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Restorative Dentistry

Restorative dentistry also known as “Conservative Dentistry” is the branch of dentistry which is concerned with the conservation of teeth in the mouth. It embraces the practice of operative dentistry and endodontics, and includes various kinds of direct and indirect restorations of individual teeth in the mouth. Primary goal is prevention, diagnosis and treatment of sequelae of dental caries and the other defects of natural teeth; techniques and procedures to restore the teeth to full function and appearance in an aesthetically pleasing manner with as little loss of the healthy tooth structure as possible with periodic check up as routine practice.

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To treat a cavity your dentist will remove the decayed portion of the tooth and then “fill” the area on the tooth where the decayed material was removed. Fillings are also used to repair cracked or broken teeth and teeth that have been worn down from misuse (such as from nail-biting or tooth grinding).

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In restorative dentistry minimum of healthy tooth structure is removed during the restorative process, is inherently a desirable dental objective. Dental filling treatment is one of the main and commonly utilized treatments for maintaining the health of teeth. In this method a surgery is performed where most of the affected area is removed and it is filled with various dental quality fillings, which helps in arresting moreinfection. Root canal treatment is also a conservative treatment that is just as important as filling teeth. With its help teeth can be retained for a longer time. It is necessary if the decay is so deep that it reaches the pulp chamber. Direct veneers or ceramic veneers also help tooth conservation, but they are more frequent in aesthetic dentistry. This option is used for front teeth, where a thin porcelain plate is attached to the outside with an adhesive. With it the original colour of the tooth can be restored, differences can be corrected and the gaps between teeth concealed.

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01. Direct Dental Fillings

For Fillings , the dentist removes the decayed part of the tooth. Local anaesthetic is used of course. After this a special bonding agent is used, then the filling material is added. A light is shone on this to make it harden. This material is called tooth-coloured photo-polymerised composite. Their advantage is their perfect aesthetics; not only the tooth, its beauty is also preserved. This technique has replaced amalgam fillings that is still in use in many countries such as in Ireland. These photo-polymerised fillings have perfect marginal integrity and can be drilled to have lifelike grooves.

Usually, a filling will last anywhere from 7-20 years, although this depends on the location of the filling, the size, and your dental hygiene. To Help Fillings last longer, brush thoroughly at least twice a day with fluoride toothpaste, and floss daily.

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Steps Are Involved in Filling a Tooth

First, the dentist will use a local anesthetic to numb the area around the tooth to be filled. Next, a drill, air abrasion instrument, or laser will be used to remove the decayed area. Once the decay has been removed, the dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. After your dentist has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that “cures” or hardens each layer is applied. When the multilayering process is completed, the dentist will shape the composite material to the desired result.

What Types of Filling Materials Are Available?

Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic, ceramic, and materials called composite resin fillings. There is also a material that contains glass particles and is known as glass ionomer. This material is used in ways similar to the use of composite resin fillings.

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What Are Indirect Fillings?

Indirect fillings are similar to composite or tooth-colored fillings except they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when not enough tooth structure remains to support a filling but the tooth is not so severely damaged that it needs a crown.

There are two types of indirect fillings — inlays and onlays.

Inlays are similar to fillings but the entire work lies within the cusps (bumps) on the chewing surface of the tooth.
Onlays are more extensive than inlays, covering one or more cusps. Onlays are sometimes called partial crowns.

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Inlays and onlays are more durable and last much longer than traditional fillings — up to 30 years. They can be made of tooth-colored composite resin, porcelain, or gold. An onlay can be used to protect a weakened tooth because it can cover the top chewing surface and distribute the forces around the tooth like a crown.

Another type of inlay and onlay — direct inlays and onlays — follow similar processes and procedures as the indirect, but the direct is made in the mouth and can be placed in one visit. The type of inlay or onlay used depends on how much sound tooth structure remains and consideration of any cosmetic concerns.

What’s a Temporary Filling and Why Would I Need One?

Temporary fillings are used under the following circumstances:

For fillings that require more than one appointment — for example, before placement of gold fillings and for certain filling procedures (called indirect fillings) that use composite materials
Following a root canal
To allow a tooth’s nerve to “settle down” if the pulp became irritated
If emergency dental treatment is needed (such as to address a toothache)

Temporary fillings are just that, they are not meant to last. They usually fall out, fracture, or wear out within a month.

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02. Root canal treatment (Endodontics)

Root canal treatment is a dental intervention performed to save a tooth if the pulp, which is the innermost layer of the tooth, is irreversibly damaged. There are several dental conditions that require root canal treatment, such as extensive decay, trauma, gum disease, abrasion (loss of enamel due to mechanical forces), or erosion (loss of tooth structure due to acids), and your dentist will reveal the exact cause.

The intervention must be performed by an expert team, because later on teeth with root canal treatment can serve as anchors for tooth replacements, which is often the case in a dental surgery offering complex dental treatments. Root canal treatment at Suir Clinic is performed using modern pain control methods and high professional standards.

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Toothache and inflammation of the pulp

When the pulp of your tooth is inflamed, eating or drinking something hot or cold can make you feel a sudden, sharp pain that lasts for minutes. If the inflammation is widespread, the pain can occur without any external impact. For example, many patients report pain that wakes them up at night and it cannot be relieved with painkillers. On the other hand, if the pulp is dead due to permanent inflammation, you may not have any symptoms. When your tooth is dead, it cannot defend itself and the bacteria in the tooth increase and cause chronic inflammation that can spread to the tip of the root and the deeper tissues. Acute inflammation of the root tip (apex) can cause sensitivity or pain when you chew or bite, or it can even lead to an abscess, collection of pus around the tip. If left untreated, the abscess can cause severe complications. Chronic inflammation around the root tip usually remains unnoticed and is only revealed on routine X-rays. Dead teeth can result in a so called focal infection.

Oral focal infection

Oral focal infection is a chronic inflammation around the teeth which may not produce any symptoms in the mouth. These inflamed areas can release pathogens (germs) or toxins (poisonous substances) that can get into other organs. Teeth are not the only sources of such infections, which can spread from the tonsils, the sinuses, the ovaries, the gall bladder, the appendix or the prostate. Depending on the pathogen or the toxin and the target organ, the infection can cause other medical conditions, such as patchy hair falling, eczema, allergic skin rashes, eye infection, arthritis, vessel inflammation or kidney infection.

The steps of root canal treatment

Root canal treatment involves removal of the pulp, cleaning of the cavity using mechanical and chemical methods, and filling the cavity. The treatment usually requires more than one visits to the dentist.

Your dentist removes the pulp and the infected dentine (hard tooth material) and shapes the cavity so that it can be filled. The first step is numbing your tooth. Then your dentist opens your crown to make the pulp chamber and the entrance to the root canal visible and accessible. The shape and structure of the roots and the root canals vary widely, therefore it may be difficult to find and clean them properly.

The steps of root filling

The purpose of filling the root is to seal the pulp chamber and prevent the accumulation of bacteria. The shaped and cleaned canals are filled with a rubber-like material called gutta percha and a fine sealing paste that can be compacted into the tiny crevices. There are various filling techniques and materials.

An X-ray is taken to check if the canal is filled properly, then your dentist removes excess filling material from inside the crown. Finally, the crown is closed with a temporary filling, because it takes 2-3 days for the root filling to set.

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Restoration of teeth after root canal treatment

The key to successful root canal treatment is preparing a durable restoration that seals the crown and prevents the tooth from bacterial re-infection. It is also essential to strengthen the remaining tooth material, because after root canal treatment there is no circulation in the tooth, it becomes dry and brittle, and can eventually break.

There are various methods to restore the tooth depending on the extent of the damage, the location of the tooth in the dental arch, and the condition of the tooth on the opposite side.

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Endodontic retreatment: the last resort to save a tooth

Endodontic retreatment is repeating faulty root canal treatment. This is the last chance to treat a tooth before your dentist performs a surgical intervention to save or remove it. Retreatment usually involves replacing a faulty, ill-fitting or incomplete filling. What is an incomplete filling? The filling is considered incomplete if it is too short and does not reach the tip of the root, or it does not fill or seal the cavity.

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