Dr. Rodney Shainbom at Dentistry-on-Bellevue in West Vancouver adheres to the ethic of conservative dentistry, which means his primary goal is to intercept problems early, preserve as much tooth structure as possible, as well as achieve what the patient’s health, budget and desires mandate for their smile. The sooner a problem is detected and treated, the more original tooth structure will be preserved. The longevity of a restoration is generally inversely proportional to its size; i.e. the bigger the restoration, the less the amount of remaining tooth material remains and the sooner it is likely to fail. Our teeth are subjected to wear and tear while we sleep as well as when we’re awake, accidents sometimes do happen, or we’ve inherited certain aesthetic flaws we eventually wish to change. These are all good reasons patients seek restorative dentistry.
The first assault on our teeth is usually during our childhood or adolescence and comes in the form of decay. Otherwise referred to as a cavity, this is a “hole” in a tooth resulting from bacterial attack on the tooth structure. It is generally a result of poor oral hygiene or dietary habits. Once the enamel has been penetrated, it is only a matter of time before the decay process will spread into the underlying dentine causing further structural damage. If not treated, the decay will eventually reach the nerve in the tooth causing the nerve to become infected and die off. When patients wait until they feel pain from a cavity before they come in for a dental visit, the decay has already reached the nerve. Regular six-month dental visits will discover these problems before they reach the “pain stage”, when they can be corrected without so much loss to the tooth structure.
A “filling” is a material that is placed into the tooth once the decay has been removed. There are different materials available to restore a tooth to normal form and function, some can be fashioned by the dentist in the office and placed the same day; others involve taking impressions, using “temporary fillings” and having a dental lab fabricate the type of restoration required. A filling serves to limit the damage caused by cavities, preserve and protect the remaining tooth structure, allow the tooth to function properly again, maintain pulp and nerve vitality if possible, and preserve the appearance and life of the tooth.
There are several options available today to restore a tooth, and this would depend on the extent of breakdown, the patient’s requirements and expectations, the cost and time available.
In years’ past, amalgam (typically a silver filling) was the best affordable filler for a tooth with decay. Nowadays, it is the lowest cost, requires the least “technique” on the part of the dentist, and is usually viewed as unsightly. Silver amalgam also weakens the tooth, and can require removal of some of the healthy tooth to make room for the material. We no longer place amalgam fillings, having only a slight amount of the material available for repairs.
This photo depicts the contrast between old silver amalgam fillings and the white plastic resin-based material, referred to as composite or “white fillings”, that is bonded to the tooth and placed directly into the cavity. Dr. Shainbom fashions the composite in our office, and glues it into place using dental adhesives and a curing light. The advantage of composite fillings is the inherent strengthening to the remaining tooth structure which results from the bonding process. They also require less tooth removal, making it a more conservative option clinically. The major disadvantage of composite is that, depending on the size of the filling(s), they will need to be replaced sooner.
Gold Inlays / Onlays
Gold inlays / onlays are fillings that are fabricated out of yellow gold in a laboratory, and are then cemented into the prepared tooth by Dr. Shainbom. An “inlay” fills the inside of the tooth whereas an “onlay” covers one or more of the outer and/or bite surfaces of the tooth. They have a very durable lifespan and are still considered to be the penultimate treatment in terms of quality and longevity. Their disadvantages are their initial higher costs compared with any other regular filling, and their colour is unacceptable to some people.
Porcelain inlays / Onlays
Porcelain inlays / onlays are fillings made out of tooth-coloured porcelain fabricated in a laboratory. Dr. Shainbom prepares the tooth, ridding it of its decay, then makes an impression which is sent to the lab. In the meantime, the patient wears a “temporary” until the inlay/onlay is bonded into place, usually about a week later. The advantages of porcelain inlays/onlays include their natural appearance in tooth colour and shape, the strengthening of the tooth structure provided by the bonding, the fact that porcelain does not discolour over time, and their greater durability compared with composite fillings. Additionally, white fillings can shrink during the bonding/curing process, but an inlay/onlay is a solid mass tucked exactly into the space left by the decay cavity.
Dental crowns are the final step in tooth restorations involving weak or damaged teeth. They can be tooth-coloured restorations made out of porcelain or porcelain-fused-to-metal, or gold, and similar to inlays/onlays, they are made in a laboratry and later cemented into place by Dr. Shainbom. They are used in cases of extensive tooth breakdown, or weak remaining tooth structure and are designed to cover the entire crown of the tooth.
Made from paper-thin porcelain, veneers are little jackets wrapped around each tooth needing a correction. Dr. Shainbom removes a small amount of the outer enamel to make room for the added veneer, each one being fashioned individually to achieve the desired effect. Veneers can be shaped to offer some slight orthodontic correction, or to improve length, breadth, tilt, shape or colour of your teeth, according to what you, the patient, and Dr. Shainbom agree would look best. Temporaries are made after your teeth are shaped for the veneers, and the impressions go off to the lab, similar to crowns. You will discuss colour and shading with both Dr. Shainbom and the lab personnel. When your veneers are ready to be “seated”, minor adjustments will be made before they are permanently affixed in our office. At the end of this appointment, when you look in the mirror, you will see the smile you’ve been dreaming of!