RESTORATIVE

• Esthetics – The removal of a silver restoration to be replaced with a material that matches the color of the natural tooth.
• Health – To decrease potential exposure to the mercury vapor released from silver (amalgam) fillings. The safety and health risks of this vapor is widely debated. However, despite their wide use, overall use of silver fillings is declining worldwide

• The procedure may be simple or more complex depending on the choice of dental material selected to replace the silver filling.
• The removal of silver fillings can be done using a controlled office protocol to reduce exposure to mercury vapor and remove environmental risk.

• You may experience temperature and bite sensitivity associated with the new restoration which can last for a few days or up to three months.
• Less commonly, a tooth may have irreversible irritation involving the need for root canal therapy and a subsequent crown.
• Pregnant women should avoid having silver (amalgam) fillings removed to avoid any negative effects on the fetus.

• When the silver filling no longer provides an adequate seal for the tooth, resulting in leakage and decay.
• When the silver filling needs to be removed and the tooth evaluated prior to crown placement.
• When the silver filling is cracked or worn.

• Esthetic concerns will not be addressed. However, the health of the tooth may not be compromised and may last many years if the silver filling is sealing the tooth and functioning properly.
• If removal of the silver filling has been recommended for decay, leakage or possible fracture, then these teeth will have continued or increasing risks, and repair options will become more complex over time.
• There will be ongoing potential for exposure to mercury vapor.

A tooth-colored filling is a mixture of a tooth-colored resin with clear glass particles that give it strength.

Tooth colored fillings come in many shades so they very closely match the color of natural teeth. They are bonded into place and require less removal of healthy tooth structure than silver fillings.

As with any filling, having a tooth colored filling involves some inherent risks both to the remaining tooth structure and to the tooth colored filling itself:

• Tooth colored fillings are limited because they seal a tooth but do not prevent it from breaking
• Tooth colored fillings may fracture; the larger the tooth colored fillings, the greater the risk of fracture
• Tooth colored fillings may decay around the edge of the filling if your dentist is unable to keep the tooth clean and dry while placing the tooth colored filling
• Preparing for and placing a tooth colored filling can irritate the tooth and cause “post-operative” sensitivity which may last for up to 3 months
• Teeth which have had tooth colored fillings may need a root canal treatment less than 1% of the time during the lifetime of the tooth

The alternatives to having a tooth colored filling are:

• Having a silver filling or “amalgam” placed
• Having a gold or porcelain inlay/onlay restoration placed

Bite problems may lead to the tooth-colored filling or tooth breaking or loosening.

•  A tooth colored filling may have a good color match with your natural tooth when it is placed but less of a match as your natural tooth ages
• Tooth colored fillings can collect stain over time from foods such as black tea, coffee and wine
• Tooth colored fillings may chip or break if used for abnormal activities (e.g., biting fishing line, sewing thread or finger nails, opening bottles).

Crowns are made of three types of materials:

• Porcelain – most like a natural tooth in color
• Gold Alloy – strongest and most conservative in its preparation
• Porcelain fused to an inner core of gold alloy (Porcelain Fused to Metal or “PFM”) – combines strength and aesthetics

Crowns restore a tooth to its natural size, shape and—if using porcelain—color. They improve the strength, function and appearance of a broken down tooth that may otherwise be lost. They may also be designed to decrease the risk of root decay.

In having a crown, some inherent risks exist both to the tooth and to the crown itself. The risks to the tooth are:

• Preparation for a crown weakens tooth structure and permanently alters the tooth underneath the crown
• Preparing for and placing a crown can irritate the tooth and cause “post-operative” sensitivity, which may last up to 3 months
• The tooth underneath the crown may need a root canal treatment about 6% of the time during the lifetime of the tooth
• If the cement seal at the edge of the crown is lost, decay may form at the juncture of the crown and tooth

The risks to the crown are:

•  Porcelain may chip and metal may wear over time
• If the tooth needs a root canal treatment after the crown is permanently cemented, the procedure may fracture the crown and the crown may need to be replaced.

Alternatives to crowns are fillings, such as composite or silver amalgam. These restorations remove decay and may restore teeth to their original form, but are limited because they do not improve the strength of broken down teeth. They also do not decrease the risk of root decay or improve the long term function and aesthetics of broken down teeth or crowns.

• Excessive bite forces may lead to the tooth under the crown breaking or loosening
• Excessive bite forces may lead to the crown chipping, breaking or loosening

• Porcelain on a crown may have a good color match with adjacent natural teeth when the crown is placed, but less of a match as your natural teeth age
• Gum recession may lead to unsightly dark roots or crown margins becoming visible
• A crown may chip or break if used for abnormal activities (e.g., biting fishing line, sewing thread or finger nails, opening bottles)

Bridges are made of three types of materials: 

1. Porcelain – most like a natural tooth in color 
2. Gold Alloy – strongest and most conservative in its preparation  
3. Porcelain fused to an inner core of gold alloy (Porcelain Fused to Metal or “PFM”) – combines strength and aesthetics

Bridges build back your smile and help you to speak and chew properly by restoring your teeth to their natural size, shape, and— if using porcelain— color. They help maintain tooth, bite, and jaw alignment by preventing remaining teeth from shifting out of position.

In having a bridge, some inherent risks exist both to the tooth and  to the bridge itself. The risks to the remaining teeth are: 

• Preparation for a bridge weakens tooth structure of the  anchor teeth and permanently alters the teeth

• Preparing for and placing a bridge can irritate the anchor teeth and  cause “post-operative” sensitivity which may last for up to 3 months 
• Anchor teeth for bridges may need root canal treatment  about 6% of the time during the lifetime of the tooth
• Anchor teeth may become mobile if there is bone loss around their roots • If the cement seal at the edge of the crown over an anchor tooth is  lost, decay may form at the juncture of the crown and tooth

The risks to the bridge are:

• Porcelain may chip and metal may wear over time 
• If a tooth needs a root canal treatment after the bridge is permanently  cemented, the procedure may fracture the bridge  and the bridge may need to be replaced

• The longer the bridge, the shorter the lifespan; three tooth bridges last  10-15 years on average

 Three alternatives to bridges exist: 

1. Replace the missing tooth with an implant 
2. Replace the missing tooth with a removable partial denture 
3. Leave the space as is

• Excessive biting forces or untreated bite problems may  lead to the anchor teeth breaking or loosening
• Excessive biting forces or untreated bite problems may lead  to the bridge chipping, breaking or loosening

• As a bridge is made in one solid piece, it is not possible to floss in
between the teeth; special dental aids must be used to maintain
the health of the anchor teeth and gums around the bridge
• Porcelain on the bridge may have a good color match with adjacent natural
teeth when the bridge is placed but less of a match as your natural teeth age
• Food may become lodged under fixed bridges; gum recession over time may
make food impaction unavoidable, even with the most ideal bridge contour
• Gum recession may lead to unsightly dark roots or bridge margins
becoming visible
• A bridge may chip or break if used for abnormal activities (e.g., biting
fishing line, sewing thread or finger nails, opening bottles)

• The nerve of a tooth can be damaged if a tooth is cracked or fractured. Deep decay or trauma, like a blow to the tooth or from a fall may also cause damage.
• Even when carefully performed, every fi lling and crown has an impact on the tooth’s nerve health, so teeth with large fi llings or crowns are more likely to need a root canal.

• A tooth can be saved that would otherwise have to be removed due to infection or nerve damage.
• Chronic infl ammation that occurs with infection may be eliminated. This infl ammation is harmful to your overall health and the infection can spread to other parts of the body, including your brain and heart, and can be fatal.
• Pain or sensitivity caused by the damaged nerve can be relieved.

• Although 90% of root canal treatments are successful, a small number will require a second root canal procedure or additional treatment on the root tip.
• Even with the best care, root canal treatment may not resolve all the infection or infl ammation. In those cases, the tooth may still be lost, usually due to a hidden deep crack in the tooth or a root canal system too small to be adequately cleaned and sealed.

• On a back tooth, a crown is needed to lower the risk of future cracking or fracture from chewing forces. If the tooth already has a healthy, well-sealed crown, the dentist may be able to seal the root canal without replacing the crown.
• A front tooth in good condition may only need a bonded filling to seal and support it. Your dentist will discuss what support your specific tooth will need.

The only alternative would be to remove the tooth.