Restoration of teeth

The concept of restoration of teeth is a process of restoration and correction, first of all functional, and only then the aesthetic parameter of the tooth, through the use of composite materials, with the obligatory observance of functional and aesthetic parameters. In other words, restoration is the restoration of functions, damaged by caries of teeth, making them indistinguishable from other teeth. Restoration of teeth consists of elements of treatment and aesthetic design, what actually differs from sealing.

A beautiful smile is one of the important components of everyday communication between people. Smiling, a person shows his disposition, friendliness, open intentions, a positive mood. For a long time already a snow-white smile has become an integral part of the image of a successful person. "Hollywood smile" is not only an element of a successful life, but first and foremost an indicator of a person's internal health. Often ugly teeth are the reason for low self-esteem of people, which can subsequently lead to depression. Bad teeth, in addition to psychological problems, can provoke fuzzy 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 - first of all, dental, and even then - psychological.

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

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

As a result of qualitative restoration - natural teeth do not differ in form, color, transparency, gloss of the surface from the restored teeth. Naturally, the main function of the tooth - chewing - does not differ from healthy teeth.

Modern dentistry allows you to do wonders. Even in the most hopeless cases, by the hands of a qualified dentist - almost everything is possible. New materials and modern technologies combined with high qualification of the dentist - the basic beautiful teeth and "Hollywood" smiles.

[1], [2], [3], [4], [5]

Methods of restoration of teeth

Depending on the type of defect and the expected result, in modern dentistry several methods of tooth restoration are used.

1. the method of direct restoration of teeth is used for small tooth injuries, if restoration is possible in the patient's oral cavity. This method uses all kinds of cements, composites, photopolymers, heliocomposites. This method of restoration of teeth - an alternative to obsolete crowns.

The method of direct restoration of teeth is applied when:

• restoration of the shape and aesthetic appearance of the tooth;
• correcting the shape of teeth and teeth;
• change of color of teeth;
• correcting the wrong position of the teeth in the dentition;
• closing and masking of the interdental gaps and gaps;
• correction of mesial occlusion;

Carrying out the restoration of teeth is a complex process, requiring not only a high qualification of a dentist, but also an aesthetic taste. In the arsenal of modern aesthetic dentistry there are many cosmetic tricks that are successfully applied in practice. For example, with the help of cosmetic contouring, you can significantly rejuvenate the patient externally.

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

Recently, the method of artistic restoration of teeth has become increasingly popular. A great advantage of this method is the improvement of aesthetic parameters of teeth, along with the traditional restoration of anatomical features of natural teeth. After applying this method, the teeth become more white, the proportion and shape are aligned. Accordingly, the specialists of the clinics offering this service must possess a high qualification in the field of anatomy of the dentoalveolar system and have an impeccable artistic taste.

Stages of restoration of teeth

Specialists have identified four main stages of restoration of teeth with composite materials:

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

What is the difference between the usual filling of teeth from restoration? First of all, the main goal of tooth filling is to restore the full functionality of the teeth, the ability to chew, the shape of the crown, while restoration in addition to the above-mentioned sealing purposes restores the aesthetic functions of the teeth, namely, the color, transparency, and gloss of the tooth surface.

This stage of restoration consists of the following manipulations:

• imposition of the matrix, if necessary;
• application of the composite and its curing;
• forming the surface of the seal;
• correction of the crown, its final processing, finishing flashing.

Multilayered tooth enamel restoration technology is the most affordable and at the same time popular among a larger number of patients restoring their teeth. This is due to an affordable price, minimal impact on teeth, speed of treatment.

The use of this technique of restoration is the best option for adjusting the front teeth.

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

• unsatisfactory hygiene of the oral cavity, interferes with quality restoration;
• the patient is unable to withstand the restoration for a long time;
• the patient is allergic to anesthesia or intolerance to the components used in the restoration;

Great importance, when restoring the teeth, has compliance with the recommendations and instructions of the specialist. Restoration of teeth is a complex and lengthy process, largely dependent on the professionalism of the specialist, but the discipline of the patient is an important point in this process. Accordingly, the care for successful restoration of teeth is distributed to both the dentist and the patient.

Modern restoration of teeth

Innovative dental technologies, at times, amaze the imagination and modern restoration of teeth in the same number. The appearance of modern composite materials of different color shades and transparency level allows not only to fill cavities and all kinds of defects, but also completely restore teeth.

As a rule, before restoration, specialists use a number of indications and contraindications to carrying out restoration by composite material.

Restoration is indicated in cases when it is necessary:

• correction of tooth aesthetics;
• correction of the shade of the tooth;

If the correction of the tooth, previously depulpated, is performed, resection of the dentin is performed. Another method of correcting the aesthetic functions of teeth is to make a crown or bleach, as well as making a ceramic or composite laminate in an indirect way in the laboratory.

• correction of the shape and size of the teeth;

Manufacturing, indirectly, a ceramic or composite insert or crown - is an alternative method of correcting the shape and size of teeth.

• correction of the location of teeth in the dentition;

The most commonly used method is restoration with composite inserts, manufacturing of crowns, fixing with a bracket system.

• treatment of caries, its varieties, non-carious lesions and the consequences of various injuries with restoration of aesthetics and dental functions;
• restoration of the tooth with small fractures of the crown after trauma;

In such cases it is advisable to restore crowns, indirect composite or ceramic inserts.

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

In the cases of filling the I and II cavity cavities, it is possible to have an amalgam and a tab, III and V classes - it is possible to fill with a glass ionomer, in case of significant destruction according to type IV class, metal and ceramic inserts or crowns are shown.

• correction of the shade of the devital teeth;

It is possible to produce ceramic laminate or crown, possibly in-channel bleaching.

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

An alternative technique, in this case - is the manufacture of orthopedic construction.

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

It is possible to make an orthopedic design, with depulpation of supporting teeth.

It is necessary to take into account the fact that restoration has absolute and relative contra-indications. Of these, there are three absolute contra-indications when performing restoration with light-curing composites:

• stimulator of heart rhythm in the patient, as «Pass-Maker». In the case where the patient has a stimulant, there is a probability of impairing the pulse frequency due to the use of a photopolymerizer, which can provoke cardiac arrest.
• an allergy in the patient to the composite or elements of the adhesive system.
• abundant salivation and as a consequence the impossibility of isolating the oral cavity or tooth from saliva.

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

From the relative contraindications can be identified:

• The patient has a direct bite and abnormal abrasion of the teeth. In this case, it is advisable to begin the restoration after the orthopedist lifts the patient's bite.
• Combination of deep incisal overlap with close contact between the incisors of the upper and lower rows of the dentition. In this case, a complex restorative process is contra-indicated, for example, restoration of the tooth crown without using an anchor pin.

Technique for restoration of teeth

Before starting the restoration of teeth, dentists tend to pay special attention to the preparedness for the patient's restoration process. Psychological preparation of the patient is an important moment in this process.

The moment of explanation to the patient of all aspects of tooth restoration with composite materials is important, while at the same time specifying his expectations, the moment of discussing the color shade and the shape of the teeth is also fundamentally important. Practitioners of dentists unanimously consider the discussion of questions concerning the shade and shape of the teeth, the most important, significantly affecting the success of the entire restoration process. There is a great need for a detailed discussion of all the stages of restoration, justifying the expediency of the decisions made.

One of the essential aspects of tooth restoration is regular oral hygiene. Failure to comply with elementary hygiene of teeth, involves a discoloration, possible loss of shine teeth, the development of caries.

If the condition of periodontium is not the best, it makes sense to first carry out treatment in the periodontal department, the carrying out of all surgical interventions is carried out before the restoration. The condition of periodontium is very important, in view of the fact that the aesthetic appearance has even healthy teeth and gums of pale pink color. First of all, a beautiful smile is a successful combination of a seamless red border of the lips, a regular shape of the teeth and a healthy gum.

Restoration of the oral cavity begins with local anesthesia. Due to high-quality anesthesia, the dentist has the opportunity to professionally perform restoration, while the patient does not experience any pain. After anesthesia, the cofferdam is placed in the oral cavity, which eliminates the chance of accidental ingestion of plaque and other particles that form during preparation. In cases where the use of 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 the tooth for restoration begins with the removal of dental plaque, which eliminates the direct contact of the acid gel that make up the adhesive system with the enamel of the teeth. Removal of plaque is done mechanically, through rotating brushes and preventative rubber cups, which are filled with paste. An alternative to this method of cleaning is the use of a so-called hand-blaster that removes plaque with a soda-based abrasive powder that is delivered to the mouth under pressure with water.

If it is not possible to remove the plaque from the gaps of the teeth, first use lavsan strips, flosses and then hand-blaster. The indicator of high-quality cleaning of plaque is a brilliant enamel on the entire surface of the tooth.

The tooth preparation technique assumes that the adhesive systems of modern composite materials sufficiently provide their chemical adhesion to the tooth tissues. Recently, such requirements apply to the prepared oral cavity:

• absence of necrotic dentin and, moreover, pigmented;
• absence of decalcified enamel and "chalk spot" effect;
• falts-bevel on the enamel, made at the edge of the cavity, at an angle of 45 °.

Faltz is made by finishing boron, with water cooling and low pressure. When trying to exert strong pressure or work without water cooling, this procedure requires a high qualification of the specialist, since probably the chipping of the enamel edge. The width of the seam changes from the type of the surface of the arrangement. In order to narrow the fold lines, the chewing surfaces are made with a smaller angle. With a too wide rebate, fragments of composite restoration often break.

If the composite is applied to most of the surface of the enamel of the tooth, as in erosion, hypoplasia, or fractures of parts of the crown, then the enamel prisms are opened vertically. In simple words, they remove a thin structureless layer of enamel that covers the beams of the enamel prism, as a result of which the composite is fixed more qualitatively.

Materials for restoration of teeth

Considering the materials for restoration of teeth, it is necessary to note the high clinical requirements for the quality of these materials, and this is understandable - they will be part of the teeth. Accordingly, materials for restoration of teeth should combine increased strength and plasticity, a wide range of colors, low thermal conductivity, non-toxicity - this is not all the clinical requirements for materials.

Qualitative materials for restoration of teeth can solve many problems of the patient, the skill and qualification of the treating dentist is just as important in its importance.

The main material widely used everywhere is a composite that is capable of withstanding significant loads, comparable in strength to natural teeth, because human teeth are very strong, because they endure heavy loads for 35-65 years. The solidification of the composite material takes place 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 to fix the composite. This allows the dentist to perform the restoration work qualitatively. In addition, the composite material has about 35 varieties of color shades, which is also another plus of this material, allowing you to choose the natural color of the restored teeth.

The popularity of the composite material suggests that there are no shortcomings, and here there was a significant "but". The composition of composite materials from different manufacturing companies may differ slightly, for example, the presence or absence of fluorine and other substances in the composition.

Composite light curing materials completely replaced obsolete silicate-phosphate cement, amalgam and chemical curing composite.

The ISO standard for light curing composites is divided according to the following parameters:

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

Classify the composite filling materials on the particles of fillers, the method of curing, consistency, purpose. Filling particles are distinguished by macronutriated particles with a particle size of 8 to 45 μm, micronized particles ranging in size from 0.04 to 0.4 μm, minified ones, 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. High-tech innovative development of recent years - nanocomposites.

Depending on the method of curing, composite materials are distinguished by chemical curing materials and light curing materials. By appointment, composites are classified for sealing chewing teeth, anterior teeth and a universal composite.

To date, dentistry is the most high-tech branch of medicine. Modern dentistry introduces new innovative materials, technologies and techniques 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 strength properties, are able to withstand a high mechanical load, have convenient manipulation characteristics, and have good elasticity.

Various cast iron alloys are more often used for the production of bridges, prostheses and crowns. Because titanium is biocompatible and easily integrated into the jaw, it is used at the heart of dental implants.

The use of precious metal alloys, alloys with gold content, silver - palladium alloys, nickel - chrome alloys in the restoration of teeth is less popular recently.

The main task of a practicing dentist, when choosing a material for dental restoration, is to choose a composite with the most convenient manipulation properties, good elasticity, long-term guarantee, convenience in work, the ability to select shades, and of course a good price-quality ratio.

Instruments for restoration of teeth

For the restoration of teeth during the necessary manipulations by a dentist, a variety of different instruments are used. At present, the range of dental instruments is quite wide. First of all, dental instruments with their functions, contribute to ensuring a high quality of restoration, maximum convenience for both the patient and the specialist. In the manufacture of dental instruments, special forms of working surfaces of tools, ergonomic forms of handles are used. The dentist's office, equipped with the most up-to-date dental equipment and tools, is an absolutely commonplace today. By appointment, a manual dental instrument can be classified into groups:

• the instruments used for examination of the oral cavity - dental mirrors, probes, tweezers;
• Toolkit used in the processing of carious cavity of teeth - excavator, tool for enamel, chisel;
• tools for medicamentous treatment of carious cavities and root canals - dental syringes, special needles, various files;
• tools used for filling and restoring the anatomical shape of the teeth, spatulas, trowels, snappers, tools for amalgams, strips, grinding strips, the Carisolv system, matrices and matrix holders;
• Periodontal instruments - probes, curettes, skeletons, polishes, special systems;
• dental materials and devices for the isolation of the oral cavity;
• tools and devices for local anesthesia.

From the set of all instruments, let us consider in more detail a few of them:

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

When restoring with photopolymeric materials, lamps of light polymerization must be used. After the application of the photopolymer material to the teeth, the material solidifies under the influence of the lamp light. In the restoration practice, a large number of manual and automatic tools are used, the main requirement for dental instruments is, undoubtedly, compliance with standards and quality certificates. High-quality instruments meet the highest requirements of modern dentistry, guarantee high accuracy of execution.

Trowel restorers for teeth restoration

In the restoration practice, many functions perform all sorts of treadmills. The trowels are intended for applying a medicinal paste-like cushioning material, for applying sealing materials of temporary fillings and forming seals, among others. According to the embodiment, the trowels are made at a variety of angles with respect to the base. The trowels are manufactured in various sizes, they can be one-sided, two-sided, combined with a snapper. With the help of an ironing dentist, he forms seals, compacts the filling material, condenses it to the walls of the mouth. Blinds can be combined with smoothers on different sides of the handle or on one side of the tool. Recently, silicone trowels with tips of various shapes used for modeling composite materials have been of great use. The convenience in using silicone ironing tools is obvious - the tool does not stick to the composite material and does not leave porous surfaces. It is possible to use the trowel with acrylics, monomer, sealant, lubricant, gel, dye.

Restoration of anterior teeth

The anterior dentition is constantly exposed when talking, when a person smiles, which is why the impeccable appearance of the front teeth is very important. In the recent past, the main goal of dentistry was to restore the functionality of the teeth. Manufacturing of seals and crowns was made using metals - materials, with unnatural color shades, but high-strength. Today, in the restoration, aesthetic appearance of the front teeth is of great importance. As a rule, when restoring the front teeth, the color shade of the materials is carefully selected, taking into account the light-refractory properties, with the aim of maximizing the natural appearance of the teeth.

Restoration of anterior teeth - is a process of restoring the forms and functions of teeth using modern filling materials. Seals from such materials are practically not noticeable, they are resistant to deformations, they are color-stable, they have reflective properties. In cases of significant destruction of the front teeth, it is possible to establish a special pin, with further application of layers of filling mass selected on the basis of color, followed by polishing and polishing.

Restoration of the front teeth can be done using ceramic veneer. Veneer is a ceramic patch on the front surface of the tooth. Initially, the dentist prepares the oral cavity, if necessary - endodontic treatment, then cleanses the channels, removes the inflammatory tissues of the teeth. Then a special cement is fixed on the prepared turned tooth to a veneer. The method of restoration with the use of veneers is considered to be quite effective on the part of aesthetics, but apart from the aesthetic appearance, which is of course very important for the front row of teeth, veneering is very practical. Correctly installed veneer should fit tightly to the tooth surface, thereby, ensuring the prevention of caries and inflammatory reactions.

Restoration of chewing teeth

Restoration of chewing teeth requires the detailed study of the following morphological elements: accessory group, the geometrical shape of the buccal surface, the accessory of the side, the individual features of the oral cavity, the dentogingival contour, the number and shape of the tubercles and the degree of their abrasion, the length of the dental contacts, the macrorelief of the oral cavity, type and depth fissure. Qualitative restoration of chewing teeth, is possible with absolute observance of the re-creation of anatomical and physiological norms. Often, the process of reproducing these signs provokes certain difficulties for specialists. The whole process of recreating anatomical forms of chewing teeth is divided into such stages:

• Simulation of cone cones and creation of the basis for restoration
• restoration of the proximal wall
• re-creation of the sign of a party's affiliation, a sign of curvature and crown angle, root deviations
• the reconstruction of the individual features of the teeth, macroreliefs of the occlusal surface and the fissure system.

The first stage is the creation of a restoration base. In case of significant destruction, firstly, the absent dentin is blocked and only then the base of the tubercles of the tooth is modeled. The next step is to restore the proximal wall, using a fluid composite material. Then the third stage is to restore the signs of the party's belonging, taking into account the sign of the curvature of the teeth, the deviation of the roots and the corner of the crown. Reproduction of individual tooth features is the most difficult stage. Especially difficult, requiring a high qualification of a specialist, is considered the restoration of the macrorelief. To do this, form the mounds on the periphery of the masticatory surface with the help of composites of enamel shade. At the time of restoration of individual characteristics, it is necessary to take into account the color shade of neighboring 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, and occlusal contacts are checked. Possible discrepancies with the anatomical norm, are removed by means of fine-grained burs, creating a microrelief of the surface.

Restoration of teeth with veneers

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

Veneers are thin, 0.5 to 0.7 mm, ceramic pads on the tooth, to give the desired shape. The use of ceramic veneers is due to the correction of all kinds of cosmetic defects in the front dentition, giving the teeth the right shape, quickly and painlessly. Installation of veneers involves only grinding the top layer of the enamel of the tooth, this keeps the tooth itself. In some cases porcelain veneer can serve as a ceramic crown.

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

Direct restoration of teeth

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

Modern materials for restoration allow the specialist to restore the tooth, which is ideally similar to the patient's natural teeth according to the color shade and its transparency.

Direct restoration of teeth has obvious functional advantages, namely:

• the procedure itself, sparing the tissues of the teeth, which ensures a better tightness of the restoration;
• adhesive techniques and restoration material are densely glued to the tissues of the teeth, like 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 construction to be transformed by the action of loads and deformed simultaneously with the natural tissue of the teeth, excluding the possibility of a breach of the integrity of the restored tooth and the probability of stratification of the restoration material and tooth.

[6], [7], [8]

Indirect restoration of teeth

Indirect restoration of teeth is performed using orthopedic structures that are manufactured in the laboratory, individually for each patient. Orthopedic constructions include crowns, liners, various veneers and lumineers, which, in general, are made of ceramics. The qualitative characteristics of ceramics fully correspond to the aesthetic requirements - it perfectly replicates the natural tooth, this material has a high safety factor.

Usually indirect restoration takes several days, due to the duration of the technological process. Orthopedic ceramic structures are made in the laboratory for casts. During the process of manufacturing of structures, it is possible to install temporary structures from plastic.

The choice of the method of restoration of direct and indirect, depends, first of all, on the initial clinical situation. In one case, direct restoration is shown, and vice versa, when an indirect restoration will be correct.

The decision to choose the method of restoration is taken individually and, of course, depends more on the level of the specialist's qualification.

Indirect restoration of the teeth provides a more qualitative and light-resistant surface of the restoration. Orthopedic structures have complete inertia and good biocompatibility, do not provoke sensitization.

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

Restoration of teeth after braces

Restoration of teeth after braces is to restore the integrity of tooth enamel from caries lesions, if any, to restore the natural color of the teeth. In general, after wearing the bracket system, in the case of non-compliance with oral hygiene or improper installation or wearing the system itself, various deformities of the 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 and significant drawback of wearing braces is especially careful oral hygiene. Due to the technical characteristics of the structure itself, food residues can become stuck and contribute to the accumulation of plaque, provoking the formation of dark spots and the development of caries. It is poor personal hygiene of the oral cavity that causes darkening of the tooth enamel under the braces, the reason for the formation of caries. Especially important at the time of installation of the bracket system is training in oral hygiene. In order to control the quality of oral hygiene, it is advisable to conduct preventive examinations, if necessary, conduct professional hygiene.

After wearing the bracket system, in some cases, the strengthening of the tooth row is shown with a wire glued on the inside. The wire holds in the correct position the entire dentition, this procedure is short-lived.