After we have completed the full exam, a lot of patients are ready to proceed with restorative work. There are a variety of restorations that we do in our practice. These include different types of tooth-colored fillings, bondings, veneers, crowns, bridges, implants and dentures.
The key to a successful restoration is ensuring that whatever is done fits in and supports the overall oral system. On the larger level, this requires proper understanding of function, speech, bite, hygiene and so on and on the more detailed level, precision and attention to detail is key.
Restorative procedures in my office typically last thirty minutes for a single filling to ninety minutes for a crown to three hours for restoring a larger section. The reason they are so time consuming is because I pay a lot of attention to detail in order to ensure the best chance of long-term use and comfort of the finished product.
For example, when I do a filling or crown preparation, I use multiple caries detection techniques. One is caries detector which is 95% accurate in identifying diseased remnants of the cavity. Another is the Diagnodent, a light sensor that detects the off gas put out by bacteria. The third method is the halogen light which raises the visibility of the caries. Combined use of these three tools allows for exceptional precision and success in removing the disease from the site being worked on. When this is done, I am ready to proceed with the actual restoration.
For fillings, I use the latest generation of sealers and desensitizers which help to virtually eliminate sensitivity by blocking the tubules where the nerves reside and sealing them closed. Next I place the primer which is essentially a very thin filling below the filling. This is an important step because that is the first line of defense to protect against new cavities. After the primer we put in the solid filling material in stages in layers to ensure proper curing. Finally, we are ready for the tooth-colored top coat, which we customize to the natural teeth colorings surrounding and shape to accurately work with the natural bite process.
When the restoration is too large to be completed with a filling, I typically proceed with some type of crown restoration. I use a Cerec machine to custom mill the restoration. I have chosen this method because it allows for the most conservative type of restoration and the most accurate fit, not to mention that, in most cases, you have your permanent crown the same day, eliminating the need for a second visit.
Dr. Sperbeck, West Los Angeles