ADVANCED PROCEDURES

CROWNS 
Tooth restoration for brittle or broken teeth can be achiveved with a crown.  When a large filling wears out or a tooth has had a root canal, crowns may be necessary.  If severe decay creates a large hole then a crown may be necessary as well.  Teeth are subjected to tremendous pressures and a crown will restore strength while protecting the tooth against breakage which can be difficult to treat.  Two appointments are necessary to restore a tooth with a crown.  In the first appointment any decay is removed from the tooth and it is shaped to accept the crown.  Then an impression is made of the tooth for use in fabricating a crown.  Between the two visits the crown is made, usually of high-strength porcelain over gold alloy, all ceramic material, or gold.  During this time a temperary crown is worn.  At the second visit the temporary is removed.  A permanent crown  is then put into place and adjusted as needed.  It is then cemented into place.   

DENTURES

When teeth become loose or are lost due to bone loss, detunres may be required.  There are several types of dentures, but they all share a common function.  Upon examination, a determination is made as to which teeth will have to be removed and which ones will remian.  Loose teeth are extracted.  Dentures are then fitted to go over or around whatever teeth remain in the mouth.  There is an adjustment period after dentures are placed in the mouth.  Once a patient becomes accustomed to the dentures, all the normal functionality and appearance return.  Implants are often used to further stabilze the dentures. 

IMPLANTS
A dental implant is an option to replace a missing tooth. In this procedure, a small titanium shaft is surgically implanted into the bone and allowed to set. The bone grows around it forming a tight connection.  This also slows or stops the bone loss that occurs when the root of a natural tooth is missing. Once the implant is firmly set in the mouth, the dentist then works to attach the replacement tooth onto the top of the shaft. This permanent solution has the advantages over bridge work because it does not stress the surrounding teeth for support.  Should the tooth wear out, another can simply be replaced on the shaft.

Implants can also be used as support as part of an implant bridge. This is an alternative to partial dentures, and has several advantages. First, there is no adjustment period for the patient.   Once the work is complete the patient will feel teeth with no metal supports intruding into the mouth.  This process also slows the bone loss occassioned by missing teeth.  Finally, implants are permanent and provide no discomfort, or difficulty while eating.  

ROOT CANAL TREATMENT
Root canal treatment (also referred to as root canal therapy or endodontic therapy) is made necessary when a cavity is allowed, through neglect, to reach all the way to this pulp. (Regular cleanings and checkups prevent and detect problems early) Sometimes deep restorations or trauma to a tooth may cause the nerve to be damaged to the point it needs root canal therapy, also. Once this occurs the pulp becomes infected, and can even extend through the root tip and begin to eat away at the surrounding bone (this is an abscess). By the time the pulp is infected it must be treated, and cannot heal on its own. It can even weaken the entire immune system. This is dangerous, not to mention very painful. Symptoms that the pulp has become infected may include sensitivity to hot/cold or sweets, pain, swelling, pain to biting or pressure, and a bad taste in the mouth. Sometimes, however, no symptoms are apparent and the person is unaware of any problem until a checkup.

A root canal is then performed to clean out the infected tooth pulp, and disinfect the canals of the tooth. The only other treatment would be to extract the tooth. Once the infection is resolved, the canal(s) are filled in to prevent any further infection. Usually a core build-up and crown is recommended for restoring a tooth that has had root canal therapy.

BRIDGES
This is an option for filling the space created by a missing tooth. It is formed to look like the missing tooth, and it takes its place in the mouth. The sides of a bridge use the two surrounding teeth for support, hence the name. A bridge replaces the missing tooth, both functionally and cosmetically. Bridge work is as much an art as it is an exact science. The materials used may be gold alloys, porcelain bonded to metal alloy, or all ceramic material. The choice of material depends on requirements for strength, wear, and/or esthetics.

It is important that a missing tooth be replaced as soon as possible for several reasons. If not treated the teeth surrounding the gap begin to shift inward, creating a whole chain reaction of bad things. Teeth use their neighbors for support, and, with one missing, they start to "fall." As this worsens the bite changes in response to the pressure. This can eventually result in problems with the entire jaw, e.g. TMJ. The surrounding teeth deteriorate and it is just a matter of time before they, too, are lost. Gum disease becomes a serious problem, with the difficulty of treatment increasing as the neglect continues.