Archive for the ‘Restorative’ Category

PLAN FOR SUCCESS: CROWNS AND BRIDGES

Wednesday, July 8th, 2009

Here’s some inside information on how to increase the chance of success of dental procedures, based on research by Dr. Gordon Christensen. Our last category is concerning crowns and bridges. A crown covers the entire tooth and is used mainly when the tooth is weakened too much by decay or cracking. The decay is removed, and also the enamel surface of the tooth, so it can be replaced by a custom-made form which is bonded permanently onto the remaining tooth. This holds the tooth together, and it can be made of porcelain, metal, or a combination of the two.
If you’re a tooth grinder, the old school of thought was to make any crowns with a metal biting surface, but now the new, nonabrasive low-fusing porcelain is better. However, it is still a good idea to find out why you’re grinding your teeth and correct that.
So here is your first hint. Whether it’s in preparation for a crown, or just to replace an old filling, have your dentist remove all of the old filling material first. The failure of that filling is the reason you are replacing it or crowning it, and the likelihood that there is further leakage and decay is very high. It is one of the basic lessons we learn in dental school, and yet, more than half the crowns I see, and practically all the failed ones have old filling material underneath them. And when we remove that old filling material it is just loaded with decay which had continued to grow underneath the crown.
Now let’s move on to what is known as the fixed bridge. It is used to replace missing teeth by preparing the surrounding teeth for crowns, and when the crowns are made, the missing teeth are fused in between them and the whole thing is cemented permanently to the remaining teeth. The fixed bridge used to be the gold standard in tooth replacement, but the new implant systems have surpassed them in success rate and they are much more conservative. However, there are still many situations which would favor the use of a bridge, and these tips might help you plan them more successfully.
The chance of failure grows exponentially with the size if the bridge. The bigger the bridge, the more complicated the stresses and the chewing patterns become. The more teeth involved, the more chances you have of one of them failing for an inaccurate fit, recurrent decay, gum disease or fracture, and often one such problem can destroy the whole bridge. Try to keep it down to three to five units per bridge (that includes crowns as well as missing teeth).
Avoid the use if cantilevers. Those are bridges that have one or more missing teeth that are not supported on both sides by natural teeth. They have an extremely high failure rate.
Never splint two teeth together in order to hold one of the crowns in place. That crown will still come loose just as easily, except then you may not realize it until after the tooth has been destroyed by decay and infection because that crown won’t fall off since it is being held in place by the other one.
Finally, be diligent in your evaluation of your treatment options, and in the proper maintenance afterward. There are usually more than one way to treat a particular problem, so if your dentist only gives you one choice, ask a lot of questions to find out what the other options are and what are their expenses, success rates, limitations and aesthetic considerations. For instance, when a nerve becomes infected, you might assume that your only choice is root canal therapy, but if your main concern is longevity, replacing it with an implant could be a much better choice. And when the treatment is completed, many people think that they’re good to go for a long time without any further care, but in actuality, the more involved the treatment has been, the more maintenance is necessary. So protect your investment with regular check-ups and cleanings.

Dr. Moulton’s article was published in the Desert Valley Times, May 2007

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Cover Up

Wednesday, July 8th, 2009

You’ve heard of it before, but maybe you don’t quite know exactly what it is. It could be a filling, or it might be a crown. It’s a veneer. In the dictionary, a veneer is a covering over the outside of something, usually to enhance its aesthetic or physical characteristics, and that’s just what it is in the mouth.

A veneer is a thin coat if porcelain or resin bonded to the face of a front tooth to make it look better and to strengthen it. If the tooth is cracked or weakened by too many fillings, a veneer may be necessary to protect it from breaking, or if the tooth or teeth are discolored or crooked, veneers are a nice, conservative and quick way to correct that. In fact, they have been called “instant orthodontics”. Although you don’t actually move the teeth with braces, they can be reshaped to instantly straighten them.

I’d like to stress the conservative aspect of doing veneers. When planning treatment, my motto is always, “if it ain’t broke, don’t fix it”, but a broken smile is every bit an injury as a broken tooth. And when doing a veneer, less tooth tissue is removed than most other types of restorations. It’s like the front half of a crown, but since there is no metal, it can be made super thin, and it looks more natural because it’s translucent like your own enamel.

There are basically two kinds of materials you can use to make veneers, plastic resin and a hybrid porcelain which is non-abrasive. The plastic is less expensive, but usually isn’t as durable. Its average life expectancy is 5 years, whereas, the porcelain is about twice that, and it is more translucent and natural-looking. These are all considerations your dentist can discuss with you based on your particular circumstances.

Dr. Moulton’s article was published in the Desert Valley Times, March 2007

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