Dental Bridges

A bridge, also known as a fixed partial denture, is a dental restoration used to replace a missing tooth by joining permanently to adjacent teeth or dental implants.

There are different types of bridges, depending on how they are fabricated and the way they anchor to the adjacent teeth. Conventionally, bridges are made using the indirect method of restoration however, bridges can be fabricated directly in the mouth using such materials as composite resin.

A bridge is fabricated by reducing the teeth on either side of the missing tooth or teeth by a preparation pattern determined by the location of the teeth and by the material from which the bridge is fabricated. In other words, the abutment teeth are reduced in size to accommodate the material to be used to restore the size and shape of the original teeth in a correct alignment and contact with the opposing teeth.

The materials used for the bridges include gold, porcelain fused to metal, or in the correct situation porcelain alone. The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. The recipient of such a bridge must be careful to clean well under this prosthesis.

When restoring an edentulous space with a fixed partial denture that will crown the teeth adjacent to the space and bridge the gap with a pontic, or "dummy tooth", the restoration is referred to as a bridge. Besides all of the preceding information that concerns single-unit crowns, bridges possess a few additional considerations when it comes to case selection and treatment planning, tooth preparation and restoration fabrication.

Dental Cleaning

Careful and frequent brushing with a toothbrush helps to prevent build-up of plaque bacteria on the teeth. These bacteria metabolize carbohydrates in our meals or snacks and excrete acid which demineralizes tooth enamel, eventually leading to tooth decay and toothache if acid episodes are frequent or are not prevented. Calculus (dental) or tartar buildup on teeth usually opposite salivary ducts is because of calcium deposits in resident plaque. Frequent brushing and swishing saliva around helps prevent these deposits.

Regular teeth cleaning (Prophylaxis) by a dental hygienist is recommended to remove tartar (mineralized plaque) that may develop even with careful brushing and flossing, especially in areas that are difficult for a patient to reach on his own at home. Professional cleaning includes tooth scaling and tooth polishing and debridement if too much tartar has accumulated. This involves the use of various instruments or devices to loosen and remove deposits from the teeth.

Most dental hygienists recommend having the teeth professionally cleaned at least once every 12 to 24 months. More frequent cleaning and examination may be necessary during the treatment of many of the dental/oral disorders. Routine examination of the teeth is recommended at least every year. This may include yearly, select dental X-rays.

However, in between cleanings by a dental hygienist, good oral hygiene is essential for preventing cavities, tartar build-up, and gum disease.

Dental Crowns

A crown is a type of dental restoration which completely caps or encircles a tooth or dental implant and is typically bonded to the tooth using a dental cement. Crowns can be made from many materials, which are usually fabricated using indirect methods. Crowns are often used to improve the strength or appearance of teeth.

The most common method of crowning a tooth involves using a dental impression of a prepared tooth by a dentist to fabricate the crown outside of the mouth. The crown can then be inserted at a subsequent dental appointment. Using this indirect method of tooth restoration allows use of strong restorative materials requiring time consuming fabrication methods requiring intense heat, such as casting metal or firing porcelain which would not be possible to complete inside the mouth.

Dental Partials

A removable partial denture (RPD) is for a dental patient who desires to have replacement teeth for functional or aesthetic reasons, and who cannot have a bridge (a fixed partial denture) for any number of reasons, such as a lack of required teeth to serve as support for a bridge (i.e. distal abutments) or due to financial limitations.

The reason why this type of prosthesis is referred to as a removable partial denture is because patients can remove and reinsert them when required without professional help. Conversely, a "fixed" prosthesis can and should be removed only by a dental professional.

Dental Sealants

Since the 1970s, in the United States, the incidence of tooth decay on the smooth surfaces of teeth has declined, in part because of fluoridation becoming widespread in public water supplies as well as improved dental hygiene among the public. However, because the teeth in the back of the mouth (molars and premolars) have numerous pits and fissures on their biting surfaces, certain areas of these teeth are often difficult to clean even with vigorous tooth-brushing. To remedy this, research into dental sealants began in the 1960s and by the early 1970s, the first generation of sealants became available and were approved by the FDA.

Sealants painted over pits and fissures in the chewing surfaces of back tooth block food from being trapped and any carbohydrate like sugar being changed to acid by resident plaque bacteria and halts demineralisation and the caries process.

The dentist, dental hygienist or assistant first cleans and dries the tooth to be treated, then paints a thin layer of liquid plastic material on the pits and fissures of the tooth. After application of the plastic liquid, blue spectrum natural light is shone on the applied material for a few seconds to cure the plastic. Alternatively, some brands of sealants self-cure via a chemical process.

After curing, the plastic becomes a hard, thin layer covering the treated portions of the tooth. Despite the incredible pressures effected on teeth during chewing each day, dental sealants may remain effective for five years or longer, although sealants do wear naturally and may become damaged over time. Bacteria and food particles may eventually become entrapped under the dental sealants, and can thus cause decay in the very teeth intended to be protected.

Gum Treatments

Periodontitis is a set of inflammatory diseases affecting the periodontium — that is, the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth. Periodontitis is caused by microorganisms that adhere to and grow on the tooth's surfaces, along with an overly aggressive immune response against these microorganism. A diagnosis of periodontitis is established by inspecting the soft gum tissues around the teeth with a probe and by evaluating the patient's x-ray films, to determine the amount of bone loss around the teeth.

Removal of microbic plaque and calculus is necessary to establish periodontal health. The first step in the treatment of periodontitis involves non-surgical cleaning below the gumline with a procedure called scaling and debridement. In the past, Root Planing was used (removal of cemental layer as well as calculus). This procedure involves use of specialized curettes to mechanically remove plaque and calculus from below the gumline, and may require multiple visits and local anesthesia to adequately complete. In addition to initial scaling and root planing, it may also be necessary to adjust the occlusion (bite) to prevent excessive force on teeth that have reduced bone support.

Teeth Bonding

Adhesive dentistry is a branch of dentistry which mainly deals with adhesion or bonding of the adhesive material or cements to the natural substance of teeth, enamel and dentin.

Dental bonding is a dental procedure in which a dentist applies a tooth-colored resin material (a durable plastic material) and hardens it with a special light. This ultimately "bonds" the material to the tooth and improves the overall appearance of teeth. Tooth bonding techniques have various clinical applications including operative dentistry and preventive dentistry as well as esthetic and pediatric dentistry, prosthodontics, and orthodontics.

As a modern science, adhesive dentistry studies the nature and strength of the adhesion to dental hard tissues, properties of adhesive materials, causes and mechanisms of failure of the bonds, clinical techniques for bonding and newer applications for bonding such as bonding to the soft tissue. There's also direct composite bonding which uses tooth-colored direct dental composites to repair various tooth damages such as cracks or gaps.

Tooth Fillings

A dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries (cavities) or external trauma. It is also lost intentionally during tooth preparation to improve the aesthetics or the physical integrity of the intended restorative material.

Various materials can be used for your fillings. The example to the right is a commonly used amalgam filling. We prefer to use tooth colored or "composite fillings" since they look more natural.