Throughout almost 5 decades in dentistry, I never realized how much my patients hated the idea of having their teeth cut down in order to place crowns, especially when it involved the front teeth. That is, until techniques were developed that allowed us to restore teeth to normal esthetics, form, and function without the use of crowns. The technique is called adhesive dentistry and the material used is a composite.
The truth is that this technology is not totally new. It has been around for 30-40 years but with limitations on strength, wear resistance, and esthetics. Now, with advances in new technology, all that has changed. The newer materials are filled with nano-particles, silica (glass) beads, which are stronger and harder. In addition, new breakthroughs in our ability to adhere the material to the teeth have tremendously increased the longevity of this service.
So what does this mean to the patients? It means that finally we can truly practice minimally invasive dentistry, where we don’t have to cut teeth down to make them stronger. Teeth are strengthened from the inside out. We now just take away the old fillings and/or decay, and adhere the composite to the teeth, thus preserving their integrity and as a side benefit, increasing the probability of preventing abscesses. Although the costs are greater than the mercury fillings, they are half to two-thirds the cost of buildups and crowns. This has totally changed the way dentistry is practiced today!
Below are some photos which demonstrate this philosophy. The first is a tooth that 5 years ago I would have done a buildup and a crown. Today, we eliminate all the old amalgam and the decay, leaving as much tooth behind as possible. Then we sterilize the tooth and do the build-out with composites. The patient was thrilled that not only did she not need a root canal treatment but that she also avoided a crown.
This next case shows how much tooth structure is preserved with this philosophy. Only the “bad” parts are eliminated, the teeth are cleaned of any contaminants or debris (like preparing a piece of furniture before the stain and sealer are placed), and the restorations are placed in increments, sculpted, and cured with a light. It is truly a great example of where art and science meet in the practice of dentistry. The red and blue “ink spots” are from the checking of the bite on the lower teeth which were done just prior to treating these upper teeth. We did upper and lower teeth on the right side in one morning.