2015 - Page 2 of 2 - Downtown Toronto Dentist | Toronto Dentistry | Soho Dental 2015 - Page 2 of 2 - Downtown Toronto Dentist | Toronto Dentistry | Soho Dental

Downtown Toronto Dentist | Toronto Dentistry | Soho Dental


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Archive for 2015

Worn Amalgam Fillings

Amalgam fillings are metal fillings and they are very strong.  Despite being a very strong material, the forces in the mouth can be enough to break these fillings especially if one is grinding or clenching their teeth. All fillings have lifespan and eventually do require replacement.  The picture above shows a broken amalgam restoration.  The patient has no pain or sensitivity despite the fact the filling is broken, there is decay under the filling and there is a gap between the filling and the tooth beside it causing food to get caught in between the teeth.

A new composite resin restoration brings the tooth back to proper form and function.

Notice there is no longer gap between the filling and the adjacent tooth.  The contour of the filling against the neighbouring tooth is at it should be.  The proper anatomy of the tooth is restored so that it can function with the opposing tooth in harmony when the patient chews.  This new restoration should serve the patient well for many years to come.

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Worn Fillings or Restorations

All fillings will eventually show signs of wear. Whatever the material that we use to restore teeth, it is subject to chewing forces which are significant, especially in the molar regions of the mouth. If a patient clenches and grinds, the life span of the dental restoration is compromised significantly. The forces of clenching and grinding are almost 10 times that of normal chewing forces. The first picture shows a worn composite resin restoration. A worn restoration can make the tooth sensitive to hot and cold. If it is cracked or debonded from the tooth, a cavity can form underneath. This worn restoration is easily replaced and the new restoration should serve the patient well for many years to come.

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Cavity Associated With Broken Amalgam Filling

Cavities are not always sensitive or painful.  The first picture shows a broken silver or amalgam filling and a large cavity is present where the filling has broken away.  The
patient was unaware that there was a problem.  If this problem was not addressed the cavity would have progressed and more extensive treatment would be required.  Cavities that progress to the nerve of the tooth require root canal treatment.

In this case the broken filling and cavity were repaired with a composite resin restoration this preventing the need for more extensive treatment.  Regular dental examinations allow the detection of such problems before they require major dental treatment.

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Restoration of Large Fracture in Maxillary Central Incisor

Repairing a large fracture of a front tooth, either with a crown or with composite resin is a challenging task. A single front tooth can have multiple shades of colour, each of varying translucency and opacity. In addition, teeth have very specific anatomy and contours which need to be replicated if the restoration is to be esthetically successful.

The following video outlines how we replace natural tooth structure with composite resin while trying to mimic all these parameters. Be sure to see the “before” and “after” photos at the end of the video.

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Composite Resin Veneers

Composite resin has many advantages,  the most important being that we can be very conservative in our tooth preparations in order to place it.  This is in contrast to porcelain which requires  more preparation to the tooth in order to allow enough room for the porcelain.  In the before picture above, you see the old composite resin veneers on the upper lateral incisors that were done many years ago by the patient’s previous dentist.

Over time, the resin has chipped and changed colour and the patient was ready to have it redone.  I replaced the old composite resin and we were able to get an improvement in shade, as well as in tooth contour. The new composite resin veneers should serve the patient well for many years to come.

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Unbalanced Bite

unbalanced1
Worn Teeth From Grinding
unbalanced2
Teeth Restored With Composite Resin

 

One of the most common signs that there is a problem with one’s bite is worn teeth.
Teeth that fit in harmony with the temporomandibular joints and the chewing muscles do
not wear down with normal function.  When there is a disharmony within this system, we
notice that the teeth have a tendency to wear very quickly. The first picture shows worn
teeth due to grinding.  The grinding often is triggered by a disharmony between the
healthy position of the jaw joints within their sockets and the way the teeth fit together.

The second picture shows the teeth restored very simply with composite resin.  For this
treatment to have a lasting result, the patient is obliged to wear a nightguard to protect the
teeth from grinding forces. The nightguard is fabricated not just to protect the teeth but
also to support the jaw joint and to allow the muscles to relax. A long term solution for
this patient would also include balancing the bite so that there is no disharmony between
the position of the jaw joints and the way the teeth fit together. This would offer a long
term solution which would protect the teeth from further wear.

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Dental Abfractions

abfraction
What you see in the photograph above is an example of dental abfraction. The discolouration and loss of enamel at the gum line is not a cavity. This is caused by grinding forces on the teeth.

Teeth actually bend at the microscopic level. The enamel is thin in the areas close to the gum line. As the teeth bend from excessive grinding forces, the enamel shears away from the tooth where it is thin, at the gum line. This exposes the underlying tooth structure, the dentin, which also stains over time. This is the discolouration in the first photograph.

Once the dentin is exposed, the abrasive nature of toothpaste can wear these areas even further. These areas can be sensitive to cold and sweets.

The teeth above where repaired very simply with dental composite resin material but the patients underlying grinding problem has to be addressed as well. This often requires an examination of the jaw joint and the occlusion, or the way the teeth fit together. The treatment may be as simple as a night guard to protect the teeth from grinding forces and an occlusal equilibration, which means to balance the bite so the chewing forces are more evenly and appropriately distributed among the teeth.

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Dental Erosion Repair

erosion1Before
erosion2After

What you see in the photo above is a typical example of dental erosion. The patient was concerned because the teeth looked yellow at the gum line and although she whitened her teeth to try to get rid of the discolouration, it was not successful.

This is because the enamel on the tooth at the gum line has been dissolved away by acid. What you see is the underlying tooth structure, dentin, which is yellow. The dentin is less resistant to acid erosion so it will wear away even quicker than the enamel.

I restored the teeth with the use of dental composite material. The shade is matched to the tooth for an esthetically pleasing result. More importantly, the dentin is now covered to prevent further erosion from acidic foods.

The most acidic foods are often citrus foods. It is a good idea to cut down on these if you have them daily. Other foods and drinks to be careful with include: carbonated drinks, wine, pickled foods, yoghurt and sports drinks.

Please see our previous post about acid erosion for more information.

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Tooth coloured fillings

Tooth coloured fillings, or composite resins, have become very popular option to restore the back teeth. They look virtually identical to natural teeth. Traditionally, they lacked the strength of amalgam fillings but recently they have been engineered to withstand the chewing forces in the back of the mouth.

bonded1 bonded4 bonded3
Broken Composite Resin Filling Filling Removed
Extensive Decay Underneath
New Composite Resin Fillings

Composite resins require specific techniques and a dry environment when they are placed. It is not uncommon to find that the teeth are sensitive afterwards. A bigger problem is the development of decay under these fillings over time. Fortunately, both problems can be avoided with good technique.

However, all fillings have a life span and old fillings can sometimes fracture, creating a situation where decay can develop under the filling. The first picture illustrates a broken filling and a filling with decay underneath. The second picture shows the extensive decay once the fillings have been removed. The final picture shows the new restorations which are bonded to the tooth, creating a seal from the oral bacteria. These should serve the patient well for many years to come.

It is important to have your fillings checked by a dentist on a regular basis. If not, decay underneath a filling can go undetected and cause more serious problems.

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COVID-19 NOTICE

Please note that as a result of the current COVID-19 pandemic, our offices will be closed until June 26th, 2020.