Repairing broken down teeth can be carried out using many different methods and material types. Currently there are 2 main ways to carry out dental restorative work.

Direct placement:

This method is carried out chair side. The material of choice is placed into the tooth, shaped and the bite checked to make sure the teeth can still come together with the opposing tooth without any interference. There are currently 3 types of materials used. These include, amalgam (silver metallic material), composite resin, and reinforced glass ionomer cement.

Amalgam:

This material has been around for decades and is the hardiest material which can be used to repair a tooth. It has very good sealing properties at the margins of the tooth and dental material, it’s strong and can lasts for a long time when handled and placed well.

The material has had very bad press in the past 20 years as there is a perception that it is toxic due to the presence of mercury in the metal. This has been proven to be false as no credible scientific literature has provided any evidence to this claim. The mercury is a binding agent for the metal alloy, just like cement binds concrete. Once it is bound within the metal and has set it is no longer a threat. There is a move to phase the use of this material out in dentistry by governments in Europe but this is done purely for environmental issues. The liberation of mercury into the atmosphere happens when cremation of the deceased takes place.

The greatest disadvantage of employing this material to restoring teeth is their appearance but more importantly, the lack of support it affords to the remaining tooth structure. Should the final tooth cavity shape not be designed well and parts of remaining tooth left unsupported, this part of unsupported tooth will eventually fracture under normal function. This can lead to the loss of the tooth in extreme cases.

We still use amalgam in some cases at ProCare Family Dental but due to the improvement in material science amalgam is slowly being superseded by other materials. We often will use this material after root canal treatment when patients cannot afford a crown immediately. It is very good at protecting the tooth by sealing the tooth from bacteria seeping in and also to act as a stress breaker from overloading during function.

Composite Resin:

Composite material is made of reinforced resin to mimic the colour of teeth. They blend really well with the tooth structure and it is very difficult to differentiate where tooth starts and the composite finish. These materials are glued to the tooth structure by the use of bonding material that is resin based but not reinforced.

The relative strength of these materials has improved over time and one day will be as strong as the amalgam restorations. Currently they don’t last as long as the amalgam restorations when used to restore large portions of missing tooth structure. Like amalgam, if the material is handled properly and placed well it can last several years without any detrimental effects to the tooth. Using this material is more difficult than amalgam as the material requires a fastidious method of placement.  The greatest benefit in using this material, other than for aesthetics, is its ability to protect the tooth from fracturing because it is glued/bonded to the remaining tooth. Bonding reinforces the remaining tooth structure just like glass is reinforced with something harder glued to the back of it.

These materials are used routinely at ProCare Family Dental to restore broken down teeth. They are also very good materials for improving cosmetic appearance of teeth. Repairing small breaks from the main body of material is also relatively straight forward. However, there are limits to how much can be repaired before the whole restoration needs to be replaced.

Glass ionomer cements:

These materials are tooth coloured but more opaque and less aesthetic compared to the composite resins. Their benefit as a restorative material lies in their ability to release fluoride at the tooth margins. This helps reduce the incidence of dental decay.

They are generally physically weaker and are only used as temporary restorations which will only be in the tooth for short periods of time. They are often used on broken down teeth awaiting the placement of crowns and when the tooth has to be root canal treated. They are sometimes used as a base under the composite resins. This provides a good insulator for the tooth in cases where the cavity is very deep and the nerve centre (pulp) of the tooth is at risk of being compromised.

Indirect placement:

This restorative technique falls under the dental discipline of prosthodontics. It is the gold standard of care for teeth which are very heavily restored. In other words, large portions of tooth structure are missing.

There are 3 main types of materials which are used in this respect.

1)      Metal alloys: These include gold and non-precious metal.

2)      Ceramic: Tooth coloured, highly aesthetic materials which mimic natural tooth.

3)      Composite resins: These resins are often stronger than the direct placement types.

These are fabricated outside of the mouth, often in a laboratory. Nowadays most of these prostheses are manufactured using computer aided design (CAD) and computer aided manufacture (CAM). They are often precise fitted prostheses which are also the most durable, strong and long lasting choice of materials for restoring a tooth.

The choice between the direct or indirect placement of a restorative material is dependent on the case. There is often a compromise between costs, serviceability, durability and being conservative on tooth structure. In some cases all the ideal factors can be met to restore the tooth back to form and function without excessive costs. At ProCare Family Dental we tailor all decision making to the individual’s circumstances and will always involve you in the decision making process. We will advise and recommend but the decision of choice of restorative option will ultimately be yours.