Dental restoration is a series of restoration procedures aimed at restoring the initial state of the dentition. There are quite a few ways today and everyone can choose the one that suits them in terms of quality and price. The term dental restoration in dentistry is the restoration of the anatomical shape of a tooth, its color and preservation of its functionality. The choice of method is made by the dentist. He conducts a preliminary examination and takes into account the destruction zone, bite, integrity of the dental tissue, the presence of allergies and other features. Without preliminary treatment of caries or removal of other destructive consequences, restoration will not be carried out by anyone.
The main types
The main division comes from where the work is done - in the oral cavity or outside it. It is quite arbitrary today, because there are no clear boundaries, many methods pass into each other. But the goal of any method remains the same - to eliminate the shortcomings of the dentition. The main slogan of restoration is to achieve maximum naturalness according to the natural shade of enamel and the shape of the tooth. Photos before and after restoration will be presented below.
Direct method
A direct method of tooth restoration is what used to be called filling. All work is done in the oral cavity. A restored tooth is no different from a healthy one. Removing part of the restoration is impossible even by the dentist.
Indirect method
An indirect method of tooth restoration is restoration by cast. The work is performed by an orthopedic dentist. A cast is made identical to the same tooth from the healthy side of the jaw. If this is not possible, virtual modeling of the dentition comes to the rescue. At the same time, the destroyed parts are, as it were, “finished” - a 3D model is obtained.
With an indirect method, the patient spends much less time in the dental chair. Tabs for the oral cavity are made in the laboratory. Reconditioned parts are easily removed in the clinic without much damage.
What materials are used?
When choosing materials for restoration, 4 signs are taken into account:
- consistency;
- hardening method;
- appointment;
- dimensions of the filler.
Recovery may concern the anterior and posterior teeth, and the methods are different. For frontal ones, the direct method uses light-curing composites and an amalgam.
With indirect tooth restoration, there is more choice: they can be reflective polymers, ceramics, zirconium, alumina, cermets. Crowns can be made traditionally from gold, or from the now popular ceramics.
Contraindications for restoration
Contraindications to tooth restoration are:
- the presence of allergies to composite material or adhesives for it;
- the impossibility of isolating the tooth and its cavity from moisture;
- increased abrasion of teeth in combination with a direct bite;
- bruxism;
- the severity of the incisal overlap;
- lack of oral hygiene.
Service life of used materials for restoration
No dentist will name the exact date of preservation of the restoration, since all this is individual. Hygiene, the presence of bad habits, diet, etc. play a role. And also, the duration depends on the qualifications of the dentist.
Restoration Classes
According to the degree of destruction, 3 conditional classes of tooth restoration can be distinguished. They are also called approaches:
- 1 class. It is used for caries fissures, which happens quite often. The problem is unpredictable because, at the start of treatment, the extent of the lesion is often much deeper than expected. The chewing surface is not broken. Restoration is carried out by the occlusal key method. This is a preparation from the chewing surface of the impression, which is subsequently squeezed into the desired portion of the composite to get the original shape of the tooth. For the manufacture of the key used bite-silicones. They are quite hard, and all the smallest details of the chewing surface are imprinted very accurately.
- 2 class of destruction and restoration. We are talking about deep cavities and untenable fillings. The main feature of the 2nd class is the destruction of up to 50% of the chewing surface, but the preservation of the basic outlines of the tubercles, ridges, part of the ridges, etc. Therefore, the dentist can quite easily recreate the external contours, and get a very accurate copy of the chewing surface. Work is carried out by the method of layer-by-layer restoration.
- Restoration of the 3rd class of destruction. This category includes large-scale defects, any pathology with absent hard tissues. If the destruction of the crown is more than 50% of the volume, the method will be used indirectly. The class is problematic, because the doctor has few guidelines. It is impossible to find the necessary tooth shapes, and to understand the correct spatial position of the components. In the dental laboratory, preliminary waxing is done using a properly configured articulator. The doctor reproduces the tooth morphology at his discretion, and then checks the compliance of the occlusion, and removes the excess with boron.
Composite restoration
Composite restoration is a filling of the external side of a tooth with a special composition (photopolymer in several layers). The procedure is progressive, takes 1 visit, in time - 30-60 minutes. For its carrying out, no turning and preparation is needed.
The composite method resembles the installation of veneers, because the filling is also superimposed on only 1 side of the tooth. However, enamel is not affected by this method. Only 2 grooves are drilled on the tooth surface as boundaries for the polymer. Then a special composition is applied to degrease the enamel and destroy microbes.
The final stage is the layering of a photopolymer. Each layer is dried with a special lamp. The number of layers is chosen by the dentist according to the condition of the tooth.
Photos before and after tooth restoration in this way are presented below. There is almost no pain during the procedure, but local anesthesia is still performed. Composite restoration can be used in the presence of chips, cracks, crevices, spots on the enamel. Use only on the front teeth.
Other names for composite restoration are artistic or aesthetic, because the whole process is quite creative.
Composite Method Details
Aesthetic restoration of teeth with light-curing material is carried out in such a way that the remaining part and the polymer are completely merged into one whole due to interdiffusion. A great advantage of composite materials is that they can withstand the load when chewing due to their ductility.
Another plus is the ability to fully complete the restoration in one visit, without casts and creating crowns. This allows you to reduce the cost of treatment. Even if part of the seal has fallen off, it can be restored in an hour. In addition, the composite material does not grind the tissue of antagonist teeth.
Disadvantages of the composites method
There are certain disadvantages of the direct tooth restoration method with composites. Firstly, such seals give some shrinkage. For each material it is individual. Secondly, composites are inferior in color fastness to other materials, for example, ceramics or veneers.
Thirdly, it often happens that the material against the walls of the cavity of the tooth does not fit tight enough over time, because of which there may be a relapse of caries. Fourth, composite materials are very sensitive to moisture, which adversely affects their proper polymerization, and the seal may fall out.
Composites darken over time. According to research, within 5 years, 15% of such fillings require cosmetic "repair" or polishing to varying degrees.
Modern filling materials for tooth restoration allow you to restore lost structures without involving healthy tissues. The dentist chooses the method and materials, it depends on his knowledge, experience.
Pros and cons of direct restoration
Advantages of direct restoration of teeth:
- speed of work (1-3 hours);
- high quality and affordable cost;
- in one visit, you can restore several teeth;
- a large defect from destruction can be eliminated.
Disadvantages:
- with the correct technology and quality of execution, the period does not exceed 10-15 years;
- success depends on the professionalism of the dentist;
- after restoration, hygiene procedures require special care - the use of high-quality pastes and brushes;
- periodically they need to be polished;
- over time, the color of any teeth changes, but there are no polymers, so the difference becomes noticeable.
The main stages of restoration
Composite tooth restoration includes the following steps:
- Preparation for restoration - complete brushing of teeth from stone and plaque. Determination by a special color scale, and selection of the corresponding shade of the composite seal.
- Conducting local anesthesia.
- Drilling cavities affected by caries.
- Isolation of the tooth from wet breathing and saliva, during which the rubber dam is used.
- If the crown is destroyed by more than 50%, the tooth is depulped, a pin must be placed. This enhances the strength of the seal fixation during loading.
- The shape of the tooth must be fully restored to make it look natural. In this case, the technique of layered restoration is used. Layers vary in color and transparency, but together they must merge into a natural design.
- Finishing the tooth. This procedure includes final modeling with boron, grinding and polishing of the seal.
Tabs
This is a way to restore chewing teeth, their internal parts. It is an alternative to pins. Tabs are temporary and permanent. In the latter case, they are made of metal or ceramic. Sometimes a tab can fill in the missing part. But it should replace no more than half the surface of the tooth.
Despite the fact that the tabs relate to the direct restoration of teeth, a cast is required for their manufacture and installation. According to the size of the destruction, they will be different. The basis for the crown becomes the stump tab. For this type of restoration, you need several visits to the doctor. On the first visit, the nerve is removed, then “hollow” and the canals are filled. And only then, with a clean tooth, a cast is taken.
During the second visit, the temporary tab is removed and the installation of a permanent seal begins. It is fixed on a special composition.
It is impossible to notice a sealed tooth if the seal is not made of metal. In terms of reliability, the service life of the tabs is superior to restoration, and if it is made of ceramics, it will surpass the artistic restoration.
Pins
The pins are used for severe destruction. Even if only a stump remained on the gum instead of a tooth, a similar design will restore it. The pin itself resembles a metal pin that is inserted into the root canal. Its upper part, protruding above the gum, becomes the basis for the restored tooth.
For incisors and fangs, 1 pin is required, for molars - 2. The installation of such structures is a preparatory stage for the formation of a base for the crown. Damaged tooth for the pin is not removed. It is only cleaned as much as possible, the channels are drilled, and a fixing solution is poured into them under the seal, into which the rod is inserted.
After the solution has dried, the missing part of the tooth is extended onto the pin. The downside of this method is the risk of a split, the metal base is not too reliable.
Crown
A crown is a type of prosthesis, similar to a cover that is worn on a sharpened, affected tooth or pin. To install it requires 3-5 visits to the dentist. The crown is made using a cast or virtual model. Therefore, it very accurately repeats the shape of a healthy tooth. A similar recovery method is indicated for large lesions, and when other methods are not suitable.
Even if the tooth is damaged by more than 70%, it can be restored with a crown. Most in demand are similar structures made of ceramics and cermets. They have a natural color and high strength.
The establishment of a crown does not require the removal of a diseased tooth, but treatment and cleaning of the canals are mandatory procedures. After that, an individual cast is made. To crown the tooth grind to a minimum size. And he becomes like a short, thin stump. If there is no native tooth, a pin is placed.
Initially, a temporary plastic crown is placed because the creation of a permanent mold design takes time. The structures made of zirconium dioxide last longer than the rest (more than 20 years). Therefore, this material is most often recommended by dentists for tooth restoration with a crown.
Alternative methods for restoration of the anterior teeth
Veneers or lumineers are an alternative to fillings. In fact, this is one and the same thing: a thin ceramic plate mounted on a tooth. They differ only in their thickness. Depilation is not needed here.
When installing veneers and lumineers, a minimal turning of the teeth is carried out, but still the enamel is almost completely erased, to the depth of the size of the structure. This is necessary for the evenness of the row. Veneers make the tooth lighter by 2-3 tones, and they are recommended to be installed if it is impossible to apply whitening. In addition, thanks to such designs, you can create the perfect smile, even if the patient has the wrong bite, there are chips or cracks, or, in general, several teeth are missing.
Monolithic veneers are much stronger in strength than any seal. For this reason, they are durable. The most popular ones are ceramic, since they are most densely bound to the surface of the teeth. By all their properties, they are as close as possible to natural enamel. The shape accuracy of veneers is up to 1 micron.
Lumineers are thinner and lighter. When installing them, enamel turning is not needed. The structures are attached to the fixing gel, where fluorine enters. Therefore, the installation of lumineers is also useful for teeth. The gel is faster fixed under the lamp.
Veneers and lumineers are almost the most expensive structures that are made on special equipment. Another problem is that, being a solid material, they quickly disable this equipment. Therefore, the price of the design also includes the cost of repairing and replacing it.
Veneers and lumineers order a full range. A complete installation of such structures can be completed in 2-3 visits to the doctor. Veneers work up to 10 years, lumineers serve even longer - up to 20 years.