Fillings & Crowns - What Dr. L Recommends

Crowns & Bridges

Restoring the Health of Your Teeth

Crowns, Bridges & Dental Implants

At some point in our adult lives, many of us will lose a tooth to injury, decay, or gum disease. When that happens, chewing forces can be shifted to another area or opposite side of the mouth and teeth can flare out, causing unwanted spaces and changing the very structure of your smile.

At our office, we can restore and improve a smile using a combination of Crowns, Bridges, Precision Dentures or Man Made Roots (dental implants).

A Crown is a restoration that covers a tooth to protect and restore it to its natural shape and size while strengthening and improving its appearance.

A Bridge is used to replace one or more missing teeth. It spans the gap left by the missing tooth, and is usually anchored to the two existing teeth on either side of the gap.

Removable Denture Or Flipper

• A Flipper is like a retainer that children wear + a plastic tooth.
• Precision Dentures are also removable that gain stability though special metal attachments which rap around or insert onto your existing teeth.

Dentures are the least expensive clinical option for replacing missing teeth. Dentures may be used temporarily during healing or as a permanent solution for missing teeth.

Man Made Roots (Dental Implants) are the tooth replacement option that is as close to natural teeth as possible. Dental implants are comfortable to place and preserve the tooth supportive bone, will not break, will not decay, and are more gum disease resistant than a natural root. Additionally, with man made roots, there is no need for anchorage on the adjacent teeth and therefore natural tooth structure is preserved.

Regardless of which option you choose, the retention of your prosthesis will be strong and secure, and your dental health may be significantly improved. Dental Crowns, Bridges, Precision Dentures, or Man Made roots or any combination of these treatment options can improve the quality of your life. Best of all, you can be more confident and comfortable when you are eating and smiling.

If you’re having a problem with one or more of your teeth, we’ll help you decide which treatment is best to restore your teeth to their normal function.

Black Ring Syndrome

Why Do I Have A Black Ring On My Gums Above My Crown?

There are several possibilities for this dark black area.

• Choice of Material used to make a dental crown. If a metal substrate is used to fabricate a crown then this could create a dark shadow.
• Poor lab layering, or wrong Color chosen for porcelain used for crown
• Old metal material left under you crown
• Remaining stain from metallic materials like i.e. silver Amalgam or gold. Even if the metal filling is removed there may be an intrinsic dark metal stain. Metal fillings may permanently stain tooth structure.
• The actual Metal collar of a poorly designed old crown.
• Metal Post or Metal Cores used under your crown to build back tooth structure
• Metal Root canal fillings like silver Point fillings
• Root Shadows created when light transmission is blacked from a material used for a crown.
• Blood which mixed with the dental cement during the clinical cementation procedure
• Decay or leaking bacteria that cause stain.
• Dark Grey Dead tooth root.
• Stain from food or liquid or intrinsic tooth discoloration.
• Dental tartar or calculus.

Solution
Replace out dated materials previously used to make old crowns / caps. Remove the black rings near your gum line. Dr. Landers employs modern dental technicians who layer advanced cosmetic tooth like materials over a strong pressed ceramic tooth-colored substructure (No Metal!). Results that are both beautiful and strong! The existing, even breathtaking, advancements in these dental materials used by Dr. Landers now allow our patients to have beautiful, functional, and natural looking smiles without the black ring syndrome.

Filling Options

What Is The Best Dental Filling Material?

• White Fillings
• No Needle Drill Less Fillings
• Metal-Free Fillings
• Porcelain Fillings
• Dental Bonding

You should always be offered the best available options and all available options for each and every dental filling or tooth restorative material, regardless of insurance limitations.

If your question is “What is the best dental filling” then the answer is easier and straightforward.

• How long does it take?
• What material will last the longest?
• What’s the most minimally invasive treatment option? How much tooth is removed?
• What’s the most predictable?
• What the price and how much does insurance cover it?
• Metal Free or Tooth colored?

If you want to answer all of the above questions then the answer becomes much more complicated.

Lets first start with an understanding of ideal and then I will explain the differences of cost/benefit assessment for each as it may relate to your individual situation.

What is the best white filling?
What is the best dental filling of any type and any color?

Q&A
Do you mind what color the filling is? Yes/No
Is the filling just on the top of the tooth or does the cavity extend in between two teeth?
Location of filling on the tooth vs normal natural forces?
Size of cavity?
Quality of tooth structure?
Color?
Location of the filling in your mouth & Type of tooth?
Anterior tooth or posterior tooth top or bottom tooth?

Onlays (3/4 Crown) Vs One Visit Fillings

(for the back molar teeth used to crush & chew)

Factors To Consider

• The size of the area on the tooth being replaced. If you have lost more tooth to decay or tooth fracture, there will be less support for a restorative material.
• The type of tooth or area of the mouth where the filling is being placed. i.e. crushing, chewing molars receive a lot of force and virtually always better served with onlays.
• Some patients place stronger forces via parafunctional habits. These habits wear the teeth and dental restorations at an accelerated rate (i.e. Bruxism/tooth grinding and excessive gum chewing etc.)
• Each patient has different saliva, tooth structure and musculature – chewing strength.
• Do you want a tooth like restoration or a metal type restoration? Would you except a metal restoration if it was stronger and in a less visible area of your mouth?
• Another factor to consider is how close to the nerve is the existing filling or decay. If the filling is dangerously close to the nerve, long term, it would be in the best interest of the patient to have a restoration placed that is less likely to need replacement in years to come. This is important because any dental work (i.e. drilling) near the nerve is cumulatively traumatic to the nerve. This is true even if the drill does not physically hit the nerve. Logically, a stronger, longer lasting restoration could be viewed as a preventative investment to avoid potential tooth nerve trauma (i.e. need for Root Canal) because it will not need to be replaced as often verses the weaker type single visit dental restorations. In addition, a stronger, longer lasting restoration will reduce the potential for tooth loss due to fracture.
• In general: “Onlays cost 6 times as much and are estimated to last 4 times as long.”
• Number of visits: Onlay restorations are hand made. During the first visit, your dentist will prepare your tooth and impress a mold of your tooth. This mold will be sent to a lab for fabrication. Usually this process will take about two weeks. A second visit is required for the delivery or seating of the final restoration.

One Visit Dental Fillings (White Plastic Vs. Silver Metal)
General notes about single visit fillings. These are wonderful if there is enough surrounding tooth structure to support the dental filling. In short, they function best when they are placed into a tooth hole or cavity with strong tooth structure on all sides. Fillings are generally not strong enough to cover a thin, weakened, or cracked tooth. Additionally, fillings are not strong enough to replace an outer wall of missing tooth structure on the cheek or tongue side. An outer wall of tooth structure between teeth can be replaced with “one visit fillings” because the adjacent tooth will help to support the filling.

Onlay Restorations, 3/4 Crowns & Crowns
Often patients will ask what is an onlay and how does an onlay differ from a crown. Both a crown and an onlay are indicated when there is extensive tooth loss or to hold together cracked or thin tooth structure. This is achieved by covering, i.e. replacing the chewing surface with a dental onlay or crown. This coverage will hold together fragmented parts of your tooth. Long term, crowns and onlays will protect the tooth from fracture. The technical difference lies in the shape of each restoration but the term crown is often used to describe an onlay that replaces more than 65% of the tooth.

Crown
A crown will typically cover both the chewing surface and circumferentially wrap around the entire tooth. Crowns are used generally used when there is more extensive tooth loss or after root canal therapy. Since crowns completely cover the tooth on all sides, they are used to correct any problems that you might have with alignment.

Onlays & ¾ Crowns
After your tooth is prepared and decay has been removed, an onlay will fit into the area where the tooth is missing and cover the top of the tooth but not wrap around the entire tooth.

Comparison Of Materials

White Plastic Fillings

Color	Durability	After Visit Sensitivity	Cost	Patient sensitivity to material
Yes! These look very natural.	Recently the ADA updated the average life of a white plastic fillings: 2.5 – 5 years.	Yes, but at our office we use desensitizers under the filling, which greatly reduce long term sensitivity.	Less expensive than Silver Fillings	Non-known

Short note from Dr L:
Long story short, these fillings are plastic. Composite resin is a tooth-colored plastic mixture filled with glass (silicon dioxide). The glass is added to create a slightly higher rate of wear than your traditional silver fillings. Often when I share the fact that these fillings are plastic and the ADA suggests that they last for 2.5 – 5 years, patients ask me: why do dentist use these fillings?” The answer is simple: cost. The only tooth colored alternative is “Pressed Ceramic” which, while very worthwhile, is more expensive. These single visit white fillings should only be used in patients who do not have a cavity prone dental history, and only in teeth with small cavities. Our dental office uses only the finest materials and the latest and best placement techniques for composite or white single visit fillings.

Silver (Metal) Fillings

Color	Durability	After Visit Sensitivity	Cost	Patient sensitivity to material
Silver metallic in color	Average 10- 15 years. (This material has been used for dental fillings for 150 years)	Very uncommon and usually due to a high bite.	Low	There is no scientific evidence of any measurable clinical toxic effects [of dental amalgam].” (American Academy of Pediatrics). At our office each patient is presented with the ADA facts and we will use the material that you choose! (Please read ADA Myths and Facts sheet)

Short note from Dr L:
Silver single visit fillings have certainly withstood the test of time. I usually recommend this material when the filling is small to medium in size. Typically, I will recommend this type of filling in non-cosmetic areas to restore cavities on the chewing surface of the upper teeth. I will also recommend silver fillings when patients have financial concerns when discussing treatment options for lower back teeth.

The strength of single visit metal fillings is slightly stronger then coffee mug material (brittle). It’s not recommended for large fillings or to replace the sidewalls of tooth because it may crack. After 10-15 years the marginal area will chip away and need to be replaced.

White Plastic Composite Molar Fillings Don’t Last

White plastic Fillings don’t last very long and fail from the inside out.

Filling Facts:

• Dental X-rays are a 2-dimensional images of teeth which do not be show all types of dental cavities. Hidden decay under white plastic fillings may go undetected for years. Depending on an individuals caries index (prone to cavities or not) undetected cavities left under fillings may lead to excessive tooth loss of tooth or cause the need for root canals.
• When white plastic composite fillings were introduced to dentists, the dental professionals were led to believe that these fillings lasted as long as the silver amalgam alternatives. It’s not true!
• Patients are more likely to experience more sensitivity on average from a White Plastic composite fillings verse Dental Amalgam fillings on back molar teeth.
• People don’t like the color of Silver Amalgam Fillings
• Porcelain is the Best Filling material. The down side is porcelain Ceramic restorations cost 4- 6 times as much as Plastic composite fillings verse Dental Amalgam fillings.

10- Factors that effect the Life-Span of any Type of Dental Fillings

1. Large fillings will not last as long as small fillings
2. Tooth surrounding entire filling will last longer then fillings that restore an outer wall of tooth structure.
3. Techniques sensitive failures: Clinically complicated techniques lend to more failures.
4. Quality and quantity of supporting tooth structure around the dental filling
5. Some tooth surfaces are exposed to more force depending on tooth location and type
6. Posterior crushing and chewing Molars put more force on fillings
7. Patient habits like grinding and clinching cause dental 230% more failures
8. An individuals uniquely Acidic oral environment
9. Sugary Diet vs. Home care
10. Regular dental Visits/ preventative care

Two Modern Studies -Average life span
Amalgams Fillings of 12.8 years
Plastic composite fillings 7.8 years.

Forss (2001) calculated
Amalgams Fillings of 12 years
Plastic composite fillings 5 years.

One theory white plastic composite fillings fail

• Plastic material shirks back from the tooth structure
• The shrinking process causes pressure that draws water out of living tooth structure.
• Bacterial grows in this moisture

Onlays (Porcelain White Vs Gold Silver):

Gold Silver

Color	Durability	After Visit Sensitivity	Cost	Patient sensitivity to material
Silver metallic in color	Average 15- 40 years. (This material has used for dental fillings over 150 years)	Very uncommon and usually due to a high bite.	Typically 6 times as much as a single visit filling.	Non-known

Note from Dr L:
This is the best dental restorative material available in dentistry, but its application is limited due to esthetic nature of gold when viewed in a patient’s smile. Gold is very strong when it’s thin and subsequently can be used to cover weakened tooth structure with out the need to remove much tooth structure. With all other dental materials, the dentist will need to reduce the tooth in order to create a certain thickness for the material to withstand the chewing forces without breaking.

Porcelain White

Color	Durability	After Visit Sensitivity	Cost	Patient sensitivity to material
Tooth Color	Average 15 years. (I would guess that the pressed ceramic used at our office will last a little longer)	Very uncommon and usually due to a high bite.	Typically 6 times as much as a single visit filling	This is the least toxic of any filling we use. We will use Zirconium for any patients who are environmentally sensitive.

Note from Dr L:
This is the material that I have chosen to restore my own teeth. It’s the best of both worlds because it is the strongest and most cosmetic dental restorative material available. One example of dental restorative material we use is a long lasting tooth colored material known as “Empress”. It is used to replace missing tooth structure and is the material of choice to form Crowns, Veneers & Dental Onlays. Non-metal Empress Tooth colored material is of the hardest pressed ceramic material available with the best tooth-like properties. When more strength is needed, especially with implant procedures, we use the strongest tooth colored material “Zirconium.” Zirconium type restorations are not as cosmetic or “tooth-like” as the Empress pressed ceramic and cannot be used for all dental restorations.

Gold Advantages & Disadvantages

In order to choose a crown that best suits your needs, you must first understand the basic materials used to fabricate crowns.

We offer two types of Gold Material

• Yellow Gold, which is yellow in color
• White Gold, which is silver in color.

Note: There are no gold restorations which are 100% gold in content. All dental metals including gold crowns are metal alloys, which is a technical way of saying a combination of metals. Rest assured, we use the best dental gold alloys available.

General Advantages Of Gold

Time tested and proven to be the best dental material.

Causes little post treatment sensitivity.

Metal is strong when it is thin, versus the “glass like” porcelain materials that need to be thick for fracture resistance. For this reason, less tooth structure is removed when it’s covered by gold restoration.

Since gold is resilient, it is a great material to use for long span dental bridge work, which is used to replace missing teeth. Gold is great when used to create key or key way type preparations with dental bridgework. The subject of key way bridge design is too complex to explain. Just know that the use of gold in capable hands gives the dentist more conservative, longer lasting design options for dental bridge work.

In some situations there is not enough space between upper and lower teeth and the doctor may not be able to create enough space between the teeth for porcelain. If there is little space you may either:

1. Choose to reduce the opposing tooth structure
2. Use gold on the chewing surface of your Crown. (This is usually white gold, which is silver in color).

Gold is not as hard as porcelain and is kinder to the opposing tooth during tooth to tooth contact. This is especially true if you grind your teeth. Some recent research is pointing out that root canal treated teeth and man made roots (implants) will have a slightly better long term success rate if they are restored with gold on the chewing surface.

General Disadvantages of Gold

It’s yellow or white metallic gold and has a metallic shinny reflection. It other words, its not a tooth colored restoration. In summary, people do not like how it looks. Especially the gold metal is on the bottom teeth, or if part of it shows from the sides of top teeth while smiling or talking.

Not very likely, but since gold is a metal, it can cause a galvanic response if placed next to a different dental metal restoration.

Gold Onlays and Crowns can become loose and require re-cementing more often vs. bonded Porcelain Crowns and porcelain Onlays. Important note: The quality and quantity of your remaining tooth structure, diet (i.e. sticky foods), and oral habits like grinding and clenching will all have an affect the life span and loosening of any and all dental restorations.

New! 2019 Best Dental Filling Material
E.max is a type of porcelain ceramic material. This material is the best dental material for most clinical applications.

7-Advantages of E.max Dental Restorative Material / 1-Disadvantage

# 1
More Life-Like Match to Natural Tooth Structure
Translucency & Color ie Hue Value Chroma are similar to natural teeth.

Consider these Facts Regarding Life-Like Esthetics & Personal Preferences

• Some natural tooth structure is monolithic and does not change much in color or transparency from the root to checking edge. Ie These Anatomically simply naturally monolithic teeth can be matched with monolithic Dental crowns and veneers.
• Some people prefer a monolithic look: i.e. Little to no yellow root stain or chewing edge grey transparency.
• Some people have teeth with numerous color variations with varying translucency. These patients may or may not desire a natural match.
• Hue, value, & Chroma are easier to see in Anterior Teeth simply because these teeth are in front of your mouth. Also anterior teeth more exposed to ambient light which refracts into and off of anterior teeth.
• Back teeth are mostly out of side and for most people the details are hidden.
• Some People do not want to spend time or money on quality care.

These is no “one size fits all” solution for matching natural tooth structure. Here are a few other ceramic non metal options:

E.max monolithic (same material through out) dental porcelain which looks life-like when used to restore most back teeth. But for patients seeking the finest esthetic results available on anterior teeth, the E.max base material may need to be cut back and layered with various layers of porcelains and artistic stains.

E.max press Multi Unit: Porcelain with a graduated level of shade and translucency similar to that of natural teeth. Again the multi unit can be used for some but not all solutions.

Dark Grey Dead Teeth may cause color match problems for any dental material including E.max. Dr Landers is very skilled at matching natural tooth structure and has the skills and wisdom to communicate limitations of clinical problems before treatment begins.

Feldspathic Ceramic porcelain layering technique.
Feldspathic Vs. E.max (Pressed or Milled ceramics)

• E.max ceramic materials come as inguts. Inguts are solid blocks of ceramic materials which are pressed into the shape of a dental restoration, or milled/ shaped by computer CAD guided lasers (or small cutting instruments).
• Feldspathic porcelain restorations are created by hand from scatch by layering ceramic powders and liquids. Feldspathic ceramic layering is a very skill technique.

Zorconia
Side Note: While zirconia material is stronger then e.max. its not very translucent! In fact it’s often too flat and too opaque.

#2
E.max wears similar to your natural teeth
If it’s a posterior tooth do not layer with other dental porcelains it will weaken the final restoration.

#3
All-Ceramic White Dental Porcelain No Metal
Does not contain metal

#4
Durability
Lithium disilicate is a glass ceramic material with superior properties:
High flexural strength of 500 MPa Ie less likely to crack or fracture under normal forces of Chewing & Normal function.
Less likely to chip (zirconia crowns is More brittle)

#5
Emax is monolithic AKA one solid material

Patient Tip: E.max Restorations on Back Teeth
Because of the superior look to E.max, dental labs don’t have to add or layer porcelain restorations to make them look life-like. This is especially true on back teeth. Not layering porcelains is a great advantage because the junction at which the layered porcelain is fused to the E.max base is the “Weak Link in the Chain.” In other words, this added material eradicates the advantages of e.max material: strength, wear resistance, crack resistant and fracture resistance. This is why posterior e.max restorations are stronger and last longer if patients are smart enough to except a very small reduction in the esthetic result and choses the monolithic solid emax material. Dr Landers highly recommends no cut backs, and no porcelain layering for posterior dental e.max restorations. At our office, if a posterior e.max crown comes back and needs a color variation, it’s done with porcelain staining materials.

#6
Can be Pressed in a dental lab or created in Dental offices with CAD Technology
Cad Cam Fabrication Computerize 3-D Milling
Can be made in one day at the dental office

#7
Saves Tooth Structure

Excellent strength and fracture resistance even then the E.max material is thin.

This is a tad on the technical side but consider the following:

1. When there is poor quality or quantity of tooth structure it can break from the forces of normal function.
2. Crowns and fillings are used to protect and cover weaken tooth structure.
3. If you cover the chewing surface of a tooth, this can create a bite force interference.
4. Tooth Structure is removed to create space for dental materials
5. Each dental material requires a specific thickness in order not to break.
6. If a material is stronger when it’s thin, then less tooth structure needs to be removed.
7. The more the tooth structure you have under or around a filling or crown, the stronger and longer lasting the filling or crown will be.

#8
Can be used to make various Dental Restorations
E.max can be used to fabricate:

1. Crowns
2. Veneers
3. Inlays
4. Onlays
5. Overlays
6. Dental Posts (Zirconia is Better)
7. Dental Bridge made to replace one tooth

Disadvantages of E.max

#1
Higher price

Crowns Vs Onlays

When we speak of dental restorative fillings, generally speaking, the public thinks of the typical “drill and fill” type of treatment. At our office, however, our patients benefit from newer dental technologies. These technologies, which have evolved, allow our patients to receive more aesthetic fillings, with more conservative treatment, and more precise marginal seal. Consequently, we can offer esthetic tooth like restorative fillings that are stronger and longer lasting.

Often patients will ask what is an onlay and how does an onlay differ from a crown. Both a crown and an onlay are indicated when there is extensive tooth loss or to hold together cracked or thin tooth structure. This is achieved by covering and replacing the chewing surface with a dental onlay or crown. This coverage will hold together fragmented parts of your tooth. Long term crowns and onlays will protect the tooth from fracture. The technical difference lies in the shape of each restoration but the term crown is often used to describe an onlay that replaces more than 65% of the tooth.

Crown
A crown will typically cover both the chewing surface and circumferentially wrap around the entire tooth. Crowns are generally used when there is more extensive tooth loss or after root canal therapy. Since crowns completely cover the tooth on all sides, they are used to correct any problems that you might have with alignment.

Onlays & ¾ Crowns
After your tooth is prepared and decay has been removed, an Onlay will fit into the area where the tooth is missing and cover the top of the tooth but not wrap around then entire tooth.

Our treatment Philosophy
At our office, more often then not, our patients who have lost large portions of tooth to dental decay or fracture will receive a conservative dental onlay restoration rather than a crown.

Onlays replace the tooth structure that you have already lost, i.e. the space left after your old filling and broken-decayed tooth structure has been removed. Your remaining sound tooth structure is shaped and an impression is made. The impression is sent to a dental technician where a custom restoration is made. It’s called an onlay or overlay because it covers the top of the tooth. Crowns cover the top AND WRAP AROUND the broken down tooth. In contrast, and in order to make space for a crown, the dentist must circumferentially cut back your tooth in addition to reducing the top of your tooth.

At our office, if you need a crown, the hollow space from your old filling and broken-decayed tooth is filled and bonded together with a core dental bonding material. Note that, sometimes, there is good reason for a crown. Crowns are needed when it is clinically established that there is not enough tooth remaining to retain an onlay, or there are stress fractures on remaining tooth structure that are in a vertical direction of the tooth root. Crowns can also be used to correct tooth position problems. Dr. Landers will clinically make the best decisions for you.

Dr. Landers always starts out conservatively. First, using fiber optic light technology, he removes old fillings and decay. At this point, he evaluates the remaining tooth structure and will advise you of your options for the final restorative needs.

No Needle Drill-Less Fillings

When we speak of dental fillings, generally speaking, the public thinks of the typical “drill and fill” type of treatment. At our office, however, our patients benefit from newer dental technologies.

What is Air Abrasion?
Using a fine, precisely controlled high-pressure stream of 27 micron particles, the air abrasion system removes dental decay with ease, precision and without compromising healthy tooth structure. While air abrasion will not replace the high-speed drill, it is today’s instrument of choice for the practice of conservative dentistry.

Two of the technologies that we have been using at our practice for the past few years include “air-abrasion micro-dentistry” and “caries detector dye”. The air abrasion allows us to pinpoint and remove spots of decay. Think of micro abrasion like a microscopically precise miniature sand blaster. In contrast to the traditional “drill and fill” dentistry, air abrasion does not generate heat or vibration, the potential for tooth chipping or microfracturing tooth structure is eliminated. Additionally, you don’t have to listen to the traditional sound of the drill. Micro abrasion will save you trips because it enables the practitioner to treat multiple quadrants in one sitting.

Does the MicroPrep eliminate the need for local anesthesia?
Most conservative preparations can be completed without local anesthesia. Although there are variable factors that exist in each case, a recent clinical study shows that approximately 90% experience 0 sensitivity (on a scale of 0-10) without anesthesia. Depending on the depth of a cavity and an individual’s unique degree of tooth sensitivity, each patient will be given the option to choose dental anesthetic at any time.

Air Abrasion is Great for Adults & Children
A wonderful benefit of “micro abrasion” is it removes the decay with very little patient sensitivity, i.e. “No Needle!” Micro Abrasion reduces the need for anesthesia because heat and friction normally transmitted by the bur to the tooth nerve are dramatically minimized. It’s great for children’s small cavities!
It makes sense that dentists would want to avoid the use of a needle for a child, and it’s especially stressful to put a dental drill in an active child’s mouth. As a result, the traditional method was to “watch” areas of suspect or small amounts of decay. Generally speaking, dentists often fail to diagnose small carious lesions until they become large problems. With the use of the MicroPrep and a carious detection dye, air abrasion takes the stress and guesswork out of diagnosis. Since it’s comfortable and conservative, it’s much easier for Dr. Landers to recommend early treatment for small cavities. The end result is preventative care that conserves your tooth structure.

What is caries detector Dye?
The second item we use is the red caries detector (cavity stain – similar concept to the chewable tablets we had as kids to see where we missed when we brushed). It has been estimated that as much as 20-40% of decay had been left in the tooth by dentists who DON’T use this in the past, because decay may be hiding under a margin or deep in the tooth and missed. It was one of dentistry’s hidden secrets until recently and now it is taught in many dental schools.

Is aluminum oxide toxic?
Aluminum oxide contains no silica and has no potential for causing respiratory problems. It is classified as a nuisance dust rather than a toxic substance. The amount of airborne aluminum oxide generated during cavity preparation with the MicroPrep is significantly less than the government allowable safe level in environments that actually produce the abrasive.

Metal Crowns

At our office we still offer the porcelain fused to metal substrate crowns for cosmetic areas of less demand. Light does not reach the posterior areas of your mouth. Our world-class lab technicians create beautiful natural looking restorations that are both cost effective and durable. Dr. Landers’ years of clinical experience help our patients make informed decisions with regard to material choice. The cost/benefit assessment is always presented. The porcelain is fused to metal substrate and a cosmetic crown is usually recommended in high force chewing areas of the mouth.

Silver Mercury Fillings Myth Vs Fact

CHICAGO, July 2002 — The following information from the American Dental Association corrects much of the misinformation about silver-colored fillings known as amalgam.

Myth: Dental amalgam causes numerous health problems.

Fact: Not true. You should feel very secure that the many organizations responsible for protecting the public’s health have said time and time again that amalgam fillings are safe. Those organizations include the World Health Organization, United States Public Health Service, the National Institutes of Health and the Food and Drug Administration.

Myth: There are better materials for treating cavities, but the ADA continues to promote use of dental amalgam because it receives money from amalgam manufacturers through its Seal of Acceptance program.

Fact: Be assured that the ADA does not profit from amalgam, nor does it promote the material. The cost of maintaining the ADA Seal program is financed primarily through ADA member dentist dues.

What the ADA does promote is having patients make informed decisions about their dental care in consultation with their dentist. The choice of a particular filling material is determined in partnership by the dentist and patient, and based upon a variety of considerations, including size and location of the cavity, patient history, cosmetic concerns and cost.

Myth: The ADA justifies amalgam use by saying the filling has been around for 150 years.

Fact: When making treatment recommendations, dentists rely on the best-available science and their own clinical experience. Because amalgam has been around so long, the dental profession and scientific community have learned a great deal about its durability, reliability and safety. Just like aspirin, amalgam has withstood the test of time and is still a valued option for patients.

Myth: Removal of amalgam cures some diseases.

Fact: It is unconscionable to lead people to believe that their serious illnesses may improve by undergoing unnecessary dental treatment. In fact, leading medical experts and health organizations have negated such statements and conclusions. For example:

“There is no scientific evidence to connect the development of MS or other neurological diseases with dental fillings containing mercury.” (National Multiple Sclerosis Society)

“According to the best available scientific evidence there is no relationship between silver dental fillings and Alzheimer’s.” (Alzheimer’s Association)

“There is no scientific evidence of any measurable clinical toxic effects [of dental amalgam].” (American Academy of Pediatrics)

Myth: Dental amalgam fillings release mercury vapors that are harmful to the body.

Fact: Minute amounts of mercury vapor (between 1-3 micrograms* per day) may be released from amalgam under the pressure of chewing or grinding, but there is no scientific evidence that such low-level exposure is harmful. In fact, dental materials experts say one would have to have almost 500 amalgam fillings to even see the subtlest symptoms in the most sensitive person.

* 1 microgram is equal to 35.2 billionths of an ounce.

Myth: Dentists cannot tell their patients that amalgam contains mercury.

Fact: Actually, the ADA encourages dentists to discuss the full range of filling options with their patients so together they can decide what is the most appropriate treatment.

Key resources for oral health care information and additional information about amalgam:

• The American Dental Association
• The Food and Drug Administration
• World Health Organization
• National Institutes of Health: Mercury in Dental Amalgams (Fillings)
• Centers for Disease Control and Prevention
• United States Department of Health and Human Services

Why Do Teeth Need to Be Covered with A Crown

1. When there is poor quality or quantity of tooth structure, the tooth can break from the forces of normal function.
2. Tooth crack coverage
3. Crowns and fillings are used to protect and cover weaken tooth structure.
4. Crowns are used to cover teeth for esthetic purposes
5. Crowns can also be used to increase the vertical opening of a patients bite. If you need this treatment Dr Landers will address your benefits in person.

Why is the Chewing Surface of a Molar Crown Reduced, What are my Best Options

1. If you cover the chewing surface of a tooth, this can create a bite force interference.
2. Tooth Structure is removed to create space for dental materials
3. Each dental material requires a specific thickness in order not to break.
4. If a material is stronger when it’s thin, then less tooth structure needs to be removed.
5. The more the tooth structure you have under or around a filling or crown, the stronger and longer lasting the filling or crown will be.

Crown Material Options For Posterior Teeth

• Full Gold Crown is strong and requires the least amount of tooth removal.
• Zirconia is white and opaque but strong
• E.max is a more life-like materalial but requires more tooth removal then Full gold or Zirconia
• Porcelain Fused to metal is a good option for lower posterior teeth. Is not used as much for upper posterior teeth because the metal inside shell can cast a shadow on the root or gums.