Tooth restoration: treatment, aesthetics and costs
Tooth restoration is a means of replacing the damaged, diseased or broken part of a tooth, which would have resulted from a number of possible causes including disease, trauma to name but a few.
Unfortunately, the natural dental tissues of various parts of human teeth do not regenerate. Once damaged or lost they need, if possible, to be replaced by a variety of ‘appropriate’ synthetic man-made materials provided by the dentist. These materials, therefore ‘restore’ the damaged tooth to its original form, function, strength and usually appearance.
Tooth restoration: things to consider
Dentists will frequently offer different materials and different types of restorations (eg Smile in a Day)to patients, depending on the circumstances. Below is an overview: there are different criteria to consider and these relate primarily to the crowns of the teeth (the ‘bits’ on top of the roots that poke into the mouth that you can see).
- Be supported by the tooth or support the tooth?
Is there enough natural crown (primarily enamel) to support a restoration or not? If there is, a filling will suffice. This is usually inserted by the dentist into the tooth at the same visit as the initial treatment of the tooth. If not, a stronger material is needed to support the remaining tooth rather than ‘be supported’ by it. This (usually) has to be made in a dental laboratory and fitted on a second subsequent appointment.
- A natural-looking tooth restoration?
The expectation today is for a really natural, aesthetic appearance. That means that the restorative material in such situations need to be colour-matched to the natural teeth. These materials, however, still need to satisfy the other criteria of being ‘healthy, strong and functional.
This, of course, is relative to each individual’s circumstances and indeed, priorities. The ideal restoration may satisfy the criteria of strength, aesthetics and longevity and yet be ‘unaffordable’ for a particular individual. In such cases, the dentist needs to offer ‘compromise’ alternatives that may not satisfy all the criteria optimally.
Tooth restoration treatment options
So what are the different restorations offered by dentists that address these requirements?
- Today, most fillings are made of a tooth coloured ‘plastic-like’ material called quartz composite inserted by the dentist into the (cleaned) cavity of the tooth and ‘hardened’ with a small light of a specific wavelength for about 20 seconds . The more old fashioned material, amalgam has silver and mercury in it and is certainly not aesthetic. Dentists and the public obviously are ‘unhappy’ about placing any mercury (a poison) containing material in the mouth. In time, this material will no longer be used and may well become ‘illegal’.
There are stronger materials available even for situations where fillings would suffice. These are made of gold or the aesthetic material, porcelain. In these cases the restorations are called inlay’. They need to be made by a laboratory.
- When teeth need materials that will strengthen and support them, overlays or crowns are recommended. A crown is like a ‘full helmet’ that replaces the entire natural crown of tooth to or ‘almost to’ the gum line.
An overlay is like a partial crown. It covers the biting (load bearing) surface of the tooth , but may not extend all the way to the gum line, so ‘conserving’ part of the enamel walls of the tooth , when possible and appropriate . Overlays are made of either gold or porcelain. Gold is almost the ‘ideal ‘restorative material other than its appearance. So it is recommended when the tooth is really not visible (e.g. upper back part of mouth) or if the patient really is not concerned about the aesthetics. Otherwise, tooth colour matched porcelain is used. It’s a very hard material, but can sometimes be a bit brittle.
The full coverage crowns are made of either tooth-coloured porcelain, just gold or porcelain bonded onto a metal (gold or otherwise) base. Often this porcelain over metal base crown satisfies the criteria of strength, longevity and aesthetics. Where aesthetics are paramount, such as at the front of the mouth, all-porcelain crowns are more likely to be used than the porcelain over gold base ones.
- Compromises usually involve the use of quartz composite rather than the harder (porcelain and/or metal) materials. One can ‘build up’ a very heavily damaged tooth with tooth-coloured quartz composite material, often with additional supporting and retaining mini pins. These restorations can look (very) good. However, the patient needs to appreciate that they are relatively ‘weak’ and will not have the strength and longevity of the laboratory-produced ones. Because the technician is not involved and the materials cost less, the fee for quartz composite restoration is less.
In conclusion, when a tooth needs ‘repairing’ or ‘re-building’, the dentist should always offer the patient alternatives, explaining the benefits and costs. This should result in the provision of the most appropriate restoration for the patient’s specific circumstances.