Crowns, or caps, are full coverage restorations that are used to cover a tooth that is likely to break if restored with a filling or if the tooth is already too broken down to be restored with a filling. Crowns are most commonly done after root canal treatment or when a very large filling breaks down and cannot be replaced by another large filling. The larger the hole made a by a cavity or filling, the more likely that a crown will be needed. Even after a filling restores a very large cavity, a tooth is then more likely to break due to the reduced natural tooth structure remaining. Keep in mind that the jaw muscles are extremely strong and teeth are subject to tremendous pressures. Crowns ride over the weakened tooth, providing strength and protecting the tooth against breakage.
The procedure for receiving a crown consists of two separate appointments scheduled approximately two weeks apart. At the first appointment, the dentist prepares the tooth be either making it smaller for the crown to fit over or building the tooth up to make it stronger before covering it. If a crown build-up is needed, there is an additional $225 charge.
The first appointment is a process of steps: preparing the tooth, taking an impression of the prepared tooth, taking an impression of the opposing teeth, and fitting a temporary crown to cover the tooth until the permanent crown is processed (approximately 2 weeks for the lab to process). This appointment will take 2 to 2 ½ hours.
The second appointment will be to remove the temporary crown and cement the permanent crown after making any necessary adjustments for proper fit. This appointment will take about 1 hour.
There are four different types of crowns to choose from: silver, gold, metal-ceramic (tooth-colored), or all ceramic (tooth-colored). The doctor will advise you on the type he recommends for you or you may ask if you have a personal preference. From that discussion, a decision can then be made as to the type of crown selected.
A bridge is a treatment option used to fill the space created by a missing tooth or multiple missing teeth. The sides or abutments of a bridge use the remaining teeth as anchors for the bridge that spans the gap, hence the name “bridge.” The completion process is very similar to the procedures to complete crowns, as discussed above.
The procedure for receiving a bridge consists of two separate appointments scheduled approximately two weeks apart. At the first appointment, the dentist prepares each tooth on either side of the gap created by the missing tooth/teeth.
The first appointment is a process of steps: preparing each anchor tooth, taking an impression of the prepared teeth, taking an impression of the opposing teeth, and fitting temporary crowns to cover each anchor tooth until the bridge is fabricated by the dental lab (approximately 2 weeks for the lab to process). This appointment will take approximately 3 hours to complete.
The second appointment will be to remove the temporary crowns and cement the permanent bridge after making any necessary adjustments for proper fit. This appointment will take about 1 hour.
There are four different types of materials bridges can be made from: silver, gold, metal-ceramic (tooth-colored), or all ceramic (tooth-colored). The choice of material depends on the requirements for strength, wear, and/or aesthetics. The doctor will advise you on the type he recommends for you or you may ask if you have a personal preference. From that discussion, a decision can then be made as to the type of bridge material selected.
There are different types of dentures but they all share a common function: to replace teeth that are missing. Complete dentures replace all teeth on an arch (the upper arch and the lower arch). They can be complete traditional dentures or complete immediate dentures (discussed below) Partial dentures replace any missing teeth while retaining any sound teeth that are still remaining.
When the bone loss around the roots of teeth is great enough to loosen them or allow the tooth to fall out, it may be time to consider complete dentures to bring your oral status back to ideal health. A panoramic x-ray is taken to determine the location of all teeth and any remaining tooth roots or remnants to be removed.
Procedures to Place Traditional Dentures
Any remaining teeth are extracted. After approximately 4 months of healing and several sets of impressions and try-ins to ensure good fit, the dentures are placed.
Procedures to Place Immediate Dentures
Remaining posterior (back) teeth are extracted. After approximately 4 months of healing and several sets of impressions, the remaining anterior (front) teeth are extracted and immediate dentures are placed that same day. A 24-hour post op appointment will be scheduled to check patient comfort. Various further post op appointments will be scheduled periodically until healing is satisfactory and adjustments are made for proper fit and comfort.
After 4-6 months of wear, a reline of immediate dentures is usually needed to regain proper fit, comfort, and ease of use. This is due to the gums healing and shrinking back to their final shape, resulting in the immediate dentures having a looser fit.
The doctor will examine the entire mouth and determine which teeth need to be removed and which are stable enough to remain. After any extractions have been completed and healing is satisfactory, a partial can be made to replace any missing teeth to create a full smile for the whole upper or lower arch. To fabricate a partial, impressions are made and dimensions are measured for the dental lab to then create your custom partial.
A dental implant can be a very solid, stable option to replace a missing tooth. Dental implants can also add significant support for an implant bridge or denture attachments. To place a dental implant, an oral surgeon will surgically implant a small titanium shaft into the bone so the bone will then heal and grow around the implant post, forming a tight connection. This grafting of the bone to the post not only provides a base to replace the tooth but it additionally slows or stops the bone loss that occurs when the root of a natural tooth is no longer present. Once the implant is firmly set in the mouth, the oral surgeon will release the patient to the care of Fisher Dental to complete the final restoration to be placed on the implant post. Dental implants are a permanent solution that has advantages over traditional removable partial dentures that require an adjustment period when first placed. Dental implants also have advantages over traditional bridge work that relies on the soundness of the surrounding teeth for support, whereas each implant is independent in its strength and solidarity.
ROOT CANAL TREATMENT
Root canal treatment (also referred to as root canal therapy or endodontic therapy) is made necessary due to a number of possible causes and is recommended when attempting to preserve a tooth rather than extract. For a number of reasons, the pulp and nerve of a tooth can become irreversibly damaged due to trauma or infection. Symptoms associated with possible nerve break down include sensitivity to hot and/or cold, sensitivity to sweets, on/off throbbing pain, swelling, pain when biting or pressure sensitivity. Throbbing pain with a damaged nerve can come and go. Sometimes a terrible toothache seems to go away but the nerve is still damaged despite no symptom at the time. So once the nerve damage or infection occurs, the only way to correct the resultant toothache is to have an endodontist perform a root canal. The procedure is quite simple – despite the horror stories associated with a root canal!
The endodontist will use specialized instruments to make a very small hole down the middle of the tooth to reach the damaged and infected tooth pulp and nerve. The pulp will be cleaned out and the canals of the tooth root will be disinfected. A temporary sponge filling will be placed by the endodontist and the patient will then be released to the Drs. Fisher for final restoration.
Final restoration of a tooth that has had a root canal is extremely important. A root canal leaves a tooth fragile and somewhat brittle, no longer able to withstand the pressures exerted when chewing. If the tooth does not have a crown on it prior to a root canal, a crown is usually required after a root canal to keep the tooth strong and usable. If the tooth does have a crown on it prior to a root canal, a small permanent final access filling will be needed to replace the temporary sponge place by the endodontist. Once a root canal and final restoration have been completed, the tooth is sound, solid, and ready to perform its duties pain-free.
TMJ stands for temporo-mandibular joint. Temporo (as in the temple area of the skull). Mandibular (as in the mandible or lower jaw bone). Joint (where the upper jaw bone meets with the mobile lower jaw bone). TMD stands for Temporomandibular Disorder. Symptoms can include pain in or around the ear, tender jaw muscles, clicking or popping noises in the jaw, difficulty opening or closing the mouth, pain when yawning or chewing, jaw joints feel as if they lock/get stuck/pop out, headaches. Problems in the TMJ can be caused by a misalignment of the teeth, excess muscle tension, stress/anxiety, tooth grinding, trauma/injury, and diseases affecting the body’s muscles or joints. Once any dental causes for TMD are ruled out with x-rays and clinical exam, our next course of treatment is usually referral to a chiropractor to assess the alignment of the joint, cartilage, and muscles. If further treatment is needed, a referral to a specialist will be recommended. Unfortunately, TMDs are often managed, rather than cured but with the proper treatment and self-care, symptoms can be decreased.