Nothing will ever perfectly replace your natural, healthy teeth. However, due to issues such as decay, cracks / fractures, dental abscesses, periodontal disease and other factors, it’s sometimes necessary to restore areas of damaged teeth (or replace teeth altogether) with alternative materials. At Natural Smiles Dental Care, we aim to ensure that the dental materials placed in our patient’s teeth and mouths for treatment will be safe for the whole body. This approach is known as biocompatibility of dental materials.
Composite (White) Fillings
Composite (white) fillings are the most common type of dental restoration, and are made out of a strong composite resin that is matched to the surrounding tooth color. White fillings are often preferable over silver (mercury) amalgam fillings because:
- Many patients prefer mercury-free fillings due to the health concerns.
- Cosmetic reasons – white fillings look more natural.
- Patients with sensitivity to heat / cold oftentimes find metal-free fillings to be more comfortable.
At our office, we are very careful to select BPA free and bis-GMA free composite and bonding agents, in order to keep the dental materials as biocompatible as possible.
Inlays, Onlays, & Crowns
A porcelain inlay or onlay is used when the cavity is too big for a white composite filling but isn’t so big that a crown is required. An inlay fits within the cusp tips of the tooth, whereas onlays will overlay one or more cusps in order to protect and strengthen the tooth.
A crown may be recommended when a white composite filling is not enough to repair extensive decay, replace large existing fillings, repair a broken, brittle or cracked tooth, or if a tooth is especially sensitive. The most common type of crown that we see is called a PFM (porcelain-fused-to-metal) and this type of crown has a metal substructure underneath a porcelain coating. Oftentimes this metal layer contains nickel, and unfortunately, it is estimated that 20% of the population has a nickel allergy. Also with the presence of more than one metal in the mouth, a phenomenon can occur called “oral galvanism,” which literally means that your mouth is acting like a small car battery or a miniature electrical generator. At our office, we therefore recommend all-porcelain crowns in almost every case. Our doctors are passionate about preserving as much tooth preparation as possible, and adhere to the principles of biomimetic dentistry, which advocates for returning the tooth to its original strength, function, and esthetics.
Porcelain veneers are one of the best, most esthetic means of creating a more beautiful smile. These ultra-thin (1mm or less) “facings” are bonded to the surfaces of your teeth, and are an immediate way to straighten, whiten, close spaces, or repair teeth.
All teeth being prepared for veneers are “reduced” slightly so that the veneers won’t look or feel thicker than your teeth have always felt. Veneers are by no means the only alternative esthetic enhancement, but they give a truly remarkable smile transformation.
Tooth replacement options
When a tooth has been extracted or is missing, the three main options for tooth replacement are implants, partial dentures, and bridges.
An implant is surgically placed in the bone, into the site of the tooth extraction. After a few months of integration and healing time, a permanent crown is placed on top of the implant. Sometimes bone grafting is necessary if there isn’t adequate bone to support the implant. Both the surgery and the final crown restoration are done at our office, and we place ceramic implants for biocompatibility purposes.
A partial is a removable appliance that relies on the existing teeth for retention. It is the least invasive and least expensive option, but it is removable and thus must be removed and cleaned everyday during brushing and flossing. The partial framework traditionally was made out of metal, but now they can be completely acrylic. They hook onto the remaining teeth in the arch. There is an adjustment period with this option, and sometimes denture adhesive is needed in order to chew certain foods. A partial does allow us to replace several teeth in the same arch using just one appliance.
A bridge is a option if there are teeth on either side of the extracted tooth. The adjacent teeth are prepared for crowns, and the bridge is cemented in permanently, with the replacement tooth connected to the crowns on either side. The replacement tooth (or pontic) rests gently on the gums. This is the LEAST recommended option at our office, as bridges tend to have a high failure rate long-term. Studies are showing a 60% chance of the supporting teeth becoming dead (necrotic). Also, they can restrict the cranial sutures within the head bones, that want to “breathe” and move naturally.
At our office, we strongly recommend Dental Materials Testing with Denise Schneider. Denise is trained in using the EAV BioScan device, in order to choose the most biocompatible restoration materials for our patients.