Services

Bonding

New hope for broken teeth

By permitting what is left of the natural tooth to remain intact, bonding has revolutionized the process of repairing broken teeth. In the past, chipping a tooth meant replacing it with a crown, unless the chip was small enough to be cosmetically contoured. Now a new tooth can be formed by simply applying moldable plastic to the remaining structure. This will build the tooth back to its original shape and can even be used to make it better than it was.

Bonding is by far the most desirable technique to use when the tooth can be rebuilt without harming the smileline, but it does have drawbacks. Although it can be done in a dentist's office usually in no more than an hour per tooth, it has to be repeated often during the life of the tooth. The plastics used in bonding stain and wear. Still, it is a marvelous material because it is inexpensive and can actually improve the shape of your tooth.

Bonding can also be used as a stop-gap measure. By immediately sealing off exposed nerve endings with a sedative dressing followed by bonding material, the nerve system has a better chance of survival. This technique should be used instead of crowning whenever possible, particularly for young people who fracture front teeth. Another reason for bonding when possible is that improved, stronger materials are likely to be available in the dental market in years to come. If the tooth is still intact, these new materials will be even stronger, longer lasting, and more stain resistant. On the other hand, once your tooth is reduced for a crown, it is gone for good.

Bonding is generally used on front teeth, but it can also chip when the underlying fracture is located in a high bite-pressure position. In this case, a metal post can be built into the tooth first, and the tooth can be bonded around it to ensure more strength. It does, however, raise the possibility that the metal will show through shallow bonding. If the tooth is this weak or has so little enamel left, crowning may be the better solution. Fractures in porcelain crowns may also be repaired with bonding, usually as a temporary solution. Gold acrylic veneers that show at the gum lines can also be repaired with bonding to avoid cracking and improve the look of the tooth. However, most fractured porcelain or acrylic veneer crowns will look better if they are remade.

Bonding is by far the most desirable technique to use when the tooth can be rebuilt without harming the smileline.Problem

Fractured and worn acrylic facings.
Plastic veneer crowns can fracture, too, as this 25-year-old male shows. The previous acrylic-bonded-to-gold crowns lasted for many years before they began to stain, wear, and finally break off.

Solution

Platinum bonded porcelain crowns.
The two new crowns were made with porcelain bonded to a very thin layer of platinum foil. Cosmetic contouring was performed on the upper and lower teeth to help improve the entire smile.

 

Cosmetic Contouring - Ideal for Minor Damage

Cosmetic contouring is the most ideal treatment for small fractures and chips because it does not require anesthesia and the amount of tooth reduction involved is minimal - just enough to smooth out the rough edges. Once the treatment is done, that's it; no replacements or touch-ups are necessary. The cost and time involved are minimal too.

In considering the appearance of your smile, there comes a point at which you may not want to have a tooth contoured even if it appears, on the surface, to be the simplest and best form of treatment.

Contouring can change the smileline if a tooth is shortened and its neighbors are brought down to match. Since the natural process of aging flattens the smileline, the result may be that you look older. If a tooth shortened by contouring would change your smileline, then it's better to bond, even if you're only dealing with a slight chip. Why add years to your smile unnecessarily?

Contouring can change the smileline if a tooth is shortened and its neighbors are brought down to match.Problem

Horizontal fracture
This 18-year-old model horizontally fractured her left central incisor. The decision of whether to shorten the adjacent tooth through cosmetic contouring, or to bond the fractured tooth is always an appropriate question.

Solution

Composite Resin Bonding
Shortening the longer tooth would have meant changing the smileline and giving her an older look, so composite resin bonding was chosen to repair and lengthen the right front tooth.

Treatment Summary

Cosmetic Contouring
  1. Treatment Time
  2. Patient Maintenance
  3. Results of Treatment
  4. Average Range of Life Expectancy
  5. Cost
  1. Fifteen to Thirty Minutes
  2. Normal Cleaning
  3. Immediate Results
  4. Indefinite
  5. $50 to $200
Advantages Disadvantages
  1. 1. No anesthesia is required
  2. 2. Permanent solution
  3. 3. No maintenance
  4. 4. Most conservative
  5. 5. Quickest solution
  1. 1. Too much reduction can alter the appearance of the smileline and may be unattractive
  2. 2. Bite may limit how much of the tooth can be taken away
  3. 3. In rare instances, sensitivity may be a problem

Pins Versus Posts for Support of Restored Fractures

Fractures often leave teeth weak and in need of underpinnings for support. Pins and posts can be placed in the tooth to give added support and create a core around which to build a restoration. However, each is used in different circumstances and for different purposes.

Pins are used to add retention for filling materials mainly in the back teeth. They are cemented, tapped, or screwed into place to add support where there is no nerve removal necessary. However, they are not usually used with composite resins. They generally cost between $10 and $30 per pin.

Posts are used in instances when the tooth's nerve has been removed. They are not always necessary. Using them depends on how much chewing force will be exerted on the bite and how much tooth structure is left. This is a cost in addition to the restoration and ranges from $50 to $250 per tooth.

Pins are used to add retention for filling materials mainly in the back teeth.Problem

Two fractured incisors.
This 19-year-old student fractured her two upper left teeth to such a great extent that the nerves in both teeth had to be removed to save the teeth.

Solution

Porcelain crowns.
Cast metal posts were then constructed to strengthen and help prevent future fractures of these teeth. Following insertion of these two gold posts, two full porcelain crowns were made on the two fractured teeth. Note how form, texture, and highlights are used to match the corresponding teeth in the arch to create a natural appearance.

Chances are that you're considering having a crown, a number of crowns, or a permanent bridge designed. To assure the most esthetic and functional results possible, your cooperation and understanding are especially important to us. We'll take you step-by-step through crown and bridge treatment. We encourage you to ask questions along the way.


 

Why replace missing teeth?

Losing a tooth can be of social and psychological concern. Teeth are lost for a number of reasons, including

  • Dental decay
  • Periodontal (gum) disease
  • Trauma (injury or accident)

Losing a tooth can be of social and psychological concern.When a permanent tooth is lost, the neighboring teeth are affected. Because the support and chewing forces are altered, the remaining teeth will begin to shift. The tooth above or below the one that was lost will begin to move up and out of its socket. This accelerates periodontal (gum) disease and causes further breakdown in the dental arch. If the missing tooth is not replaced, more teeth will eventually be lost because of improper forces exerted during chewing.

What is crown and bridge treatment?

Crown and bridge treatment is a permanent method of replacing missing teeth. A crown is placed on an individual tooth (somewhat like a thimble over your finger), where there is no longer sufficient tooth structure left to place a filling.

A bridge spans a space where one or more teeth have been lost in the dental arch. The teeth on either end of the span are crowned and are referred to as abutments. The false teeth in a bridge that join the abutments are referred to as pontics.

Crowns and bridges are most often made from superior materials such as precious metals (gold), semiprecious metals, porcelain, or a combination of metal fused to porcelain. Both esthetics (appearance) and function are considered when selecting the material most suitable for you.

How is treatment performed?

At the first appointment, a thorough oral examination, an evaluation of your dental history, and necessary X-rays are completed. The diagnosis is based on these three factors. Once it has been determined that crown and bridge treatment is indicated, you will be set up with a series of appointments. Note: It's important that you keep all of these appointments. You see, your treatment occurs in a planned sequence. Missing or postponing your appointment may cause treatment delays, allowing further tooth movement before treatment can be completed.

What will happen?

Modern impression materials make it possible to take an extremely accurate record (impression) and thus make the best possible restoration for your mouth.The tooth or teeth to be treated are numbed with an anesthetic. Sometimes you can expect the side of your face to feel numb, as well. Next, during the preparation phase, your tooth or teeth to be crowned are trimmed down. This allows sufficient space for the crown or bridge to fit.

After this preparation stage has been completed, an impression of that area of your mouth is taken. Modern impression materials make it possible to take an extremely accurate record (impression) and thus make the best possible restoration for your mouth.

 

At the following appointment, the crown or bridge is adjusted for proper fit prior to permanent placement. It is often necessary to fine trim and polish the new crown or bridge. Other factors we consider include

  • Esthetics - color match and appearance
  • Function - chewing and biting accuracy
  • Tissue compatibility - the contour of the prosthesis must allow the surrounding issue to conform to
    a natural, healthy position

Replacing missing teeth

  • Helps restore and maintain the natural bite
  • Prevents unnatural stress on other teeth
  • Helps keep opposing teeth in their proper place
  • Prevents shifting and tilting of adjacent teeth
  • Helps prevent further dental decay and periodontal (gum) disease
  • Maximizes your smile, speech, and chewing function

A final word

Throughout your crown and bridge treatment, you may have questions or concerns not covered in this pamphlet. We will make every effort to ensure your comfort during crown and bridge treatment. And we're happy to answer any questions you may have. Our concern is your comfort and confidence. Our goal is to help preserve your smile for a lifetime.