Advantages of Porcelain
If you have a tooth that should be crowned to save it, you will probably want Dr. Patenaude to use the best and longest lasting material available as long as it's within your budget. One of the finest materials available is porcelain because of it's strength and durability as well as it's appearance. In one technique, porcelain is fused with a strong metal to increase its strength. Once in place, it can withstand the hardest biting forces without danger of fracturing.
A porcelain crown, as in all tooth crowning procedures, will require several visits to prepare the tooth and to fit the crown onto the restored tooth. Once the crown has been cast and the porcelain fused, it will be properly shaped and coloured to match your other teeth to insure both a good match as well as chewing efficiency. It should serve your needs well for many years, providing you maintain good oral hygiene habits at home and have regular dental checkups. If you need a tooth crowned, ask Dr. Patenaude about the advantages of porcelain.
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Avoiding Tooth Extraction
If you have an infected or badly decayed and damaged tooth and conventional restorative treatment can not save it, the next step would likely be root canal therapy. This technique offers an important alternative for saving your teeth. By keeping your teeth in your mouth as long as possible, they can continue to function in maintaining the shape of your face as well as in chewing food. There is NO equally strong substitute for your teeth.
Root canal treatment involves the removal of diseased tissue from the root of a tooth and replacing it with a sterile filler. The tooth is then sealed to prevent further infection. This is a relatively comfortable procedure and is usually performed with the aid of local anesthesia when a tooth is severely infected.
High-speed dental instruments and other techniques also help make root canal therapy more comfortable for the patient. They have also helped reduce the time needed to complete the procedure.
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Beauty and Strength
If you want both beauty and strength in a restored tooth, you can have your cake and eat it too. You'll find it in a technique called porcelain-fused to metal.
This is a crown that's made with an alloy core. This gives the restoration strength and durability. Then porcelain is baked onto the metal crown to give it the beauty and stain-resistance of porcelain.
When your tooth is prepared and fitted with the porcelain-fused-to metal crown, it will look like a perfectly health, natural tooth. That doesn't mean your new tooth is carefree, You'll still have to practice good oral hygiene to keep the bacteria away from the restored tooth as well as from all the other teeth in your mouth. But you'll have a tooth reinforced with the strength and durability of the alloy and capped with the natural appearance of porcelain.
Because of these qualities, the porcelain-fused-to-metal technique is often recommended for teeth in the front of your mouth when they need restoration. Ask your Dr. Patenaude about it.
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Cast Metal Alloy
The silver amalgam filling is an excellent restorative material, but it does require support by the tooth structure. When there is insufficient tooth structure remaining to support the amalgam or when the load (biting force) exceeds the strength of restorative material, Dr. Patenaude must then use a stronger material to construct a lasting restoration. The metal casting is such a restoration,
The casting can be constructed from any number of alloys with barring gold content. Each of these materials has its strong and weak characteristics. In an alloy these materials are combined in proportions to take advantage of the best qualities of each, In the final analysis, the choice of material is best left to the dentist who has to work with it and construct the restoration. Keep in mind that these restorations require more chair time and laboratory time therefore will be more costly than amalgam fillings.
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Colour of Front Teeth
If one of your front teeth has darkened from old fillings, in most cases it is possible to restore the original colour. It can be reduced, reshaped and covered with porcelain fused to metal crown or porcelain jacket.
It should give you an excellent colour match. There is no reason to accept a truly off-color jacket, bridge or denture, on the other hand, do not study the colour with a magnifying mirror held 6 inches from your face under a high-intensity light. It is best to picture of how your mouth looks to others.
Besides, not even your original teeth match perfectly. If you were to really study your won natural teeth, you would find about three shades of the same color in the upper teeth. You would also find that lower teeth are a different shade of the same colour as the uppers.
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Fixed Bridge Advantages
One of the very best ways to replace a missing tooth, or teeth, is through the use of a fixed bridge. This is attached to two or more adjacent teeth by use of abutment crowns. Gold, coated with porcelain, is normally the material used to construct the crown. The same materials are used to replace the missing tooth or teeth. The fixed bridge has many advantages. Since it remains permanently in the tooth, it cannot be dropped, lostor stolen. It can be cleaned in the same way as natural teeth. It adds no extra bulk to the mouth and does not interfere with speech. It is very unlikely to cause irritation to the gum or jawbones. It is esthetically pleasing and can often last a lifetime. Unfortunately, a fixed bridge may not be for everyone in every situation. Dr. Patenaude can give advice on the feasibility and the desirability of a fixed bridge only after a careful examination.
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Fixed Bridge: Filling the Gap
A fixed bridge can replace one or more missing teeth. It consists of one or more replacement teeth attached to crowns that are placed on two or more surrounding support teeth. Along with replacing teeth the fixed bridge helps restore the normal function and proper position of your bite. A fixed bridge is made of various metals, porcelain, or a combination of the two.
Dr. Patenaude reshapes the support teeth that will hold the crowns of your fixed bridge. Then an impression of the prepared tooth and of the surrounding and opposing teeth is taken. To protect your prepared teeth, the dentist may fit a temporary bridge.
Your dentist sends the impression and color recommendation to the dental laboratory making your fixed bridge. Dr. Patenaude will adjust the bridge for fit and bite. Once these are comfortable, it is cemented into place. The fixed bridge is the next best thing to natural teeth.
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From Partial to Fixed
Suppose you've been wearing a partial denture for several years and find it doesn't fit as well as it once did. This happens in normal use even if you only remove the partial to clean it. You may also prefer to have an appliance in your mouth that would be less trouble and more efficient than a partial denture. If that's your case, you should ask Dr. Patenaude about the non-removable fixed bridge.
A fixed bridge is permanently cemented into place and helps complement the efficiency of your natural teeth in chewing food. But you must have enough natural teeth left to act as anchor teeth. In a three-unit fixed bridge, for example, the artificial tooth (or pontic) if firmly cemented to the natural teeth on either side by means of crowns. That is how the bridge is secured in place. The anchor teeth serve as abutments, similar to the engineering principle used in the construction of a bridge over a river. Again, sound natural teeth must be there to make the fixed bridge possible. Ask Dr. Patenaude about the advantages as well as the feasibility of a fixed bridge for you.
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Gold Inlay Justified
The two most widely used filling materials are silver amalgam and gold inlay. Although gold inlay is more costly in the first instance, its cost is more than justified over year of use. The gold alloy used in inlays is a stable, durable compound, and when the inlay is properly constructed and inserted in the tooth, it maintains its form, contour and margins. A gold inlay rarely, if ever, breaks or cracks. On rare occasions an inlay may become loose, but it can be recemented unless new dental decay has occurred. Though it is superior, gold inlays are not for everyone. Usually they are not recommended for children or young adults who show a high incidence of dental decay. On the other hand, use of the gold inlay in adults who show a low incidence of new dental decay is highly recommended. Gold inlay is also recommended in instances where it has become necessary to replace old, defective silver amalgam fillings.
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Inlays/Onlays
A cast alloy inlay or onlay is one of the better methods for restoring a tooth. An inlay replaces that portion of the tooth that has been destroyed by the ravages of decay. Leaving the majority of the walls of the tooth still intact, the inlay fits into the tooth.
An onlay is used when portions of the walls and /or cusps of the teeth are also destroyed, An only fits ON the tooth as a name implies.
There are several methods used to construct inlays and onlays.
Usually the tooth is prepared, and impression is taken and from impression, a model is made, A casting is then produced. The patient usually wears a temporary medicated filling until the restoration is ready to be placed in the tooth. Then the temporary filling is removed, and finished restoration is placed in or on the tooth.
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Protecting Enamel
Enamel is the hard, translucent substance that covers the crown of the tooth (the part that extends above the jawbone). It is the part of the teeth that you show when you smile. It can be white, healthy and attractive; or it can be stained, pitted with cavities and ugly. There is good news and bad news when it comes to enamel. The good news is that it incredibly hard. Only seven natural substances, including diamonds and carborundum, are harder than tooth enamel, and you are not likely to chew them. It is the hardest tissue that the body develops. It is made up almost entirely of calcium, phosphorous and a few other minerals. The bad news is that once the enamel has been formed, it loses all capability of self-repair. Since-unlike dentin and pulp-it is on the outside of the tooth, it has no repair cells and is no longer in contact with the supply of nutrition from the blood. It resists decay, but once decayed it cannot fix itself.
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Pulp Capping
Pulp capping is a technique used by dentists to restore a tooth to health when decay gets dangerously close to a vital pulp. The pulp is the inside portion of a tooth, which contains nerves and a blood supply. If the decay goes all the way to a vital pulp, a medicating material is placed directly on the pulp after all the decay had been removed. This stimulates the pulp to heal by producing a protective 'bridge' under the medication. If the decay is deep but has not yet touched the pulp, a medication is placed at that point which stimulates the remaining dentin to remineralize and harden. The tooth is then restored with a conventional filling.
If either product fails, root canal therapy will be necessary. Why not then do root canal procedures immediately? The answer is the root canal treatment is more involved, takes longer, and is more costly- and in some situations, may not be successful. It's a judgment call that only a dentist can make.
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Replacement options
There are a number of ways to replace lost teeth, and many people are confused by the terms. A fixed Bridge is an appliance used to replace one or two teeth (occasionally more). In this method, crowns are placed on one, two or more supporting teeth in the area, and the missing teeth are attached to these crowns. It is not removable.
A partial Denture is a removable bridge which is constructed in many forms, The simplest is the flipper. This is a piece of plastic to which one or two teeth have been attached and which fits closely to the inside of the teeth. The most common partial denture is the cast metal framework that contains clasps and teeth that are attached to the frame with tab acrylic base. A Denture, on the other hand, is used where there are no remaining teeth. Usually it completely covers the palate or the mandible and is constructed from acrylic.
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Replacing Old Bridgework
You probably realize the importance of replacing missing teeth with bridgework for your appearances sake as well as to help keep your teeth in proper alignment. Even the best-made bridgework, however, will show signs of wear in time. This wearing may also lead to irritation of your gums because the bridgework no longer fits as well in your mouth as it did initially.
If you have bridgework that shows signs of wear or if you notice your gums have receded or look red and puffy, ask Dr. Patenaude if he would recommend replacing the old bridgework with a new appliance. In checking your mouth and your old bridgework he may also study signs of wear on the artificial teeth as well as opposing natural teeth.
Before the new bridgework is fitted into your mouth, Dr. Patenaude will want to make sure your gums are healthy. Any infection that is causing irritation, redness, or puffiness will be treated before you begin wearing the new bridgework. In addition to a good fit, he will make the bridgework as natural-looking as possible to it will blend in well with your other teeth.
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Root Canal Myth
If you think root canal therapy has something to do with extracting a tooth or that it makes a tooth turn black, you have a misconception about one of the most important dental procedures. Root canal therapy is often recommended to save a tooth and prolong its usefulness for many years.
What it really amounts to is taking the nerve out of the tooth. The tooth is not extracted, nor does it turn black. You may notice some discoloration in the tooth after root canal therapy, but your dentist can correct this, just as he can correct any discolored or stained tooth. He may use one of several procedures to make it match up with your teeth. One method involves bleaching. Another method is to bond a composite resin over the surface of the tooth. Also, a very thin veneer of plastic laminate can be applied.
If the tooth needs rebuilding so you can use it more efficiently for chewing, your dentist may recommend that the tooth be covered with a porcelain crown.
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The Post Crown
If you have a tooth that is so badly broken that it is fractured right down to the gum line, Dr. Patenaude may recommend root canal therapy (to save the tooth) followed by the post-crown procedure. In this procedure, a post is used to provide added support to the crown. The post he uses is a metal rod with a core at the end of it. After root canal therapy, he will fit the metal post directly into the tooth's nerve canal and cement it into place with the core extended out to receive the crown. This is the first stage. A crown will then be prepared to fit over the core so the tooth will be restored to proper function an appearance. The crown will be shaped to match the natural contours of your teeth and a natural-looking colour selected.
Often times a tooth will become so badly damaged and decayed that your first thought might be to have it extracted. Any natural tooth is worth saving because no artificial tooth can fully replace its function and chewing efficiency.
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Using a crown to Save Teeth
If you have a badly decayed or damaged tooth, Dr. Patenaude may recommend a crown to save the tooth and make it properly functional. He will have to x-ray the tooth first to find out if it can be saved. An x-ray will also show the size and location of the nerve canals within the tooth as well as the condition of your surrounding teeth.
Another tool Dr. Patenaude may use is a study model or plaster mold of your mouth. Using this, he can examine and measure the size and shape of the tooth to be crowned. The model will also reveal the relationship of your upper jaw to your lower jaw. If a crown is to be made, it should fit properly in your mouth and improve your chewing efficiency.
Any natural tooth is far superior to the best artificial tooth that can be made, as long as it is carefully protected and restored to its natural shape. That's why crowns are often recommended to save teeth as well as to improve your appearance.
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What's Up Front
If you've been told that it's what's up front that counts', your dentist would be the first to agree with you when you need dental work on your front teeth. These are the teeth that are most noticeable every time your open your mouth to talk or smile. You want them to look as attractive as possible. There are many types of dental materials recommended in restoring your teeth so they will look as natural as other healthy teeth. He can use these materials to match the colour of your other teeth and he can also reshape the tooth to make it look better, eliminating any noticeable gaps. In selecting a material that will hold its colour as long as possible, he may recommend one of the new micro-filled materials which consist of very hard micro-sized crystals. Mixed with resin and applied to the surface, this material produces a very smooth surface and has highly satisfactory aesthetic results. This is only one of the options available to improve your appearance.
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When to Crown
If you have a tooth that is so badly damaged or decayed that a simple filling will not protect it adequately, Dr. Patenaude will probably recommend that it be crowned. He may also recommend a crown if the tooth has already had several fillings that are badly worn and the tooth is in danger of fracturing.
One of the advantages of crowning a tooth is that it completely encircles the tooth, giving it full support. Another reason is to improve the appearance of your teeth. There are many materials available that can be used to give a crowned tooth a natural look as superior strength.
Once a tooth has been crowned, you will need to practice good oral hygiene and have regular checkups to protect the tooth from decay. Like other restorations, crowns will eventually show signs of wear. Depending on the type of material used, they will usually last a long time before they need to be repaired or replaced. If you have a badly damaged tooth that could benefit from crowning, ask Dr. Patenaude what he would recommend.
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Why A Fixed Bridge?
Whenever there is a legitimate choice for replacing a missing tooth, opt for a fixed bridge. The result will be stronger and more permanent. Think of your teeth as fence posts. If you were to put lateral (shaking) forces upon those fence posts and exert that force about 3, 000 times a day every day of your life, what do you think would happen? You would make the holes in the ground larger and larger and the posts looser and looser.
You swallow about 2,000 times a day. Swallowing brings your teeth together. Chewing foods adds another thousand. This goes on every twenty-four-hour day. Gum chewing compounds the felony.
With a fixed bridge, much can be done to minimize the effect of these forces on the teeth. The top of the restored chewing surface can be narrowed from cheek to tongue. Also, it can be rounded to minimize the forces received. These forces go more into the long (or strong) axis of the teeth than laterally.
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Why Tooth Replacement
Once you have a tooth extracted, there are all sort of false reasons to postpone having it replaced. It may be a molar toward the back which doesn't show, so who cares? You don't want to have the adjacent teeth prepared just to replace a missing one. You don't have time for the replacement work. There are better things to spend money on. None of these reasons are valid.
The number of reasons may seem to make an overwhelming argument, but the reasons on the other side of the issue are just as numerous and definitely more compelling. The simple, indisputable fact is that leaving a space where the tooth once stood will hasten the break-down of otherwise good teeth. Teeth next to and opposite the space can and will shift. The chain of contacts will break down. Food will pack into and cause inflammation and gum problems between the teeth on that side of the mouth. Radical bone changes also occur.
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Dental Implants
The technology involved in dental implants has changed radically in the last few decades. Although the history of implants goes back a long way, it was not until the use of titanium alloys that the technique became really successful. Until that time, implants didn't become like a part of the bone. With titanium, the bone can grow right into the metal, forming a healthy bond. The technique for implantation has become very successful. The success rate of the implants is highly dependant on the skill and experience of the dentist or oral surgeon involved, and the dentist who constructs and inserts the bridgework on the posts. Success also depends largely on a recipient who is patient and willing to work with his doctors. The results can be truly remarkable.
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Implants for Dentures
There have been efforts for many years to develop a firmer foundation for dentures. Specifically, efforts have been made to implant anchors that would connect replacement teeth to the underlying bone as securely as natural teeth are connected by their roots. Research advances have brought us to the point where implants, in some situations, are the approach of choice.
Although conventional dentures generally do an excellent job of replacing lost teeth, there are certain problems, which may require a different approach. If a denture is placed over a ridge that has become thin and sharp, the concentrated pressure of chewing can cause irritation and pain. There are also situation where, because of accident, disease, surgery, or genetic defect, the jaws are unable to support any conventional denture. If this occurs, implants can work miracles. When indicated, they have proven to be the answer, and have an excellent record of function, comfort, and esthetics.
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Why Replace Lost Teeth?
When teeth are lost, they should be promptly replaced. There are exceptions to this rule such as wisdom teeth, but the rule applies to virtually all other teeth. For most people, appearance is the most important reason. Gaps left by missing teeth are unsightly, and the mouth is likely to look caved in or collapsed. Deep creases may form at the outer corners of the mouth, which often leads to an inflammation and makes you look older. Even more important are function disorders. Missing teeth affect your chewing ability, cause your bite to be out of balance and may result in pain in the jaw's hinge joint. Damage to the remaining teeth also becomes more likely. So does periodontal disease which, in part, is the result of a bite which pounds some teeth.
Perhaps most serious of all are misalignments. If teeth are deprived of the support and restraint of adjacent teeth, they will rotate, tip or shift. In addition, when teeth don't meet opposing teeth, they may grow out too far, causing a whole new set of problems.
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What is a Dental Onlay?
Onlays are essentially large fillings. The term onlay is used when a substantial portion of the tooth crown needs to be replaced. Onlays are used to restore teeth severely damaged by decay or wear. Since they are often subjected to heavy chewing pressures, they must be made of very durable material. In most instances, this means gold or some other cast metal that can withstand chewing pressures without shattering or deforming. Porcelain is sometimes used as it has the advantage of matching the tooth in colour.
The use of metal onlays is generally limited to the back teeth, where they are not so visible. They are fabricated, inserted and cemented in place just like cast metal fillings. It is considered to be a superior type of restoration when excessive wear or a difficult bite are encountered. It has greater strength than a conventional filling, yet requires less loss of tooth structure than a crown.
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Tooth Bleaching
A tooth with a damaged pulp may become discoloured, usually from iron in the blood that has leaked. It usually occurs from trauma to the tooth, and it may be the first sign that the pulp has been damaged. The discolouration problem may usually be solved by internally bleaching the crown.
It is important to note that not all discoloured teeth are dead. Sometimes the pulp may recover completely after some trauma and leave a healthy and yet discoloured tooth. When pulp therapy is completed, Dr. Patenaude introduces a bleaching solution internally in the tooth. More than one visit may be necessary and between visits a milder bleach is sealed in the tooth. When a satisfactory degree of lightening has been achieved, a tooth-coloured filling will be inserted to seal the chamber. Although generally successful, bleaching doesn't always remove all stains. Other techniques such as jackets, bonding or veneering may then be used.
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Prosthetic Teeth
Artificial or prosthetic teeth are either acrylic or baked porcelain. They are available in a tremendous variety of sizes, shapes and colours and, just like a face, no two teeth are exactly identical. Although Dr. Patenaude is a skilled evaluator of which tooth form and colour to use, his choice should reflect your views. A word of caution, do not opt for teeth that are too perfect or too white. They will not look natural and may dominate a smile which looks and is false. Follow your dr. Patenaude's advice and go with a tooth form and colour that will restore as well as enhance.
The best prosthetic teeth have slight irregularities in shape and alignment and subtle graduations in colour, just as natural teeth do. Porcelain teeth are stronger and more resistance to wear and staining than acrylic teeth. Acrylic plastic, however, is more resilient and does not transmit as much as chewing pressure to the underlying gum and bone. It is also less prone to fracture.
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