Restorative Treatments

Crowns

Crowns are used to cover and protect badly broken down or heavily filled teeth.  They can also be used to mask severe discolouration, correct crooked teeth or restore worn down teeth. The teeth are prepared to a specific shape using a dental drill. Crowns are made in the laboratory from metal alloy, a tooth coloured ceramic or a combination of metal and ceramic.  The crowns are bonded in place to the tooth.  Around 95% of crowns will survive over 5 years.  Crowns are more destructive than fillings and can result in irritation of the nerve within the tooth. If this happens a root canal treatment may be required. However, crowns are a very effective way to prevent further breakdown of a tooth.

Posts

A post is constructed from metal or resin fibre.  They are placed into teeth that have very limited tooth structure remaining. The post acts to retain a crown over the tooth to rebuild it to a natural shape and size. The tooth must be root canal treated first or have an existing root filling.  Teeth with posts have a shorter life span and when a post fails the tooth may require removal.

Veneers

Veneers are thin ceramic coverings for the front of teeth.  They involve some preparation of the tooth but not as much as a crown as they only cover the front of the tooth. They are bonded to the underlying tooth and have a similar survival rate to crowns. 

Bridges

A bridge is a false tooth that is supported by the adjacent teeth.  Typically, bridges can only replace a one or two tooth space.  There are two main types of bridges.  The first type is a conventional bridge which involves preparing the supporting tooth or teeth in a similar way to a crown preparation.  The second type is referred to as a resin retained “sticky bridge”, which does not involve any preparation of the supporting tooth:

Conventional bridges

This involves drilling the adjacent teeth or tooth to a peg shape.  A crown like cap is cemented onto the prepared tooth which is attached to the false replacement tooth in the gap. The false tooth may be supported by one or both sides of the space. Therefore, a conventional bridge is destructive to the supporting teeth and is subject to the same complications as crowns.  This type of bridge is only considered when the adjacent teeth are strong enough to support the false tooth. 

Resin retained bridges

These bridges are made with a metal wing that is bonded to the back of the adjacent tooth.  This requires little or no preparation of the adjacent supporting tooth.  The main risk of a resin bonded bridge is debonding of the metal wing.  If this happens it may be possible to cement this back or to remake the resin retained bridge.  There is usually no damage to the supporting tooth if these bridges fail.  

Composite fillings

This is a very conservative technique where composite material (a type of reinforced plastic) is bonded to the surface of the teeth.  It can improve their appearance, correct problems of size, shape and position of the teeth. This avoids cutting down the teeth at all.  However, these fillings will require periodic maintenance such as polishing or repairing chips.  Composite fillings require more maintenance than crowns but are much less destructive to the underlying tooth.  They are much easier to repair and often new filling material can be bonded to existing white fillings. 

Tooth whitening

The natural teeth can be whitened using a bleaching technique. There are various ways of bleaching teeth, but one of the most effective techniques is using a home bleaching system. Impressions are taken of the mouth and a thin, clear, tailor made tray is made that fits the teeth very well. Bleaching gel is applied to the inside of the tray and the trays are worn for a few hours a day or overnight. Over a period of a number of weeks, the natural teeth can be seen to lighten by a significant amount. You can choose how much to whiten your teeth and the effects have been found to be long lasting.

Risks of tooth whitening include sensitivity to cold temperatures. This is usually limited to whilst you are doing the treatment and can be controlled by desensitising toothpastes. Tooth whitening only changes the colour of your natural teeth and will make no difference to the crowns and fillings. The results of tooth whitening can sometimes be unpredictable.

Partial dentures

Partial dentures replace one or more missing teeth. In some situations, a removable partial denture may be the most practical option to replace multiple missing teeth. They are attached to acrylic or metal frameworks. They are designed to fit snugly around your remaining teeth and they may have clips which attach to your natural teeth to keep the denture secure in your mouth. Sometimes implants can be placed to help retain dentures in the correct position. This is a more cost-effective way to securely replace multiple missing teeth than fixed implant bridges and crowns.

Complete dentures

Complete, or full dentures, replace all the natural teeth in the lower or upper jaw. They also support your cheeks and lips and help support your facial muscles.  Dentures on the upper jaw are held in place by saliva and suction to the palate. The facial muscles and tongue also play a part. A full denture on the lower jaw can be trickier to hold in place as there is no palate to create suction and the tongue, cheeks and lips can move the dentures. With practice, you will learn to control your muscles to keep them in place. The more you wear them, the easier this will become.

Some people may decide to go for implant retained complete dentures, which can transform a loose denture – greatly improving chewing and confidence. Typically 2-4 implants are required to securely hold a complete denture in place.