The structure of a tooth, composed of hard enamel and dentin layers protecting the soft inner pulp, is remarkably durable but susceptible to damage from decay, trauma, or wear. Modern dentistry offers a tailored spectrum of restorative treatments that match the severity of the structural compromise. These solutions range from simple surface repairs for minor flaws to complex procedures for full reconstruction or replacement, all aimed at preserving function and maintaining oral health.
Addressing Minor Damage
When decay or trauma affects only the outer surfaces of a tooth, simple restorative procedures are sufficient to restore the structure. The most common solution is a dental filling, where the dentist first removes the decayed or damaged enamel and dentin. The resulting void is then prepared to receive a filling material that seals the tooth against bacteria.
The material chosen for a filling is either a silver-colored dental amalgam or a tooth-colored composite resin. Amalgam fillings, a durable alloy of metals including silver and mercury, are known for their longevity and strength, making them a traditional choice for back teeth that endure heavy chewing forces. Composite resin, made of a plastic and glass mixture, is chemically bonded directly to the tooth structure. This resin is preferred for visible areas due to its ability to be color-matched seamlessly to the natural tooth shade.
For small chips, cracks, or minor cosmetic issues, dental bonding provides a minimally invasive repair. The tooth’s surface is first lightly etched to enhance the adhesion of the material. A putty-like composite resin is then applied, sculpted into the desired shape, and hardened instantly with a curing light. This technique is useful for closing small gaps between teeth or making minor adjustments to the tooth’s shape in a single appointment.
Restoring Significant Structural Loss
When a tooth has suffered extensive decay, a large fracture, or significant wear that cannot be supported by a simple filling, external reinforcement becomes necessary. A dental crown, often described as a cap, is a custom-made restoration that covers the entire visible portion of the tooth down to the gum line. The crown restores the tooth’s shape, size, and strength, effectively holding a compromised structure together.
The process of placing a crown requires two appointments, beginning with the preparation of the tooth by precisely removing a layer of the outer structure. This shaping creates space for the crown material to fit over the tooth without appearing bulky or interfering with the bite. An impression or digital scan is taken of the prepared tooth and sent to a dental laboratory, where the permanent restoration is fabricated from materials like porcelain, zirconia, or metal alloys.
Where the damage is too large for a filling but not extensive enough for a full crown, an intermediate restoration called an inlay or onlay may be used. Inlays fit within the cusps, or peaks, of the chewing surface, similar to a traditional filling, but they are fabricated in a lab as a solid piece. Onlays, sometimes called partial crowns, are larger and cover one or more cusps of the tooth, providing better protection and strength than a filling alone. These indirect restorations preserve more natural tooth structure compared to a full crown.
Treating Internal Infection and Pulp Damage
When decay or a fracture penetrates deeply through the enamel and dentin, it can reach the pulp chamber, which contains the nerves, blood vessels, and soft tissue. Once the pulp becomes infected or irreversibly inflamed, root canal therapy (endodontic treatment) is required to save the tooth from extraction. Severe pain, prolonged sensitivity to temperature, or localized swelling indicate that the internal pulp is compromised.
The procedure involves the dentist or an endodontist creating a small access opening in the crown of the tooth to reach the pulp chamber. Specialized instruments are used to remove the infected pulp tissue from the chamber and the root canals. The canals are thoroughly cleaned, disinfected, and shaped for filling.
After cleaning and disinfection, the space within the root canals is filled and sealed with a biocompatible, rubber-like material called gutta-percha. The access opening in the crown is closed with a temporary or permanent filling. Because the tooth is structurally weakened after a root canal, a full-coverage dental crown is often required shortly thereafter to protect the tooth from fracturing.
Replacing Missing or Irreparable Teeth
When a tooth is fractured below the gum line, has extreme mobility, or has advanced decay, extraction becomes the only viable option. Once the tooth is removed, the focus shifts to replacing the missing structure to restore chewing function and prevent adjacent teeth from shifting. The two primary methods for replacement are dental implants and dental bridges.
A dental implant is considered the most stable and long-lasting replacement, involving surgically placing a titanium post directly into the jawbone. This post acts as an artificial tooth root, providing a secure anchor that promotes the preservation of the surrounding bone structure. After a healing period that allows the bone to fuse to the titanium, a custom-made crown is attached to the implant post.
A dental bridge offers an alternative solution that does not involve surgery, using the adjacent natural teeth as anchors. The adjacent teeth are prepared to receive crowns, which are then fused to an artificial tooth, called a pontic, that fills the missing space. Bridges can be fabricated and placed more quickly than implants, but they require the modification of healthy neighboring teeth for support.