The term bonding is used to describe procedures where tooth-colored dental resins and composites are used to change the shapes and colors of teeth as well as to close unattractive spaces. It can also be used to repair chipped or broken teeth or even to cover up stains. Unlike crowns or caps, direct bonding procedures require only one visit, and a minimal amount of tooth reduction, making it a very conservative procedure.
After slight preparation, the tooth is etched with a weak phosphoric acid solution to create a more porous and rougher surface for increased bonding strength. Next, a bonding agent is applied to the tooth and cured with a special LED light. Then, a composite (plastic) resin is placed on the tooth and contoured into the appropriate shape and hardened with the curing light. It is then further shaped and highly polished, to create a natural appearance. The procedure usually requires only one visit and often does not require anesthesia.
The bonded composite has an average life of four to eight years, and often lasts longer depending on how and where in the mouth it is applied and how it is maintained. The area can be touched up and even re-bonded over time as necessary. The disadvantage to bonding over porcelain restorations is the tendency for the margins (where the tooth and bonding come together) to stain.
Cosmetic contouring (or recontouring) is the reshaping of a patient's own teeth. This process involves removal of a very small amount of tooth structure to help achieve a more desirable appearance. Chipped or fractured areas are smoothed out and specific angles or edges can be rounded or squared to alter the way your smile looks. In conjunction with bleaching, this procedure can create dramatic results.
When a person loses one or more teeth, the neighboring teeth can shift, tip or even "super-erupt" into the space. Teeth that have drifted from their normal and healthy position are often more susceptible to decay and gum disease. Perhaps even more important, this movement can lead to changes in a patient's bite that can ultimately put stress on the jaws, muscles, teeth and the temporomandibular joints (TMJ). Over time this can affect a patient's ability to chew and may even change the facial appearance depending on the location and number of missing teeth.
There are three ways to replace a missing tooth or teeth:
1. A fixed prosthesis, A bridge is a permanent or fixed replacement. A bridge consists of replacement teeth (one or more) that are attached to crowns on the adjacent teeth. The replacement teeth are shaped and contoured to blend in with the natural teeth in the mouth.
2. A removable prosthesis. A denture is a removable replacement. A denture can be either partial or complete, a partial denture has replacement teeth attached to either a metal or flexible plastic framework, while a complete denture replaces all the teeth in either the upper or lower arch, attached to an acrylic base.
Dental implants are metal cylinders placed in the jaw bone underneath the gum tissue to support artificial teeth where natural teeth are missing. Unlike other types of tooth replacements, such as removable dentures or fixed bridges that are cemented to remaining teeth, dental implants are actually placed ("implanted") into the bone under the gum tissue. These implants are generally made from titanium, which is readily accepted by the body, and artificial teeth that look like natural teeth are then attached to the implants. Accepted by the American Dental Association, dental implants have been used for many years, and hundreds of thousands have been placed. Implants are actually able to fuse to the bone after placement, which means they look and function like natural teeth. This procedure has an overall success rate of around 90%, which allows me to recommend them with confidence.
Anyone who is missing teeth and can benefit from increased chewing efficiency, and improved appearance or speech, is a candidate for dental implants. Implants can be the solution when it has become difficult or impossible to wear a removable denture. Portions of the jaw that are missing due to an accident, disease, or birth defect can often be reconstructed using implants.
You are a candidate if:
• your jaw has enough dense bone, to secure the implants.
• you do not have a disease or condition that interferes with proper healing after implant surgery (e.g. uncontrolled diabetes, or radiation/chemotherapy for treating cancer)
A discussion with your periodontist and Dr. Sahara will determine if you are a candidate for dental implants. As a rule, age is not a barrier to implant treatment if you are in good health. In fact, thousands of people of all ages are turning to dental implants to replace a single missing tooth, several teeth, or all teeth.
A bridge takes two or more visits to complete. At the first visit, the adjacent teeth are reduced, an impression is taken and sent to a dental laboratory for fabrication. At the second visit, the bridge is fit and placed permanently in the mouth. Like crowns, bridges can be made from variety of materials for strength and esthetic appearance.
A partial or complete denture takes approximately 5 visits, spaced about 1 week apart, due to turnaround time in the lab. The first two visits are comprised of record taking, impressions, shade and shape selection, and recording of the appropriate facial dimensions. The third visit is typically a try-in of the denture in wax, while the fourth visit is generally the delivery of the denture. Dentures typically require one or more adjustment appointments due to the remodeling of a patients tissue under the appliance.
An implant requires the longest investment of time. Implants generally need 6 weeks of healing time before they can be “loaded” or withstand the biting forces, The crown or restoration will be placed after this healing period.
Natural tooth-colored fillings have become widely accepted and are often used in place of metallic restorations. Studies have shown that in some cases the use of certain tooth-colored materials can strengthen a tooth, making it a better choice than the metallic predecessor - amalgam. Another key benefit of tooth colored fillings is the obvious improved appearance over a metal based filling. Two basic types of tooth-colored restorations are used: composite and ceramic.
Composites have been in use for many years, mostly for aesthetic applications. The newest generations of composites have improved their chemical make-up so dramatically that the materials today can be used in many different applications, including the restoration of decay, closing undesirable spaces, improving the shape, size and color of a tooth, replacing an unsightly amalgam restoration, covering abraded or worn areas of a tooth (usually at the gum line) and to cover stains. Composites can also be used to protect thermally sensitive areas and to repair and strengthen broken teeth.
Once the tooth has been prepared and all decay removed, chemicals and materials are placed on the tooth to increase bond strength and to protect the tooth. Next, the composite material is placed incrementally into the tooth and is hardened by exposure to a special curing light. The restoration is then contoured to fit the bite and then is highly polished. These fillings require a bit more time than the silver fillings because of the number of steps involved. Composite fillings can also be a bit more sensitive, at first, to extreme hot and cold and they may discolor over time if the patient smokes or drinks a lot of coffee, tea or cola. They can also be more expensive and some composites may wear faster than silver fillings; however, they yield a much more natural and aesthetic result.
Ceramic fillings, like composites, come in several different types that can be used for different situations. Ceramics are typically used for the larger and more broken down areas. In these cases, an inlay or onlay to cover more of the tooth's surface may be indicated. These restorations are called indirect because they require fabrication by a dental laboratory, and therefore require two visits for completion. The ceramic restorations are considerably more expensive and therefore simple, one-visit composite fillings are typically used instead. Ceramic restorations are much more durable and will not stain. The final result with ceramics can be spectacular.
Veneering a tooth means to cover its facial or front surface. It is actually very similar to placing acrylic fingernails on top of natural nails. Veneers are used to enhance shapes and colors of teeth as well as to close spaces between teeth and to cover up significant stains such as those caused by tetracycline.
There are two types of veneers: direct and indirect. Direct veneers are done in a single visit and with a composite or plastic material. Indirect veneers are usually done in two visits and require a dental laboratory to fabricate the final restoration. The indirect veneer can be either a composite material or more commonly, a porcelain material. Due to the advancements in the porcelain substrates and the bonding materials used to place them, they are often used in place of crowns for a more conservative and natural looking smile.
During the first visit, a local anesthetic is used and the tooth or teeth are reduced by approximately 0.5mm - 2.0mm. An impression of the teeth is then taken and sent to a dental laboratory for fabrication of the veneers. This usually takes one to two weeks to complete. A temporary restoration may or may not be placed depending on the amount of reduction necessary. There may or may not be slight sensitivity to hot and cold during this period.
At the second visit, a local anesthetic may be used for the patient’s comfort in seating the veneers. After thoroughly cleaning and preparing the teeth, the veneers are then placed with a resin material and cured or hardened with a special curing light.
There are many different variations of porcelains used today and this should be discussed with the dentist ahead of time. Typically, the porcelains should last about 15 years, although with proper care and maintenance, they can last longer. Porcelain veneers resist staining, reflect light and are among the strongest and most natural looking restorations available.
Bleaching is a very conservative and non-invasive approach to creating a brighter and more appealing smile. Teeth can often take on a darker and unattractive appearance with age or from contact with staining substances. The discoloration can be caused by tobacco, coffee or tea, juices, poor hygiene, genetics, and natural aging.
There are two commonly used methods for bleaching: at-home and in-office. Gentle Dentistry of Newnan P.C. only recommends the at home method. The at home technique is the most popular, least expensive for the patient, and allows a gradual change in shade for the best results.
A custom mouth piece or "tray" is made to fit your teeth by the dental office. This tray fits over the patient's teeth and holds the bleaching material against the teeth and away from the gums for a specified period of time. There are different concentrations of bleach that are worn via the tray for one to five hours per day for an average of 10 to 14 days. The regimen will be determined by the dentist and may differ for each patient. If the teeth become more sensitive to hot and cold, a "desensitizing" material may be used in the same tray on alternating days. Results are usually excellent with this method.
Both at-home and in-office treatments are considerably more effective than the whiteners available at retail. The over-the-counter products have much lower concentrations of whitening agent, and sometimes use materials and ill-fitting trays that can cause damage to the gums. Over the counter options can be appropriate for very mild staining, but the results are not as dramatic nor as good for the teeth and gums as with the agents used by dentists.