Root canal treatment, also known as endodontic treatment, is a dental procedure in which the diseased or damaged pulp (core) of a tooth is removed and root canals are filled and sealed.
Inflamed or infected pulp (pulpitis) often causes a toothache. To relieve the pain and prevent further complications, the tooth may be extracted or it may be saved by a root canal treatment. Once root canal treatment is performed, the patient must usually have a crown placed over the tooth to protect it. The cost of the treatment and the crown may be expensive, however, replacing an extracted tooth with a fixed bridge, a removable partial denture, or an implant to maintain the space and restore the chewing function is typically even more costly.
The dentist removes any tooth decay and makes an opening through the natural crown of the tooth into the pulp chamber. Creating this access also relieves the pressure inside the tooth and can dramatically ease pain.
The dentist determines the length of the root canals, usually with a series of x rays. Small wire-like files are then used to clean the entire canal space of diseased pulp tissue and bacteria. The debris is flushed out (irrigation) with large amounts of water and /or disinfectant solutions. The canals are also slightly enlarged and shaped to receive an inert (non-reactive) filling material called gutta percha. The tooth is not filled nor is it permanently sealed until it’s completely free of active infection. The dentist may place a temporary seal, or leave the tooth open to drain, and prescribe an antibiotic to counter any spread of infection from the tooth. This is why root canal treatment may sometimes require several visits to the dentist.
A metal post may be placed in the pulp chamber for added structural support and better retention of the crown restoration. The tooth is protected by a temporary filling or crown until a permanent restoration may be made. This restoration is usually a porcelain crown, although it may be an inlay or a composite filling (paste fillings that harden).
The tooth may be sore for several days after filling. Pain relievers may be taken to ease the soreness.
Periodontal diseases range from simple gum inflammation (gingivitis) to serious disease that result in major damage to the soft tissue and bone that support the teeth (periodontitis). In the worst cases scenarios teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on your daily dental hygiene.
The longer bacteria are in contact of gums and teeth, the more harmful they become. The bacteria (in the form of plaque and tartar) cause an inflammation of the gums called “gingivitis.” With gingivitis, the gums become red, swollen, and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing, flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue around the teeth.
When gingivitis is not treated, it can advance to “periodontitis” (inflammation around the tooth). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.
The dentist, periodontist, or dental hygienist removes bacteria through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove plaque and tartar. In many cases more invasive surgery procedures might be used in conjunction with antibiotics and antimicrobial treatments.
When treatment occurs too late dental extractions might be the last solution to avoid further bone loss.
Successful dental restoration starts with a correct diagnosis of the patient’s existing oral problems, and an analysis of the patient’s health, needs, and desires. Restorative dentistry repairs teeth that have become damaged by decay and abrasions. The treatment of such teeth will restore their appearance and function.
Fissure sealants are a preventive treatment. For example, molars have deep fissures on their biting surfaces where the decay easily develops. Fissure sealants will prevent decay from developing on newly erupted teeth.
Dental fillings are used to restore teeth. In the past, it was common practice to use amalgams containing mercury. The disadvantage to using mercury amalgam is the toxicity of the material and the non-aesthetic look of the filling. Nowadays, amalgams have been replaced by modern composite fillings.
At Lausanne Dental & Implant Clinic we use the most modern and advanced composite fillings, techniques, and materials to ensure the results are stable, predictable, and aesthetic. The highest precision is required for this technique.
Dental inlays and onlays are restorations used to repair rear teeth with mild to moderate decay or cracked and fractured teeth that are not sufficiently damaged to need a crown.
Ideal candidates for inlay or onlay work typically have too much damage or decay in the tooth structure to be successfully treated using a filling, but have sufficient healthy tooth remaining to avoid the need for a crown. This allows the dentist to conserve more of the patient’s original tooth structure.
There are other benefits to inlays and onlays in comparison to metal fillings:
Inlays and onlays are durable — they’re made from tough, hard-wearing materials which last up to 30 years.
They help to strengthen teeth by up to 75 percent, unlike traditional metal fillings which can actually reduce the strength of the teeth by up to 50 percent.
Inlays and onlays prolong tooth life and prevent the need for more dental treatment in the future.
Dental inlays and onlays are used when old fillings need to be removed or replaced. A dental inlay is similar to a filling and fits inside the cusp tips (top edges) of the tooth. A dental onlay is more extensive and extends over the cusps of the treated tooth.
During treatment the dentist removes the old fillings under local anesthesia and takes an impression of the tooth, which is sent to the dental laboratory. The new inlay or onlay is made from this mold in porcelain, gold or composite resin material. The inlay or onlay is then cemented into place at the next appointment. The inlay or onlay blends successfully with the treated tooth and the rest of the teeth to achieve a natural, uniform appearance.
It takes two appointments for the inlays and onlays treatment to be completed and to be finally bonded to the damaged area of the tooth.
Inlays and onlays are performed using very similar procedures. At the first appointment, your dentist begins the procedure by numbing the area to be treated with local anesthetic. Any decay or damage is removed by drilling, which cleans and prepares the tooth for the dental inlay or onlay.
Using a small tray filled with dental putty that fits over the teeth, the dentist takes a mold (impression) of the damaged tooth. This impression is sent off to the dental laboratory, where a dental inlay or onlay is created that will fit your tooth exactly. Inlays and onlays are usually made from porcelain, which often most closely matches the normal color of the tooth, but they can also be made from composite resin or gold. While the inlay or onlay is being created at the lab, the dentist creates a temporary restoration (cover or filling) for your tooth to protect it until your next appointment.
At the second appointment, your dentist will remove the temporary restoration and then take time to ensure the inlay or onlay fits correctly. Only when the inlay or onlay fits perfectly will the dentist bond the inlay or onlay to the tooth with a strong resin adhesive. The inlay and onlay treatment is completed with a polish to ensure a smooth and aesthetically pleasing finish.
Each visit to the dentist for inlay or onlay treatment takes about an hour, with the first appointment taking slightly longer due to the preparation process. There will probably be a little discomfort after the inlay or onlay procedure, and the new tooth surface may feel a little odd, but you soon get used to the new tooth surface and how it feels and looks in your mouth. The tissue around the treated tooth may feel sore or sensitive, but this should subside in a couple of days. If you do feel some discomfort, you can take over-the-counter pain medication to alleviate the symptoms.
Dental veneers are a shell or layer of tooth-colored porcelain placed over the facial surfaces of teeth to correct worn tooth enamel, uneven tooth alignment or spacing, discoloration, and chips or cracks.
Although dental veneers fall into the category of cosmetic dentistry (because they create bright, white smiles with beautifully aligned, shapely teeth), they also protect the surface of damaged teeth and may eliminate the need for more extensive treatments. Other benefits of veneers include durability, an improved smile appearance, and the need for little-to-no removal of tooth structure compared to crowns.
Dental veneers may solve most or even all of your cosmetic dental issues, like:
Worn enamel: Over time, the thin, hard translucent substance covering your teeth (enamel) may become worn, dulled, and discolored. Such wear and discoloration is often the result of consuming soft drinks, tea or coffee, smoking, the use of certain medications, etc.
Wear and tear: Teeth naturally wear down as people age. Aged teeth are more likely to have chips, cracks or a generally uneven appearance.
Uneven teeth: Uneven teeth can result from tooth grinding or general wear and tear
Porcelain is the most appropriate and long lasting material for dental veneers. The removal of any natural tooth structure is permanent, so dentists today prefer to offer patients the most minimally invasive options first. If your natural teeth are functionally and esthetically adequate, dental veneers may not be an appropriate treatment for you. Veneers do have the added benefits of longevity and a proven ability to enhance the appearance of the mouth, smile and other facial features that are better supported by properly shaped teeth.
Porcelain dental veneers may require the “shaping” or “prepping” of all teeth being treated. Therefore, some cosmetic dentists first recommend teeth whitening to people with mildly discolored teeth who want a whiter smile because it’s the least invasive cosmetic dentistry option. If crooked teeth or alignment issues are involved, whitening also may be combined with orthodontic treatments.
Teeth whitening or teeth bleaching can be defined as the whitening or lightening of a single tooth or multiple teeth through the application of chemical agents. Teeth whitening is the most commonly requested cosmetic dentistry procedure, and is one of the most straightforward ways to give you a whiter and brighter smile. Teeth bleaching can be achieved by your dentist or dental hygienist. When full arch bleaching is requested, the dentist or dental hygienist can offer two choices: take-home or in-office.
Take home bleaching is more common, and usually more affordable. In this case, the dentist will take impressions (molds) of each arch, pour stone models of the teeth, and make custom trays for the patient to wear. These custom trays are made from a clear, soft material, and they serve to hold the bleaching gel on the teeth. This optimizes treatment by keeping the bleaching material on the teeth and away from the gums, thus reducing irritation.
In-office bleaching is usually more expensive than the take-home alternatives. However, advantages to using this technique include speed, convenience, and predictability. In some instances, patients can see a dramatic change in about an hour. This is compared to similar changes that could take up to two weeks using the take-home technique. This speed of treatment also leads to more predictable results. Each step of the bleaching process is monitored and controlled by the dental professional. There are no compliance issues (such as not wearing the trays every night, not smoking, or not drinking red wine during the bleaching process), which could lead to less than optimal results.
In order to obtain long lasting results both techniques, in-office and take-home, should be associated.
Patients who have many missing teeth or severe deterioration of most teeth may require a full mouth reconstruction using a combination of restorations, veneers, crowns, bridges, dental implants or partial dentures. The oral cavity is a dynamic environment where changes constantly occur, sometimes quickly but more often slowly over time. Changes can be due to a traumatic accident, periodontal disease, shifting teeth, a lifetime of neglect, a destructive habit such as grinding or a lifetime of dentistry focusing on one tooth at a time leaving the mouth resembling a patchwork quilt.
Full mouth reconstruction is not the same as smile makeover. The fundamental difference is the former is a need while latter is a want. Although some of the equipment and techniques used for full mouth reconstruction are also used in a smile makeover, the latter is still done to improve the appearance of the person as opposed to a treatment for a medical complication.
A denture is a removable replacement for missing teeth and surrounding tissues. Two types of dentures are available: complete and partial. Complete dentures are used when all the teeth are missing, while partial dentures are used when some natural teeth remain.
Dentures can be conventional or immediate. Made after the teeth have been removed and the gum tissue has begun to heal, a conventional denture is ready for placement in the mouth about 8 to 12 weeks after the teeth have been removed.
Unlike conventional dentures, immediate dentures are made in advance and can be positioned as soon as the teeth are removed. As a result, the wearer does not have to be without teeth during the healing period. However, bones and gums shrink over time, especially during the healing period following tooth removal. A disadvantage of immediate dentures compared with conventional dentures is that they require more adjustments to fit properly during the healing process, and generally should only be considered a temporary solution until conventional dentures can be made.
A removable partial denture (don’t mistake it with a bridge which is a fixed prosthesis) usually consists of replacement teeth attached to a pink or gum-colored plastic base, which is connected by metal framework that holds the denture in place in the mouth. Partial dentures are used when one or more natural teeth remain in the upper or lower jaw. Not only does a partial denture fill in the spaces created by missing teeth, it prevents other teeth from changing position. A precision partial denture has internal attachments rather than clasps that attach to the adjacent crowns. This is a more natural-looking appliance.
Dental implants and bridges can be used to replace missing teeth eliminating the need for a denture. The cost is usually greater, but the implants and bridges more closely resemble the feel of real teeth. However, depending of the situation in your mouth “high-end dentures” might be an unavoidable solution. In many cases dentures can be “anchored” to dental implants and to natural teeth using several types of attachments.
The denture development process takes several weeks and several appointments. Once your dentist determines what type of appliance is best for you, the general steps are to:
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