Tooth Restoration

Introduction

Some of the ways one can severely damage or destroy their teeth include:

CONGENITAL DISORDERS:

Some congenital disorders associated with teeth that are weaker, easily damaged, prone to decay, and prone to tooth loss include:

  1. 48,XXYY syndrome is a chromosomal abnormality that causes behavioral and medical problems in males.  Dental conditions frequently seen with this condition include:  delayed eruption of primary or secondary (permanent) teeth, crowded/misaligned teeth, and increased incidence of decay.
  2. Amelogenesis imperfecta is a condition that effects tooth development.  The condition leads to teeth that are discolored, pitted/grooved, small, and susceptible to breakage and rapid wear.  Amelogenesis imperfecta may also be associated with other dental abnormalities.  These abnormalities can vary among affected individuals and can affect both baby and adult teeth.
  3. Dentinogenesis imperfecta is a genetic disorder which negatively effects tooth development.  This disorder causes teeth to be translucent and discolored (typically the teeth have a blue-gray or yellow-brown discoloration).  The condition also results in teeth that are weak and prone to damage, rapid wear, and loss.  Dentinogenesis imperfecta may affect both primary and permanent teeth.
  4. Hypohidrotic ectodermal dysplasia causes pre-birth development abnormalities that affect the hair, nails, skin, sweat glands, and teeth.  This genetic disorder is characterized by missing teeth or teeth that are malformed (frequently small and pointed).
  5. While oculodentodigital dysplasia can affect various parts of the body, this condition predominantly results in abnormalities of the eyes, teeth, and fingers (hence the name of this disorder).  Individuals with this condition frequently have tooth abnormalities such as: weakened enamel, widespread decay, missing or small teeth, and premature tooth loss.  While some abnormalities associated with oculodentodigital dysplasia are evident at birth, other features of this condition become more apparent with age.

Decay:

If a cavity is left untreated, it will progressively erode the tooth. Eventually, decay may destroy the entire tooth and lead to tooth loss. This decay process starts by dissolving minerals in the outer surface of the tooth known as the enamel. Once the enamel is broken down and a cavity forms the tooth is permanently damaged. A dentist must remove the decay and fill the cavity. Left untreated, the decay will erode through the enamel and then attack the dentin which is the main body of the tooth. After the decay reaches the dentin it can spread and undermine other parts of the enamel. The decay can also penetrate deeper and infect the tooth’s pulp where the tooth’s nerves and blood vessels are found. An infected pulp can subsequently lead to the formation of an abscess in the soft tissues that surround and support the decayed tooth. Eventually the whole tooth is consume by decay and permanently destroyed.

GUM DISEASE:

Gum disease or periodontal disease is any condition that affects the gums and other supporting structures which surround the tooth. Typically periodontal disease is the result of bacteria that resides within dental plaque. When bacteria first infect the gums they cause gingivitis. Some signs of gingivitis include gums that are bleeding, red, sensitive, or swollen. Without professional intervention and improved oral hygiene, gingivitis can progress to a more serious form of gum disease call periodontitis. Periodontitis can destroy both the gums and bone which support the teeth. Over time, periodontitis can cause teeth to become loose and even fall out.

INJURY:

Trauma to the mouth can knock-out a tooth. A knocked-out or avulsed tooth represents a dental emergency because there is chance to save the tooth if a dentist can quickly place the tooth back in its socket. In the process of rushing to see your dentist you should heed the following with regard to preserving the knocked-out tooth:

  1. Do not touch the part of the tooth that is normally hidden under the gums (the root);
  2. Handle the tooth by hold it from the chew surface (the crown);
  3. If the tooth is dirty, gently rinse it with water.  Do NOT scrub the tooth, clean the tooth with any soap or chemicals, or remove any attached tissues fragments;
  4. Try to keep the tooth in its natural environment by gently inserting the tooth back in its socket;
  5. If the tooth cannot be placed back in the socket, keep it moist by placing it in milk or water.  There are also kits available at some pharmacies which contain a saliva-like solution.  Do NOT store the tooth in tissue or any other material that can dry the tooth.

ROOT CANAL THERAPY FAILURE:

At the center of a tooth’s crown is the pulp chamber, which houses blood vessels, connective tissue, and nerves (collectively known as the “pulp”). The pulp travels down the tooth’s root in a thread-like fashion via channels known as root canals. If exposed to bacteria the pulp can become infected. The pulp is commonly infected when an untreated cavity or crack in the tooth allows bacteria to enter the pulp chamber or root canals. The pulp can also get irreparably damaged when a tooth cracks or receives restorative treatments (such as fillings or crown preparation). This physical damage to the pulp can result in persistent inflammation and subsequent infection. An infected pulp can cause pus to build up at the base of the root forming an abscess. This abscess can damage the bone and tissues that surround the tooth. Without treatment the tooth will eventually be lost or require extraction.

Root canal therapy (a.k.a. endodontic treatment) can help save an infected tooth by removing the infected pulp. The pulp helps nourish teeth as they form and grow. Mature teeth, however, are nourished by the blood supply in healthy gum tissue and therefore these fully formed teeth are not dependent on the pulp for survival. Accordingly, an infected pulp can often be eliminated without killing the tooth. During root canal therapy, your dentist or endodontist (a dentist with expertise in treating the pulp) will remove the diseased pulp and any debris from the tooth. The pulp chamber and root canals are also shaped, sterilized, and filled with a disinfecting material before being sealed off with a crown. The goal of root canal therapy is to save the tooth by removing the diseased pulp and treating any infection in a timely manner. A successfully treated tooth could last a lifetime as long as it is nourished by the surrounding tissues.

Sadly, root canal therapy is not always successful, and tooth loss can occur despite professional intervention. Common factors that cause root canal failure include the following:

  1. The root canal system is intricate and it can sometimes contain an extra canal that is hidden.  For instance, lower incisors which normally have one canal can have a second canal hidden behind the first.  Another example is molars with three roots can have four canals instead of the expected three canals (one per root).  Obviously if your dentist cannot visualize the extra canal it will not be treated.  Untreated canals will remain diseased and will eventually result in an abscess and tooth loss.
  2. A root canal may have physical obstructions that prevent the cleaning and sterilization of the pulp system.
  3. The root canal system may have branches deep within the root of the tooth.  Even a skilled dentist may find these deep branches impossible to reach with dental instruments.
  4. A crack in the tooth’s root may make it impossible to keep bacteria from re-entering and re-infecting the tooth.

Cosmetic Dentistry Treatments:

Bridges:

A bridge or a fixed partial denture is a prosthetic replacement for missing teeth. These artificial teeth look natural and literally bridge the gap where one or more teeth have been lost. The types of fixed dental bridges include traditional bridges, cantilever bridges, and resin-bonded bridges. Both traditional and cantilever bridges are anchored to adjacent teeth, whereas bonded bridges have “wings” that are attached to the back of existing teeth. Traditional and cantilever bridges are more expensive than bonded bridges because the adjacent teeth must first receive crowns in order to support the bridge. Missing teeth can adversely affect bite, chewing, smile esthetics, speech, and temporomandibular joint functioning. Accordingly, your dentist may recommend replacing any missing teeth with a bridge or another restoration such as dental implants or partial dentures.

Crowns:

A dental crown is a sturdy shell which is placed over a tooth that is badly damaged, broken, cracked, or decayed. Dental crowns are also known as “caps” because they sit on top of existing teeth, covering the entire outer surface. Fabricated to look like a tooth, a crown can make a damaged tooth stronger, restore its normal shape and size, improve its appearance, and preserve its functionality. Your dentist may recommend a crown to restore a significantly decayed tooth which does not have enough integrity to support a large filling, protect a weak tooth from breaking, restore a tooth that has already broken, or hold the parts of a cracked tooth together. Crowns can cover teeth that are unattractively shaped or severely discolored with stains that are resistant to whitening treatments. A crown can also be used to hold a bridge in place or cover a dental implant.

Dentures:

Dentures are artificial teeth that replace natural teeth which have been lost to decay, injury, or periodontal disease. There are two fundamental types of dentures: complete and partial. Complete dentures are for people who have lost all their teeth, whereas partial dentures can be used by people who still have some of their natural teeth. Replacing missing teeth has esthetic and functional benefits. Missing teeth can negatively impact your self-confidence, ability to bite, and ability to chew properly. Furthermore, since teeth provide structure and support to facial muscles, missing teeth can cause your cheeks to sag which makes you look older. For all these reasons, if you have lost some or all of your natural teeth, your dentist may recommend dentures or an alternative tooth restoration solution such as fixed bridges or dental implants.

Implants:

Like bridges and dentures, dental implants are another solution to help replace missing teeth. A dental implant is a device which is surgically anchored to your jawbone and replaces the root portion of a missing tooth. This artificial root is typically made from titanium and can serve as a sturdy base to support bridges, crowns, and dentures. Implants are able to provide a stable support for these other tooth restorations because they fuse with the surrounding bone in a process called osseointegration. The integration of the implants to your jawbone can help replacement teeth feel more comfortable, natural, and secure than restorations which are not anchored to implants. Accordingly, dental implants are a popular way to replace missing teeth because they provide a strong, durable solution that can maximize the effectiveness of other restorative prosthetics.

Inlays/Onlays:

Inlays and Onlays are reparative solutions which can often be used instead of conventional fillings to treat a damaged or decayed tooth. A dental inlay or onlay can be made of ceramics, composites, or gold and is bonded or cemented into place. An inlay lies within the center of the chewing surface of the tooth (within the cusps), whereas an onlay is typically larger and covers one or more cusps (bumps on the tooth’s chewing surface). Some of the benefits offered by inlays and onlays include superior fit, strength, durability, and resistance to discoloration.

Complete Oral Restoration:

If your mouth has significant functional problems with bite, bone structure, jaw musculature, and teeth your dentist might recommend a Complete Oral Restoration instead of just a smile makeover. This process involves replacing or restoring many or all of the teeth in both the upper and lower jaw. Complete Oral Restoration may require treatments from a general or restorative dentist (for bridges, crowns, or implants) in conjunction with other dental specialists such as endodontists (specializing in the tooth’s pulp), oral surgeons, orthodontists (experts in tooth alignment, movement, and positioning), and periodontists (experts in gums and periodontal treatments). If you need Complete Oral Restoration, modern day dentistry can provide you with durable enhancements that look natural and are functionally sound.