Restorative Procedures  |  Cosmetic Dentistry Procedures  |  General Dentistry

Composite Fillings

Until recently, dentists filled and sealed cavities exclusively using a silver and mercury amalgam. Unfortunately, these fillings (or restorations) often weaken teeth due to the large amount of the original tooth that has to be removed. Modern dentistry has increasingly turned to composite fillings as a strong, safe and more natural looking alternative. Composite fillings utilize a soft white plastic substance that includes a hardening agent.

Pros and Cons of Composite Fillings
The major advantage of these fillings is that they come in a range of shades that closely match the color of an individual's tooth. Due to the increased strength of modern composite material, they can now also be used in the back teeth. Unfortunately, composite fillings are 1 1/2 to 2 times more expensive than traditional restorations. Dental insurance typically covers the cost of composite fillings up to the price of the silver/mercury fillings.

The Filling Procedures
During your initial visit to the dentist, he or she begins by anesthetizing the tooth and removing any remaining decay. Once the tooth has been prepared, the dentist places the composite inside, where it binds to the original surface. The process is typically performed in several layers wherein each layer is cured or hardened with the use of a hardening light. Composite restorations (fillings) for the back teeth are referred to as inlays. If the inlays need to be custom-made at an off-site dental lab, two visits to the dentist may be required. Once the dental office receives the custom inlays, the patient returns to the dentist's office, where the inlays will be bonded into place.

After the Fillings Have Been Placed
Patients may have increased sensitivity in the tooth for several weeks following the procedure. Unlike veneers, composite fillings are porous. Over time, they may become stained from coffee, tea, tobacco, etc. Many dentists place a clear covering over the filling to avoid any future staining. Composite fillings typically last three to twelve years, depending on the location of the restoration, an individual's occlusion (or bite), and several other factors.

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Traditional Amalgam Fillings

Composite Resin Fillings

Comparison of Traditional
versus Composite Fillings

Composite Bonding

Composite bonding is a technique used to improve the appearance of your teeth. The term composite bonding refers to any composite material, either a plastic or resin, which is bonded to an existing tooth. Bonding is ideal for fixing chipped or cracked teeth, hiding discoloration on the tooth's surface, or reducing the gaps between teeth. Whatever the specific intent, composite bonding creates more aesthetically pleasing teeth and a brighter smile. Unlike veneers or crowns, composite bonding removes little if any of the original tooth.

The Advantages of Bonding
Composite bonding is a quick process, typically lasting less than an hour. Compared to veneers or crowns, it is a popular choice because it does not reduce the tooth's original structure. Composite bonding is also relatively inexpensive. And finally, composite resins are available in many different shades. The shade can be chosen to match the natural color of the original tooth.

The Process
The dentist begins by examining and cleaning the tooth to be bonded. Once the tooth is properly prepped, the dentist rubs the tooth with a mild solution that facilitates the bonding of the composite resin to the tooth. The composite resin is then applied in several coats. Each coat is hardened (or set) using a specially designed dentist's light. Once the dentist has placed an adequate amount of resin on the tooth, the bond is sculpted for the desired shape and texture. Bonding is performed in the dentist's chair and usually does not require any anesthesia.

After your Bonds are Placed
Proper care of the bonded tooth ensures the longest possible duration of the bonding. The bonded teeth, just like the rest of your teeth, should be brushed and flossed daily. This is especially important if you drink coffee, tea, or smoke tobacco, all of which stain composite bonds. Bonds typically do not last as long as veneers or crowns and may need to be retouched or replaced every five to ten years.

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Before Composite Bonding

After Composite Bonding

Crowns

When a tooth is cracked, decayed, or damaged, a crown may need to be fitted onto the tooth. A crown is a permanent covering that fits over the original tooth. Crowns can be made of porcelain, gold and other metals, acrylic resin, or an amalgam (a mix) of these materials. Porcelain crowns typically have the most realistic appearance, although they tend to be less durable than other materials. Crowns can whiten, reshape, and realign existing teeth, adding to a bright, healthy smile.

Preparing the Tooth and Crown
During your first visit, the dentist will numb the tooth to be crowned and remove the decay in or around it. The tooth is then rescultped to provide an easy fit for the crown. This is a painless process that is performed in the dentist's chair.

An impression of your teeth is then taken and sent to the dental lab where permanent, custom-made crowns are created (this usually takes one to two weeks). During this interim period, temporary crowns made of an acrylic resin are fitted onto the teeth.

Applying the Crown
On your next visit, the dentist removes the temporary crown and fits the permanent crown onto the tooth. He or she makes sure the crown has the proper look and fit, and then cements the crown into place.

Maintaining Your New Crown
The proper dental hygiene for normal teeth should be applied to any new crown. Daily brushing and flossing will help to keep the teeth, gums, and crown free from the bacteria that can cause gum disease. Chewing on hard foods such as ice or pistachios should be avoided because over time, they can cause crowns to crack or break. Given proper care, crowns can last several decades and may last a lifetime.

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 Before and  After
 Porcelain Crowns

Before Crowns
for Teeth Spacing

and After
Crowns for Teeth Spacing

A bridge is a device used to fill the space where a tooth has fallen out or been removed. A typical bridge consists of a pontic (a filler tooth) that is attached to two surrounding abutments (crowns). Once complete, this bridge structure is bonded into the mouth. Without the use of a bridge, spaces in the mouth from missing teeth can cause multiple teeth to shift, lead to occlusion (biting) and/or jaw problems and spur periodontal disease. Bridges safeguard the integrity of existing teeth and help maintain a healthy, vibrant smile.

The Process
Bridges usually require two trips to the dentist's office. During the initial visit, the surrounding teeth are numbed with a local anesthetic. The dentist prepares the surrounding teeth by cleaning any plaque or decay that remains and reducing them so that the crowns can be fitted. The dentist makes a mold of the teeth and sends it off to a dental lab where the customized impression is prepared. The customized mold takes one to two weeks to return to the office. In the interim, patients are fitted with a temporary bridge constructed of acrylic resin. When the patient returns to the dental office, the dentist removes the temporary bridge and replaces it with the permanent one. The dentist then adjusts the bridge for the proper bite and fit, and the bridge is permanently bonded into the mouth.

Types of Bridges
There are several different types of bridges. The first is a fixed bridge, which consists of a filler tooth (a pontic) that is attached to two crowns. The crowns fit over the existing teeth to hold the bridge in place. The fixed bridge is the most popular bridge.

Another bridge design is a composite bond, known as a "Maryland" bridge. This type of bridge is commonly used to replace the front teeth. The pontic is attached to metal bands that are bonded to the abutment teeth, and the metal bands are hidden with a white-colored composite resin.

A cantilever bridge is often used when there are teeth on only one side of the span. A typical 3 unit cantilever bridge consists of two abutment crowns that are positioned next to each other on the same side of the missing tooth space. The pontic is then connected to the two crowns, which extend into the missing tooth space.

If the missing tooth space has no surrounding teeth, the dentist may decide an implant is the most appropriate choice. Please refer to Dental Implants in the Patient Education Library for more information. When a series of teeth are missing, the dentist may suggest a partial denture as the most effective way to maintain the structure of the jawbone and teeth.

Proper Maintenance
Special care must be given to ensure that the gumline and area surrounding the new structure is kept clean. This is especially true because the pontic and crowns are constructed as a single piece. Special floss is often necessary to clean underneath the teeth and maintain strong, healthy gums. With proper dental care, bridges can last up to 10 years.

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Before a Dental Bridge

After a Dental Bridge

Dental Implant

After a Dental Implant