Restorative/Crown Alternatives

This information is provided to assist you in making choices about restorations for your posterior teeth (bicuspids and molars).

1. Gold Alloys have been used for many decades for the highly successful restoration of posterior teeth. They are nontoxic, wear very similarly to tooth enamel when opposed by natural teeth, and are soft enough that years of use allow them to "wear in" much like natural teeth. Well-placed cast gold restorations usually have longevity of several decades in patients without peculiar tooth grinding habits (bruxism or clenching). In mouths with severe wear patterns, gold is the material of choice because gold is strong yet soft.
   
   However, gold is not tooth colored, and in many situations, it cannot be used because it creates unsightly display of metal. You will be advised if gold could be used in your mouth without significant display. WHEN ESTHETICALLY POSSIBLE, CAST GOLD IS THE LONGEST LASTING, STRONGEST TYPE OF POSTERIOR TOOTH RESTORATION.
   
   
2. Porcelain-Fused-To Metal Restorations have been in service for over 30 years. They are a metal coping (thimble), with tooth-colored porcelain baked onto it. Such restorations can be as beautiful as natural teeth when placed in the mouth. These restorations are strong and very lifelike, but they have some negative characteristics.
   
   These usually are not acceptable for patients with tooth grinding habits because they may crack or break under enormous stress. Second, they wear down opposing natural teeth in patients with grinding habits. Third, extreme stress (e.g., ice chewing, bones, or cherry pits) can break the porcelain from the metal.
   
   However, in most patients, PORCELAIN-FUSED-TO METAL RESTORATIONS PROVIDE EXCELLENT, BEAUTIFUL, LONG LASTING POSTERIOR TOOTH RESTORATIONS.
   
   
3. CERAMIC RESTORATIONS are now available. They do not have any cast metal in them. These are fired cast porcelain, or other ceramics. They are suggested only for single crowns and not for multiple units connected together. Their strength is not as high as porcelain-fused-to metal restorations. THESE RESTORATIONS ARE HIGHLY ESTHETIC AND ARE MOST INDICATED FOR PEOPLE WITH METAL ALLERGIES.

Whitening

Advantages of Whitening
The advantages of tooth whitening over other procedures that whiten teeth are that it doesn't require any tooth structure be removed and it is the most economical. Even teeth that have had root canals can easily be whitened. Whitening, which has been practiced for more than 15 years, has virtually no side effects.

Results
To get the best results, whiten your teeth a shade lighter than you desire, since they will tend to darken slightly with time. Anywhere from 2 to 10 visits may be required to complete the process.

You should avoid stain-causing beverages such as coffee and tea for several days after the procedure, because your teeth may more readily absorb stain at that time. Daily brushing and flossing and regular professional cleanings--along with occasional touchups keep your teeth white so that you can again feel confident in exercising your smile.

Crown & Bridge

Symptoms And Signs:

1. Pain when chewing
2. Pain on cold air application
3. Unsolicited pain (usually leakage of sugar into tooth crack)
4. No radiograph evidence of problem
5. No dental decay present
6. Easy verification of crack when tooth is prepared for restoration

Treatment of Cracked Teeth

1. Simple Crack : The majority of cracked teeth (about 9 out of 10) can be treated by the replacement of a simple crown (cap) on the tooth. When the tooth is prepared for the crown, and a temporary restoration is placed, the pain usually leaves immediately. IF THIS IS THE CASE WITH YOUR TOOTH, WE WILL PLACE THE FINAL CROWN WITHOUT A PROBLEM ON YOUR NEXT APPOINTMENT AND THE CONDITION SHOULD BE SOLVED.
   
   
2. Complex Crack : Occasionally (about 1 in 10) the tooth cracks into the pulp (nerve) of the tooth. IF PAIN PERSISTS AFTER PLACEMENT OF THE TEMPORARY CROWN, YOU MAY HAVE A CRACK INTO THE PULP OF THE AFFECTED TOOTH. PLEASE CALL US. THIS TOOTH MAY REQUIRE ENDODONTIC TREATMENT (ROOT CANAL THERAPY) BEFORE THE CROWN IS PLACED. This requires about two additional appointments before the crown is placed.

Endodontics & Root Canal Therapy

What is Endodontics?
Endodontics is the area of dentistry concerned with the prevention, diagnosis and treatment of disorders of the dental pulp (the tooth's soft core). Years ago, teeth with diseased or injured pulp were extracted. Today, endodontic treatment gives dentists a safe and effective means of saving teeth.

What is Dental Pulp?
The pulp is a soft tissue that contains the nerves, arteries, veins and lymph vessels of a tooth. It lies within the dentin, the bone-like tissue that supports the enamel. Within the dentin, the pulp extends from the pulp chamber in the crown (the portion of the tooth that is visible above the gums) down to the tip of the root by way of the root canal. All teeth have only one pulp chamber, but teeth with more than one root will have more than one canal.

What happens to the damaged pulp?
When the pulp is diseased or injured and unable to repair itself, the pulp dies. The most common cause of pulp death is a tooth fracture or a deep cavity that exposes the pulp to saliva. The bacteria found in saliva causes infection inside the tooth. Left untreated, the infection eventually causes the pulp to die. Pus can build up at the root tip, forming an abscess that can destroy the supporting bone that surrounds the tooth.

Why does the pulp need to be removed?
If the damaged or diseased pulp is not removed, the tooth and surrounding tissues become infected. Pain and swelling may accompany the infection. Even in the absence of pain, certain byproducts of a diseased pulp can injure the bone that anchors your tooth in the jaw. Without endodontic treatment, your tooth will eventually have to be removed.

What does Endodontic treatment involve?
Treatment usually requires from one to three appointments. During these treatments, the diseased pulp is removed. The pulp chamber and root canal(s) of the tooth are then cleaned, shaped, filled and sealed to prevent recontamination of the root canal system. Root canal therapy usually is a relatively painless procedure. In the final step, a gold or porcelain crown is usually placed over the tooth to restore structure, function and appearance.

*This information was provided by the American Dental Association

Orthodontics

For more information about what kinds of orthodontic treatments are available at Tully Dental, please call our office to schedule an appointment with Dr. Tully for a consultation.

Limited Surgery

For more information about the limited surgery available at Tully Dental, please call our office to schedule an appointment for a consultation with Dr. Tully.

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Periodontics

Visible Signs

1. Gums that bleed when you brush your teeth.
2. Gums that are red, swollen, or tender.
3. Gums that have pulled away from you teeth.
4. Permanent teeth that are loose or separating.
5. Changes in the way your teeth fit together when biting.
6. Any changes in the fit of partial dentures.
7. Pus between your teeth and gums.
8. Chronic bad breath or bad taste.

Invisible Signs

1. Abnormal spaces (periodontal pockets) developing between the teeth and gums.
2. Loss of the jawbone that normally surrounds and supports the teeth.

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Removable Full & Partial Dentures

IF YOU HAVE A REMOVABLE PARTIAL DENTURE, OR ARE ABOUT TO GET ONE, YOU'VE TAKEN A NECESSARY AND IMPORTANT STEP TOWARD MAINTAINING YOUR ORAL HEALTH.
Here's why:

1. Wearing a partial denture can help your remaining teeth stay in position. When there are spaces between natural teeth, the teeth may drift or tip, placing unnatural stress on the tissues of the mouth. Teeth that are tipped or out of position are often hard to clean and are therefore at greater risk of tooth decay and periodontal diseases, which can cause additional tooth loss.
2. Chewing is easier and more comfortable if missing teeth are replaced. If teeth are missing, you may chew food on only one side of your mouth, placing too much stress on that side. This can eventually lead to further problems with the gums and other tissues of the mouth.
3. Wearing a partial denture can also benefit your speech and appearance. You need your teeth to make many sounds properly. They also help maintain the natural shape of your face by supporting your lips and cheeks.

Adjusting Partial Dentures
Your partial denture was made to fit precisely, but your mouth is constantly changing. In time, your gums and the bone supporting your partial denture may shrink, causing it to become loose or rock. If your appliance becomes loose, contact us as soon as possible. Only a dentist can determine how your mouth has changed and what should be done to refit your partial dentures.

Repairing Partial Dentures
If your partial denture breaks, cracks or chips, or if a denture tooth becomes loose, contact us immediately. Do not try to mend it yourself. Using a do-it-yourself repair kit can damage the denture and make it impossible to repair. Over-the-counter glues often contain chemicals that can damage the plastic denture material and harm oral tissues. However, we can usually repair a broken denture, often on the same day.

It is especially important to contact us if your partial denture breaks while you are eating. This sometimes indicates that there has been a change in the fit of the dentures because the underlying tissue has changed. When we repair your denture, we will also examine your mouth and check whether your partial denture needs adjustment.

Regular Dental Visits
Even if your partial denture is undamaged and feels comfortable, you should see us at least once a year to protect your oral health. During these visits, you will receive a complete oral examination. We will check for signs of oral cancer and examine your gum ridges, tongue and the joints of your jaw. If you suffer from dry mouth (xerostomia) an artificial saliva may be prescribed. We will also look for signs of general diseases, including diabetes, that can show up in the mouth. When necessary, your natural teeth will be cleaned and your partial denture will be refitted.

Most people can wear a removable partial denture successfully-it just takes a bit of time to become adjusted. And with a little effort spent on regular oral hygiene, all remaining natural teeth can last a lifetime.

Cleaning The Dentures And Your Mouth
Your dentures can be cleaned easily with a denture brush and a mild toothpaste or mild hand soap. Use special care to clean any part of the partial that comes in contact with any natural teeth. Both the partial denture and the natural teeth must be kept very clean on a daily basis to reduce the chance of new dental decay starting. Use toothpaste containing fluoride. Denture soaks are also useful for the denture. Brush your gums twice a day with regular toothbrush to toughen and clean them. Leave the dentures out of your mouth at night. While they are out leave them soaking in water.

*This information was provided by the American Dental Association.

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Implants

Originated in Sweden in the 1960's, this type of system has now had over 30 years of successful use. Upper or lower implants can replace single teeth or an entire arch of teeth and have shown approximately 90% success over 30 years. Lower implants have been more successful than uppers and are currently the most widely used implants.

Dental Implants Solve Problems Associated With Removable Dentures.
While conventional dentistry enables some people to wear dentures comfortably, research has shown 85% of the estimated 32 million people with dentures experience some discomfort and difficulty due to their false teeth. Dental implants eliminate the discomfort and embarrassment often associated with dentures. Where some teeth are missing, dental implants may be used to eliminate the need for a removable partial denture by providing the support necessary for attachment of a fixed bridge. Patients with implants have reported their confidence has been restored and their quality of life improved. Dental implants help prevent the premature loss of remaining teeth and are a good investment in oral health.

What are implants?
Implants, made from biocompatible materials, can become directly attached to the jaw bone. In dental terms this is called "osseointegration". The implant then performs a function similar to a healthy natural tooth.

What procedures are used to insert implants?
The insertion of implants is a surgical procedure performed in a single office visit. The implant is designed to be submerged under the gum tissue, allowing time for the implant to attach directly to the bone. After a healing period of three to six months, a brief second procedure is needed to expose the top of the implant. An appropriate post is then attached to the implant to support a bridge or denture.

What restorations are possible with implants?

• REPLACE A SINGLE TOOTH. One implant with a crown can replace a single missing tooth, eliminating the need to prepare adjacent natural teeth.
• ELIMINATE A PARTIAL DENTURE. Implants can be used as a support for a fixed bridge by either connecting to natural teeth or to other implants.
• STABILIZE A DENTURE. A removable denture can be retained by several implants while still being supported by tissue.
• RETAIN AND SUPPORT A DENTURE. A removable denture can be retained and supported by four to six implants joined by a bar.
• SUPPORT A COMPLETE BRIDGE. Jaws missing all the teeth can be restored with fixed bridges anchored by five or six implants. This restoration is removable only by your dentist.

Am I a candidate for implants?
Generally, anyone who is healthy enough to have a routine extraction can be considered for dental implants. The main limitation is the amount of available bone which can usually be determined by a clinical and radiographic examination.

What inconvenience will I experience?
Most patients report only minor discomfort similar to that associated with simple tooth extraction. When the patient wears a partial or full denture prior to the surgery, the denture can often be modified with a soft lining. This surgery provides little disruption of normal business or social activities.

How long will my implants last?
Research has indicated that implants offer long-term predictability once osseointegration has taken place. Studies have shown that implants achieve osseointegration on a highly consistent basis. The success of implants depends on a number of variables including individual patient health, oral hygiene, anatomical variations and restoration design.

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Preventative

Tooth decay often occurs in the chewing surface of back teeth. To prevent the chance of cavities forming in these areas sealants are applied.

What is a sealant?
A sealant is a clear shaded plastic material that is applied to the chewing surfaces of the back teeth (premolars and molars), where tooth decay occurs most often. Sealants act as a barrier, protecting the decay-prone areas of the teeth from plaque and acid.

Fact: Even a single tooth brush bristle is too large to reach inside the pits and fissures of the molars.

How are sealants applied?
Each tooth takes only a few minutes to seal. First, the teeth that will be sealed are cleaned. The chewing surfaces are then etched (roughened) with a weak acidic solution to help the sealant adhere to the tooth surface. Finally the sealant is brushed on and and allowed to harden. Some sealants need a special curing light to help them harden; others do not.

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Diagnostic X-Rays

1. A bitewing X-ray picture shows the upper and lower teeth on one film. It is especially helpful in revealing decay between the teeth, and bone loss in early stages of periodontal (gum) disease.
2. A periapical X-ray picture shows the entire tooth, including the tip (apex) of the root and some of the surrounding tissues.
3. A Panoramic X-ray picture shows all the upper and lower teeth, jaws and other structures. It is frequently used to the extent of growth, tooth eruption, and orthodontic problems. Panoramic radiographs can also be used for diagnosis of jaw fractures or before a denture is considered. Unerupted teeth, retained root tips, and other conditions of the jaw can all be seen.
4. Digital x-rays are a computer generated image of the teeth and boney structures.  Digital x-rays offer the benefit of using 70-80% less radiation using a digital sensor versus traditional plastic x-ray films.  The computer image permits immediate viewing and can be enlarged and modified to enhance patient education and quick diagnosis.

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