THINK CONSERVATIVE

A couple of weeks ago I discussed the different types of materials that are being used today to “fix” teeth. I broke them down into two main categories – direct vs. indirect materials. Direct materials are things like silver amalgam and tooth-colored resin/composite that are placed directly into the tooth after the tooth is prepared. Indirect restorations are things like crowns, gold and ceramics in which the tooth is prepared and a manufactured restoration is cemented or bonded to the tooth. Whatever your feelings are on amalgam, there is no disputing that it proved to be a very successful material over a long period of time. Despite this, it has not been used in most of Europe in decades and is used relatively infrequently in the United States. Its replacement, tooth-colored composite resin has made much progress in its ability to look good, allow more conservative treatment, and hold up well if used within the recommended parameters. However, it falls short when restorations get larger, cusps of teeth are involved, and/or when patients have bruxing/grinding issues. In my experience, most patients don’t ask too many questions about the materials that will be used to “fix” their teeth. However, I think it is a conversation worth having. The expected lifespan of the materials being used in your mouth is good information to know to help you make a decision about your treatment. If you had a moderate to large silver filling to be replaced (that’s been there for 30 years) and the dentist told you that your new composite resin had an expected lifespan of 5-10 years, would you be okay with that? I was recently at a training session for my CAD/CAM (computer-aided design/computer-aided manufacturing) machine which produces indirect restorations. The presenter discussed the fact that we live in a challenging time for our dental restorations. Teeth are under a lot of stress with the normal functions of eating. Throw in additional stress from grinding and an acidic environment from all the carbonated beverages we drink or gastric reflux issues people unknowingly have, and teeth are at a disadvantage.

Conserving Tooth Structure When Choosing a Restoration

This is why I think it is so important for patients to be more active participants in their treatment decisions. My first thought when I am determining what type of restoration to propose in any given situation is – What can I do that is the most conservative, yet adequately protective, keeping in mind that I want as much tooth around as possible for the next time this tooth needs to be fixed? CAD/CAM technology allows the dentist to perform less invasive, longer-lasting dentistry. Tooth-colored direct composite resin is great for smaller to moderate sized fillings and should be used whenever cusps of teeth are not involved. The traditional crown (which covers the whole tooth) should be done less frequently with the use of CAD/CAM technology, which allows more conservative restorations to be done in one visit. Ask your dentist about the materials being used to make your restorations and if you have any choices. If you have the time, google dental “onlays” to see what more conservative dentistry looks like.