Restorative Treatments

There are several “restorative” treatments that a dentist will perform for you :

  • an inlay or an onlay
  • a crown
  • a CEREC restoration
  • a veneer
  • a bridge

Inlay or Onlay

These restorations are often constructed when a tooth needs a large restoration, but where provision of a crown will result in excessive cutting of the remaining tooth structure.

  • An inlay is a composite, metal based, or ceramic insert in a tooth to restore a large breakdown in tooth structure due to decay or a large broken filling
  • An onlay is the next stage where there is so much tooth structure breakdown that the tops of the teeth need to be held together after the core of the tooth is filled. Hence this restoration is called on ‘onlay’.

Where there is even greater breakdown, it is best to have a crown.

Crown

A crown is made after your tooth has suffered tremendous mechanical breakdown. A crown is suitable when a tooth is very heavily filled, such that there is a risk of mechanical failure if it is not “held together”. A crown is indicated after root canal treatment and when there is typically a large complex filling in place after a root canal procedure.

NHS crowns are fabricated with a basic porcelain which is not often cosmetic. If a very cosmetic crown is desired, then this is better constricted privately where bespoke and “live” porcelain with a refractive index that resembles tooth structure.

CEREC restoration

CEREC stands for ‘CER’amic’  ‘REC’onstruction. These restorations can take the form of an inlay, onlay or a crown, and they are nade in a single visit using CADCAM technology.

The CEREC workflow is as follows :

  1. The tooth is scanned
  2. The new tooth is designed on the CADCAM software
  3. The new restoration is milled with a very accurate milling machine
  4. The milled restoration is tried in and adjusted slightly
  5. The restoration is bonded adhesively to the remaining tooth structure
  6. The finished restoration is polished with fine rotary tools

The benefit to you is :

  • a one visit tooth coloured restoration
  • no temporaries or impressions
  • potentially reduced sensitivity
  • time saving

A veneer is a thin shell of porcelain or composite  that is glued to the front of your teeth to enhance the appearance. Your natural tooth needs to be shaved back slightly before an impression is taken. Our highly skilled technicians will then make the thin veneer to mask the colour of your tooth. We will take multiple high quality photographs of your teeth during an animated and repose smile to capture the character of your smile, and dynamics of your lip support. If your teeth need an improvement in length because of  tooth wear we may then make a provisional ‘snap-on’ smile for you to evaluate before any significant work is undertaken. This will allow you to consider the improved shape, even though the colour rendition of the “snap-on smile” will not be perfectly natural

Once the veneer is stuck onto your tooth, it derives great strength from the large bonded surface area, and the porcelain laminate shell which is made out of layered porcelains, OR a characterised lithium dilicate glass ceramic shell OR a zirconia shell OR a veneer made out of high density polymer such as milled composite resin.

Your dentist will advise you on the best veneering product. Isn’t it about time that your enjoyed your true smile again?

A bridge is a prosthesis to replace a single tooth unit. Sometimes, and with careful planning, a bridge can replace more than one tooth unit. There are two sorts of bridge:

  1. A conventional preparation bridge
  2. A resin-retained bridge (sometimes called a ‘maryland’ bridge)

A conventional bridge requires the surgeon to gently shape the teeth either side of the gap. An impression is then taken, and two or more toothe units are made from various materials such as nickel-chromium, palladium, gold, or zirconia. An overlying layer of glassy porcelain (known as ‘feldspathic’ porcelain) is layered over the bridge to make this natural:

The downside to this bridge is the preparation that is needed to adjacent teeth. Our reserach indicats that over time, the teeth that were prepared can suffer complications such as death of the nerve, and an abscess will form under the root. These ‘abutment’ teeth then need root canal therapy. It is for this reason that a ‘conventional preparation’ bridge needs to be carefully considered and the benefits of a dental implant considered before embarking on a conventional bridge.

A resin bonded bridge on the other hand relies on the presence of a wide surface area of sound adjacent tooth structure. The resin bonded bridge typically has a single large metal wing which is adhesively bonded onto tooth structure by a very clever cement that bonded metal to enamel. Although the diagram below shows two small metal wings, it is more correct to have a large single metal wing.

The resin bonded bridge is more suited to the restoration of front teeth, and not back teeth as there are excessive forces on back teeth.

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