Dental restoration

The concept of dental restoration is a process of restoration and correction, first of all, of the functional, and only then of the aesthetic parameter of the tooth, by means of the use of composite materials, with mandatory observance of the functional and aesthetic parameters. In other words, restoration is the restoration of functions damaged by dental caries, making them indistinguishable from other teeth. Dental restoration consists of elements of treatment and aesthetic design, which is actually what distinguishes it from filling.

A beautiful smile is one of the important components of everyday communication between people. Smiling, a person shows his disposition, friendliness, open intentions, positive mood. A snow-white smile has long been an integral part of the image of a successful person. "Hollywood smile" is not only an element of a successful life, but above all an indicator of a person's internal health. Very often, ugly teeth are the cause of low self-esteem, which can subsequently lead to depression. Bad teeth, in addition to psychological problems, can provoke unclear diction, speech difficulties, distortion of facial expressions. Not every person can boast of beautiful, healthy teeth. Modern dentistry, at the current stage of its development, solves several problems associated with bad teeth at once - primarily dental, and then - psychological.

Beautiful teeth, in the concept of modern dentistry, are primarily aesthetically pleasing in shape, natural color and transparency of teeth. The last two criteria are very important when performing dental restoration. The color of the tooth consists of the color of dentin and the color of enamel, for this reason the color of natural teeth is quite difficult to imitate.

A natural tooth has two shades, visually it seems to change color from the neck to the cutting part - this is explained by the different thickness of the tooth enamel. The natural beauty of the tooth is due to the presence of a transparent edge.

As a result of high-quality restoration, natural teeth do not differ in shape, color, transparency, surface shine from restored teeth. Naturally, the main function of the tooth - chewing - does not differ from healthy teeth.

Modern dentistry allows us to do miracles. Even in the most hopeless cases, with the help of a qualified dentist, almost everything is possible. New materials and modern technologies combined with the high qualifications of a dentist are the foundations of beautiful teeth and a "Hollywood" smile.

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Methods of dental restoration

Depending on the type of defect and the expected result, modern dentistry uses several methods of dental restoration.

1. The direct dental restoration method is used for minor dental damage if restoration is possible in the patient's oral cavity. This method uses all kinds of cements, composites, photopolymers, and heliocomposites. This dental restoration method is an alternative to outdated crowns.

The method of direct restoration of teeth is used in the following cases:

• restoration of the shape and aesthetic appearance of the tooth;
• correction of the shape of teeth and dental arches;
• change in tooth color;
• correction of incorrect position of teeth in the dental row;
• closing and masking interdental spaces and gaps;
• correction of mesial bite;

Carrying out dental restoration is a complex process that requires not only a highly qualified dentist, but also aesthetic taste. The arsenal of modern aesthetic dentistry includes many cosmetic tricks that are successfully used in practice. For example, cosmetic contouring can significantly rejuvenate a patient's appearance.

2. the indirect restoration method is used for severely damaged teeth, when restoration in the patient's oral cavity is not possible and requires the production of missing parts of the tooth - inlays, veneers. Inlays and veneers are an alternative to crowns, have a natural appearance.

Recently, the method of artistic restoration of teeth has become increasingly popular. A big advantage of this method is the improvement of the aesthetic indicators of teeth, along with the traditional restoration of the anatomical features of natural teeth. After using this method, the teeth become whiter, the proportion and shape are aligned. Accordingly, specialists of clinics offering this service must have high qualifications in the field of anatomy of the dental system and have impeccable artistic taste.

Stages of dental restoration

Experts have identified four main stages of dental restoration using composite materials:

• diagnostics of teeth, features of structure, structure, color;
• selection of composite materials for restoration work;
• preparatory work;
• dental restoration.

What is the difference between regular dental filling and restoration? First of all, the main goal of dental filling is to restore the full functionality of teeth, chewing ability, crown shape, while restoration, in addition to the listed purposes of filling, restores the aesthetic functions of teeth, namely color, transparency, shine of the tooth surface.

This stage of restoration consists of the following manipulations:

• matrix overlay if necessary;
• application of the composite and its curing;
• shaping the surface of the filling;
• crown correction, its final processing, final glazing.

Multilayer technique of restoration of tooth enamel, the most accessible and at the same time popular among the majority of patients who restore teeth. This is explained by the affordable price, minimal impact on teeth, promptness of the course of treatment.

The use of this restoration technique is the optimal option for correcting the front teeth.

Dental restoration, like any surgical intervention, entails minor changes in the human body, and accordingly has indications and contraindications. In general, there are no contraindications for the general number of patients, but restoration is not possible in cases where:

• poor oral hygiene prevents high-quality restoration;
• the patient is not able to withstand the restoration for a long time;
• the patient is allergic to anesthesia or intolerant to the components used in the restoration;

Of great importance in dental restoration is compliance with the recommendations and instructions of the specialist. Dental restoration is a complex and lengthy process, largely dependent on the professionalism of the specialist, but the patient's discipline is also an important point in this process. Accordingly, the care for the successful implementation of dental restoration is distributed between both the dentist and the patient.

Modern dental restoration

Innovative dental technologies sometimes amaze the imagination and modern dental restoration is no exception. The emergence of modern composite materials of different color shades and transparency levels allows not only to fill cavities and all sorts of defects, but also to completely restore teeth.

As a rule, before restoration, specialists use a number of indications and contraindications for restoration using composite material.

Restoration is indicated in cases where it is necessary:

• correction of dental aesthetics;
• tooth shade correction;

If a previously depulped tooth is corrected, dentin resection is performed. Another method of correcting the aesthetic functions of teeth is the production of a crown or bleaching, as well as the production of ceramic or composite laminate indirectly in the laboratory.

• correction of the shape and size of teeth;

The indirect production of a ceramic or composite inlay or crown is currently an alternative method for correcting the shape and size of teeth.

• correction of the position of teeth in the dental row;

The most frequently used method is restoration with composite inlays, production of crowns, and fixation with a bracket system.

• treatment of caries, its varieties, non-carious lesions and consequences of various injuries with restoration of aesthetics and functions of teeth;
• restoration of a tooth with small cracks in the crown after an injury;

In such cases, restoration with crowns, indirect composite or ceramic inlays is advisable.

• filling of class IV cavities with restoration of the natural color, transparency and shape of the tooth;

In cases of class I and II cavity filling, it is possible to use amalgam and inlays, class III and V cavity filling can be done with glass ionomer, and in case of significant destruction of class IV type, the production of metal and ceramic inlays or crowns is indicated.

• correction of the shade of devital teeth;

It is possible to manufacture a ceramic laminate or crown, and intracanal bleaching is possible.

• production of an artificial tooth based on fragments of a natural tooth.

An alternative method, in this case, is the production of an orthopedic structure.

• installation of a bridge prosthesis with quick fixation for minor defects.

It is possible to manufacture an orthopedic structure with depulpation of the supporting teeth.

It is necessary to take into account the fact that restoration has absolute and relative contraindications. Of these, three are absolute in significance contraindications when performing restoration with light-cured composites:

• a patient has a pacemaker, such as the "Pass-Maker". In cases where the patient has a pacemaker, there is a risk of a disturbance in the pulse rate due to the use of a photopolymerizer, which can cause cardiac arrest.
• the patient is allergic to the composite or elements of the adhesive system.
• excessive salivation and, as a consequence, the inability to isolate the oral cavity or teeth from saliva.

The last two contraindications, in practice, are extremely rare.

Relative contraindications include:

• the patient has a straight bite and pathological abrasion of teeth. In this case, it is advisable to begin restoration after the orthopedist has raised the patient's bite.
• a combination of deep incisal overlap with tight contact between the incisors of the upper and lower rows of the dental arch. In this case, a complex restoration process is contraindicated, for example, restoration of the tooth crown without using an anchor pin.

Dental restoration technique

Before starting dental restoration, dentists usually pay special attention to the patient's readiness for the restoration process. The patient's psychological preparation is an important point in this process.

It is important to explain to the patient all aspects of dental restoration with composite materials, simultaneously clarifying his expectations, the moment of discussing the color shade and shape of the teeth is also fundamentally important. Practicing dentists unanimously consider the discussion of issues regarding the shade and shape of the teeth to be the most important, significantly affecting the success of the entire restoration process. There is a great need for a detailed discussion of all stages of restoration, justifying the appropriateness of the decisions taken.

One of the essential aspects of dental restoration is regular oral hygiene. Failure to observe basic dental hygiene entails discoloration, possible loss of shine of teeth, development of caries.

If the condition of the periodontium is not the best, it makes sense to first undergo treatment in the periodontal department, all surgical interventions are carried out before restoration. The condition of the periodontium is very important, given that an aesthetic appearance is provided by even healthy teeth and pale pink gums. First of all, a beautiful smile is a successful combination of a whole red border of the lips, the correct shape of the teeth and healthy gums.

Oral restoration begins with local anesthesia. Thanks to high-quality anesthesia, the dentist has the opportunity to professionally perform the restoration, while the patient does not experience any pain. After anesthesia, a cofferdam is applied to the oral cavity, which eliminates the possibility of accidental ingress of plaque and other particles that form during preparation into the respiratory tract. In cases where the use of a cofferdam is not provided, the isolation of the operating space from saliva is carried out using retraction threads, vestibular contour matrices and wedges.

The process of preparing a tooth for restoration begins with the removal of plaque, which eliminates direct contact of the acid gel, components of the adhesive system with the enamel of the teeth. Plaque removal is done mechanically, by means of rotating brushes and prophylactic rubber cups, which are filled with paste. An alternative to this cleaning method is the use of the so-called handy blaster, which removes plaque with an abrasive powder based on soda, supplied into the oral cavity under pressure with water.

If it is impossible to remove plaque from between the teeth, first use lavsan strips, floss and then a handy blaster. An indicator of high-quality plaque removal is shiny enamel on the entire surface of the tooth.

The technique of tooth preparation assumes that the adhesive systems of modern composite materials sufficiently ensure their chemical adhesion to dental tissues. Recently, the following requirements have been applied to the prepared oral cavity:

• absence of necrotic dentin and especially pigmented;
• absence of decalcified enamel and the “chalk spot” effect;
• a beveled fold on enamel, made along the edge of the cavity, at an angle of 45°.

The fold is made with a finishing bur, with water cooling and low pressure. When trying to apply strong pressure or working without water cooling, this procedure requires high qualifications of the specialist, since it is likely that the enamel edge will split. The width of the fold varies depending on the type of surface location. In order to narrow the fold lines, chewing surfaces are made with a smaller angle. Fragments of the composite restoration often chip off from a fold that is too wide.

If the composite is applied to a large part of the tooth enamel surface, as in the case of erosion, hypoplasia or chipped parts of the crown, then the enamel prisms are opened vertically. In simple terms, a thin structureless layer of enamel is removed, which covers the bundles of the enamel prism, as a result of which the composite is fixed more efficiently.

Materials for dental restoration

When considering materials for dental restoration, it is necessary to note the high clinical requirements for the quality of these materials, and this is quite understandable - after all, they will be part of the teeth. Accordingly, materials for dental restoration must combine increased strength and plasticity, a wide range of colors, low thermal conductivity, non-toxicity - these are far from all the clinical requirements for materials.

High-quality materials for dental restoration allow solving many of the patient’s problems; the skill and qualifications of the treating dentist are also no less important in their significance.

The main material, widely used everywhere, is a composite, which is able to withstand significant loads, comparable in strength to natural teeth, because human teeth are very strong, as they withstand heavy loads for 35-65 years. The composite material hardens under the light of a powerful special lamp, this property of the composite is important, since the dentist has time to give the desired shape to the restored tooth and only then fix the composite. This allows the dentist to perform high-quality restoration work. In addition, the composite material has about 35 color shades, which is another advantage of this material, allowing you to choose the natural color of the restored teeth.

The popularity of the composite material indicates the absence of disadvantages, and here it was not without a significant "but". The composition of composite materials from different manufacturers may differ slightly, for example, the presence or absence of fluorine and other substances in the composition.

Light-curing composite materials have completely replaced the outdated silicate-phosphate cement, amalgam and chemically cured composite.

The international ISO standard classifies light-curing composites according to the following parameters:

• polymer matrix based on copolymers of acrylic and epoxy resins;
• the volume of inorganic filler in the composition is more than 50%;
• The filler particles are treated with surfactants.

Composite filling materials are classified by filler particles, curing method, consistency, and purpose. According to the filling particles, there are macrofilled - particle size from 8 to 45 μm, microfilled - particle size from 0.04 to 0.4 μm, minifilled, particle size from 1 to 5 μm, hybrid - consist of a mixture of particles of different sizes - from 0.04 to 5 μm, microhybrid - composites with an average particle size of 0.5-0.6 μm. A high-tech innovative development of recent years is nanocomposites.

Depending on the curing method, composite materials are divided into chemically cured materials and light-cured materials. According to their purpose, composites are classified for filling chewing teeth, front teeth, and universal composite.

Today, dentistry is the most high-tech branch of medicine. Modern dentistry introduces new innovative materials, technologies and methods in restoration, uses nanotechnology in the production of composite materials. All this contributed to the creation of materials that meet the requirements of practicing dentists: composites have super-strong properties, are able to withstand high mechanical loads, have convenient handling characteristics, and have good elasticity.

Casting metal alloys of various compositions are most often used to make bridges, dentures, and crowns. Since titanium is biocompatible and easily integrated into the jaw, it is used as the basis for dental implants.

The use of precious metal alloys, gold-containing alloys, silver-palladium alloys, and nickel-chromium alloys in dental restoration has become less popular in recent years.

The main task of a practicing dentist, when selecting a material for dental restoration, is to choose a composite with the most convenient handling properties, good elasticity, long-term warranty, ease of use, the ability to select shades, and, of course, a good price-quality ratio.

Instruments for dental restoration

To restore teeth, a dentist uses a variety of different tools when performing the necessary manipulations. Currently, the range of dental tools is quite wide. First of all, dental tools, with their functions, help ensure high quality restoration, maximum convenience for both the patient and the specialist. In the production of dental tools, special shapes of the working surfaces of the tools, ergonomic shapes of the handles are used. A dentist's office equipped with the most modern dental equipment and tools is an absolutely common thing today. According to their purpose, hand dental tools can be classified into groups:

• instruments used for examining the oral cavity - dental mirrors, probes, tweezers;
• instruments used in the treatment of dental caries - excavator, enamel tool, chisel;
• instruments for medicinal treatment of carious cavities and root canals - dental syringes, special needles, various files;
• instruments used for filling and restoring the anatomical shape of teeth: spatulas, smoothers, pluggers, instruments for amalgam, strips, grinding strips, Carisolv system, matrices and matrix holders;
• periodontal instruments - probes, curettes, scalers, polishers, special systems;
• dental materials and devices for isolating the oral cavity;
• instruments and devices for local anesthesia.

Of all the many tools, let's take a closer look at a few of them:

• To create large and dense contact points on the lateral teeth on the upper and lower proximal surfaces, a modeling hand dental instrument is used.
• A ball-end stopper in combination with a smoothing tool is used to model dental restorations.
• Dental instrument for packing gingival retraction cord used in dental restoration.
• a dental instrument for final preparation is used when processing the outer edge of the cavity in horizontal planes, as well as for removing the thinned enamel wall.
• The light polymerization apparatus is used in restoration with light-curing composite materials.
• LED wireless dental photopolymerizer is used for restoration with photopolymer materials.

When restoring with photopolymer materials, light polymerization lamps are necessarily used. After applying a layer of photopolymer material to the teeth, the material hardens under the light of the lamp. In restoration practice, a large number of manual and automatic instruments are used, the main requirement for dental instruments is, of course, compliance with quality standards and certificates. High-quality instruments meet the highest requirements of modern dentistry and guarantee high precision of execution.

Smoothers for dental restorations

In restoration practice, various trowels perform many functions. Trowels are intended for applying medicinal paste-like lining material, for applying filling materials of temporary fillings and forming fillings, among other things. According to the form of execution, trowels are made at various angles in relation to the base. Trowels are made of various sizes, can be single-sided, double-sided, combined with a stopper. With the help of a trowel, the dentist forms fillings, compacts the filling material, condenses it on the walls of the oral cavity. Stoppers can be combined with trowels on different sides of the handle or on one side of the instrument. Recently, silicone trowels with tips of various shapes, used for modeling composite materials, have been widely used. The convenience of using silicone trowels is obvious - the instrument does not stick to the composite material and does not leave porous surfaces. It is possible to use irons with acrylics, monomer, sealant, lubricant, gel, dye.

Restoration of front teeth

The front row of teeth is constantly exposed when talking, when a person smiles, that is why the perfect appearance of the front teeth is very important. In the recent past, the main goal of dentistry was to restore the functionality of teeth. Fillings and crowns were made using metals - materials with unnatural color shades, but highly durable. Today, the aesthetic appearance of the front teeth is of great importance during restoration. As a rule, when restoring the front teeth, the shade of the color of the materials is carefully selected, taking into account the light-refracting properties, in order to achieve the most natural appearance of the teeth.

Restoration of front teeth is a process of restoring the shape and function of teeth using modern filling materials. Fillings made of such materials are practically invisible, resistant to deformation, colorfast, and have light-reflecting properties. In cases of significant destruction of the front teeth, it is possible to install a special pin, with further application of layers of filling mass, selected by color, with subsequent grinding and polishing.

Restoration of the front teeth can be done using a ceramic veneer. A veneer is a ceramic overlay on the front surface of a tooth. Initially, the dentist prepares the oral cavity, if necessary - endodontic treatment, then cleans the canals, removes inflammatory tissues of the teeth. Then, a veneer is fixed to the prepared ground tooth with special cement. The restoration technique using veneers is considered quite effective from the aesthetic side, but in addition to the aesthetic appearance, which is of course very important for the front row of teeth, veneering is very practical. A correctly installed veneer should fit tightly to the surface of the tooth, thereby preventing caries and inflammatory reactions.

Restoration of chewing teeth

Restoration of chewing teeth requires a detailed study of the following morphological elements: group of belonging, geometric shape of the buccal surface, belonging of the side, individual features of the oral cavity, gingival contour, number and shape of tubercles and the degree of their abrasion, length of dental contacts, macrorelief of the oral cavity, type and depth of fissures. High-quality restoration of chewing teeth is possible with absolute observance of the recreation of anatomical and physiological norms. Often, the process of reproducing these features provokes certain difficulties for specialists. The entire process of recreating the anatomical forms of chewing teeth is divided into the following stages:

• modeling of tubercle cones and creation of a basis for restoration
• proximal wall restoration
• reconstruction of the attribute of belonging to the side, the attribute of curvature and angle of the crown, deviations of the roots
• recreation of the individual characteristics of teeth, macro-reliefs of the occlusal surface and the fissure system.

The first stage is the creation of a restoration base. In case of significant destruction, the missing dentin is first covered and only then the base of the tooth tubercles is modeled. The next stage is the restoration of the proximal wall using a flowable composite material. Then the third stage is the restoration of the signs of belonging to the side, taking into account the sign of curvature of the teeth, the deviation of the roots and the angle of the crown. Reproduction of individual features of the tooth is the most difficult stage. The restoration of the macrorelief is considered to be especially difficult, requiring high qualification of the specialist. For this, the tubercles along the periphery of the chewing surface are formed using enamel-colored composites. When restoring individual characteristics, it is necessary to take into account the color shade of the adjacent teeth. All layers of the composite are polymerized. Upon successful completion of the entire process, abrasive surface treatment is carried out: removal of the inhibited layer, surface contouring, occlusal contacts are verified. Possible discrepancies with the anatomical norm are removed using fine-grained burs, creating a microrelief of the surface.

Restoration of teeth with veneers

Restoration of teeth with veneers, the so-called lamination of teeth, strengthens the structure of tooth enamel, corrects tooth defects. It is possible to use ceramic, more expensive, or porcelain veneers, cheaper in cost.

Veneers are thin, from 0.5 to 0.7 mm, ceramic overlays on the tooth, to give the desired shape. The use of ceramic veneers is due to the correction of all sorts of cosmetic defects of the front row of teeth, giving the teeth the correct shape, quite quickly and painlessly. Installing veneers involves only grinding down the top layer of tooth enamel, which preserves the tooth itself. In some cases, a porcelain veneer can serve as a ceramic crown.

The main functional quality of veneers is reliable protection of teeth and impeccable cosmetic effect, for relatively little money. The color of veneers is stable, does not change under the influence of natural dyes. The cost of installing veneers depends on the material used in the technological process.

Direct dental restoration

Direct restoration of teeth involves performing the procedure directly in the patient's oral cavity. As a rule, direct restoration is a one-stage process, except for cases when many teeth are restored.

Modern restoration materials allow a specialist to restore a tooth that is ideally similar to the patient’s natural teeth in terms of color shade and transparency.

Direct dental restoration has obvious functional advantages, namely:

• the procedure itself is gentle on dental tissue, which ensures better sealing of the restoration;
• Adhesive techniques and restorative material are tightly glued to the dental tissues, as well as the dental tissues, to each other. This feature allows to strengthen the supporting structure of the teeth, to preserve the remaining dental tissues.
• elastic materials allow the structure to transform under the influence of loads and deform simultaneously with the natural tissue of the teeth, eliminating the possibility of a breach of the seal of the restored tooth and the likelihood of delamination of the restoration material and the tooth.

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Indirect dental restoration

Indirect restoration of teeth is performed using orthopedic structures that are manufactured in laboratory conditions, individually for each patient. Orthopedic structures include crowns, inlays, various veneers and lumineers, which are mainly made of ceramics. The quality characteristics of ceramics fully meet the aesthetic requirements - it perfectly duplicates a natural tooth, this material has a high margin of safety.

Usually, indirect restoration takes several days due to the length of the technological process. Orthopedic ceramic structures are made in the laboratory using impressions. During the technological process of manufacturing structures, temporary plastic structures can be installed.

The choice of the restoration method, direct or indirect, depends primarily on the initial clinical situation. In one case, direct restoration is indicated, and vice versa, when it is correct to perform indirect restoration.

The decision on the choice of restoration method is made individually and, of course, largely depends on the level of qualification of the specialist.

Indirect restoration of teeth provides a higher quality and light-resistant restoration surface. Orthopedic structures are completely inert and have good biological compatibility, and do not provoke sensitization.

Despite the high technological development of dentistry, there is no absolutely ideal method of restoration. The determining factor in choosing direct or indirect dental restoration is the dental health of each patient.

Restoration of teeth after braces

Restoration of teeth after braces consists of restoring the integrity of tooth enamel from carious lesions, if any, and restoring the natural color of teeth. In general, after wearing braces, in case of non-observance of oral hygiene or improper installation or wearing of the system itself, various deformations of teeth are possible. But such cases in practice are not significant and individual.

The bracket system itself does not damage the tooth enamel. The only significant disadvantage of wearing braces is particularly thorough oral hygiene. Due to the technical features of the design itself, food debris can get stuck and contribute to the accumulation of plaque, causing the formation of dark spots and the development of caries. It is poor individual oral hygiene that causes the darkening of tooth enamel under the braces, the cause of caries. It is especially important at the time of installing the bracket system to train in oral hygiene. In order to control the quality of oral hygiene, it is advisable to conduct preventive examinations, if necessary, professional hygiene.

After wearing the braces, in some cases, it is recommended to strengthen the dental row with a wire glued to the inside. The wire holds the entire dental row in the correct position, this procedure is short-term.