Conservative Dentistry and Endodontics

The subject of Conservative Dentistry and Endodontics is dental caries and its complications (pulpitis and apical periodontitis).

Treatment of dental caries

Dental caries is an infectious disease of the tooth enamel and dentin caused by microorganisms. Poor oral hygiene, presence of dental plaque and tartar, frequent consumption of sugar, sticky foods and carbonated drinks, hereditary predisposition, old fillings with fractures or overhanging edges, wide crowns and bridges, etc. just make the situation even worse.

The caries can affect any surface of the tooth, but most often is located on the occlusal (chewing) surface of the posterior (back) teeth, between adjacent teeth (the two contact surfaces), on the roots of exposed teeth.

The caries could be superficial, with an average depth, deep caries almost reached the pulp (the vital tissue of the tooth) or the pulp to be already damaged (pulpitis).

The sooner the caries is found, the less the time, the efforts and the price of the treatment will be!

Caries infiltration with Icon

This kind of treatment is used for initial caries (white spots) and it is done without any removal of enamel or dentin and without any pain and anesthesia.

Caries infiltration is used when white spots are already present on the teeth (on their smooth surfaces, for example after orthodontic treatment with braces or between the teeth). It is important the surface to be without any loss of dental tissues, it must be smooth, not rough and it could have only changes in color. The most beneficial fact of such kind of treatment is that the initial caries is infiltrated without any removal of tooth tissues and without any pain or anesthesia. Infiltrated white spots  change color and merge optically with the color of healthy enamel.

 

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Before - white spots on upper molar
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After caries infiltration with Icon white spots have disappeared

Fillings

Dental caries  is treated by direct restoration of missing tooth tissue using different kinds of materials (according to the indications)- composites (resins), glass-ionomeric cements, compomers etc. We use materials with proven quality manufactured by leaders such as GC, 3M ESPE etc. In this way the affected tooth is restored functionally and aesthetically with a filling directly in the dental office during one visit.

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Before- old amalgam fillings on upper jaw
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After- composite fillings on upper jaw
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Before-old amalgam fillings on lower jaw
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After- composite fillings on lower jaw
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Before- an old filling and secondary caries
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During the procedure
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Teeth are isolated with rubber dam
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The new composite filling
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Before- an old broken filling
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During the procedure
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Composite filling

Inlay, overlay

In cases of severe damage of the tooth crown it is recommended composite or ceramic/porcelain inlays, overlays. The dentist takes an impression of the tooth after preparing it. The dental technician pores a dental model and fabricates the inlay/ onlay/ overlay on it. After that the dentist fixes it permanently on the tooth. Two visits in the dental office are necessary because of the collaboration with dental laboratory.

The advantages of indirect inlays, onlays, overlays are lower polymerization shrinkage of the material which means greater strength and accurate fitting, two shorter visits of the patient instead of one long and exhausting visit, etc. Read more in section Veneers, Crowns, Bridges.

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An old composite filling
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Severely damaged tooth with deep caries
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During the procedure
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Overlay on a dental model
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After- a composite overlay

Endodontics

Endodotic treatment of pulpitis and apical periodontitis

Endodontics is a part of Dental Medicine taking care of pulp diseases (pulpitis) and tissues around the roots of the teeth (apical periodontitis).

General causes of pulpitis (inflammation of the pulp tissue inside the tooth) are delayed or not exact caries treatment, trauma of the tooth, fracture, etc. The main symptoms are sharp, strong, spontaneous night pain, pain in a result of something cold or hot, while eating or just touching the tooth, etc. The progression of this process leads to necrosis of the pulp and inflammation of the bone around the roots. Apical periodontitis develops either with acute spontaneous predominantly daytime pain, severe biting or chewing pain (acute periodontitis) or almost asymptomatic (chronic periodontitis).

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Root canas are filled with gutta
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X-rays before and after endodontic root canal treatment
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Composite filling of a tooth after root canal treatment

Treatment of fractured teeth

Depending on the volume of the affected tissues, the individual treatment approach is determined:

In case of fractures of enamel and dentin of vital teeth, a conservative approach to keep healthy tissues and a composite filling is applied.

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Before- fractured upper central incisor
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During the procedure
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After- restored with composite filling upper central incisor

Fractures of non-vital teeth usually require additional strengthening of the rest of the tooth tissues and restoration with a fiber post or metal pinlay (post and core) and a crown. Read more in the section Veneers, Crowns, Bridges.

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Fiber post restoration
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A metal-ceramic crown
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Before- fractured non-vital tooth
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Metal pinlay (metal post and core)
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After- metal-ceramic crown

Fractures affecting the pulp of vital teeth require biological treatment to maintain the vitality of the tooth or root canal treatment without preserving the vitality.

In case of root fractures or along the long axis of the tooth, it is often necessary to extract the tooth and replace it with a bridge or an implant and a crown.

The bigger the fracture is, the more procedures are necessary to restore the tooth aesthetically and functionally.

In order to avoid more comprehensive treatment, it is important to find early dental problems and to solve them in time!

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