Conservative dentistry is a branch of restorative dentistry that deals with restoring the integrity of dental elements even in very critical areas that have lost part of their structure due to several causes.
It deals with the rehabilitation of teeth affected by carious processes, all congenital lesions of the teeth and those caused by traumas such as accidental falls, car accidents or sports injuries.
To restore these lesions, you can use:
- a direct technique: the dentist prepares a suitable cavity in the tooth eliminating the diseased or non-preservable tissue and reconstructs the tooth during the same session;
- an indirect technique: the dentist prepares a specific filling for the cavity, potentially carries out a pre-reconstruction and takes an impression of it that is later on forwarded to a dental laboratory. The dental technician – a technician specialized in constructing artifacts such as dentures, dental prostheses, inlays – then constructs a bespoke, highly precise filling that will be cemented to the dentist’s tooth during another session.
Nowadays the reconstructions of the cavities are carried out with the use of filling materials such as composite and ceramic resins, completely non-toxic and with a high aesthetic value. Almost no restoration techniques are performed with gold and silver amalgam.
Conservative dentistry is based on the concept of minimal invasiveness by removing only the carious tissue and replacing it with a restorative material, which is directly bonded to the healthy tissue.
However, in the case of excessive tooth substance loss the filling is not sufficient to restore all the tooth’s functions, so it is necessary to make adhesive restorations with indirect technique called inlays, which are designed by the dental laboratory. The inlay ensures greater precision and long-lasting quality. The fillings are not recommended even when the teeth are devitalized. In this case the best restoration system is the crown (or inlay). This solution is able to reduce the risks of fracture, which otherwise would be very high for these teeth (especially for premolars, canines and incisors).
As for fractured teeth due to trauma, an excellent reconstruction with the highest aesthetic value is a veneer. The inlay offers more advantages than the filling, both in terms of resistance and adaptation of the points of contact. Infact, the composite fillings are not always possible to achieve with the contact points perfectly adherent to the teeth close, with discomfort for the patient because food residues can be stopped between the teeth.
On small faults, the inlay and filling resistance is similar, but on large restorations the inlay is by far the best solution.
What is a decay?
Tooth decay is a degenerative disease of the hard tissues of the tooth (enamel and dentin) made by bacteria: the infection starts on the surface of the tooth and then proceeds towards the inside until it reaches the dental pulp, causing pain and inflammation.
Dental cavities is caused by bacteria, that are common microorganisms normally located inside the oral cavity, usually in the form of bacterial plaque. The acid is produced by the bacteria when they break down food debris or sugar on the tooth surface.
This is why the very first form of caries prevention includes a careful oral hygiene.
The more the decay approaches the pulp tissue, the more bacteria and toxic products are able to activate very painful and asymptomatic inflammatory processes such as pulpitis.
What are the symptoms of tooth decay?
Among the most frequent symptoms of tooth decay we can highlight:
- tooth sensitivity (hot/cold)
- pain when chewing
- Mild to sharp pain when eating or drinking something sweet
- intense pain due to pulpitis
- Throbbing pain may be accompanied by swelling of the gum or even the face near the affected tooth
Since advanced dental cavities can cause severe discomfort, it often happens that a patient neglects it when in reality the tooth affected by a decay would need long and complex therapies in order to achieve a fully dental rehabilitation.
Cavities and tooth decay – treatment
When caries is located in non-visible areas, such as interdental areas or carious recurrences (caries developed below old restorations) it is very important to perform an X-ray examination.
In fact, by limiting the diagnosis to visual examination only, part of the carious lesions can escape clinical control. The dentist then performs anesthesia and, once the tooth is asleep, isolates the work area with the rubber dam, so that every operation takes place in a clean field without bacterial contamination. After this, the cavity is prepared by removing the soft and decayed tissue, and proceeding with adhesion which allows the restoration material to be bonded to the tooth structure.
We then move on to the stratification which consists of filling the cleaned cavity by means of increases in composite resin.
The restoration is modeled so as to correctly reproduce the anatomy of the tooth and often stains are used that are able to give greater naturalness to the work.
Finally, the restored tooth is polished using special cutters and rubbers in order to achieve the best possible aesthetic result.
TOOTH NECK RECONSTRUCTION
Sometimes it happens to feel somewhat of an unevenness between the tooth and the gum, by moving your tongue on the tooth’s enamel. Looking carefully in the mirror, you might realize that one or more tooth necks are exposed as gums recede, which results in leaving uncovered a part of the tooth that is normally protected by this tissue.
What does it depend on? Is this the first stage of periodontitis?
Clearly the answer to this question depends on each case. This is why it is highly recommended for those who have healthy teeth to carry out a professional cleaning every six months with the hygienist. In any case, if the patient does not suffer from gingival inflammation, receding gums may depend on the incorrect use of the toothbrush. Over-brushing causes receding gums even when dental hygiene might otherwise be good. This irreversible process involves an increase in dental sensitivity when eating something hot, cold or food containing sugars or acid substances, such as lemon citric acid.
In order to reconstruct tooth necks, a dentist can intervene in two ways:
- Replacing the area of missing gum tissue due to recession making it slide with a surgical operation;
- Using dental veneers for a more long-lasting result, so as to give the maximum aesthetic result possible.