur just on back teeth. Abrasion and breakdown of the biting edges of the front teeth is also a common problem. Before restoring such cases, it is critical to understand why the breakdown occurred, and to address that cause. In most cases, it is related to the overall bite relationship of the front and back teeth.
After correcting the bite, the front teeth can be restored to their original length and shape. To ignore the cause would be to condemn the new restorations to failure by either fracture or periodontal breakdown. Notice the customized staining in the porcelain which was done to match this individual’s natural teeth. A severe change in color to a shade that is too white would make the restorations appear very unnatural.
Trauma Restoration Using Implants
We are sometimes faced with severe aesthetic challenges as a result of trauma. This unfortunate young lady was the victim of an auto accident resulting in the loss of four upper front teeth along with a substantial amount of bone.
The young man in the following pictures sustained severe bone loss in an accident that his lip line would not adequately hide. Since bone grafting in his case was not predictable, we elected to use tissue-colored porcelain to avoid the necessity for un-naturally long teeth.
What about the use of implants in patients who are totally edentulous (without any natural teeth)? Depending upon the amount and quality of the remaining bone structure, there are many treatment options available the use of implant technology. The simplest is the use of one two or more implants used to support an “over” denture. The denture is removable, but when in place it is supported by and attached to the implant substructure by simple snap attachments.The first photo shows the implants connceted by a support bar. The second photo shows the inside of the denture which holds the snaps which attach to the bar.