Wonderful changes have developed in today’s dentistry. We are able to create restorations on teeth that look more beautiful, improve strength and leave a lot more of the original tooth than the old days. When patients look in the mirror, “Wow!†is frequently the first word out of their mouth. This is dentistry people love. When I finished my graduate training in 1983, I could do some pretty fancy dentistry, BUT– it was all too often done with ugly metal showing or porcelains that looked blah. Times have changed, thank goodness.
The ability to bond porcelain to teeth has been one of the great changes. The porcelain is bonded or fused to the tooth making them almost one. When restorations don’t have any metal underneath, light transmits through the teeth naturally; solving the problem of dark gumlines and dull looking porcelain. The cement between the tooth and porcelain creates a seamless interface that locks them together and allows natural light transmission. The third great thing this bond does is improve strength.
Old silver fillings and inlays weaken teeth. Porcelain restorations help reinforce the tooth they are fused to. It is one of the great material science advances in dentistry. Over the past twenty years, the quality and consistency of the material and technique have steadily improved. Years ago, many patients experienced post-treatment sensitivity or leaking and loosening or porcelain restorations. Today, these are infrequent occurrences even rare. I would say the porcelain work (and implants) we do today is the finest dentistry I have seen in my career. It makes dentistry very enjoyable for me and incredibly positive for my patients.
When teeth have a smaller cavity or old silver filling, they can be repaired with a porcelain inlay. Inlays are like inlayed woodworking. A precision porcelain piece is carefully inserted into the tooth where it has been shaped to remove the decay or old filling. The result is a tooth that just looks normal and is also re-strengthened.
If the tooth has a larger cavity, old filling, or stress cracks; today’s choice solution may be a porcelain onlay. An onlay is a restoration that covers the biting surface of the tooth an slightly wraps over the edges; sort of like an umbrella sitting on the top. By reaching over the edges of the biting surface, it effectively holds the tooth together. If a tooth has a crack, it is no longer being forced apart when you bite down. Or if the tooth had a weakened area, the porcelain helps strengthen it again. If the tooth has problems on the outer face or is very undermined in strength, a full porcelain crown does the same as above, but covers the whole tooth like a new outer shell layer. Beautiful again.
Porcelain restorations are not the cure-all though. Teeth under heavy pressure can have porcelain fracture. Full crowns on the back teeth are still usually done with a metal reinforcement layer underneath; called a porcelain fused to metal (pfm) crown. When properly done they too can have a near life-like look and are quite strong. Teeth that are under very heavy load, like way in the back on patients who clench or grind their teeth a lot, can fracture the porcelain on pfm crowns. This is the place where gold onlays or crowns are still useful.
The key to long term success and patient satisfaction is to clearly understand the patients preferences and priorities. Some people prefer stronger, others prefer prettier. In our practice we often have a few ways something can be done and choose the one that most closely matches the patients preference. We provide highly customized care. Is is care people choose for themselves, not imposed by us. We are here to help.