AOH Services
Click on a Service below to learn more about it.
These are just a few of the many services we offer at AOH.
Crowns: An Overview
There are usually three reasons for the placement of crowns (caps) and bridges:
- * The first reason is that a tooth has been so badly damaged by decay or so heavily restored by fillings that it can only be saved with cast restoration.
- The second reason is that a tooth has been treated endodontically (root canal treatment). These teeth are almost always restored with a cast restoration because they have lost a great deal of tooth structure from fracture, decay, or the drilling process. These teeth are prone to fracture under normal and light chewing forces.
- The third reason a crown might need to be placed is that the tooth needs to be used as an abutment (anchor) for a bridge to replace missing teeth.
The procedure involves:
- * Preparing (drilling) the tooth in an appropriate fashion for the type of crown chosen.
- Making impressions of the prepared tooth, opposing teeth, and the occlusal (bite) relationships.
- Selecting a shade for tooth-colored crowns.
- Fabricating a provisional restoration that will remain in place while the crown is being constructed.
- Cementing or bonding the completed crown into position. If the work to be done is extensive, there may also be several appointments needed for preliminary seating (try-in) of the crowns or castings.
Crowns are made from many different types of materials. We have prepared written information describing the advantages and disadvantages of each. If you have not seen this information, please ask for it. If you have any known sensitivity to metals, please let us know prior to treatment. If you would prefer that no metals be used in the construction of the crowns, please let us know. We will discuss your options prior to preparation of the tooth (or teeth).
It is important for the ultimate success of the crown(s) that you understand and can perform thorough plaque removal. You should immediately begin following the oral self-care instructions that you have been given. It will make the procedure more comfortable and efficient, and the resulting restorations will look better. Final impressions cannot be taken until the gum tissue is healthy. Your cooperation is appreciated and necessary.
Maintaining Your Fixed Prosthetics
As is true with your natural teeth and especially with teeth that have been restored with any dental material, you should avoid chewing on excessively hard or sticky foods after the crowns have been cemented. It is especially important not to bite down on hard foods with just one tooth. The porcelain material can fracture from the metal substructure under extreme forces. Anything you chew that could break a natural tooth could break a crown!
Be sure to brush and floss daily as instructed. We also advise using a fluoride mouthrinse as part of your daily routine. Please be sure to return for your regular examinations and prophylaxis (cleaning) appointments at the time intervals we suggest.
After observing these types of procedures for many years, we note that the gingiva (gums) can recede from the crown margins and the surrounding tooth structure may become visible. This recession usually takes place over a period of several years and may require restoration replacements or a periodontal plastic surgery procedure to correct it.
We expect that you will receive many years of service from the cast restoration.
Porcelain and Resin Veneers: Bonding
When people speak of "bonding" their teeth to make them look better, they are usually referring to either porcelain or resin veneers. Veneers cover only the outside portion of the tooth, the part that shows when you smile or talk. In fact, all tooth-colored dental restorative materials are bonded, whether the restoration is in a front tooth or a back tooth. Strictly speaking, in dentistry, bonding refers only to adhesive joining of two dissimilar materials. Silver fillings can be bonded, as can crowns (caps).
Porcelain and resin veneers are placed in order to correct slight or severe defects in tooth alignment, shape, or color. They are also placed when teeth have been moderately restored and the teeth have been weakened. This is done when there is still enough enamel left for the bonding to be successful. If the teeth are in very poor alignment or there is insufficient enamel remaining, bonding to improve the appearance is not possible. At that point orthodontics or full-coverage crowns must be considered. The most common use for bonding veneers, either porcelain or resin, is to improve the cosmetic appearance of the patient.
Without question, porcelain veneers look the best and last the longest. They are indicated when the teeth are in fair to good alignment or when a more pleasing tooth color is desired. They are not usually placed in a patient under 16 years of age. The procedure usually requires some slight to moderate tooth preparation (drilling). Local anesthesia is usually necessary. The procedure requires two separate appointments, approximately 10 days apart to complete. This is because the veneers are constructed in an offsite laboratory. Once bonded into place, the porcelain veneers become very strong. The success rate is high, and they can last up to 12 or more years. Anything that will break your natural teeth can break the porcelain veneers, for example, hard candy or frozen candy bars. Veneers are highly stain resistant. They are a good treatment choice when all the front teeth are being restored. They are more expensive than resin veneers, but they last longer and look better than resin. Porcelain biting surfaces can cause more rapid wear of opposing natural teeth.
Resin veneers are also available. They are placed by the dentist in one office visit. Resin veneers are used in similar situations to porcelain veneers. However, they last only half as long before requiring repair or replacement. They are advised for patients who are still growing. They look very good but are not as good as porcelain. While repairs to the resin veneers are not too difficult, they have a tendency to chip more than porcelain veneers.
Basically, porcelain looks better, lasts longer, is stronger, more expensive, and requires two dental appointments to complete. Resin veneers are less expensive, easier to repair, and better for children, or if there are financial considerations.
It is very important to come in for regular recare appointments for cleaning and examination if either type of veneer is placed. This way, we will be better able to quickly correct any problems that develop. A 3- to 4-month interval between appointments is customary.
Bonded Resin Restorations: Tooth-colored Fillings
Tooth-colored restorations have been used in dentistry for a long time. Several variations of these materials have been used in front teeth for many years. The newest generation of tooth-colored filling materials (resins) is also used to restore cavities in back teeth. This is especially true when the restoration would be easily visible when you talk or smile. The use of silver amalgam filling materials in small- to medium-sized restorations is declining. These posterior (back) tooth-colored resins can be expected to last for several years. A reasonable estimate at this time is approximately 10 to 12 or more years. Longevity of the resin fillings (and silver fillings) is a function of the position and size of the filling, the care the patient gives it, and the foods the patient eats.
Resin restorations in back teeth require less drilling than for silver fillings. Because of the filling material itself and the insulating liners and bases used under these resins, there can be fluoride release and a subsequent inhibition of new cavity formation. They are excellent for small one-, two-, and three-surface restorations in premolars and molars. Advantages of the resin restorations include a natural appearance similar to that of your real tooth and the most conservative preparation of your tooth. The less the dentist must drill your tooth, the better off you are and the fewer dental problems you will develop in the future. They also restore a high percentage of the tooth's original strength. When a tooth is prepared (drilled), it becomes weaker. Restoring it with a bonded resin material will help make it strong again. They require only one appointment for completion.
Disadvantages include technique sensitivity, that is, they are harder to place than silver fillings. They also cost about 50% more than silver fillings. They can be used only rarely in patients who have a grinding or bruxing (clenching) habit. They cannot be easily used in areas where there is not a sufficient amount of original tooth structure. They require more time to finish.
Resin restorations are among the most conservative restorations in dentistry today. They require the least amount of drilling. The smaller any filling can be, the longer it will last. They are best for small to medium fillings. In areas where the display of metal from a silver filling would be unsightly, they are of great cosmetic importance.
Endodontic Therapy: An Overview of Root Canals
The pulp of your tooth, which contains the nerve and tiny blood vessels, can become infected. The pulp has a limited ability to heal itself. This infection can be caused by a deep cavity that reaches the center of the tooth causing the pulp to die, a traumatic injury to the tooth, or an extensive preparation (drilling) of the tooth. The extensive preparation may have been done to prepare the tooth for a crown (cap) or other large preparation for a restoration. The pulp may or may not abscess immediately in these cases. It may take years for a problem to develop. The infected pulp tissue may or may not be painful. It may or may not be visible on a dental radiograph. A tooth with this type of an abscess is not usually extracted because the infection can be treated with endodontic therapy on the tooth. This routine procedure can save the tooth and enable you to avoid the harmful effects of tooth loss. It is successful in more than 90% of the teeth in which the treatment is completed.
Endodontic treatment can take from one to three appointments to complete. Teeth can have one to four canals that need to be treated. An opening is created to access the nerve, and the abscessed nerve is removed from the root or roots. The canals where the nerves had been located are then cleaned and shaped and a medication may be placed in the canal to promote better healing.
When it has been determined that the canals are free of infection, they are filled with a special rubber-like material and sealed with a cementing medium. The abscessed area associated with the tooth will then begin to heal. It may take several months before healing is completed and for the tooth to become asymptomatic, that is, for any soreness in the area to disappear.
Once the endodontic therapy has been completed, the tooth is usually restored with a cast crown or onlay. This is done to protect the tooth and prevent it from fracturing. Failure to follow through with mandatory restorative procedures after endodontic therapy on a previously uncrowned tooth can result in a vertical fracture. If there is very little tooth structure remaining, we may also advise the use of a post and core to further help the tooth retain its final restoration. We will discuss with you the exact type of restoration that you will need.
Please note that this infection may cause discomfort between root canal appointments. This is normal and usually not a cause for any concern. Contact the office if there is pain and/or swelling. Remember to avoid biting down on the tooth until the root canal is completed and the final restoration has been placed. You may have had no discomfort from the tooth prior to the root canal treatment or have been unaware that you even had an abscess. However, you may experience pain or swelling after the root canal treatment has begun.
If we have prescribed antibiotics for the abscess, be sure to fill the prescription and take it until it is finished. It is important that you do this in order to quickly control the infection. If you do not take the prescribed medication, the resolution of the abscess may be delayed and problems with the postoperative pain are more likely.
If you have any questions about the root canal procedure or the final restoration of the tooth, please feel free to ask us.
Sedation Dentistry
To learn more about sedation dentistry, click Sedation Dentistry.