William F. Dismuke, Jr, DDS, PC

 

 ADVANCED PROCEDURES

CROWNS                                                              

Crowns are full-coverage restorations that are used to cover a tooth that is likely to break, or is too broken down to be restored with a filling. They are most commonly done after root canal treatment, or when a large filling wears out, or a tooth breaks. The larger the hole made by a cavity that has to be treated, the more likely a crown will be needed. Even after a filling is put in a large cavity, a tooth is more likely to break. Keep in mind that the jaw muscles are the strongest in the human body. Teeth are subjected to tremendous pressures. Crowns cover the weakened tooth, providing strength and protecting the tooth against breakage. A severly broken tooth is a far more serious matter and much more difficult to treat. Crowns prevent this, as well as making for a nice smile.

It used to take two appointments to restore a tooth with a crown.  However, with CEREC technology, your crown is made within minutes after your tooth is prepped, so only one appointment is necessary!  Once Dr. Dismuke has prepared the tooth for the crown, digital impressions are taken of your prepped tooth and surrounding teeth and Dr. Dismuke designs your crown chairside on a computer.  Once he has completed the design to his satisfaction, a solid block of porcelain in a shade to match your teeth is placed in a milling unit, where two burs mill the customized crown in less than 15 minutes.  Some crowns need an additional 20 minutes to cure in a special oven.  Then your crown is ready to bond and you leave with it in your mouth. 

ONLAYS                                                                                                                                                  

Onlays are similar to crowns (see information above) in that they are restorations that are used to cover a tooth that is likely to break, or is too broken down to be restored with a filling.  Onlays, however, help to preserve healthy tooth enamel and do not go all the way down to the gumline.  They are also always done on the back teeth, whereas crowns can be done on either the front or back teeth. They are most commonly done after a large filling wears out or a tooth develops an incomplete fracture. Onlays cover the weakened tooth, providing strength and protecting the tooth against breakage. A broken or cracked tooth is a far more serious matter and much more difficult to treat.  Onlays prevent this from occurring.

The process for making the onlay is the same as the crown, requiring only ONE appointment with CEREC technology. (See 2nd paragraph of CROWNS)

  

VENEERS

Veneers are a dental procedure in which a covering is placed over the outside (visible area) of the tooth. Veneers are usually only done to the part of the teeth that are visible when talking or smiling.

Veneers can often be made utilizing CEREC technology, thus requiring only one appointment. (See 2nd paragraph of CROWNS)

In select cases, two appointments are necessary because the veneers will be fabricated at a dental laboratory. At the first appointment the teeth are prepared, impressions taken, and the teeth are given a temporary covering. In  three to four weeks the veneers are back from the laboratory, the temporaries are removed and the veneers are bonded to the teeth. The laboratory fabricated veneers are usually made using porcelain or pressed ceramic, and are very esthetic.

The advantage of veneers versus crowns is that much less tooth material is removed, and the procedure is generally less uncomfortable. Veneers are sometimes recommended for front teeth that have significant enamel imperfections,  multiple small fillings, need a shape or alignment change, etc.  Veneers are generally considered a cosmetic procedure.  They may or may not be covered by your dental insurance plan.

 

DENTURES AND PARTIAL DENTURES (aka Partials)                                                              

There are different types of dentures, but they share their common function. They replace teeth that have become loose or been lost due to bone loss (periodontal disease), severe decay, or abscess. When teeth are lost, one way to replace them is with a denture or partial denture. Overall, this is the least expensive method for replacing multiple teeth.  However, there are several drawbacks, including but not limited to:  the appliances are removable and may be difficult to get used to, especially with eating; partial dentures tend to cause detriment to the supporting natural teeth over time; they are not as easy to chew with as are fixed bridges or implants; the bone of the jaws is lost over time where there are no teeth, causing a denture to fit less well the longer it is worn; they have to be removed for periods of time to clean and to let the oral tissues “breathe.”

Often implants can be used to further stabilize the dentures.


IMPLANTS

A dental implant is generally the best option for replacing a missing tooth. In this procedure, a small titanium shaft is surgically implanted into the bone and allowed to set (this part of the procedure is performed by a Periodontist, to whom we refer you). The bone grows around it forming a tight connection, which additionally slows or stops the bone loss that occurs when the root of a natural tooth is missing. Once the implant is firmly set in the mouth, the dentist then works to attach the replacement tooth onto the top of the shaft (refer to CROWNS, above). This permanent solution has the advantages over bridge work that it does not stress the surrounding teeth for support and it is easier to clean, like a natural tooth. 

Implants can also be used as support as part of an implant bridge. This is an alternative to partial dentures and has several advantages. First, the adjustment period is easier because implants are more like natural teeth and don't have all the excess metal within the mouth like a partial requires. Second, this slows the bone loss caused by missing teeth. Third, there is no discomfort or difficulty in eating. And best of all, of course, they don't have to be taken out all the time.

 

ROOT CANAL TREATMENT

Root canal treatment (also referred to as root canal therapy or endodontic therapy) is made necessary when a cavity is allowed, through neglect, to reach all the way to the pulp, where the nerve of the tooth resides. (Regular cleanings and checkups prevent and detect problems early). Sometimes, deep restorations or trauma to a tooth may cause the nerve to be damaged to the point it needs root canal therapy also. Once this occurs, the pulp becomes infected, and can even extend through the root tip and begin to eat away at the surrounding bone (this is an abscess). By the time the pulp is infected it must be treated, and cannot heal on its own. It can even weaken the entire immune system. This is dangerous, not to mention very painful. Symptoms that the pulp has become infected may include sensitivity to hot/cold or sweets, pain, swelling, pain to biting or pressure, and a bad taste in the mouth. Sometimes, however, no symptoms are apparent and the person is unaware of any problem until a checkup with radiographs.

A root canal is then performed to clean out the infected tooth pulp, and disinfect the canals of the tooth. The only other treatment would be to extract the tooth. Once the infection is resolved, the canal(s) are filled in to prevent any further infection. Usually a core build-up and crown is recommended for restoring a tooth that has had root canal therapy, as these teeth are generally weaked by extensive decay already and they become more weak over time after the root canal is performed. 

If you need a root canal, you will be referred to an Endodontist, who is a doctor that specializes in this type of treatment.


BRIDGES

This is an option for filling the space created by a missing tooth. It requires crowning neighboring teeth, which are connected to the false tooth that replaces the missing tooth.  The crowns of a bridge are on either side of the space and support the replacement tooth, hence the name. A bridge replaces the missing tooth, both functionally and cosmetically. Bridge work is as much an art as it is an exact science. The materials used may be gold alloys, porcelain bonded to metal alloy, or all ceramic material. The choice of material depends on requirements for strength, wear, and/or esthetics.

It is important that a missing tooth be replaced as soon as possible for several reasons. If not treated the teeth surrounding the gap begin to shift inward, creating a whole chain reaction of bad things. Teeth use their neighbors for support, and with one missing, they start to "fall." As this worsens, the bite changes in response to the pressure. This can eventually result in problems with the entire jaw, e.g. TMJ. The surrounding teeth deteriorate and it is just a matter of time before they, too, are lost. Gum disease becomes a serious problem, with the difficulty of treatment increasing as the neglect continues.

 

TMJ TREATMENTS

TMJ stands for temporal-mandibular joint. Temporal, as in temple area of skull; mandibular as in mandible, or lower jaw; joint as in it's where the head and jaw meet. Problems in this joint may be caused by a misalignment of the teeth, trauma, or excess muscle tension. Aside from the two bones that meet there, cartilage buffers them and five muscles are involved in the area. If something goes wrong a good deal of trouble can result.  This is known as TMD, or Temporomandibular Disease.

TMD syptoms:

  • Headaches
  • Earaches
  • Trouble/soreness in opening and closing the mouth
  • Clicking or popping of the jaw
  • Pain in the jaw muscles
  • Soreness in the area, sometimes extending to the face

Treating TMD involves pain management.  An appliance may be used to prevent clenching/grinding, which stresses the TMJs and can result in pain.  We recommend that sufferers of TMD avoid overworking the joints, as habits like chewing gum can do just that and make pain symptoms worse.

 


 

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Rome, GA 30161
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