The most basic restorative dental treatment is a filling. During your comprehensive exam, we may identify dental caries, a condition in which bacteria have broken through the tooth surface and degraded a portion of the tooth structure. When identified early, the decayed area can be removed and replaced with a filling material, helping to prevent further bacterial invasion into the tooth.

A few years ago, amalgam (a mixture of metals) was our go-to filling material. Although an abundance of research has demonstrated amalgam to be a safe and effective choice for dental fillings, its metallic appearance doesn’t blend seamlessly with the tooth, and the cosmetic result is often undesirable. More recently, the use of dental composites has become more popular. Composite is a tooth-colored filling material whose color can be accurately matched to your teeth. This allows us to place fillings that meld impeccably with the remaining tooth structure, thereby disguising their presence and yielding a highly esthetic result. In the old days, composites were too weak to be used in certain "high-traffic" areas of the mouth. But fortunately, newer composites are much stronger and can therefore be used for most dental fillings.

A crown is like a cap which sits over and protects an existing tooth. There are many reasons why we might recommend getting a crown. If a tooth has fractured or had so much decay that there’s very little of the natural tooth remaining, it may be incapable of withstanding the biting force. In this scenario, a crown may provide strength to the tooth and protect it against further breakdown. Sometimes, we place crowns to achieve a cosmetic goal, such as a more desirable tooth shape or color. For patients with partial dentures, a crown might be designed specifically to support and hold a denture in place. In short, the possible applications of crowns are endless.

In the old days, dental crowns were made from gold. Gold is strong, biofriendly, and resistant to tarnishing, which makes it an excellent material for dental restorations. But gold isn’t very esthetic, and in the interest of achieving a more natural appearance, we now make so-called porcelain-fused-to-metal (PFM) crowns. As its name suggests, a PFM crown consists of two connected layers: a (hidden) inner metal shell provides strength to the crown, while an outer layer of porcelain gives the appearance of a natural tooth. When deciding on the precise shape and color of the crown, we carefully evaluate the surrounding teeth to achieve the best match possible.

Recent advancements in dental materials have allowed us to begin making all-ceramic crowns, which are quite strong even though they lack the metal core of a PFM. This allows us to make a crown translucent (slightly see-through), which best imitates the appearance of natural teeth and thereby allows us to achieve the best possible cosmetic result. In some cases, these ceramic crowns may be designed digitally and milled (sculpted) from a solid block of ceramic using a process called computer-aided design and computer-aided manufacturing (CAD/CAM). This can cut out laboratory processing time, and often allow for same-day delivery of the crown. Not every tooth is a candidate for a ceramic crown, and so the materials we choose for each crown are determined on a case-by-case basis with careful consideration of the patient’s best interests and desires.

Think about a bridge carrying a roadway over a river. Foundations on each end are anchored into the ground and support the center span, which crosses over the river. Similarly, a dental bridge consists of caps anchored to real teeth on either end and a center span of one or more false teeth between them. When teeth are missing, a dental bridge offers a way to fill the empty space, thereby improving mastication (chewing), speech, and esthetics.

A bridge isn’t always a good option for replacing lost teeth. In general, a bridge requires healthy teeth on either end of the empty space to serve as abutments (supports) for the bridge. Like an automotive bridge, a dental bridge with poor supports would be likely to fail. Sometimes, the empty space is simply too long, and the biting force on such a long bridge would challenge the strength of the bridge or the health its supporting teeth. Years ago, it was more common to place such long-spanned bridges because there were few other options for replacing missing teeth. Fortunately, the advent of dental implants has provided us an excellent alternative in cases where dental bridges aren’t ideal.