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Restorative Dentistry & Types of Dental Restoration

What Is Restorative Dentistry?

The term “restorative dentistry” is the integrated management of oral health problems and restoring of the mouth to a functional and esthetic state. While it is not currently recognized as a dental specialty by the American Dental Association, general dentists are able to perform many of these procedures without additional education and certification. It all depends on how difficult the procedure is and what the dental professional feels comfortable with. Many of the procedures are also covered by the dental specialty of prosthodontic dentistry, including fillings, veneers, crowns, bridges, full and partial dentures and dental implants.

The goal of restorative dentistry is to return destroyed or lost tooth structure to full form and function. If you have a filling, crown, or dental implant, you have already benefited from restorative dentistry.

Today’s dentists have many successful options of repairing decayed teeth. Besides traditional silver amalgam or gold alloy fillings, composite resins and dental ceramics have come on the scene that are beautiful. These materials can be used to create tooth restorations that are virtually indistinguishable from natural teeth.

Here are some of the restorative procedures we provide to help you achieve the strongest and best-looking teeth possible

Replacing Missing Teeth

Restorative dentistry is often referred to as prosthodontic dentistry. Whether your dental professional uses the term “restorative dentistry” or “prosthodontic dentistry,” the goal is to preserve natural teeth as much as possible. Replacing missing teeth with a dental implant, bridge, full or partial denture helps promote dental health as well. Filling in empty spaces in the mouth can help prevent cavities in the remaining teeth because odd-shaped gaps are vulnerable spots for plaque-causing bacteria to build up. Missing teeth also put extra stress on your remaining natural teeth because you don’t have as much surface area to chew with.

Tooth Restoration Options

When deciding on a strategy for restorative dentistry, you’ll need to consider both physical and fiscal factors—your health and your budget. Most dentists involved in restorative dentistry will try to preserve your natural teeth if possible before resorting to full or partial dentures so you won’t have to remove and clean the devices regularly. But sometimes full or partial dentures are the better option if you have many missing teeth and you’re not a good candidate for dental implants due to other health issues.

Types of Dental Restoration

These days, thanks to a variety of options for dental restoration, you have many choices for repairing, worn, decayed, damaged or missing teeth and restoring a healthy and beautiful smile. Depending on the nature of your problem, your dentist will perform one of two types of dental restorations:

  • Direct.

    Direct tooth restoration involves placing a filling into a prepared tooth cavity immediately. This procedure can be done in a single office visit. Your dentist chooses from a variety of filling options based on the type and location of the filling. For example, glass or resin ionomers are often used for replacements near the tooth root or other areas not subjected to heavy pressure from chewing.

  • Indirect.

    Indirect tooth restoration involves customized tooth replacements in the form of crowns, onlays, or inlays. A crown covers the entire chewing surface of a tooth, an inlay lies within the cusps of the tooth, and an onlay covers and one or more cusp tip, including part of the chewing surface. An indirect tooth restoration will require more than one office visit because the inlay or onlay must be fabricated in a lab. Crowns, inlays and onlays can be made from a variety of materials. Gold is still used for some inlays, but for someone concerned about white teeth, porcelain and tooth-colored composite resins are other options.

Dental Restoration Costs and Insurance

Also, keep in mind that most dental insurance plans don’t currently cover dental implants. They may be covered under your medical insurance depending on the reason for your tooth loss and whether you have other related medical conditions. Talk to your dental professional to determine the best strategy to promote your oral health.

Restoration is a term used in dentistry to describe the repair of a missing or damaged tooth structure. Restorations are classified as either direct or indirect. Direct restorations are repairs made inside of the mouth (fillings), while indirect restorations are fashioned outside of the mouth and then affixed to either the tooth or the supporting tooth structure in a separate procedure (examples include veneers and crowns). What is appropriate for you depends on the issue you’re facing, but your personal preferences may also be able to play a role in your decision making.

Direct Restoration
With direct dental restoration, all of the work is fabricated and completed within the mouth. The procedure, commonly referred to as filling, involves the placement of a malleable substance into a prepared and cleaned cavity. The material is then hardened to restore the structure (and sometimes appearance) of the damaged tooth.

Fillings are one of the more conservative ways to repair a tooth and often the least invasive. There are three materials typically used for this:

Silver amalgam is a compound consisting of 50 percent mercury and 50 percent silver, tin, zinc, and copper. The advantages of silver amalgam include low cost, easy installation, and exceptional strength and durability. On the downside, it is not aesthetically pleasing and is prone to expansion and contraction. This may cause a tooth to crack, or allow food and bacteria to become trapped and promote decay. The use of mercury also remains controversial.
Composite fillings, made of synthetic resins, are extremely popular because they can be matched to the shade of your tooth. However, they are far more expensive than silver amalgam fillings and less durable, requiring replacement every five years or so.
Glass ionomer fillings are created by mixing silicate glass powder and polyacrylic acid to form a hardened, cream-colored bonding agent. The fillings are relatively weak and mainly used on baby teeth and non-biting tooth surfaces. On the plus side, they are moderately priced, do not shift or contract, and contain fluoride-releasing compounds that can prevent tooth decay.

Another form of direct restoration is direct dental bonding. This refers to the procedure 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 tinted to match the optimal aesthetic of the tooth and then dried in your mouth with a curing lamp.

Indirect Restoration
With indirect dental restoration, the fabrication occurs outside of the mouth. Examples include veneers, crowns, bridges, implants, inlays, and onlays. While some people will refer to dentures as a form of indirect restoration, the term usually applies to a permanent or semi-permanent dental fixture rather than a removable one.

Because the procedures require more work (such as a dental impression, tooth preparation, fabrication, and a temporary veneer, bridge, or crown), they tend to be costly. On the upside, 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 manufactured using an impression of your teeth and are especially desirable because their color and translucency mimic your natural tooth enamel.
Dental crowns, also known as dental caps, are appliances that completely cover the surface of a tooth. They are typically bonded to a prepared surface with dental cement, which improves both the strength or appearance of a tooth. Crowns may be made of metal (such as gold or titanium), ceramic (such as zirconia, silica, or alumina), or a metal-ceramic composite.
Bridges are artificial teeth that are affixed between real ones to fill in a gap where teeth have been removed or are missing. The natural teeth that support the bridge are called abutments. A bridge may either be fixed (joined to two abutments), cantilevered (joined to one abutment), or adhered (cemented to adjacent abutments). The bridge is typically made of porcelain, metal, or porcelain fused to metal (PFM).
Implants are dental appliances that are surgically fixed into the bone of the jaw. The implant may be used to support a crown and bridge. The procedure can often require several steps to create a temporary prosthetic, extract the damaged tooth, prepare the implant site, manufacture the permanent prosthetic, and affix the implant. Once completed, it can take three to six months for the new bone to form (ossify) around the implant and secure it into place.

Inlays & Onlays
When the damage done to a tooth by decay is too extensive to be treated with a simple filling, yet not significant enough to need a full-coverage crown, the best solution may be an onlay. These fillings are fabricated outside the mouth (usually by a dental laboratory) and then bonded to the tooth by the dentist. It is considered an “inlay” when the filling fits within the little points or “cusps” of a back (premolar or molar) tooth. It is an “onlay” if it covers one or more of these cusps.

In order to receive an inlay or onlay, the tooth and surrounding area must be numbed with a local anesthetic and the decay removed. Sedation is available for those that are anxious about the procedure. We then take an impression of the tooth with a putty-like material and send it to our dental laboratory, where the inlay or onlay will be made. We will cement a temporary filling to your tooth to protect it until the permanent restoration is ready. At your next visit, the permanent inlay/onlay will be cemented to your tooth with either a resin that hardens under a special curing light, or a type of permanent cement. Inlays and onlays are strong, long-lasting, and require no greater level of care than any other tooth. Onlays also act to hold the tooth together, to provide fracture resistance for a weaker tooth.

Inlays are similar to fillings but, rather than using malleable materials, are created from a dental impression using porcelain, gold, or a resin composite. The molded inlay, which mimics the appearances of a natural tooth, is then cemented into 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 inlays. Rather than restoring an area of fracture or decay, an onlay would replace any bits of tooth that have broken off. An onlay differs from a crown in that it only covers part of a tooth, not the entire thing.