Fillings
Dental fillings are done to remove diseased and infected parts of a tooth and replace it with a material that restores function to that tooth. By the age of 30 without sealants almost all molars will have decay requiring fillings. Teeth are weakened by the placement of fillings. They are more prone to fracture and post operative pain. If a filling gets close to the nerve of the tooth then small fractures may occur in the tooth that leads to pain on chewing. As the nerve gets inflammed the tooth will become sensative to cold or hot. If the bite surface of a new filling is too high then that tooth will likely crack on chewing. Therefore, it is imprortant to return to the office to get the bite surface adjusted if it is too high after the anesthesia wears off. Three materials are used to do fillings in teeth: silver, composite, and glass ionomer.
Silver fillings: Silver fillings are alloys of mercury, copper, tin and silver. They are silver in color and do not resemble the tooth structure they replace. Their metalic properties make them great conductors of cold leading to sensitivity if the filling is deep. Silver fillings are not glued, attached, or bonded to the tooth structure in any way. As a result the remaining tooth structure is weaker then prior to the filling and prone to fracture. Fractures of these teeth can require crowns, root canal therapy, or tooth removal. The surface rust products of these fillings are toxic to humans and bacteria alike. The bacteria trying to reinfect the tooth at the edges of the filling are exposed to a lethal concentration of surface rust. Therefore these filling tend not to get reinfected. This makes silver fillings some of the longest lasting restorations in dentistry. The small bit of rust we consume over years of chewing on these fillings have not been prooven to be a health risk; however, some european countries have banned there use.
Composite fillings: Composite fillings are acrylic plastic materials reinforced with ceramic and glass particles. Most of the modern dental materials research has gone into improoving composites. They are bonded to the tooth enamel with microscopic plastic "fingers" or tags of plastic. They resemble tooth enamel so well that they can be hard to identify once properly placed. Their weakness lies in the bonding to the tooth. Since they don't make a toxic rust they must be water tight. Therefore, an intact filling and intact tooth may be reinfected by the breakdown of the bond. This appears as a brown line between the tooth and the filling.
Glass Ionomer fillings: This white material chemically bonds to the calcium in the tooth structure and is fluoride releasing. These fillings are more resistant to leakage then the composites and can be placed with greater ease. This makes glass ionomer a great material for filling childrens' teeth. The ethetics of glass ionomer an inferior to composite. It is easy to see as it is opaque, not translucent like tooth enamel.
Sealants
Sealants are preventative composite or glass ionomer materials used to fill the natural deep pits in the bite surfaces of back teeth. These areas are so prone to decay that unsealed decay is almost inevitible. As a result insurance companies ussually pay 100% for the sealants on children rather then have these teeth end up with more expensive deep fillings. Adults also need sealants but insurance companies do not cover them as cavities grow slower in adults a peoples' dental insurance companies change so often. Sealants are very thin and have to be replaced from time to time because they wear out. Sealants can leak and and often need replacement with fillings; however, the fillings replacing sealants are done years later in life and are ussually smaller then they would be without the prior sealant.
Crowns
A crown (also called a cap) is placed on a tooth to replace the enamel of the tooth. Enamel is replaced on a tooth with a crown when the tooth can not support the forces of chewing without the risk of fracturing or if the extent of damage to the tooth make it impossible to fill properly.
Many teeth with failing, old, large fillings need crowns. Every time a filling is replaced the size of the filling gets bigger. Therefore, replacing a big filling may mean the new filling is too big and the risk of tooth fracture is great. In this case a crown would be recommended. A good rule of thumb is a filling must be smaller then half the bite surface of a tooth. Thin areas of enamel at the sides of the teeth can fracture and lead to tooth extraction.
Root Canal Therapy
In the past an infected tooth was extracted to stop pain and prevent infections of the head and neck. The perfection of root canal techniques has allowed us to save many teeth from extraction. The goal of a root canal is to create a sterile space inside the tooth that is then sealed with a rubber filling material. The outside of the root stays healthy and the tooth stays strongly embedded in the jaw bone.
It should be noted thast root canal treatments are 85% successful statistically. That means that one in ten teeth will be extracted after our best efforts to save the tooth. Teeth may function well and not have any sensitivity to cold or hot after a root canal therapy but remain sensative to tapping for months and years into the future. From time to time the delicate tools used to clean and shape the root canal system separate and are left in the tooth root (ussually without incident.)
Root canals used to take three or more visits to complete but now are rutinely finished in one visit. A tooth may be very sensative to pressure for 14 days following a root canal treatment. Symptoms vary greatly from case to case. A molar or premolar should be crowned as soon as possible following root canal therapy.
Some root canals are very hard to treat and fall outside the scope of the general dentists ability. If this happens Dr. Milgram refer you to one of the great root canal specialists in the Naperville-Plainfield area. If a tooth remains sensative after root canal therapy and the tooth is retreated by a specialist and the sensativity resolves then Dr. Milgram's guarantee is to credit your financial account at Tall Grass Dental for the root canal procedure.
Implants
Implants are artificial tooth roots made of titanium that are placed in the jaw. Implants can be used to support crowns, bridges, and dentures.
Receiving an implant involves evaluation of the bone where the implant is to be placed at the first visit. Then a specialist either in Tall Grass Dental or in a near by office will place the implant in the jaw at the seacond visit. (Often bone grafts are needed to support the implant.) The implant is given weeks to become one with the bone until at the third visit the specialist places an attachment to the implant that brings the implant through the gum tissue. At the forth visit Dr. Milgram creates models of the mouth for the dental laboratory which will make the final restoration on the implant. At the fifth visit the restoration is delivered.
Dental implants enable us to replace teeth without traumatizing other teeth in the mouth. Also implants preserve bone in the jaw that in stimulated by the implant. This bone would be resorbed by the body over time and leave a pit in the jaw bone which is hard if not impossible to cosmetically repair.
It is a process to get dental implants but we have seen many happy patients who have gone through the effort and testify that it is worth the added cost and time.
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