Restorative Dentistry Archives - Prosthodontist in Johannesburg
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Restorative Dentistry

Dr Gerald B Kaplan

You be a fly on the wall and listen in to a discussion that I had with a new patient this week.
Ellen (name changed) was in dispair. She had been troubling with a loose implant crown on an upper front tooth for over a month. She saw a dentist but he could not help. The problem was beyond him and he offered no practical advice.
Not knowing who to turn to for help, she Googled and found me on the Internet.
I set about dealing with this problem because it was a matter of urgency. She was very uncomfortable and self-conscious and needed prompt attention, which is now being dealt with. Her immediate problem was now my focus.

Having gotten the process in motion to deal with the upper front tooth, I then spent the next 30 minutes talking to her about how she would like her teeth to be going forward, even as far as 15 to 20 years from now?

She told me that her teeth are important for eating and smiling. She does not ever want to wear dentures.
The reality is that her mouth is greatly run down and in need of much advanced restorative dentistry and she was not aware of anything other than the failing implant on the front tooth! It was only after I asked her whether she would like me to make her aware of other dentistry that needed to be attended to that I proceeded to complete the comprehensive examination.. She said yes to my professional advice and that led us into a lengthy discussion as to how did she get into such a predicament?

Well let’s hear what she had to say…

She remembers seeing a dentist when she was in standard 9 and 17 years old. She presented with a large cavity on the lower molar tooth which was then filled. It was fine for a few years before the tooth started to break. The tooth started to become painful and the decay extended into the nerve of the tooth .The choice was now: a root treatment or extraction. A root treatment was chosen. With time the root treated tooth developed an abscess and became excruciatingly painful. This happened whilst the dentist was on holiday and it was difficult to get help. What unnecessary pain and suffering to endure especially at the wrong time. The abscess has to be drained and therefore the tooth was extracted.

The tooth was never replaced. No suggestion was made about a bridge or implant. The bite began to change with drifting and shifting of teeth. The wrinkles on her face started to increase.

With the passage of time she noticed all the other teeth starting to chip and break down. Spaces started to develop between the front teeth as well . Over the years she saw her dentist regularly and had extensive dental care which involved fillings and more root treatments .She was for ever having to be at the dentist for one problem or another.

Three years ago the crown on the upper front tooth came off. An x-ray of the tooth showed that the root had fractured. They attempted to save the tooth with a surgical procedure. That failed. The tooth was then extracted and replace with implant. And now the implant crown has failed!

This story of a downward spiralling cascade in dental health has spanned 25 years, slowly but surely. What a futile cost in time, effort and expense!

The starting point many years ago was a beautiful mouth in a young patient who was never shown effective plaque control nor properly taught by a dentist and also endured bad dentistry.

A small cavity becomes a big cavity; which becomes a root treatment; which becomes a failed root treatment and fractured tooth; and ultimately another tooth has been lost.

Is it not sad to see a dentist year in and year out and slowly suffer the consequences of poor dentistry done in an environment of inadequate plaque control and home care? But nobody told me they all say.

It is a lot more expensive to repair than to prevent.

The story is classic. I hear such a history time and again. I can only shake my head in despair .
Sad but true!

Teeth that are damaged, loose, cracked or missing require restorative dentistry to repair, restore or make them look more natural. Dr Kaplan is a prosthodontist, or an advanced dentist, who has over 40 years of experience in restorative dentistry. He provides some expert tips on cosmetic and restorative dentistry.

Q. My Crown In The Front Doesn’t Match My Teeth –– It Looks Fake. What Can Be Done?
A. This is the hardest thing to do in restorative dentistry – match a single front tooth. Look for an excellent cosmetic dentist who works with a “master ceramist” in his or her office. Sometimes it is necessary to do more than one tooth. In that case, bonding or porcelain laminates might be the answer. Remember, it takes a great deal of artistry involved on the part of the dentist and ceramist.

Q. What’s A Cap? What’s A Crown?
A. A cap and a crown are the same thing. The entire tooth surface is reduced and usually replaced with artificial material such as porcelain or porcelain bonded to metal.

The soft tissue around the upper front teeth is inflamed because of ill-fitting crowns. These crowns were removed. Provisional crowns were fitted and gum treatment was done. The final crowns preserve the health of the soft tissue and give the patient a confident smile.

Q. I’ve Lost A Tooth. What Can Be Done?
A. Today’s restorative dentistry offers many options:

  • Tooth bonded back in place
  • A removable appliance
  • A fixed bridge
  • An implant and crown
Q. What’s The Difference Between Bonding and Porcelain Laminate Veneers?
A. Bonding is a tooth–coloured plastic (composite) resin material and is done in one visit (little tooth reduction, no anesthesia required). Porcelain laminate veneers can mask dark stains better with less long–term chipping than bonding. They are made by a ceramist and do not stain, offering greater choice in colour, shape, and vitality. They do require only two office visits.

Q. What’s The Difference In Cost Between Bonding and Veneers?
A. Generally bonding is 1/2 to 1/3 of the cost of veneers or crowns. Your best bet is to review the fee range and advantages/disadvantages for all restorative dentistry procedures described in a book called Change Your Smile (Quintessence Publishing Company).

Q. How Long Does A Bonding/Veneer last?
A. On the average, bonding lasts three to eight years. Porcelain laminate veneers lasts four to twelve years or more.

Q. Why Should I Spend A Lot Of Money On A Root Canal? Why Not Just Pull The Tooth?
A. Losing a tooth can be the beginning of many more lost teeth. Saving the tooth maintains space, keeps other teeth from shifting, and eliminates the need and cost of a bridge or implant and crown. Although seemingly expensive, it is actually quite cost effective.

Q. I Have So Many Dental Problems, Sometimes I Think I Should Just Pull Out All My Teeth
A. To be able to wear a denture comfortably requires sufficient retention. Bone is invariably lost when teeth are pulled and then continues to reabsorb and shrink back, resulting in poor–fitting loose dentures. These consistently require remaking and never function as natural teeth. Taste, speech and overall functions are severely compromised. Most times, if even the root can be saved, a good dentist can give a patient good functioning and esthetically pleasing, long–lasting teeth. Today, dental implants used to anchor a denture add stability and are an ideal choice for most denture patients.

Q. I Have A Space Between My Two Front Teeth. How Can It Be Closed?
A. There are several ways in which this can be corrected:

Orthodontics is the best way (multiple visits)
Bonding (one visit)
Porcelain laminate veneers (two visits)
Crowns (two visits)

Q. My Teeth Are Too Small, Can I Have Bigger Teeth?
A. Yes. it’s possible either with composite resin bonding, porcelain laminate veneers or full crowns if they break or are already broken. Have a consultation, which will include a diagnostic wax–up to see how you can look with long or perhaps wide teeth.

Q. My Eye Teeth Are Too Pointed. Help! I Look Like A Vampire!
A. Cosmetic contouring or reshaping your natural teeth would be the best possible procedure for this. It only takes one quick, painless appointment to improve your look.

Q. My Teeth Are Uneven, What Can I Do?
A. Cosmetic contouring, porcelain laminate veneers, orthodontics, bonding, or crowns can be used to correct this.

Q. I Was Hit In The Mouth And My Teeth Are Broken, Chipped, And Cracked. What Can I Do?
A. Translumination or an intraoral camera can be used to determine the extent of the cracks. Your possible choices to correct the problem would be:

  • Bonding
  • Porcelain laminate veneers
  • Porcelain crowns
Q. I Have Big Dark Silver Fillings . . . Can They Be Made Tooth-Coloured?
A. Yes. Possible tooth coloured replacement choices include:

  • Composite (plastic) resin
  • Porcelain inlay/onlay
  • Porcelain crowns
  • Amalgam fillings replaced with porcelain inlays.
Q. My teeth stick out in the front. Are braces my only option?
A. No. Many times a compromise can be suggested after a restorative dentistry consultation.

Possible options include:

  • Cosmetic contouring
  • Bonding
  • Porcelain laminate veneers
  • Crowns

Keep in mind that orthodontics is usually the best choice for these situations.

Q. My Teeth Don’t Show When I Smile.
A. Orthodontics is your best bet –– the teeth can usually be brought down enough to show. However, at times orthognathic surgery may be suggested as well.

Bonding or porcelain laminate veneers or full crowns are a possible compromise.

The soft tissue around the upper front teeth is inflamed because of ill-fitting crowns. These crowns were removed. Provisional crowns were fitted and gum treatment was done. The final crowns preserve the health of the soft tissue and give the patient a confident smile.