Crowns, bridges & dental implants

The choice of cosmetic dentistry treatments is wide and varied – from veneers and crowns to bridges, dental implants and teeth whitening. We look at some common methods for correcting slight or significant cosmetic dental issues.

Crowns

Crowns are used to restore and protect chipped, damaged or broken teeth. They are dental restorations placed in or over a tooth when conservative restorations such as bonding aren’t enough to restore form and function. A dental crown sits over the existing tooth and covers the outer surface, which is why it is also often referred to as a cap.

Inlays or onlays are like a partial crown, usually made of porcelain. An inlay usually replaces a filling while an onlay covers more tooth surface.

Crowns improve the appearance of teeth, restore tooth function and enhance oral health. They can be made of tooth-coloured material, metal or a combination. Some metal-free crowns incorporate stress-bearing materials to make them stronger and wear longer. All-porcelain or all-ceramic crowns are the most popular materials used in modern-day dentistry as they create a natural-looking aesthetic result and eliminate the dark line at the gum line often seen in metal-fused crowns.

All-porcelain crowns are similar to porcelain veneers, however more natural tooth structure is removed than with veneers, typically around 1.5 to 2mm in thickness all around the tooth. Additionally, while veneers cover only the front of the tooth, a crown usually covers the tooth in its entirety.

During the initial treatment session, the tooth is prepared for crowning by the dentist. This involves a thorough clean of the tooth, removal of any decay and reshaping it using a special dental drill for shaping teeth, typically under local anaesthetic. An impression of the tooth is then taken using a special dental putty and a replica of the mouth is created for the dental laboratory to make the restoration and custom-fabricate the new crown. A temporary restoration is fitted to protect and cover the prepared tooth.

At the second visit, the dentist removes the temporary restoration and roughens the outer surface of the prepared tooth with a special etching acid to give the dental cement a good surface to bond to. The dentist then sits the crown over the tooth to ensure it fits perfectly and that it meets the patient’s wishes. Once approved, the restoration is permanently secured with an adhesive bonding agent or dental cement.

The procedure is irreversible, however the longevity of results depends on how well the crown is cared for and maintained. In most cases, with a good oral hygiene program including regular brushing, flossing, check-ups and a tooth-friendly diet, dental crowns can last around 10 to 15 years.

Fixed dental bridges

Bridges are artificial teeth that cover the gap where a tooth is missing or a gap is present, anchoring to the two teeth on either side. They can be used for one or more missing teeth.

Dental bridges offer many advantages – they not only improve the appearance of the smile and even the shape of the face but also reduce strain on the teeth at either side of the missing tooth, prevent bite alterations and help prevent gum disease and tooth decay due to accumulation of food in the gap.

There are three main types of dental bridges. Arguably the most common type is the traditional fixed bridge, in which the artificial replacement tooth, known as a pontic, is attached to two crowns (abutments) or dental implants. The restorations are cemented on the teeth on either side of the missing tooth, which support the permanent bridge.

Another relatively new type of permanent bridge is the resin-bonded or Maryland type, which doesn’t require crowns on the teeth either side of the missing tooth. A ‘wing’ type retainer made of either metal or tooth-coloured material is bonded to the back of the supporting tooth, which is then attached to the replacement tooth. This type of bridge is more conservative as it involves less adjacent tooth structure removal. However, depending on the patient’s bite, it may not be as strong as a conventional bridge.

The other main dental bridge is the cantilever bridge. This type is typically used when there are teeth present on only one side of the space, where the pontic is attached to one or more adjacent teeth on one side. Cantilever bridges may also be used in areas such as the front teeth, which are susceptible to lower stress.

Similar to the placement of dental crowns, the procedure of fitting a bridge first involves shaping and trimming away the teeth on either side of the missing tooth. Following this preparation, an impression is taken of the teeth and sent to the laboratory technician to make the bridge and crown, during which time a temporary bridge is fitted for the patient to protect the prepared teeth and exposed gums. At the next appointment the custom-made bridge is placed in the patient’s mouth to check the fit before being permanently cemented.

Dental bridges offer a natural-looking solution to replacing a missing tooth or teeth and do not need to be removed from the mouth for cleaning. They can be made to resemble the existing colour variations in the patient’s teeth and control size, shape and texture, as well as mimic the feel and function of natural teeth.

Provided the patient practises proper dental hygiene, including regular dental visits and professional cleanings, a dental bridge can last around 10 to 15 years in most cases.

Dental implants

Dental implants are artificial tooth root replacements that are used as part of prosthetic (artificial replacement) dentistry to compensate for tooth loss. Often the result is not only an enhanced smile but also a more youthful appearance, since missing teeth cause the face to collapse, which can make a face look older.

Teeth can be lost because of tooth decay, root canal failure, gum disease (periodontitis), trauma to the mouth, excessive wear and tear, and congenital defects. People who have lost teeth might feel self-conscious when smiling or talking or can experience functional problems with eating.

Dental implants are stronger and more durable than their restorative counterparts (bridges or dentures). Implants may be used in conjunction with other procedures. For example, a single implant can serve to support a crown replacing a single missing tooth. Implants can also be used to support a dental bridge for the replacement of multiple missing teeth. Because implants can also help maintain bone, they can help prevent additional tooth loss and a sunken facial appearance.

Today’s implants are virtually indistinguishable from other teeth. Once the implant, usually made from titanium, is surgically placed in the bone, it takes around four to six months for it to become integrated into the jaw (a process called osseointegration). A ceramic porcelain tooth restoration is then matched to the original tooth colour and is attached to the implant. These feel more natural than conventional replacement bridges or dentures.

Usually implants can be placed with the patient awake, however anaesthesia can be used upon request. If necessary, pain medications can be prescribed.

Like natural teeth, implant restorations require regular daily oral care and professional dental hygiene appointments. Provided they are well cared for and the patient remains healthy, dental implants can last indefinitely.

Fillings

White fillings are for people with smaller gaps, chipped teeth or to fill the edge of a tooth. They are made of a composite of resin and glass particles, cemented onto the existing tooth using a bonding agent. One appointment is required and, while they are less resilient than veneers, results can be long lasting if properly cared for.

Chipped, broken, discoloured or decayed teeth may be repaired or have their appearance corrected using a procedure called composite bonding. A dental composite material with the look of enamel is applied into the cavity or onto the surface of a tooth, where it is then sculpted into shape, contoured and hardened with a high-intensity light.

The result is a restoration that blends invisibly with the remainder of the surrounding tooth structure and the rest of the natural teeth.

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