Restoration is a term used in dentistry to describe the restoration of a missing or damaged tooth structure. Restorations are classified as either direct or indirect. Direct restorations are repairs made inside the mouth (fillings), while indirect restorations are shaped outside the mouth and then placed either on the tooth or on the supporting tooth structure in a separate procedure (examples include veneers and crowns). What is right for you depends on the issue at hand, but your personal preferences may also play a role in your decision making.
Immediate Restoration
With immediate dental restoration, all the work is made and completed inside the mouth. The process, commonly referred to as filling, involves placing a malleable substance into a prepared and cleaned cavity. The material is then hardened to restore the structure (and sometimes the appearance) of the damaged tooth.
Fillings are one of the most conservative ways to repair a tooth and often the least invasive. There are three materials,it is usually used for:
- Silver amalgam is a compound consisting of 50% mercury and 50% silver, tin, zinc and copper. Advantages of silver amalgam include low cost, easy installation, and excellent strength and durability. On the downside, it is not aesthetically pleasing and is prone to expansion and contraction. This can cause a tooth to crack or allow food and bacteria to become trapped and promote tooth decay. The use of mercury also remains controversial.,,
On September 24, 2020, the Food and Drug Administration published a recommendation against giving mercury fillings to certain high-risk individuals whenever possible and appropriate—specifically:
- Women who are pregnant or planning to become pregnant
- Breastfeeding women
- Children under 6
- People with certain pre-existing neurological conditions, reduced kidney function or known allergies to mercury
These individuals should receive alternatives such as composite resins or glass ionomer cement fillings. Removing existing mercury fillings is not recommended as doing so will increase the risk of exposure to the metal.
- Composite fillings, made from synthetic resins, are extremely popular because they can match the shade of your tooth. However, they are much more expensive than silver amalgam fillings and less durable, requiring replacement every five years or so.
- Glass ionomer fillings are created by mixing silica glass powder and polyacrylic acid to form a hardened, creamy bonding agent. Fillings are relatively weak and are mainly used on baby teeth and non-biting tooth surfaces. On the plus side, they are moderately priced, won’t shift or shrink, and contain fluoride-releasing compounds that can prevent tooth decay.
Another form of direct restoration is direct dental bonding. This refers to the process in which a putty-like bonding agent is used to repair cracks, reshape teeth, or reduce gaps between teeth. The bonding agent is shaped and colored to match the optimal esthetics of the tooth and then dried in your mouth with a curing lamp.
Indirect Restoration
With indirect dental restoration, the construction is done outside the mouth. Examples include veneers, crowns, bridges, implants, inlays and inlays. While some will refer to dentures As a form of indirect restoration, the term usually applies to a permanent or semi-permanent dental component rather than a removable one.
Because procedures require more work (such as dental impression, tooth preparation, fabrication and temporary veneer, bridge or crown), they tend to be expensive. On the other hand, they can increase the aesthetic appearance of your teeth or provide a more stable, longer-lasting solution when the damage is severe or extensive.
Among the most common indirect restoration options:
- Veneers, also known as indirect dental bonding, are thin shells of porcelain that can replace or cover the enamel of a damaged, stained or misshapen tooth. They are made using an impression of your teeth and are highly desirable because their color and transparency mimic your natural tooth enamel.
- Dental crowns, also known as dental caps, are devices that completely cover the surface of a tooth. They are usually attached to a prepared surface with dental cement, which improves both the strength and appearance of a tooth. Crowns can be made of metal (such as gold or titanium), ceramic (such as zirconia, silicon or alumina) or a metal-ceramic composite.
- Bridges are artificial teeth that are placed between real teeth to fill a gap where teeth have been removed or are missing. The natural teeth that support the bridge are called abutments. A bridge can either be fixed (joined at two abutments), cantilever (joined at one abutment), or glued (cemented at adjacent abutments). The bridge is usually made of porcelain, metal or porcelain fused to metal (PFM).
- Implants are dental devices that are surgically attached to the jawbone. The implant can be used for crown and bridge support. The procedure can often require several steps to create a temporary prosthesis, extract the damaged tooth, prepare the implant site, fabricate the permanent prosthesis, and place the implant. Once complete, it may take three to six months for the new bone to form (ossify) around the implant and secure it in place.
- Inlays are similar to fillings, but instead of using brittle materials, they are created from a dental impression using porcelain, gold, or composite resin. The molded inlay, which mimics the appearance of a natural tooth, is then fixed in place. Inlays are less prone to shrinkage than fillings and are usually indicated when decay or a fracture is extensive.
- Onlays are more extensive versions of inserts. Instead of restoring an area of fracture or decay, a filling will replace any pieces of the tooth that are broken. An inlay differs from a crown in that it only covers part of a tooth, not the whole thing.
