Materials Options: An Overview
When a natural tooth undergoes extensive damage, it cannot be successfully restored for the long term with a “regular filling" (the one placed by the dentist in a single office appointment). Materials constructed and processed in a laboratory can be contoured exactly to the contours and shape desired, are stronger and will last longer. All materials for cast restorations have advantages and disadvantages. Foundations or Build-ups prior to restoration with crowns is often necessary. Link to the page of Amalgam for more information on materials for foundations/build-ups. Link to the page for Composite Resins for more information on those materials. The following is a summary of the materials that can be used for inlays, onlays, crowns and bridges.
Partial Coverage Restorations: Inlays and Onlays
Partial coverage restorations are indicated when there is sound remaining tooth structure that does not need to be included in the preparation. Advantages of an inlay or onlay include less drilling than for a full coverage crown. Because of esthetics and concern over potential allergic reactions to metal, dentistry is and has been moving away from any restorations that have metal in them.
Full Coverage Restorations: Crowns and Bridges
- Gold Alloy: Gold is absolutely the best choice for a dental restorative material and wears in a similar fashion to natural tooth structure. It has been used successfully in tooth restoration for many years with a long history of service. The yellow color might be visible when you speak or smile and for that reason is not considered an esthetic material. It is, however, excellent for restorations and especially for those who brux or grind.
- Laboratory-Processed Resin: This is a good cosmetic choice because it can closely match natural tooth color. Laboratory-processed resins are well suited for small to medium restorations but not as successful in patients with a tooth grinding habit. The restorations have a tendency to break under extreme compressive forces. The resin is more porous and softer than porcelain and is subject to higher wear and staining or discoloration over time. A mouthguard may be recommended for protection.
- Porcelain/Ceramic: Excellent for use in cosmetic dentistry, porcelain/ceramic restorations are used to restore almost any sized cavity to be restored - from inlays to onlays to veneers. The material is more wear-resistant than resin but can wear opposing enamel. It is not as successful for patients who brux or grind and has the potential to break under extreme biting forces. A mouthguard may be recommended for protection.
Full coverage restorations are indicated when the entire remaining tooth structure needs protection or is vulnerable to fracture. A full coverage crown requires more preparation than an inlay or onlay.
- Full Cast Gold (High Noble): Made of a gold alloy, full cast gold is the longest lasting of any of the laboratory-processed materials (20+ years). The alloy consists of gold, silver, palladium, and sometimes zinc, copper, and platinum. Although it is a very strong material, the yellow color makes it not as esthetically pleasing as other options in some areas of the mouth.
- Full Cast Noble: Similar in properties and qualities to full cast gold, this material contains mostly palladium plus silver, gold, and other trace metals. Full cast noble material is more silver in color than a full noble metal. (I do not use Noble or non-precious metals (unless specifically requested by a patient), but only High Noble metals for fixed restorations in my practice.)
- Porcelain Fused to Gold (High Noble Alloy): This material is very esthetic and can last 10 to 20 years. The gold substructure is covered with porcelain, which can wear opposing teeth or fracture under forceful biting or grinding. The porcelain can be applied to just the surface of the crown facing on cheek, using metal on the tooth contacting surface. The result will not be as esthetic, but will last longer. A mouthguard may be recommended for protection.
- All Ceramic or Porcelain: This is the newest technology in laboratory-processed restorations and is considered very esthetic. No "shiny" metal is used in the process. The consumer is familiar with metal being shiny, but the materials used in this process are actually metal oxides which appear to be white, or tinted to appear more like a tooth color. These are not the "shiny" metal one is accustomed to seeing, therefore no metal will ever be visible. It is excellent for restoration of many teeth; expected service life is 10+ years. This type of restoration can be cemented or bonded in place. The same cautions exist as with any porcelain or ceramic material: it can wear opposing natural enamel, and a mouthguard may be recommended for protection from bruxing or grinding. Some processes in fabrication of the all ceramic or porcelain crown are actually controlled by a computer.
All the above take at least two appointments to finish. Tooth preparation, impressions, and temporary crown, bridge, or inlay/onlay will be done at the first appointment. Permanent cementation will take place during the second appointment. Because of the highly technical nature of the process and our exacting standards, we may need to make more than one impression. If we detect an irregularity with the returned laboratory restoration, we will take a new impression and redo the onlay or crown.
We will recommend the best material to meet your specific needs and answer any questions you have. Longevity of any of the restorations depends on the quality of the materials (and we only use the best), the technical skills in construction and placement (and we provide the best service possible), and what you do to and with the restorations once they are in your mouth. Clenching and grinding habits will significantly shorten the useful life of any restoration placed. What can break your natural tooth can break any restoration. Your oral self-care will affect the length of service of the restoration. You will need regular dental examinations and hygiene maintenance (cleaning) at intervals determined by your particular oral health requirements. A rule of thumb is that the more restorations you have in your mouth, the more care you (and they) will need. Any problem that begins can be discovered and corrected when it is small: with regular dental examinations, you can protect your investment.
For Chairside Restorations go to: Amalgams or Composite Resins for more information.
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