In this article I would like to describe one of the most common restorative procedures in the dental practice- treatment of tooth decay with a dental filling restoration.
Some Basic Information about Tooth Decay (Dental Caries)
Tooth decay (also called dental caries) is a softening and breakdown of the hard tooth tissues. It is caused by certain types of oral bacteria. Despite preventive efforts, tooth decay is still the most common oral disease.
Some risk factors for the development of tooth decay include poor oral hygiene, diet high in refined sugar, quality and amount of saliva, and developmental problems affecting hard tissues of the teeth.
Most common professional methods of diagnosing tooth decay include visual and tactile inspection of the teeth and evaluation of the dental x-rays.
The best strategy to deal with tooth decay is prevention. Common measures include regular brushing with fluoride tooth paste, flossing, oral rinses and professional cleaning appointments.
Small and superficial tooth decay can be treated with conservative regimen which includes cleaning and fluoride application to the surface of the decay, and sealing of the decay with special adhesives.
More advanced tooth decay is treated with restorative procedures such as dental fillings and dental crowns.
Treatment of Tooth Decay with Dental Fillings
Dental filling for treatment of tooth decay is an advanced restorative procedure. It includes removal of the infected portion of the tooth, disinfection of the tooth cavity, and replacement of the missing portion of the tooth with an artificial biomaterial.
In addition to the replacement of missing tooth structure the area of the tooth in close proximity to the dental pulp (dental pulp is a neurovacular tissue inside the root canal of the tooth) is often treated with special biologic preparations. This is done in order to enhance healing of the dental pulp and prevent root canal infection.
Dental fillings can be made from several dental materials such as dental composites, glass-ionomers, ceramics and metals. In some situations two different materials such as dental composites and glass-ionomers, or metals and glass-ionomers are combined in a single cavity in order to achieve desirable performance of the restoration.
In contemporary dental practice, dental composite (also called “white” or tooth colored fillings) is the most common restorative material utilized for the treatment of tooth decay. The advantages of dental composite fillings include their tooth like appearance, ability to be bonded to the tooth, relatively low cost, and reasonable longevity (typically 5-10 years).
The disadvantages of the dental composites include their low antibacterial property, and increased degradation under high chewing, chemical, thermal stresses of the oral cavity. What it means that for some patients longevity of the composite filling may be shorter than average. Although very rare, another disadvantage of the dental composite include possibility of an allergic reaction.
Case Example of Composite Dental Filling
During routine examination, tooth decay was discovered on the dental x-ray. It was located on the front side of top second molar, between the molar teeth. It is marked with a white arrow on the photo. This type of tooth decay is called interproximal caries and in majority situations can only be detected on a dental x-ray unless it becomes very large in size.
During the first step the tooth was anesthetized and dental dam was placed over the teeth to isolate the working field. The cavity was accessed from the chewing surface of the tooth. The photo below and to the right shows tooth decay which is a discolored area at the bottom of the cavity.
All infected tooth tissues were removed and tooth cavity was prepared with a smooth outline. At its bottom portion, the cavity extended onto the root surface of the tooth. A small glass-ionomer base was placed at the bottom of the cavity onto the root surface (as shown in the photo below and to the right). This type of material performs well on the root surfaces of the teeth.
A special metal band was secured around the side of the cavity in order to contain the filling material. Also special spring like device was placed between the teeth to slightly separate the them. This is done so the teeth would have a tight contact after removing of the band. In the next step the surface of the cavity was etched with phosphoric acid in order to crete a rough surface and achieve the highest possible bond between the filling and the tooth (photo below to the right).
After washing of the acid, specially formulated liquid dental adhesive was applied to the cavity with a brush. This adhesive was than set with the help of special blue spectrum LED (light emitting diode) light. The beam of light was directed to the surface of the tooth for 15 seconds.
Filling material comes as a paste in a special carpule. This paste was than extruded into cavity. Just like adhesive it was set with LED light. In the final steps the surface of the filling was adjusted to the patient’s bite and polish with special abrasives.
As you can see composite dental filling is an advanced restorative procedure and this type of treatment plays an essential role in the management of dental caries.
Thank you for reading,
Dr. Alex Shor