Until recently anyone who needed to repair cavities in his or her teeth ended up with a mouth full of “silver” fillings. Dental amalgam, which has a silver appearance, was the tooth restoration material of choice. Amalgam, a combination of metals including silver, mercury, and other metals, is still used — but today there are other options that mimic the original teeth they are restoring.

You may have read about some people's concerns about the mercury used in dental amalgam. According to the American Dental Association (ADA), scientific studies have found no ill effects arising from using dental amalgam in fillings for adults or children: “While questions have arisen about the safety of dental amalgam relating to its mercury content, the major US and international scientific and health bodies, including the National Institutes of Health, the US Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.” Dental amalgam is still used for molars (back teeth) that must withstand heavy pressure from chewing.

For teeth that are more visible, materials that look and perform more like the original teeth — and are thus more pleasing in appearance — are now available. Dentistry is now taking a “biomimetic approach” (from words meaning “life mimicking”). The new materials — composite resins and porcelains — look like teeth because in many ways their structure imitates the biologic structure of teeth.

Composite resins are made of a plastic material (methacrylate) combined with fillers made of silica, a form of glass. They are able to bond to natural tooth structure and resemble the dentin, the inner layer of the tooth, which has a porous structure similar to bone.

Dental porcelains are a form of ceramic. They are non-metallic materials formed by the action of heat, like the ceramics used in porcelain cups and bowls. They come in a powder form that is mixed with water, shaped, and then placed in an oven until they reach the proper hardness. The end product is translucent and very hard, resembling the densely packed crystals of calcium that make up a tooth's normal outer layer, the enamel.

The old amalgam fillings required removal of tooth material to prepare a site in which they could be placed. Composite resins and porcelains can be used to treat teeth that have small or large amounts of damage to their natural substance because the materials bond directly to the remaining dentin and enamel. Thus they end up stabilizing and strengthening the restored tooth, as well as providing a natural-looking appearance.

Contact us today to schedule an appointment to discuss your questions about tooth colored fillings. You can also learn more by reading the Dear Doctor magazine article “The Natural Beauty of Tooth Colored Fillings.”

When choosing among different ways to solve a problem, knowledge is power. In the case of selecting the best repair for a dental problem, count on your team of dental professionals to advise you. But you as the patient make the final decision, and it helps to thoroughly understand the different options, their advantages and disadvantages. If you have a chipped or broken front tooth, your likely repair options are composite resin or porcelain veneer.

Composite resins are synthetic materials that can be colored to match your natural teeth. The material is bonded to the tooth surface using adhesives that become part of the tooth structure, strengthening the original tooth. The repair looks as good as, or even better than, your original tooth. Such repairs can be used to restore small to large chips and other damage caused by decay or trauma.

Since the composite resin repair is applied directly to the tooth in the dental office, the repair can be made in a single appointment. You do not need to use a temporary repair while waiting for the final replacement to be made at a dental laboratory. This also means that the repair will cost less.

Another advantage of composite resin is that less of the healthy tooth needs to be removed to prepare the tooth to receive the replacement, since it bonds directly to the original tooth structure.

Porcelain veneers are very thin layers of tooth-colored porcelain that are also bonded to the tooth. They are usually recommended in situations with more serious injury or risk to the tooth, such as teeth that have been fractured, treated for root canal, or injured in contact sports.

Application of porcelain veneers may require more tooth preparation (in which more of the original tooth material must be removed) before the restoration can be bonded in position. Bonded porcelain veneers are likely to be longer-lasting than composite resins. They must be fabricated in a laboratory, so they require more than one visit and cost more.

All of the above are factors to consider in choosing composite resin or porcelain veneer to restore your chipped or damaged tooth. As usual in making such decisions, the final choice will depend on your individual situation.

Contact us today to schedule an appointment to discuss your questions about bonding to repair chipped teeth. You can also learn more by reading the Dear Doctor magazine article “Artistic Repair of Front Teeth with Composite Resin.”

What does the term “two-implant overdentures” mean?
For more than a century, complete dentures were the only care option for edentulous (toothless) people. As a solution, these left a lot to be desired, particularly for the lower jaw. Now dental technology has developed a better alternative that combines two strategically placed dental implants and a traditional lower denture that has been modified to fit over the two implants — thus the term.

What are the problems with traditional dentures?
The problem is that when you lose teeth, the bone that supported the missing teeth begins to shrink away. This is known as resorption, and it is the reason that dentures fitted too soon after teeth are lost quickly become loose. Bone loss happens most rapidly during the first year and is four times greater in the lower jaw than in the upper.

Why not just use dental adhesives to hold dentures tightly to the lower jaw?
Zinc, a major ingredient in most dental adhesives, has been associated with neurological disorders and may be unsafe. In addition, dental adhesives are expensive and the cost of frequent usage adds up.

Besides dental adhesives, are other health problems associated with dentures?
Yes, edentulism has been related to poor nutrition. Many edentulous people switch to soft foods with high fat content because they find healthier foods like vegetables and proteins difficult to chew.

What are dental implants?
Dental implants are replacements for the roots of teeth, the parts that are below the gumline and anchored in bone. They are usually covered with a crown that shows above the line of the gums.

What are the benefits of implants?
Most importantly, implants reduce the amount of bone resorption. Studies have shown about 75% less resorption in parts of the jaw with implants compared to areas without them. Since most of the bone loss occurs within the first year after tooth loss, it is important to place implants within this time period.

Is a complete set of dental implants a good solution for edentulism?
Yes, it can be a good solution, but it is not for everyone. Some patients, who have lost a great deal of bone support, need another solution for cosmetic reasons that offer more facial support like an implant overdenture. In addition, depending on their resources and insurance, some people require a less expensive solution.

Why does the two-implant overdenture work better for the lower jaw?
Based on differences in bone volume, density and other factors, we think that four to six implants are needed to retain an upper implant overdenture. Thus a two-implant overdenture is a good solution to consider for a lower jaw, but other options might be preferred for an upper jaw.

Contact us today to schedule an appointment to discuss your questions about dentures and implants. You can also learn more by reading the Dear Doctor magazine article “Implant Overdentures for the Lower Jaw.”

A veneer is a cosmetic dental procedure that we use in some situations to correct discolored teeth, small spaces or gaps between teeth, small chips or oddly shaped teeth, and teeth that are slightly misaligned by placing a thin shell covering over the teeth. They are artistically hand-crafted by lab technicians out of tooth-colored porcelain using precise molds that we have made in our office. We attach veneers to the tooth's surface using a special adhesive that creates a chemical bond. Veneers are often a key component in a smile makeover.

Traditional veneers will require some tooth preparation, a process where we reduce or file down some of the facial (front, visible) portion of your tooth by 0.3 to 0.7 millimeters. For this reason this cosmetic procedure is not reversible.

How Long Do They Last?

Veneers can last from 7 to 20+ years depending on how you care for them. This may include sleeping in a protective, professionally made mouthguard. And while porcelain is a durable material that can withstand a great deal of pressure, you must remember that they are a type of glass. You could possibly shatter a veneer if you bite into anything that requires a hefty amount of twisting movement and biting pressure.

By using the latest technologies and procedures, we will create the naturally beautiful smile of your dreams and we will restore your mouth to full functionality and optimal health. Contact us today to discuss your questions or to schedule a consultation.

Want To Learn More?

Learn more about veneers when you continue reading the exclusive article from Dear Doctor, “Smile Design Enhanced With Porcelain Veneers.”

Worldwide it is generally accepted that the best method for permanently replacing a missing tooth is with a dental implant. However, one fact that can affect the timing of placement of dental implants is that the person should be fully mature. In this case, it means that growth is complete, in particular the jawbones have completed growing. And while we are sensitive to teens who may beg for a dental implant to replace a missing, damaged or traumatized tooth, parents or caregivers should know that research and experience have shown that it is better to wait.

The main reason it is best to wait is because natural teeth grow and move with the jaws as they mature whereas implants don't. Natural teeth change positions and move with the jaws as the jaws grow, implants don't. They are fused to the bone in one position and as the jawbone grows, they get left behind and appear to sink as the adjacent teeth and jawbone grow in harmony.

Although it is not really possible to determine exactly when a person has finished growing, it is generally best to wait until the jaw is fully matured and developed. However, we are the most qualified, along with our orthodontic colleagues to “guesstimate” based on family history, age and genetics. Specialized radiographs (x-rays) of the skull and jaws may also be helpful in determining the timing of jaw growth completion and when implants can be placed.

Dental implants are a permanent solution to a dental problem and thus should not be used until all growth is complete. Think about it. Your young child gets a beautifully restored smile through a dental implant...and for a year or two it looks fantastic. However, as your child's jaws continue to grow, everyone begins to notice gaps between the implant and adjacent teeth. So it makes sense to avoid this eventuality; by just waiting until late teens when beautifully restored crowns on properly positioned dental implants should last for many many years.

To learn more on this subject, read the Dear Doctor article, “Teenagers & Dental Implants.” You are also welcome to contact us to discuss your questions or to schedule an appointment.