Restorations
Dr. Gretzinger believes the best teeth are your own teeth, so he offers many different dental procedures to make sure you keep your teeth.
Dr. Gretzinger may recommend a treatment or procedure to restore or replace a tooth that has been lost or damaged or to improve the appearance, health and function of your teeth. Some of these procedures are straightforward, while others are more involved.
Fillings
When you go for a dental exam, Dr. Gretzinger checks your fillings and may suggest that you replace any loose or broken ones. He also looks for signs of decay, such as brown or black spots and may want to use X-rays to take a closer look at suspicious spots.
Metal
1. Dental Amalgam Fillings
Dental amalgam fillings are sometimes called “silver” fillings. They are the most common type of filling used in Canada today. Because these fillings are silver in colour, they are used to fill back teeth. They are a mix of metals such as mercury, silver, copper and tin.
Advantages
- These fillings are the least expensive type of filling.
- They last a long time.
- They are easy to put in place; because they are a direct filling, one visit to Dr. Gretzinger will do the job, in most cases.
Disadvantages
- The silver colour may not appeal to people who want a “natural” look.
- Tiny amounts of mercury are released from the filling when you chew. For most people, this bit of mercury is nothing to worry about. Studies have shown that amalgam fillings do not cause illness. They have been used on people for more than 150 years.
- Health Canada advises pregnant women in need of a filling to wait until the baby is born before they go ahead with the procedure. Your dentist can suggest other kinds of fillings, if the work is urgent.
2. Cast Gold Fillings
Cast gold fillings are based on a model (or cast) of your tooth. Cast gold fillings are a mixture of gold with other metals such as silver and copper. These other metals make gold fillings more durable.
A cast gold filling is made in a dental lab and sent back to Dr. Gretzinger, who cements it in place in your mouth. You will need at least two visits to the dentist to get the job done. During the first visit, your dentist cleans out all the decay and makes a mold of your tooth. The hole is filled with a temporary filling.
Meanwhile, in a dental lab, the mold of your tooth is used to make a model. A filling that is the same size and shape as your tooth is built, based on the model. When you go back to Dr. Gretzinger, the gold filling is cemented in place.
Advantages
- Gold is stronger than amalgam.
- Gold fillings last a long time.
Disadvantages
- Gold costs more than other kinds of fillings.
- Gold fillings and crowns are indirect fillings, so they require at least two appointments.
- The gold colour may not appeal to people who want a “natural” look.
Tooth-coloured
1. Composite Fillings
Composite fillings are also called white fillings. Composites can be made in a wide range of tooth colors allowing near invisible restoration of teeth
Advantages
- These fillings will be the same colour as your natural teeth.
- They are direct fillings, so they can be done in one appointment, in most cases.
Disadvantages
- This kind of filling can break more easily than amalgam or gold fillings, and may not last as long.
2. Glass Ionomer Materials
Glass ionomer materials are only used in teeth where you do not bite down hard. There have not been many studies about how long this kind of filling lasts. Newer forms of the filling may be stronger and last longer. Research is underway to evaluate the effectiveness of these materials.
Advantages
- These fillings are the same colour as your natural teeth.
- They contain fluoride, which helps stop recurrent decay in the tooth.
- They do not have to be put in layer by layer; thus, they are simpler to put in than composite resins.
- They are direct fillings and can be done in one appointment, in most cases.
- They cost less than gold fillings.
Disadvantages
- They are not as strong and will not last as long as other fillings.
- They cost more than amalgam fillings.
3. Porcelain Materials
Porcelain materials are the most common type of dental ceramic used by dentists. They are hard and brittle. Porcelain and metal can be combined to make a strong, tooth-coloured crown.
Dental porcelain is made in a dental lab. Unless you have a bad tooth-grinding habit or some other problem, a combination of porcelain and metal can be used anywhere in the mouth.
Advantages
- Dental porcelain is the same colour as natural teeth.
- These fillings last a long time.
Disadvantages
- For teeth that bite down hard – like molars – ceramics are not a good choice. Fillings can break.
- They are indirect fillings, so at least two appointments will be needed.
- They cost more than most other types of fillings.
How Fillings Are Done
To fill a cavity, Dr. Gretzinger may first give you “freezing” (or local anesthetic), so you do not feel any pain. He then takes out all traces of decay, shapes the hole and fills it.
Most fillings are done in two ways:
- Direct Filling – These fillings go right into the cavity, after Dr. Gretzinger has cleaned out the decay. Amalgam (or silver) fillings and plastic (or white) fillings are examples of direct fillings. They harden quickly. Most of the time, you will be able to have a direct filling put in place in one appointment.
- Indirect Filling – Examples of this type of filling are crowns (or caps) and inlays. They are custom made in a lab to fit your tooth. Dr. Gretzinger cements the filling in place. Most indirect fillings take two or more appointments to complete.
Dental amalgam is the best-known direct material. Cast gold alloy is the most durable indirect material. However, ceramics are gaining in popularity because of their longevity relative to other tooth-coloured materials.
Dental Implants
If one or more of your teeth are missing, there are a number of ways to replace them. An alternative to bridges, partials or complete dentures may be dental implants. Implants are used to replace missing roots and support artificial replacement teeth. They are comfortable and look like natural teeth.
What are dental implants?
A dental implant is an artificial root made of titanium metal. It is inserted into the jawbone to replace the root of the natural tooth. An artificial replacement tooth is attached to the implant. The implant acts as an anchor to hold the replacement tooth in place.
Who does this procedure?
If you are having an implant, your dentist may refer you to a dental specialist who has further training in this area. Specialists who place implants are periodontists or oral and maxillofacial surgeons, also called oral surgeons. Specialists who place crowns, bridges and dentures on implants are called prosthodontists.
Who can get dental implants?
If you are in good general health, have healthy gums and have enough bone in the jaw to hold an implant, dental implants might be right for you. If your jawbone has shrunk or if it has not developed normally, you may be able to have a bone graft to build up the bone. A bone graft is a way of adding new bone to your jawbone. Your dentist or dental specialist will tell you if bone grafting can be done.
How dental implants are done
- Your dentist or specialist will carefully examine your mouth and take x-rays of your head, jaw and teeth to find out if dental implants are right for you.
- During the first stage of surgery, your dentist or specialist will put a dental implant into your jawbone beneath the gum tissue. The gum tissue is then stitched back into place. As the tissue heals, the implant will bond with the bone and attach to the gum. It can take several months to heal.
- During the second stage of surgery and once the tissue is healed, your dentist or specialist will attach an abutment to the implant. An abutment is a post that connects the replacement tooth to the implant. In some cases, the first and second stage of implant surgery may be done in one single stage.
- An artificial replacement tooth is made and your dentist or specialist attaches it to the abutment. It may take several appointments to properly fit the replacement tooth to the abutment.
- When replacing several teeth or all of your teeth, a fixed bridge is anchored to your dental implants. A bridge is a dental restoration that replaces one or more missing teeth by spanning an area that has no teeth. The bridge is held firmly in place by dental implants on each side of the missing tooth or teeth.
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- A dental implant is inserted into the jawbone.
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- An abutment is attached to the implant. The abutment connects the artificial tooth to the implant.
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- An artificial tooth is attached to the abutment. Properly fitting the artificial tooth may take several appointments.
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- A fixed bridge is anchored to dental implants to replace one or more teeth.
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- A fixed bridge is anchored to dental implants to replace all teeth.
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- Example of dental implants vs fixed bridges.
Caring for my dental implant(s)
Because dental implants are placed in the jawbone, artificial replacement teeth attached to implants look and act much like natural teeth. Like natural teeth, implants need to be kept clean using a toothbrush and floss. Your dentist will show you the proper cleaning procedure for implants. Regular dental checkups are important so your dentist can make sure that your bite is right and that your implants are not loose.
What else should I know?
- Several visits to your dentist or dental specialist may be needed until the process is done.
- Checkups will be scheduled during the following year so your dentist can be sure your implants are working properly.
- You will need to take very good care of your implants.
- Implants can cost more than other kinds of replacement teeth and might not be covered by your dental plan. But in most cases this is a one-time cost, unlike other kinds of tooth replacement procedures
- Although rare, possible complications due to dental implants include bleeding, infection, numbness or injury to nearby muscles or the sinus cavity. In some cases, the implant may not be successful because it didn’t bond to the bone.
Crowns
If your tooth is damaged but not lost, a crown can be used to restore its shape, appearance and function. You may need a crown if you have a root canal, a large filling in a tooth or a broken tooth.
A crown, also called a cap, is a hollow, artificial tooth used to cover a damaged or decayed tooth. The crown restores the tooth and protects it from further damage. Crowns can also be used to cover a discoloured or misshapen tooth. A tooth that has been fixed with a crown looks and works very much like a natural tooth.
Who does this procedure?
If you need to have a tooth crowned, Dr. Gretzinger may do it, or he may refer you to a prosthodontist. A prosthodontist is a dentist who has completed a university post-graduate specialty program in prosthodontics. Prosthodontics is a specialty of dentistry that deals with restoring and replacing natural teeth and tissues with artificial substitutes.
How a crown is done:
- Dr. Gretzinger gives you a local anesthetic.
- To make room for the crown, he files down the tooth that needs to be restored.
- An impression of the filed-down tooth and nearby teeth is taken. This impression is used to custom make your final crown. The crown is built using restorative material (material used for fillings) based on the impression. The final crown will be the right shape for your mouth.
- Until your final crown is ready, your dentist places a temporary crown over the tooth that needs to be restored. The temporary crown is made from an impression of your tooth before it was filed down. It protects your tooth until the final crown is ready. A temporary crown may not have the same shape and colour as a final crown.
- On your next visit, Dr. Gretzinger takes off the temporary crown and puts on the final one. Your dentist checks to make sure the crown is the right fit, shape, colour and bite. If it is, your dentist cements the crown into place.
These are the steps most often used in making a crown, but your tooth may need special care. You may need orthodontic treatment, gum treatment or root canal treatment. It may take more than 2 visits, or your visits may last longer.
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- A crown can be used to restore a damaged tooth.
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- To make room for the crown, Dr. Gretzinger files down the tooth to be restored.
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- The final crown is cemented into place. It looks and works very much like a natural tooth.
Different types of crowns
Crowns are made from various types of materials. Depending on which tooth needs a crown, Dr. Gretzinger will suggest a material, or combination of materials, that is right for you.
Metal crowns are made of gold. They generally last a long time and won’t chip or break. They tend not to wear down your opposing natural teeth. However, the gold colour does not look natural, particularly on front teeth.
Composite crowns look natural. They won’t chip as easily as porcelain crowns, but they tend to wear more quickly from chewing. Tooth brushing tends to remove the highly polished surface of composite crowns and this causes them to stain more easily.
Porcelain crowns look the most natural. They are more brittle than metal or composite and may chip more easily. Because of this, they are not usually placed on back teeth.
Porcelain-fused-to-metal crowns look natural and are stronger than porcelain or composite crowns. They won’t chip as easily as porcelain or ceramic crowns. However, depending on their design, the metal may show if your gums are thin or shrink.
What else should I know?
Crowns are strong and generally last for about 10 years or longer if you take good care of them. Brush and floss your crown, just like you clean your natural teeth. Crowns may not be as strong as your natural teeth. So like your natural teeth, remember not to bite down on hard objects or use your teeth to open or cut things.
Bridges
The best teeth are your own natural teeth. But sometimes, a tooth is badly damaged or lost. If a tooth is lost, it is important to replace it with an artificial tooth as soon as possible. This will prevent the teeth that are left from drifting out of line and possibly causing jaw problems. Teeth that are out of line are harder to clean and are more likely to get periodontal disease (gum disease) and cavities. If one or more of your teeth are missing, your dentist may suggest replacing your missing teeth with a bridge or a denture. If you need to have a tooth (or teeth) replaced, your dentist may do it, or he or she may refer you to a prosthodontist. A prosthodontist is a dentist who has completed a university post-graduate specialty program in prosthodontics. Prosthodontics is a specialty of dentistry that deals with restoring and replacing natural teeth and tissues with artificial substitutes.
A bridge, also called a “fixed bridge” or a “fixed dental prosthesis,” is a dental restoration that replaces one or more missing teeth. It extends across an area that has no teeth and is typically made up of an artificial tooth fused between 2 crowns. (A crown is a hollow, artificial tooth that fits over a natural tooth or a dental implant). The bridge is held firmly in place by your own teeth on each side of the missing one(s) or by dental implants. A bridge is permanent and cannot be removed.
How a bridge is done
- If you have healthy teeth on each side of a missing tooth (or teeth), your dentist files down the 2 healthy teeth to prepare them for the bridge. If you don’t have healthy teeth or enough teeth to support a bridge, then dental implants may be surgically placed. A dental implant is an artificial root made of titanium metal that is inserted into the jawbone to replace the root of the natural tooth. The implant acts as an anchor to hold an artificial tooth or bridge in place.
- Next, your dentist makes a model of your teeth by taking impressions (molds). The model is used to custom-make the artificial tooth (or teeth) and 2 crowns as one piece. This piece is called a bridge.
- Meanwhile your dentist places a temporary bridge in your mouth to protect the exposed teeth and gums.
- During your second visit, your dentist removes the temporary bridge and places the custom made bridge in your mouth. The crowns are either cemented to your 2 healthy teeth or attached to your dental implants on each side of the missing tooth (or teeth).
Types of bridges
There are different types of dental bridges. Your dentist or prosthodontist will recommend the most appropriate one depending on the location of the missing tooth (or teeth) and the condition of your teeth, mouth and gums.
Traditional bridges are used if there are natural teeth on each side of the gap where the tooth is missing. (As an alternative to a bridge, your dentist may suggest a single implant to replace a missing tooth between 2 healthy teeth. An implant will prevent you from having to get your healthy teeth filed down in preparation for the crowns.)
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- With a traditional bridge, healthy teeth on each side of the missing tooth are prepared for crowns.
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- The custom-made artificial tooth is fused to 2 crowns. This is called a bridge.
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- A bridge is permanent and cannot be removed.
Implant bridges are used if you don’t have healthy teeth or enough teeth to support a bridge, or when several or all teeth are missing. A custom-made bridge is anchored to the dental implants. Your dentist will first determine if dental implants are right for you.
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- With an implant bridge, dental implants are surgically placed into the jawbone.
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- A custom-made bridge is anchored to the dental implants.
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- Implant bridges can be used when all your teeth are missing.
Resin-bonded bridges, also known as “Maryland” bridges, are used when the missing teeth are in the front of the mouth. This type of bridge involves the artificial teeth being fused together to metal bands and cemented to the back of your natural teeth.
Cantilever bridges are used when there are healthy teeth on only one side of the missing tooth or teeth. This procedure involves anchoring the artificial tooth over one or more of your natural adjacent teeth.
Caring for your bridge
If you take good care of your bridge, it should generally last for about 10 years, or perhaps longer. Like natural teeth, bridges need to be brushed and flossed every day. Your dentist will show you how to use a floss threader to floss under and around the artificial tooth (or teeth) in the middle of the bridge. Regular dental visits and professional cleanings are also important. If you have an implant bridge, your dentist will show you how to properly care for them.
Dentures
Dentures are artificial replacements for your natural teeth and gums. If an accident, a disease or poor oral health care has left you with only a few healthy teeth or none at all, Dr. Gretzinger might suggest dentures to replace your missing teeth. There are 2 types of dentures: partial and complete. For both types of dentures Dr. Gretzinger makes a model of your teeth by taking impressions. The models are used to custom-make your dentures.
Types of Dentures
Partial dentures are also called “removable partial denture prostheses” or “partials.” They may be used when nearby teeth are not strong enough to hold a bridge, or when more than just a few teeth are missing. Partial dentures are made up of one or more artificial teeth held in place by clasps that fit onto nearby natural teeth. You can take the partial denture out yourself, for cleaning and at night.
Complete dentures are what we most often refer to as “false teeth.” They are also called “full dentures” and are used when all your natural teeth are missing. Complete dentures are removable as they are held in place by suction. They can cause soreness at first and take some time to get used to. There are 2 types of complete dentures: immediate dentures and conventional dentures.
Conventional dentures are made and inserted into your mouth after your teeth have been extracted and the gums and jaw tissues have healed.
Caring for your Dentures
Complete and partial dentures need to be cleaned every day just like natural teeth. Otherwise, plaque and tartar can build up on your dentures and cause stains, bad breath and gum problems. Plaque from your dentures can also spread to your natural teeth and gums, causing gum disease and cavities.
To clean your dentures, remove them from your mouth and run them under water to rinse off any loose food particles. Then wet a denture brush or a regular soft-bristle toothbrush and apply denture cleaner or a mild soap. Household cleaners and regular toothpaste are too abrasive and should not be used for cleaning dentures. Gently brush all surfaces of the dentures including under the clasps where bacteria collect. Be careful not to damage the plastic or bend the attachments. Rinse your dentures well in clean water before placing them back in your mouth.
While your dentures are removed, be sure to clean and massage your gums. If your toothbrush hurts your gums, run it under warm water to make it softer or try using a finger wrapped in a clean, damp cloth. If you have partial dentures, brush your natural teeth with a soft-bristled toothbrush and floss.
Always remove your dentures overnight to give your mouth a chance to rest. Soak them in warm water with or without denture cleanser. If your dentures have metal clasps, only use warm water for soaking, as other soaking solutions can tarnish the metal. When you’re not wearing your dentures, keep them in water to stop them from drying out or warping. Never use hot water for soaking.
Look for cracks in your dentures. If you find any, take them to your dentist or specialist for repair. See Dr. Gretzinger regularly and at least once a year. Your mouth is always changing, so your dentures will need adjusting or relining from time to time to make sure they fit well. Poorly fitted dentures may cause denture sores that make oral cancer more difficult to spot. At your dental exam, Dr. Gretzinger will also examine your gums for any signs of disease or oral cancer and any natural teeth you may have for signs of decay or infection.
