Restoration of Implants

RESTORATION OF IMPLANTS

This section looks at the various types of dental implant restorations. This includes a single restoration where only one crown (false tooth) is fitted through to a bridge and/or fixed dentures.

If you want to know more about the dental implant procedure then visit the dental implants section.

Dental implants are favoured over bridges and dentures as they are seen as a permanent and aesthetic solution to the problem of missing teeth. Plus they are strong and durable and fit in well with a busy lifestyle.

The term ‘restoration’ is used to refer to a false tooth. This tooth is then attached to the implant and looks and behaves in the same way as a natural tooth.

RESTORATION OF CROWNS

A restoration can involve a single tooth or several teeth, many of which can be attached to a single implant. The implant is inserted into the jaw and allowed to fuse with the bone in a process called osseointegration.

This process takes anywhere from 3 to 6 months.

Once the gum has healed and fusion has taken place the implant is then ready for the attachment of a metal abutment. This device acts as an anchor for the restoration. There are several types of abutments which are designed to blend in with your natural teeth.

The dentist will take an impression of your teeth using a mould which contains dental putty. You will be asked to bite into this putty so that the dentist has an imprint of your teeth.

This impression is sent to a laboratory for them to produce your new restoration. You will be fitted with a temporary restoration during this time.

This process is the same for both a single crown and multiple crowns.

RESTORATION OF A BRIDGE

The process is the same as mentioned above but with one difference. This involves the creation of several crowns which are then fixed to a bridge.

A bridge consists of a false tooth known as a pontic and two or more crowns (restorations) which are attached either side of it. This bridge slots into the space between your teeth caused by tooth loss and is supported by the other teeth.

The big difference between this and ordinary dentures is that a fixed bridge is cemented in place and cannot be removed each night.

Find out more about this in the bridges section, under general dentistry.

RESTORATION OF AN IMPLANT RETAINED DENTURE

A denture is a device worn in the mouth to replace missing teeth. It can replace a few or all of your teeth. It consists of a plate with artificial teeth (restorations) attached to it and is worn on a daily basis.

But one of the problems with a denture is that of clicking noises or shifting around in the mouth. There are people who have badly fitting dentures or find that they have become lose, often due to changes in their jaw as part of the ageing process.

One solution is a denture which is fixed in place with a dental implant. This is similar to a fixed bridge and removes the need to remove the dentures at night for soaking before replacing them in the morning.

The advantages of an implant retained denture are the reduced risk of trapped food particles underneath the plate which can lead to an infection: no risk of sores developing caused by friction of the denture: strong and lifelike: plus this is customised to your individual requirements.

Source= http://www.myperfectdentist.com/restoration-of-implants.html

Keyhole Dental Implants

Receiving Keyhole small diameter dental implants is usually a quick and easy one-appointment procedure. The Keyhole implants mimic your natural tooth root and can be used to stablise a removable denture or as a foundation for a fixed implant supported bridge. A fixed implant supported bridge can be used to replace any number of teeth so it can replace a partial or full denture with solid natural feeling teeth.

Keyhole dental implant surgery is minimally invasive, performed in our office usually under a local anaesthesia, and requires no stitches or long healing times. They are designed to function immediately because of the self tapping action. The implants are placed in the jawbone with the head protruding above the gum-line and provide a solid foundation. Keyhole dental implant systems have proven to be durable and long lasting. The longevity of keyhole dental implants are comparable and in many cases exceeding conventional dental implants.

If used to stablise a denture, the denture when seated will rest comfortably on your gum tissue with virtually no movement and enable you to talk with confidence and eat with ease. Your denture will feel totally secure. A full lower denture can be stablised with four key hole implants for only $3,950.00.

The advantages of mini dental implants include:
A Keyhole Implant is around 50% of the cost of a Conventional Implant. Only $2,700.00 to replace a single tooth (or $3,500.00 for a molar) including implant and Ceramic Crown. To replace multiple missing teeth the cost per tooth can be further reduced.
Keyhole dental implants are typically inserted directly through the gum tissue and into the underlying bone. There is no need to make a surgical incision into the gum, resulting in much less post surgery discomfort.
Keyhole dental implants can be placed with less available bone. We can place keyhole implants without a bone graft most of the time, even if you have been told you need one.
Keyhole dental implants are not only constructed of titanium like conventional implants, but a blend of other metals, resulting in one of the strongest materials available. Keyhole dental implants are noticeably smaller and stronger than conventional dental implants.
For more information please visit The Australasian Society For Conservative Implant Dentistry.

Source= http://captivatedental.com.au/keyhole-dental-implants/

Overdentures and Implant Fixed Bridge/ Zirconia Fixed Implant Bridge

Overdentures and Fixed Implant Bridges

Overdentures

An “overdenture“ is a full or partial denture that is modified to attach to dental implants. In this procedure, patients with sufficient bone density have a denture made or adjusted for fit. Two or more implants are placed and allowed to heal. After the implants have healed, the denture will clip onto the implants.

Rather than the denture using pressure on the gums to stay in place, the implants bear the pressure of the dentures, so there is no need to use adhesives. Implant overdentures help reduce and even prevent bone loss in the jaw that results from missing teeth, and our patients report that the fit and feel of full or partial dentures is far more natural and comfortable when fixed to dental implants.

Over time, patients can choose to have more dental implants placed and replace their denture with a set of fixed bridges.

Fixed Implant Bridges

Fixed implant bridges are an outstanding dental treatment option for individuals missing all or many teeth. When replacing an over-denture, six or more implants are typically placed in the upper and lower jaw. After healing, each implant will serve as an anchor for a dental bridge, just like a natural tooth would. A crown, or abutment, is placed over each dental implant, and a pontic, or fabricated tooth, is connected in between the crowns.

Unlike a denture, which is typically made of gum and tooth-colored acrylic and plastic, bridges and the crowns over the implants are made from porcelain fused to metal, and modeled to look as close as possible to your original teeth. The look and feel of the porcelain is so realistic that most patients (and just about everyone else) can’t tell the difference between their new smile and their original.

People who have overdentures or fixed dental implant bridges still need to visit the dentist for regular checkups and to monitor the density the jaw, and to ensure the dental implants remain strong.

Source= https://1stfamilydental.com/resource-library/implant-dentistry/overdentures-fixed-dental-implant-bridges/

HA Synthetic Bone Regeneration

Macro and nano bone-like structure
Excellent volume maintenance
Low substitution rate
HA is a synthetic, macro and nanoporous bone regeneration material based on hydroxyapatite with a low substitution rate. It is used for bone regeneration of missing or lost bone tissue independently, or in combination with autologous bone tissue, blood or PRP.

structure of HA

Advantages
Structure system of interconnected macro and nanopores which mimic the structure of human bone
Excellent osteoconductive properties of OssaBase-HA enable predictable bone regeneration
Optimal non-irritating shape of polygonal macro and nano-porous granules
No organic porogen compounds used during manufacturing – ensures particularly high chemical and phase purity
Fully synthetic material – no risk of immunological reactions or pathogen transmission
Narrow size ranges of available granules – enough space for optimunm bone ingrowth over large distances
High osteoconductivity.
macro and nano bone-like structure

Indications
Implantology, periodontology

Remodeling of the alveolar ridge
Sinus lift
Treatment of bone defects around dental implants
Filling of bone defects after surgical extractions to prevent alveolar atrophy
Filling of bone defects after extirpation of cysts
Treatment of periodontal defects
Orthopedics, traumatology

Tumor-like lesions (unicameral bone cyst, aneurysmal bone cyst, bone gangliomas, fibrous dysplasia, ...)
Pathological fractures with the above-mentioned lesions
Posttraumatic bone defects (comminuted osteoporotic fractures, compressive fractures of a long bone epiphysis)
Benign bone tumors
Arthrodesis

Source= https://www.lasak.com/for-professionals/products/bone-regeneration/ossabase-ha

EZI Dental Implants

An EZ Dental Implant is a titanium root form that is gently and carefully placed where the previous tooth was. The surface of the implant is treated in such a way that your bone actually bonds to it. It essentially becomes part of you.

A crown is then placed on top of the implant and you are able to chew with it and clean it just like with natural teeth. Crowns look and function so naturally that if you lost a front tooth you could have it replaced with an implant and nobody would know.

Implants are not just for front teeth though. If you are missing any – or even all – of your teeth, dental implants will provide you with the strongest and most realistic life-like solution. You will feel whole again. You will be more confident when you smile and face the world. And you will be able to chew better than with any other form of tooth replacement.

If ever in the situation, hands down if I ever lost a tooth, I would replace it with a dental implant.

There is no guess work here, the EZ Implant Systems use a 3-D imagining to safely and comfortably plan the precise placement of your implant. The planning and guides are so precise that the implants are placed in minutes with no cutting of the tissue or sutures needed. All the work is done in a computer 3-D imaging system so for you it’s easy!

Imagine being able to smile without the embarrassment of missing teeth or ill-fitting partial or dentures. Don’t you owe it to yourself to strong, confident… whole?

Source= http://www.cignodental.com/solutions/ez-dental-implants/

Composite Filling

Composite resins, or tooth-colored fillings, provide good durability and resistance to fracture in small- to mid-size fillings that need to withstand moderate pressure from the constant stress of chewing. They can be used on either front or back teeth. They are a good choice for people who prefer that their fillings look more natural.

Composites cost more than amalgam and occasionally are not covered by some insurance plans. Also, no dental filling lasts forever. Some studies show that composite fillings can be less durable and need to be replaced more often than amalgam fillings.

It generally takes longer to place a composite filling than it does for a metal filling. That’s because composite fillings require the tooth be kept clean and dry while the cavity is being filled. Tooth-colored fillings are now used more often than amalgam or gold fillings, probably due to cosmetics. In a society focused on a white, bright smile, people tend to want fillings that blend with the natural color of their teeth.

Ultimately, the best dental filling is no dental filling. Prevention is the best medicine. You can dramatically decrease your risk of cavities and other dental diseases simply by:

brushing your teeth twice a day with fluoride toothpaste
flossing daily
eating a balanced diet
visiting the dentist regularly.

Source= http://www.mouthhealthy.org/en/az-topics/c/composite-fillings

Glass Ionomer Cement Filling/ includes Resin-Modified

A glass ionomer cement is a dental restorative material used in dentistry for dental fillings and luting cements. It is also now commonly used as an orthodontic bracket adhesive, either as a glass ionomer, or a glass ionomer-based cement. Glass-ionomer based cements are essentially hybrids of glass ionomers and another dental material, for example Resin-Modified Glass Ionomer Cements (RMGICs) and compomers (or modified composites). These materials are based on the reaction of silicate glasspowder (calciumaluminofluorosilicate glass)and polyalkenoic acid, an ionomer. Occasionally water is used instead of an acid, altering the properties of the material and its uses. This reaction produces a powdered cement of glass particles surrounded by matrix of fluoride elements and is known chemically as Glass Polyalkenoate. There are other forms of similar reactions which can take place, for example, when using an aqueous solution of acrylic/itaconic copolymer with Tartaric acid, this results in a glass-ionomer in liquid form. An aqueous solution of Maleic acid polymer or maleic/acrylic copolymer with Tartaric acid can also be used to form a glass-ionomer in liquid form. Tartaric acid plays a significant part in controlling the setting characteristics of the material.

Background
Glass ionomer cement is primarily used in the prevention of dental caries. This dental material has good adhesive bond properties to tooth structure, allowing it to form a tight seal between the internal structures of the tooth and the surrounding environment. Dental caries is caused by bacterial production of acid during their metabolic actions. The acid produced from this metabolism results in the breakdown of tooth enamel and subsequent inner structures of the tooth, if the disease is not intervened by a dental professional, or if the carious lesion does not arrest and/or the enamel re-mineralises by itself. Glass ionomer cements act as sealants when pits and fissures in the tooth occur and release fluoride to prevent further enamel demineralisation and promote remineralisation. Fluoride can also hinder bacterial growth, by inhibiting their metabolism of ingested sugars in the diet. It does this by inhibiting various metabolic enzymes within the bacteria. This leads to a reduction in the acid produced during the bacteria’s digestion of food, preventing a further drop in pH and therefore preventing carious.
The application of glass ionomer sealants to occlusal surfaces of the posterior teeth, reduce dental caries in comparison to not using sealants at all. There is evidence that when using sealants, only 6% of people develop tooth decay over a 2-year period, in comparison to 40% of people when not using a sealant. However, it is recommended that the use of fluoride varnish alongside glass ionomer sealants should be applied in practice to further reduce the risk of secondary dental caries.
However, the addition of resin to glass ionomers, improves properties significantly, allowing it to be more easily mixed and placed. Resin-modified glass ionomers allow equal or higher fluoride release and there is evidence of higher retention, higher strength and lower solubility. Resin-based glass ionomers have two setting reactions: an acid-base setting and a free-radical polymerisation. The free-radical polymerisation is the predominant mode of setting, as it occurs more rapidly than the acid-base setting, which is comparatively slower. Only the material properly activated by light will be optimally cured. The presence of resin protects the cement from water contamination. Due to the shortened working time, it is recommended that placement and shaping of the material occurs as soon as possible after mixing.
History
Dental sealants were first introduced as part of the preventative programme, in the late 1960s, in response to increasing cases of pits and fissures on occlusal surfaces due to caries.[6] This led to glass ionomer cements to be introduced in 1972 by wilson and kent as derivative of the silicate cements and the polycarboxylate cements. The glass ionomer cements incorporated the fluoride releasing properties of the silicate cements with the adhesive qualities of polycarboxylate cements. This incorporation allowed the material to be stronger, less soluble and more translucent (and therefore more aesthetic) than its predecessors.
Glass ionomer cements were initially intended to be used for the aesthetic restoration of anterior teeth and were recommended for restoring Class III and Class V cavity preparations. There have now been further developments in the material’s composition to improve properties. For example, the addition of metal or resin particles into the sealant is favoured due to the longer working time and the material being less sensitive to moisture during setting.
When glass ionomer cements were first used, they were mainly used for the restoration of abrasion/erosion lesions and as a luting agent for crown and bridge reconstructions. However, this has now been extended to occlusal restorations in deciduous dentition, restoration of proximal lesions and cavity bases and liners. This is made possible by the ever-increasing new formulations of glass ionomer cements.
Glass ionomer versus Resin-based sealants
When the two dental sealants are compared, there has always been a contradiction as to which materials is more effective in caries reduction. Therefore, there are claims against replacing resin-based sealants, the current Gold Standard, with glass ionomer.
Advantages
Glass ionomer sealants are thought to prevent caries through a steady fluoride release over a prolonged period and the fissures are more resistant to demineralization, even after the visible loss of sealant material.
These sealants have hydrophilic properties, allowing them to be an alternative of the hydrophobic resin in the generally wet oral cavity. Resin-based sealants are easily destroyed by saliva contamination.
Chemically curable glass ionomer cements are considered safe from allergic reactions but a few have been reported with resin-based materials. Nevertheless, allergic reactions are very rarely associated with both sealants.
Disadvantages[edit source]
The main disadvantage of glass ionomer sealants has been inadequate retention. Due to its poor retention rate, periodic recalls are necessary, even after 6 months, to eventually replace the lost sealant.
Clinical Applications
Glass ionomers are used frequently due to the versatile properties they contain and the relative ease with which they can be used. Prior to procedures, starter materials for glass ionomers are supplied either as a powder and liquid or as a powder mixed with water. A mixed form of these materials can be provided in an encapsulated form.
Preparation of the material should involve following manufacture instructions. A paper pad or cool dry glass slab may be used for mixing the raw materials though it is important to note that the use of the glass slab will retard the reaction and hence increase the working time.] The raw materials in liquid and powder form should not be dispensed onto the chosen surface until the mixture is required in the clinical procedure the glass ionomer is being used for, as a prolonged exposure to the atmosphere could interfere with the ratio of chemicals in the liquid. At the stage of mixing, a spatula should be used to rapidly incorporate the powder into the liquid for a duration of 45–60 seconds depending on manufacture instructions and the individual products.
Once mixed together to form a paste, an acid-base reaction occurs which allows the glass ionomer complex to set over a certain period of time and this reaction involves three overlapping stages:
Dissolution
Gelation
Hardening[disambiguation needed]
It is important to note that Glass ionomers have a long setting time and need protection from the oral environment in order to minimize interference with dissolution and prevent contamination.
The type of application for glass ionomers depends on the cement consistency as varying levels of viscosity from very high viscosity to low viscosity, can determine whether the cement is used as luting agents, orthodontic bracket adhesives, pit and fissure sealants, liners and bases, core build-ups, or intermediate restorations.
Clinical Uses
The different Clinical uses of Glass Ionomer compounds as restorative materials include;
Cermets, which are essentially metal reinforced, glass ionomer cements, used to aid in restoring tooth loss as a result of decay or cavities to the tooth surfaces near the gingival margin, or the tooth roots, though cermets can be incorporated at other sites on various teeth, depending on the function required. They maintain adhesion to enamel and dentine and have an identical setting reaction to other glass ionomers.The development of cermets is an attempt to improve the mechanical properties of glass ionomers, particularly brittleness and abrasion resistance by incorporating metals such as silver, tin, gold and titanium. The use of these materials with glass ionomers appears to increase the value of compressive strength and fatigue limit as compared to conventional glass ionomer, however there is no marked difference in the flexural strength and resistance to abrasive wear as compared to glass ionomers.
Dentine surface treatment, which can be performed with glass ionomer cements as the cement has adhesive characteristics which may be useful when placed in undercut cavities. The surfaces on which the glass cement ionomers are placed would be adequately prepared by removing the precipitated salivary proteins, present from saliva as this would greatly reduce the receptiveness of the glass ionomer cement and dentine surface, to bond formation. A number of different substances can be used to remove this element, such as citric acid, however the most effective substance seems to be poly(acrylic) acid, which is applied to the tooth surface for 30 seconds before it is washed off. The tooth is then dried to ensure the surface is receptive to bond formation but care is taken to ensure desiccation does not occur.
Matrix techniques with glass ionomers, which are used to aid in proximal cavity restorations of anterior teeth. Between the teeth that are adjacent to the cavity, the matrix is inserted, commonly before any dentine surface conditioning. Once the material is inserted in excess, the matrix is placed around the tooth root and kept in place with the help of firm digital pressure while the material sets. Once set, the matrix can be carefully removed using a sharp probe or excavator.
Fissure sealants, which involve the use of glass ionomers as the materials can be mixed to achieve a certain fluid consistency and viscosity that allows the cement to sink into fissures and pits located in posterior teeth and fill these spaces which pose as a site for caries risk, thereby reducing the risk of caries manifesting.
Orthodontic brackets, which can involve the use of glass ionomer cements as an adhesive cement that forms strong chemical bonds between the enamel and the many metals which are used in orthodontic brackets such as stainless steel.
Fluoride varnishes have been combined with sealant application in the prevention of dental caries. It has been proven that the combined usage of both increases the overall effectiveness as compared to using fluoride varnish alone.
Chemistry and Setting reaction[edit source]
All GICs contain a basic glass and an acidic polymer liquid, which set by an acid-base reaction. The polymer is an ionomer, containing a small proportion - some 5 to 10% - of substituted ionic groups. These allow it to be acid decomposable and clinically set readily.
The glass filler is generally a calcium alumino fluorosilicate powder, which upon reaction with a polyalkenoic acid gives a glass polyalkenoate-glass residue set in an ionised, polycarboxylate matrix.
The acid base setting reaction begins with the mixing of the components. The first phase of the reaction involves dissolution. The acid begins to attach the surface of the glass particles, as well as the adjacent tooth substrate, thus precipitating their outer layers but also neutralising itself. As the pH of the aqueous solution rises, the polyacrylic acid begins to ionise, and becoming negatively charged it sets up a diffusion gradient and helps draw cations out of the glass and dentine. The alkalinity also induces the polymers to dissociate, increasing the viscosity of the aqueous solution.
The second phase is gelation, where as the pH continues to rise and the concentration of the ions in solution to increase, a critical point is reached and insoluble polyacrylates begin to precipitate. These polyanions have carboxylate groups whereby cations bind them, especially Ca2+ in this early phase, as it is the most readily available ion, crosslinking into calcium polyacrylate chains that begin to form a gel matrix, resulting in the initial hard set, within five minutes. Crosslinking, H bonds and physical entanglement of the chains are responsible for gelation. During this phase, the GIC is still vulnerable and must be protected from moisture. If contamination occurs, the chains will degrade and the GIC lose its strength and optical properties. Conversely, dehydration early on will crack the cement and make the surface porous.
Over the next four and twenty hours maturation occurs. The less stable calcium polyacrylate chains are progressively replaced by aluminum polyacrylate, allowing the calcium to join the fluoride and phosphate and diffuse into the tooth substrate, forming polysalts, which progressively hydrate to yield a physically stronger matrix.[20]
The incorporation of fluoride delays the reaction, increasing the working time. Other factors are the temperature of the cement, and the powder to liquid ration - more powder or heat speeding up the reaction.
GICs have good adhesive relations with tooth substrates, uniquely chemically bonding to dentine and, to a lesser extend, to enamel. During initial dissolution, both the glass particles and the hydroxyapatite structure are affected, and thus as the acid is buffered the matrix reforms, chemically welded together at the interface into a calcium phosphate polyalkenoate bond. In addition, the polymer chains are incorporated into both, weaving cross links, and in dentine the collagen fibres also contribute, both linking physically and H-bonding to the GIC salt precipitates. There is also microretention from porosities occurring in the hydroxyapatite.

Source= https://en.wikipedia.org/wiki/Glass_ionomer_cement

Conscious Sedation for Dental Treatments

Conscious Sedation

Nothing to Fear

In spite of the dental technology that has made dentistry virtually pain-free, dental fear and anxiety still keeps millions of patients away from the dental office every year. For these patients, local anesthesia is not enough to treat the psychological factors of their condition -- a sedative is often needed to put them at ease during dental treatment. Conscious sedation is an excellent way to treat dental anxiety so your dentist can get to work on your teeth!

Conscious sedation dentistry allows you to enter a state of relaxation while staying awake during the procedure. Although you won't feel any pain, you'll be able to respond to your dentist's questions and commands. As communication is key with any dentist-patient relationship, conscious sedation is an excellent option for fearful dental patients.

Dental Sedation in a Nutshell

There are several types of sedation dentistry used to treat different levels of dental anxiety, each putting you in varied states of relaxation:

Light Sedation -- With minimal sedation, you are relaxed while remaining awake and alert.

Moderate Sedation -- You will remain conscious during a procedure, but you probably won't remember much about it. While you're able to communicate, you may feel groggy and slur your words. Some patients do fall asleep with moderate sedation but can be easily woken back up.

Deep Sedation -- This renders you either semi- or totally unconscious during your dental procedure, and does not usually fall under the category of conscious sedation. You will not regain consciousness until the drug wears off or is reversed, and recovery time takes longer.

Most forms of conscious sedation are considered "light" or "moderate" sedation. Surprisingly, conscious sedation is also referred to as sleep dentistry even though you remain awake during the procedure!

Choose Your Administration

There are several ways conscious sedation can be administered:

Inhalation Sedation -- Nitrous oxide, or laughing gas, is considered a light form of dental sedation. Your sedation dentist will administer the nitrous oxide though a mask that's placed over your nose. The gas is inhaled through the nose and expelled through the mouth. When the procedure is over, the nitrous oxide wears off almost immediately with minimal to no side effects or recovery time.

Oral Sedation -- Oral medication used for sedation purposes produces a light to moderate effect depending on the strength of the prescription. Oral sedation usually comes in the form of a pill taken an hour before the procedure. Although you'll be able to respond to your dentist's commands, you may feel sleepy. Recovery time will take longer, and you'll need an escort to drive you home. Although rare, side effects may include nausea and vomiting.

IV Sedation -- Like oral sedation, IV sedation is considered moderate. The difference is the drugs are delivered intravenously, producing an effect much sooner. IV sedation also allows your dentist to adjust the level of sedation needed during the procedure.



General Anesthesia

Note that general anesthesia is not included on the above list. General anesthesia is a form of deep sedation, and it is the only dental sedation that puts you to sleep. But before you jump at the chance of using general anesthesia to treat your dental fear, you should understand all that's involved.

General anesthesia can only be administered by an anesthesiologist, dental anesthesiologist or oral and maxillofacial surgeon. If your general or cosmetic dentist doesn't have the facilities or certification needed for general anesthesia -- and most don't -- you may need to have your work done in a hospital, which includes separate fees. There are also certain risks involved with general anesthesia that aren't present with conscious sedation dentistry; one example is the need for assisted breathing. Regardless, general anesthesia may be an option for those who don't respond to conscious sedation, need extensive dental work or are too mentally or emotionally disabled to understand the nature of their dental visits.

Going Local

Conscious sedation is not a painkiller, and in most cases you'll still need a local anesthetic during your dental procedure. If you strictly suffer from a fear of needles, conscious sedation can help. With conscious sedation, your dentist will easily be able to administer shots of novocaine while your mind wanders elsewhere.

Not to Be Taken Lightly

Conscious sedation is considered relatively safe -- but as with any medicine, there are risk factors. To ensure your safety, dental sedatives should only be administered by those with appropriate training. Your dentist will consider your health background when choosing a form of conscious sedation, so be sure to provide your dental office with your medical history and any medications you're taking to avoid complications.

Conscious sedation can help you conquer your dental fears so you can get the work you need. Discuss your fears with your dentist -- he or she will help you choose the right form of dental sedation for you.

Source= http://www.1800dentist.com/conscious-sedation/

CEREC Dental Restoration

The CEREC Procedure

Let's face it, very few of us have perfect teeth, free of decay and fillings. You can probably see a filling or two in your own mouth, which do just that -- "fill" a cavity, or hole, in your tooth left from the excavation of decayed tooth structure. In many cases, those fillings are made of metal material and can go bad, weaken the tooth, or get additional decay under or around it. In fact, 1.2 billion of these metal fillings will need to be replaced in the next 10 years. CEREC is a method used by thousands of dentists worldwide since 1987 not only to replace these fillings, but also to restore any tooth that is decayed, weakened, broken, etc. to its natural strength and beauty. Better yet, it's done with all-ceramic materials that are tooth colored in a single appointment!

Exam and Preparation

First, your Dentist examines the tooth and determines the appropriate treatment. It could be a simple filling, or a full crown, depending on how much healthy tooth structure is remaining and the clinical judgment of your Dentist. Next, he or she administers an anesthetic and prepares your tooth for the restoration, removing decayed and weakened tooth tissue. This preparation is just like he or she would do for many other restorative techniques.

Optical Impression

Then, your Dentist takes an Optical Impression of the prepared tooth. Instead of filling a tray with impression "goop" that you must bite into and hold in your mouth until it hardens, your Dentist coats the tooth with a non-toxic, tasteless powder. A camera is then used to take a digital picture of your tooth. This whole Optical Impression process only takes a minute or two.

No Temporaries

Next, the CEREC machine helps the Dentist create the restoration for your tooth. The CEREC 3D software takes the digital picture and converts it into a 3-dimensional virtual model on the computer screen. Your Dentist then uses his or her dental expertise to design the restoration using the CEREC 3D computer program. Within a few minutes, your Dentist clicks a button, and the restoration design data is sent to a separate milling machine in the office. A ceramic block that matches your tooth shade is placed in the milling machine. About 10 - 20 minutes later, your all-ceramic, tooth-colored restoration is finished and ready to bond in place. Finally, your Dentist tries the restoration in your mouth to ensure proper fit and bite. The restoration is then polished and bonded to the prepared tooth. Your tooth is restored with no "temporary" or return trip necessary. All of this is done in a single appointment! Ask us about CEREC today.

What is CEREC? CEREC is an acronym...

Chairside: The technology is in the dental operatory and used while you are in the chair
Economical:The procedure is economical for both dentist and patient
Restorations: The procedure restores your tooth to its natural beauty, function, and strength
of Esthetic: The restorations are metal-free and tooth-colored
Ceramic: High-strength ceramics are used that are close in composition to your natural tooth structure.
For an advanced dental restorative system that allows your dentist to restore decayed teeth, place crowns, remove defective amalgam fillings, or place cosmetic veneers in just one appointment. This allows you to have the highest quality, most lifelike dental restorations in just one visit to the dentist...in, out, and on with your busy life.

CEREC Acquisition Unit

The CEREC Acquisition Unit is mobile and houses a medical grade computer and the CEREC camera. Your dentist uses the camera to take a digital picture of your prepared tooth. This picture is used instead of a traditional impression. This means no impression tray and material for you to gag on. The computer and CEREC 3D software converts the digital picture to a three dimensional virtual model of your prepped tooth. Your dentist then designs your restoration right on screen using the software while you wait (and watch!). This software can assist your dentist with designing any single tooth restoration: crowns, inlays (fillings), onlays (partial crowns), and veneers. Once your dentist has designed your restoration (usually about 5 minutes), he or she clicks a button, and the design data is communicated via a wireless radio signal to the CEREC Milling Unit.

CEREC Milling Unit

Your dentist or dental assistant selects a ceramic block that matches the shade of the tooth being repaired. He or she then inserts the block into the Milling Unit. The data from the Acquisition Unit is used to direct two diamond coated burs to carve the block into the indicated shape of the restoration. This process usually takes 8 to 18 minutes depending on the size and type of restoration. After the milling is finished, your dentist polishes the finished filling or crown and bonds it into place.

Source= http://www.3-ddental.com/cosmetic-dentistry-north-andover-ma/cerec.html

Guided Tissue Regeneration

Guided bone regeneration or GBR, and guided tissue regeneration or GTR are dental surgical procedures that use barrier membranes to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiva for proper function, esthetics or prosthetic restoration.
GBR is similar to guided tissue regeneration (GTR) but is focused on development of hard tissues in addition to the soft tissues of the periodontal attachment. At present, guided bone regeneration is predominantly applied in the oral cavity to support new hard tissue growth on an alveolar ridge to allow stable placement of dental implants. Bone grafting used in conjunction with sound surgical technique, GBR is a reliable and validated procedure.

Use of barrier membranes to direct bone regeneration was first described in the context of orthopaedic research 1959. The theoretical principles basic to guided tissue regeneration were developed by Melcher in 1976, who outlined the necessity of excluding unwanted cell lines from healing sites to allow growth of desired tissues. Based on positive clinical results of regeneration in periodontology research in the 1980s, research began to focus on the potential for re-building alveolar bone defects using guided bone regeneration. The theory of Guided tissue regeneration has been challenged in dentistry. Most frequently by Hessam Nowzari and Jorgen Slots.

Four stages are used to successfully regenerate bone and other tissues, abbreviated with the acronym PASS:
- Primary closure of the wound to promote undisturbed and uninterrupted healing
- Angiogenesis to provide necessary blood supply and undifferentiated mesenchymal cells
- Space creation and maintenance to facilitate space for bone in-growth
- Stability of the wound to induce blood clot formation and allow uneventful healing

The first application of barrier membranes in the mouth occurred in 1982 in the context of regeneration of periodontal tissues via GTR, as an alternative to resective surgical procedures to reduce pocket depths.
Several surgical techniques have been proposed regarding the tri-dimensional bone reconstruction of the severely resorbed maxilla, using different types of bone substitutes that have regenerative, osseoinductive or osseoconductive properties. In cases where augmentation materials used are autografts or allografts the bone density is quite low and resorption of the grafted site in these cases can reach up to 30% of original volume. For higher predictability, nonresorbable titanium-reinforced d-polytetrafluoroethylene (d-PTFE) membranes—as a barrier against the migration of epithelial cells within the grafted site—are recommended. In patients with systemic problems interdisciplinary collaboration is indicated to adjust therapy background so that it does not adversely affect implanto-prosthetic treatment.


Source= https://en.wikipedia.org/wiki/Guided_bone_and_tissue_regeneration

Metal Bridge

METAL CERAMIC BRIDGES

The metal ceramic bridge (known as the porcelain fused to metal bridge) has been a stalwart in the dental world for many years. This dental bridge has been worn by countless numbers of people and is considered a strong and resilient type of bridge.

Other options are all ceramic bridges, such as zirconia bridges which are metal free and prized for their translucent appearance.

But it is important that you weigh up the pros and cons of both types of bridge before making your decision.

WHAT IS A METAL CERAMIC BRIDGE?

This bridge is comprised of a metal alloy framework and ceramic crowns which are designed as a replacement for missing or crooked teeth.

There are different types of metal ceramic bridges which include:

Metal alloy based
Noble alloy based, e.g. contains gold and copper
High noble alloy based
Metal alloy based bridges have a silvery grey appearance and are strong, durable and resistant to staining. They are less likely to fracture compared to the all ceramic bridge and have a long lifespan. Noble alloy based bridges contain a variety of metals such as gold and copper which makes them resistant to tarnishing as well as being a strong and tough type of bridge. Plus gold alloy is tolerated well by the body so no risk of an allergic reaction and does not damage your natural teeth.

High noble alloy based bridges contain higher percentages of gold or other metals which means a very strong type of bridge. This bridge is able to withstand any amount of pressure or force placed upon it and only requires a tiny amount of tooth reduction in the preparation stage.

ADVANTAGES OF A METAL CERAMIC BRIDGE

In brief: metal ceramic bridges have great strength and durability. They are known to last for many years and are generally biocompatible. There is only a small risk of an adverse reaction to the metals used in its manufacture.

Plus they are hard wearing and unlikely to crack, chip or break, even if you are heavy biter or tend to grind your teeth.

DISADVANTAGES OF A METAL CERAMIC BRIDGE

One disadvantage is that of being able to see a dark grey line around the edge of the gums which you may find less than attractive.

Plus some people suffer a reaction to the metals used in the production of the bridge.

Metal ceramic bridges also cause a heightened sensitivity to hot and cold liquids in some people.

As a result of this many people opt for the all ceramic bridge as these are metal free with no risk of rejection and have a realistic looking appearance. They closely match the colour of your natural teeth.

HOW IS A METAL CERAMIC BRIDGE FITTED?

This procedure involves two visits to your dentist: the first visit is the initial consultation followed by an examination of your affected teeth. The dentist will also prepare the affected teeth by cleaning and reshaping them so that they will be an exact fit for the bridge.

He/she will also take an impression of your teeth, using a mould containing putty which you bite into. The imprint of your teeth along with any x-rays will be sent away to a laboratory for manufacture of your bridge.

This usually takes two to three weeks. You will wear a temporary bridge during this period.

The second visit is where you will be fitted with your new bridge. The dentist will check that the colour of the crowns in the bridge closely resemble the colour of your own teeth before fitting it into your mouth.

He or she will check that it is a good fit and is not likely to cause you any discomfort. The crowns will be given a final polish before the bridge is fixed in place with dental cement.



Source=http://www.myperfectdentist.com/metal-ceramic-bridges.html

Metal Crown

What are all-metal crowns?
Just as their name implies, this type of crown has a construction that's 100% metal.

A gold dental crown.
The classic all-metal is the "gold" crown, however, they can also be made using silver-colored metals too ("white gold").

What type of metal is used?
Crowns aren't made out of pure metals because none has the ideal physical properties required for dental applications (good strength, resistance to tarnish and corrosion, wear resistance and characteristics that make it easy for the lab technician to fabricate the restoration and the dentist to adjust it).

Dental alloys.
What is used is some type of dental alloy (a blend of metals). One that's been engineered so its physical properties approach the ideal.

That means your "gold" dental crown isn't 24 karat (pure gold). In fact, the "precious" yellow-gold alloys used to make all-metal dental crowns usually only run about 15 to 20 karat. (See below for more details.)

Advantages of all-metal / gold crowns.
Opting for an all-metal crown can make an excellent choice, if you don't mind the fact that it's not tooth-colored. Here's why:

a) Superior strength.
Due to their 100% metal construction, there's no type of crown that's stronger than an all-metal one. (That can be said no matter what type of dental alloy has been used to make it.)

Failure due to breaking is an extremely rare event. In comparison, that's a real possibility with an all-ceramic crown. Or in the case of a porcelain-fused-to-metal one (PFM), a significant portion of its porcelain covering may fracture off thus resulting in restoration failure.

b) Superior longevity.
Due to their single-component construction and the great strength and durability characteristics they possess, no other type of dental crown can be expected to provide more lasting service than an all-metal one.

Considerations.
That doesn't mean that other types of crowns can't provide lasting service too. But in terms of predictability (what type of things might go wrong and how often these events occur), an all-metal crown is the safest bet possible.

c) Good biocompatibility.
In terms of how your crown might affect you or your mouth, all-metal crowns generally offer good biocompatibility.

Minimal wear to opposing teeth.
The wear coefficient of dental alloys is typically similar to tooth enamel. That's good because it means that restorations made using them won't cause excessive wear on the teeth they bite against.

The specific metal used may matter. - As rules of thumb, "gold" (high-noble, see below) alloys typically are "kind" to teeth in this manner. Possibly base-metal alloys are comparatively more abrasive to opposing teeth. (Yin 2004) [page references]

Considerations.
Keeping in mind how many decades a person's teeth might be in perpetual contact with the crown opposing them, this might be a significant point to consider. Especially in the case where they have a habit of clenching or grinding their teeth.
In comparison to all-metals, porcelain-surface crowns that have not been polished or glazed appropriately (a failure on your dentist's part) are likely to cause tooth wear, possibly significantly so.
Beyond that, due to the wide range of ceramics that can be used to make tooth-colored crowns, no other hard and fast rules can be stated. Studies do suggest however that some types of ceramics are kinder or gentler to opposing dentition than others, possibly on the same order as high-noble dental alloys. (Yin 2004)
Hypoallergenic
While possible, it's relatively rare for a person to have an allergic sensitivity to a crown that's been made using a "gold" (high-noble) dental alloy. This same statement cannot be made for base-metal ones (see below).

Considerations.
In cases where potential complications with a metal allergy are a concern, placing an all-ceramic dental crown can sidestep this issue entirely.

Gold dental crowns have a very accurate fit.
d) Superior fit.
When a "gold" (high-noble) dental alloy is chosen for an all-metal crown, no other type of restoration exceeds the crown-to-tooth fit that's possible.

Precious alloys have characteristics that make them easy and predictable to work with during crown fabrication.
And even if the dentist identifies a slight aspect of the crown's original fit that needs improvement, the malleable (pliant, workable) nature of a high-noble metal allows that an adjustment can be made.
(In comparison, base-metals are considered fairly unworkable. Dental ceramics have no potential for this same type of adjustment.)
e) Less tooth reduction is required.
When preparing (trimming) a tooth for dental crown placement, comparatively less tooth reduction is needed for an all-metal as opposed to a porcelain-fused-to metal or (almost all types of) all-ceramic crowns.

That's because crown strength is the only consideration involved. And since dental alloys are so strong, only about 1.5 mm of thickness is required (about the same thickness as a penny). In comparison, most porcelain-surface crowns require 2 mm or more.

Disadvantages of all metal crowns.
a) Their shiny metallic appearance.
The single disadvantage of an all-metal is the obvious. It simply doesn't look white like a tooth.

If that were not the case, in the vast majority of cases choosing a "gold" (high-noble alloy) crown would make the very best choice.

Gold crowns on a 1st and 2nd molar.

A gold crown on a molar that shows prominently.
The look of one or both might be too much for some people.
Minimal-visibility applications.
Metal crowns do make a great choice for those teeth that are hard for others to see.

Each individual person's situation will be different but possible candidates might include: 1) lower 2nd and 3rd molars, 2) upper third molars, 3) possibly some upper second molars, 4) possibly some lower first molars.

Upper first molars are typically too prominent in a person's smile to have a shiny metal crown placed on them.

Ask your significant other's opinion.
Crowns are expensive items and there are no free do-overs. Make sure to ask your significant other (the person who spends the greatest amount of time looking at you) for their opinion when making this decision.

b) Metal allergies.
About 10% of women and 5% of men experience an allergic response to nickel, chrome and/or beryllium. Base-metal dental alloys (see below) frequently contain these metals and for that reason may prove problematic for some patients.

The use of a high-noble ("gold") alloy instead of a base one may offer a solution. The more predictable alternative would be to place an all-ceramic (non-metallic) crown.


Source= http://www.dental-picture-show.com/dentists-crowns/a-gold-crowns.html

Dental Bonding

Dental bonding is a procedure in which a tooth-colored resin material (a durable plastic material) is applied and hardened with a special light, which ultimately "bonds" the material to the tooth to restore or improve person's smile.

For What Conditions Is Dental Bonding Considered?

Dental bonding is an option that can be considered:

To repair decayed teeth (composite resins are used to fill cavities)
To repair chipped or cracked teeth
To improve the appearance of discolored teeth
To close spaces between teeth
To make teeth look longer
To change the shape of teeth
As a cosmetic alternative to amalgam fillings
To protect a portion of the tooth's root that has been exposed when gums recede
What's the Procedure for Having a Tooth Bonded?

Preparation. Little advance preparation is needed for dental bonding. Anesthesia is often not necessary unless the bonding is being used to fill a decayed tooth, the tooth needs to be drilled to change its shape, or the chip is near the nerve. Your dentist will use a shade guide to select a composite resin color that will closely match the color of your tooth.
The bonding process. Next, the surface of the tooth will be roughened and a conditioning liquid applied. These procedures help the bonding material adhere to the tooth. The tooth-colored, putty-like resin is then applied, molded, and smoothed to the desired shape. A bright, usually blue, light, or laser is then used to harden the material. After the material is hardened, your dentist will further trim and shape it, and polish it to match the sheen of the rest of the tooth surface.
Time-to-completion. Dental bonding takes about 30 to 60 minutes per tooth to complete.
What Are the Advantages and Disadvantages of Dental Bonding?

Advantages: Dental bonding is among the easiest and least expensive of cosmetic dental procedures. Unlike veneers and crowns, which are customized tooth coverings that must be manufactured in a lab, bonding usually can be done in one office visit unless several teeth are involved. Another advantage, compared with veneers and crowns, is that the least amount of tooth enamel is removed. Also, unless dental bonding is being performed to fill a cavity, anesthesia is usually not required.
Disadvantages: Although the material used in dental bonding is somewhat stain resistant, it does not resist stains as well as crowns. Another disadvantage is that the bonding materials do not last as long nor are as strong as other restorative procedures, such as crowns, veneers, or fillings. Additionally, bonding materials can chip and break off the tooth.

Because of some of the limitations of dental bonding, some dentists view it as best suited for small cosmetic changes, for temporary correction of cosmetic defects, and for correction of teeth in areas of very low bite pressure (for example, front teeth). Consult with your dentist about the best cosmetic approach for your particular problem.

Do Bonded Teeth Require Special Care?

Bonded teeth do not require special care. Simply follow good oral hygiene practices. Brush teeth at least twice a day, floss at least once a day, rinse with an antiseptic mouthwash once or twice a day, and see your dentist for regular professional check-ups and cleanings.

Because bonding material can chip, it is important to avoid such habits as biting fingernails; chewing on pens, ice, or other hard food objects; or using your bonded teeth as an opener. If you do notice any sharp edges on a bonded tooth or if your tooth feels odd when you bite down, call your dentist.

How Long Does Bonding Material Last?

The lifespan of bonding materials for the teeth depends on how much bonding was done and your oral habits. Typically, however, bonding material lasts from three years up to about 10 years before needing to be touched up or replaced.

Source= http://www.webmd.com/oral-health/guide/dental-bonding#1

Composite Veneers

Composite veneers
Not having a confident smile can effect every aspect of your life from your social interactions to business situations. We provide no interest financing options for people to help pay for their life changing smile makeovers. We try to find something in everyones budget that can still meet their goals. Same day smile makeovers can be a great option for people who want a great looking smile but don't have the budget for porcelain veneers.
Composite veneers, often called direct veneers, chair side veneers or bonding is an alternative to porcelain veneers for smile makeovers. There are positives and negatives to composite veneers. They enable dentists to charge lower fees than porcelain veneers, because there is no lab bill for the veneer. Each veneer is made by the dentist using tooth colored composite directly onto the teeth. Because the veneer is made entirely by the dentist, it is especially important to do your research to find a dentist who has an artistic eye and the experience to pull off a natural looking result. This is one area that really pays to have an experienced dentist. Dr. Olitsky has passed his accreditation with the American Academy of Cosmetic Dentistry where he spend over 200 hours on perfecting the techniques of composite veneers. This process is an art and it requires knowledge of the details of tooth shapes, morphology and translucency and the principles of smile design. Composite veneers can make teeth whiter than tooth bleaching using peroxide. They can also make smiles wider and correct some chipping, tooth wear, crowding and spacing. Composite veneers typically cost about half as much as porcelain veneers.
The drawbacks of composite veneers is that it is much more difficult to make extreme changes to the smile. If the teeth are more crowded or have moderate or severe wear and bite changes, there are more benefits to using porcelain veneers. Composite veneers have a higher chance of getting small chips and staining. While the composite materials are strong, the are not as strong as porcelain. The good news is that these situation can in most cases be repaired easily. Composite veneers will slowly darken over the years and the only way to lighten the veneer is to replace it. Composite also looses its polish quicker, but they can be repolished at cleanings. The lifespan of composite veneers is 7-10 years. Porcelain veneers do not stain or darken over time. Porcelain veneers can last 15 or more years. Porcelain veneers are created by ceramists in dental laboratories. If the ceramist who makes the porcelain veneer is not highly skilled or the dentist is using an in expensive lab, the porcelain veneer will look about as good as a well done composite veneer. If the dentist cuts back and stains the composite veneer, the veneer can look translucent and vital like a nice porcelain veneer. The best dental laboratory ceramists can make porcelain veneers look better, more natural and vital than any composite veneer. Make sure if you are getting porcelain veneers, your dentist is working with the best laboratory ceramists.


Source= http://www.smilestylist.com/content/composite-veneers

Zirconia Bridge

ZIRCONIA BRIDGES

A zirconia bridge is considered a top quality type of bridge which is stronger, durable and visually appealing as compared to other types of bridges.

It is often preferred to metal ceramic bridges in that it causes less tooth sensitivity and with no sign of the dreaded grey line around the edge of the gums. For many people this is a downside of wearing a bridge.

But one way of avoiding that is to choose an all ceramic bridge or the highly rated zirconia bridge instead.

WHAT IS A ZIRCONIA BRIDGE?

A dental bridge is a structure in which a false tooth and two crowns are attached to a metal base which acts as a replacement for missing teeth.

The false tooth sits in the gap and is flanked by the two crowns which fit over the natural teeth on each side of the gap. In other words, it ‘bridges’ the gap in your teeth.

A zirconia bridge is different in that it is produced from Zirconium oxide – a tough form of dental ceramic which is also compatible with the body. This means that the body will not reject or react in a negative way to the bridge.

This is a problem with metal based bridges as there are people who have an allergy to the metals used in the bridge.

A zirconia bridge has a translucent appearance and is an ideal match with the rest of your teeth.

ADVANTAGES OF A ZIRCONIA BRIDGE

The main advantages are a strong, stable and great looking bridge which blends in well with the rest of your teeth. Plus the material used to fabricate this bridge is ‘biocompatible’ which means that is kind to living tissue within your body and will not cause any ill effects, e.g. an allergic reaction.

Less preparation is needed which refers to the process you undergo before the crown is fitted. Your dentist reshapes the tooth, removing a tiny sliver which enables a better fit between crown and tooth. But minimal tooth reduction is required for a zirconia crown.

Plus there is no metal base within this bridge which means no ugly looking black line at the edge of the gums which is a common feature of metal ceramic bridges. This is good news from an aesthetic point of view as many people prefer to wear a bridge whose crowns closely match the colour of their natural teeth.

DISADVANTAGES OF A ZIRCONIA BRIDGE

The advantages of a zirconia bridge have been discussed; but are there any disadvantages of this type of bridge?

Cost is one issue as this type of bridge may be more expensive than the standard metal ceramic bridge. This means shopping around to find the most suitable (and affordable) bridge for you. But do not be guided by price alone as it is important that you choose a bridge which is best suited to your teeth.

Ceramic is a tough, long lasting material but what can happen is that the surface of the crowns becomes rough which then rubs against natural teeth. This causes them to become worn down and less effective than before.

One problem with all ceramic bridges is that they can be less resistant to stress or extra forces, e.g. biting compared to metal ceramic bridges. There is an increased risk of chipping or a fracture as a result of this although the newer varieties have a stronger inner structure.

HOW IS A ZIRCONIA BRIDGE FITTED?

The process for this is the same as for any other type of bridge. Your dentist will assess the current state of your teeth before discussing the pros and cons of the treatment with you.

If you are considered a good candidate for a zirconia bridge then he/she will prepare your teeth for this bridge. The preparation stage is part of a two stage procedure which includes taking an impression of the affected teeth along with supporting x-rays.

It also includes what is known as ‘tooth reduction’ in which the dentist trims the affected teeth with a small drill so that it will enable the crowns to fit over the top.

These are all used in the fabrication of your zirconia bridge. They are sent to a dental laboratory that produces your bridge over a period of two to three weeks.

During this time you will be given a temporary bridge to wear. Once your new bridge has been made you will return for the fitting. Your dentist will fit the new bridge and check that it is a correct fit before cementing it in place.

He or she will then advise you about looking after your bridge.


Source= http://www.myperfectdentist.com/zirconia-bridges.html

Zirconia Crown

Advantages of Having Zirconium Crown
Zirconium is becoming one of the most chosen materials for dental crowns. Its many advantages include:

Extraordinarily tough
Can withstand wear and tear
Translucent enough to be similar to natural teeth
Less tooth removal
No Metal fuse
Modifiable size, shape and color
Biocompatible
The aesthetic effects alone of a zirconia crown should be the biggest advantage it can give. It is important that you have dental crowns that will look natural especially if it will be placed at the front teeth and will be visible beside the natural teeth.

The capacity of zirconium to be modified according to the set of teeth it will be placed alongside with is very important. Zirconium crown will not only replace a tooth but it can shaped so that it will look better than the one it will be replacing with. This therefore is why you can sport that perfect natural looking smile anytime.

Zirconia manufacturers are now producing and designing dental crowns custom milled from solid block of the material and baked at ultra high temperatures to ensure that the finished crowns are almost indestructible.

The fact that this material is biocompatible means that it is safe to stay within your mouth for a long time. There is no need to worry about any adverse reactions from your body because it is not rejected by the human body.

Advantages of Zirconium Crowns over Gold Crowns and Porcelain Crowns
It is a fact that gold crowns have been used by many people for so many years and it is well tolerated by the body. But it is still better to be able to show that natural effect when you smile. Add the fact that gold is metal and some people just do not like having metals in their internal parts.

Zirconium crowns are definitely more robust than porcelain crowns. They last longer too, compared to porcelain that chip and break.
Porcelain crowns also need to be fused to a metal base and the metal is that black unsightly line above the gums of people with porcelain crowns.

Since Zirconium crowns are milled from a chunk of crystal, they are guaranteed to be at least 5 times stronger than porcelain and it metal fuse. Zirconium crowns also provide strength without that bulky appearance that porcelain is so known for.

Disadvantages of Using Zirconium Crowns:
One of the disadvantages of zirconium crowns is that they are so hard that is why most dentists still prefer the gold crowns.

Another disadvantage is that, although the crown itself will be almost indestructible; the decay underneath it caused by the abrasion of the hard material against the other teeth is not noticeable. You will only realize that there is decay once the crown falls off.

Source= http://www.dental-treatment-guide.com/dental-crowns/zirconia-crowns

PFM Bridge

Porcelain-fused-to-metal (PFM) bridges consist of a metal core inside and a layer of porcelain outside blended together. PFM bridges look just like normal teeth.

BENEFITS:

Unlike purely metal tooth bridges, shade will be matched to the color of existing teeth.
Porcelain provides the most natural final appearance of any other dental bridge material.
PFM bridges can be used on both the hidden and prominent teeth.
PFM crowns are of better quality when they are high in noble metal inside.
They are durable and have enough the strength.
DOWNSIDE:

Porcelain can wear away at neighboring teeth.
More vulnerable to chipping and breaking than metal.
Porcelain's translucence sometimes allow the inside metal core to show through.
There is more a problem at the crown-gum line, especially if the gums recede over time.
If the patient has a missing tooth, the dentist will replace that tooth cavity with a dental bridge. The anchor teeth are prepared and an impression is made of the prepared teeth to send to the dental technician. A temporary plastic dental bridge is fitted over the prepared teeth to protect them while the final bridge is being manufactured.
The finished porcelain fused to metal bridge is tried in and the bite adjusted if necessary.
Once the fit, shape and color of the bridge is satisfactory the dental bridge is cemented in place permanently. A very natural looking end result is achieved.


Source= http://www.turkeyestheticdentistry.com/porcelainfusedtometal-pfm-bridges.html

PFM Crown

What are Porcelain-fused-to-metal crowns?
A porcelain-fused-to-metal dental crown.
PFM's can be thought of as a hybrid between all-metal and all-ceramic dental crowns because they're made out of both materials.

A metal alloy is used to create a thin thimble-like cap ("substructure") that fits snugly over the tooth.
Porcelain is then fused over the substructure to form the shape of the crown and give it a white tooth-like appearance.
Advantages of PFM's vs. all-metal crowns.
The clear advantage of a PFM crown over an all-metal one is simply one of appearance.

Its porcelain covering gives it a tooth-like look. And for teeth that hold a prominent position in your smile, that can be a vitally important factor.

(FYI: In all other ways other than appearance, an all-metal crown makes the superior choice.)

Advantages of PFM's vs. all-ceramic crowns.
Just like with PFM's, all-ceramic restorations give a natural-tooth look too. But beyond that similarity, metal-ceramic restorations offer some advantages.

Sagital view of a porcelain-fused-to-metal crown.
PFM crown construction - A layer of porcelain fused over an underlying metal substructure.
a) Greater strength.
Due to their metal substructure, PFM crowns are the stronger type of restoration.

Even if some of its surface layer of porcelain fractures off, the metal substructure underneath will characteristically stay intact thus maintaining the crown's seal over, and reinforcement of, the tooth.

In comparison, the full thickness of an all-ceramic may fracture, thus compromising both functions.

Further comparisons.
It's possible that some newer types of all-ceramics offer strength properties that are somewhat on par with PFM's.

However, it's important to mention that porcelain-fused-to-metal restorations have a 50+ years track record of providing lasting and durable service. (Only all-metal crowns are superior or more proven in this regard.) In comparison, no type of all-ceramic even remotely approaches this benchmark.

b) A more precise fit.
Due to differences in how they're made, a PFM's metal substructure typically achieves a more exacting fit over its tooth than an all-ceramic one.

Admittedly, on a clinical level this may only be of limited concern. But at least in theory, the less dependence the tooth-to-crown relationship has on its weakest link (the cement layer in between) the better.

What are the disadvantages of porcelain-fused-to-metal crowns?
a) They may wear opposing teeth.
The porcelain surface of a PFM crown may cause significant wear of those teeth (or dental restorations) that touch against it. In comparison, all-ceramic and all-metal restorations have less of a reputation for creating this type of damage.

Porcelain repair.
With just minor incidences, the chip or break is often ignored or polished/smoothed off.
For larger fractures, it's possible that an in-the-mouth repair can be made. However, these types of patches can't be expected to offer the same predictable lasting service as crown replacement does.
Ozcam (2002) evaluated 289 PFM restorations that had been patched (using a silane and dental composite technique). Repairs that failed typically did so in the first 3 months. At 3 years after placement, 89% of the fixes were still in place.
In cases where patching is not possible (the tooth can't be kept saliva-free during the repair process, repair has been repeatedly tried and failed) crown replacement is the only alternative.
c) Challenges in creating a truly lifelike look.
Most dentists would probably agree that it's easiest for them to achieve the most natural-looking results when placing an all-ceramic crown vs. a porcelain-fused-to-metal one.

All-ceramic crowns often have more translucency than PFM's.
All-ceramics.
Because there's no metal substructure to hide, with an all-ceramic crown a greater portion of the restoration's total thickness can be made using relatively more-translucent porcelain.

That's important because it's the kind of ceramic that typically mimics the look and luster of natural tooth enamel the best.

PFM's.
In comparison, the metal substructure of a PFM must be masked by placing a layer of very opaque (chalky-white) porcelain over it. And having to do so reduces the total thickness of translucent ceramic that can be used to make the crown.

(If you'd like to read more about this subject, use this link.)

PFM vs. All-ceramic: Which to choose?
This issue about appearance is just a difficulty with PFM's, not an impasse. When selected for the right applications (ones where the tooth can be trimmed in ideal fashion), the look of a porcelain-fused-to-metal crown can be exceedingly lifelike.

In situations where the restoration holds a prominent position in the person's smile and therefore its appearance is critical (like with incisors or eyeteeth, and especially in cases where just one or a few crowns are being placed), opting for an all-ceramic might make the better-matching choice.
When a set of crowns is placed (like all 6 or even 8 upper front teeth), uniformity is created and that alone often allows a smile to look acceptable to others. If so, then either type of crown could make a suitable choice.
For front teeth that show relatively less so and therefore their appearance isn't as critical (like the situation where a person has a long lip line) the issue of esthetics might not be much of a factor at all.
For posterior teeth that show (like premolars and 1st molars) the added strength that a PFM offers might make its possibly just-average appearance an acceptable tradeoff.
The dark line that may show at the edge of a porcelain-fused-to-metal dental crown.
The issue of the dark edge showing is never an issue with an all-ceramic crown.
d) The "dark line" phenomenon.
Another potential problem associated with porcelain-fused-to-metal crowns is one of managing how their metal substructure's edge remains hidden.

The problem.
If changes such as gum recession occur, the appearance of a tooth that's been crowned with a PFM can be spoiled by its metal edge (dark line) that then becomes visible.

For teeth that show prominently (like the front tooth of a person who has a high lip line), this can be an important issue. For many people however, this portion of their tooth may not be readily visible, and therefore of just minimal or even no concern.

PFM crown with receded gum line and dark edge showing.
The gum line has receded on this PFM crown and now its metal edge shows as a dark line.
The solution.
Preventing recession by practicing diligent oral home care is the best solution, although admittedly sometimes recession occurs anyway.
Dentists do have a couple of ways they can deal with this difficulty, either planning ahead for it or trying to resolve it if it occurs. Both approaches do however typically involve compromises.
If no other solution is possible, a new crown will have to be made. Based on previous events, your dentist will have to advise you as to how likely or when they think the dark line problem might be expected again.
The alternative.
Keep in mind that in cases where this issue is a concern or has been a problem in the past, placing an all-ceramic crown avoids this matter altogether.

e) Greater tooth reduction is needed.
Porcelain-fused-to-metal dental crowns require a greater amount of tooth reduction (trimming) than their all-metal counterparts. For example, metal crowns can be as thin as 1.5 mm on their chewing surface whereas PFM crowns need to be at least 2 mm thick.

This issue is typically of limited concern but can crop up in certain instances:

An example involving back teeth.
Sometimes creating enough clearance is difficult with molars.

If the tooth is trimmed in ideal fashion, doing so may make it so short that the finished crown might not stay in place well.
If the tooth isn't trimmed enough, the crown's metal might not be thick enough for proper rigidity or its porcelain thick enough to look natural.
In this type of instance, an all-metal (or at least a crown with an all-metal chewing surface) would make the better choice.

An example involving front teeth.
Creating adequate reduction can sometimes be difficult with front teeth too, such as the case where the dentist feels that trimming aggressively might encroach on the tooth's nerve tissue.

For teeth that show prominently, only being able to trim a minimal amount of tooth structure may result in a PFM crown that looks acceptable but not fantastic (due to it just having a minimal thickness of translucent porcelain).
All-ceramic crowns generally require a similar amount of tooth reduction as PFM's, but tend to give a more lifelike result due to their greater thickness (in percentage terms) of translucent porcelain.
Selecting the type of alloy that will be used to make your PFM.
The metal substructure of a porcelain-fused-to-metal crown can be made out of any one of a number of dental alloys specially formulated for this purpose.

Based on their past experiences, your dentist will probably have an opinion about which ones tend to make their job easiest and produce the best results.
Your insurance policy may only provide benefits for certain classes of alloys.
Types of PFM alloys.
The same classification system that's used to categorize alloys for all-metal dental crowns is used with PFM alloys too. They are:

a) High noble (precious).
High-noble alloys have a composition that's over 60% gold, platinum and/or palladium, with over 40% of the formulation being gold.

These metals have the advantage that they are the easiest and most predictable to work with. Using them usually insures the most accurate crown fit and the most predictable bond with porcelain.

b) Noble alloys (semiprecious).
Alloys in this group have a noble metal content (gold, platinum and/or palladium) that's over 25%.

c) Base (nonprecious).
These alloys have a formulation that's less than 25% noble metal. They're typically high in nickel, chromium and/or beryllium content. Biocompatibility (some people are allergic to these metals) and corrosion are sometimes a concern with these materials.

Source= http://www.dental-picture-show.com/dentists-crowns/a-porcelain-dental-crowns.html

Porcelain Veneers

THE HOWS AND WHYS OF PORCELAIN VENEERS
Porcelain laminate veneers consist of a compilation of several thin ceramic layers which replace original tooth enamel, and an adhesive layer. To apply a veneer, a very small amount of the original tooth enamel must be removed, usually less than a millimeter. This is essential as it creates room for the porcelain veneer to fit within the mouth and most accurately restore natural tooth function while creating an even better appearance than the original tooth.

The bond between original tooth and porcelain veneer is critical as it not only provides the esthetic perfection desired, but also a strong bond which is essential for correct veneer function. Light-sensitive resin is placed between the original tooth and the veneer and then hardened using a special curing light.

Porcelain veneers are a very successful option in many situations where the original tooth has developed poor color, shape, and contours. It is also a good choice for fractured teeth, gaps between teeth, and in some situations where the tooth position is compromised and there are minor bite-related problems. For some people, superficial stains do not respond well to tooth whitening or bleaching. In these situations, a porcelain veneer may be the best option.

MINIMAL PREP OR “NO-PREP” VENEERS
Some patients are looking for an alternative to traditional dental veneers or bonding, but be aware that this treatment option is not appropriate for everyone.

Just as with porcelain veneers, “no-prep” or minimal preparation veneers— so called because they typically don’t require the dentist to remove as much tooth material—are bonded to the front surface of your teeth. Often, the placement of no-prep veneers can be done more quickly and with less discomfort than traditional veneers.

Your dentist will let you know if you are a good candidate for minimal preparation or “no-prep” veneers and if this option makes a sensible treatment plan.

THE BENEFITS OF VENEERS
Since veneers are individually sculpted for each patient, it is nearly impossible to tell the difference between a veneer and a natural tooth. Unlike natural teeth, custom-made veneers resist coffee and tea stains, and cigarette smoke because they are made of high-tech materials.

With veneers—as opposed to crowns—your natural teeth remain largely intact with only a minimal amount being altered to fit the veneer.

For teeth that resist whitening, veneers can make even the darkest teeth appear bright white.

Dentists may also recommend veneers to quickly fix minor twists, overlaps, and small gaps.

POTENTIAL VENEER DOWNSIDES
Because a portion of the original tooth enamel is reduced, a veneer is not considered a reversible treatment. Although adjustments and even new veneers can be made, you can never reliably return to the original condition of the tooth.

Creating porcelain veneers requires some laboratory time, so expect at least a week before they’re ready to be applied.

After the porcelain veneers are attached you will probably have some sensitivity to hot and cold temperatures due to the removal of that thin layer of enamel. This typically disappears within a few days. In a healthy mouth properly treated with porcelain veneers—and where destructive forces are minimized or eliminated—a patient should be able to use porcelain veneers like his or her own teeth. Although they’re very strong, veneers are also brittle. You should avoid the same excessive stresses you would avoid with non-veneered teeth: don’t bite your fingernails, chew ice, or open beer bottles with your veneers!

MAINTENANCE OF A PORCELAIN VENEER
Maintaining porcelain veneers is actually quite simple: Treat them as you would your original teeth, with routine brushing and flossing. Using non-abrasive fluoride toothpaste will typically be suggested by your dental professional.

One week after your veneers are placed, you will be required to return to the office for a follow-up visit and evaluation so the dentist can see how your mouth is reacting to the veneers. Even if you feel the veneers are a success, this appointment is vital to your future oral health.

If you have a habit of grinding or clenching your teeth, your dentist may fit you with a nighttime bite guard so you do not damage your veneers.

You should also return to your dentist for regular professional maintenance because porcelain veneers should be polished with a specially formulated, non-abrasive paste, and because your dentist needs to inspect your dentistry for any sign of potential failure.


Source= http://yoursmilebecomesyou.com/procedures/porcelain-veneers/

Porcelain Bridge

Dental porcelain is remarkable in its ability to replicate both the form and function of original teeth. Whether you’re looking at veneers, crowns, or a fixed bridge, the use of porcelain can provide the longevity, durability, and esthetic you desire.

A porcelain fixed bridge is very useful when replacing a tooth or a couple of teeth that are no longer viable. The porcelain can be sculpted to replicate the look of natural tooth enamel and using this durable material gives your bridge a strong base to rely upon.

Porcelain is so flexible in its design capabilities that it can be used not only to replace lost teeth, but also to improve the original appearance of those teeth and create a flawless replacement.

PORCELAIN BRIDGE CONSULTATION
There are different ways to replace missing or damaged teeth, so a dental health professional should be contacted if this is a problem you are facing. Your teeth will carefully be examined and the right course of treatment will be pursued.

If you think a porcelain bridge is an avenue you want to explore, be certain you raise this with your AACD member dentist. He or she will explain the benefits of using porcelain and the few pitfalls you may run across. Make sure you express your concerns and if the main reason you’re seeking porcelain is cosmetic, don’t be ashamed to admit it; you will quickly discover that porcelain is excellent for esthetic reasons, but also has some highly desirable functional benefits as well.

THE HOWS AND WHYS OF A PORCELAIN FIXED BRIDGE
A porcelain fixed bridge replaces missing teeth by using the surrounding teeth as a foundation. This creates a literal “bridge” between the remaining teeth and the missing teeth.

Dental porcelain is a great product because it can be shaped to replicate original teeth and fit comfortably within the established bite pattern. Porcelain is also very durable, will withstand most natural tooth functions, and can vividly mimic tooth enamel with its glass-like whiteness and translucence, which allows light to penetrate and scatter as it does with natural organic teeth.

MAINTENANCE OF A PORCELAIN FIXED BRIDGE
Maintaining a porcelain bridge is actually quite simple. Treat your bridge in the same manner as you would original teeth, with routine brushing with non-abrasive fluoride toothpaste and regular flossing.

A follow-up appointment will be scheduled to evaluate your bridge shortly after it’s placed, so the dentist can review his or her handiwork and see how your mouth is reacting to the treatment. Even if you think everything feels perfect, this appointment is vital to your future oral health.

Source= http://yoursmilebecomesyou.com/procedures/porcelain-fixed-bridges/