Tooth decay goes through various stages:

1. a healthy, living tooth;
2. a living tooth that is decayed and/or already has a filling;
3. a devitalized tooth;
4. a tooth that needs to be extracted.

At every stage in the decay process, we can propose various ways of delaying and, if possible, preventing any further deterioration leading to the next stage.

For healthy, living teeth (1), preventive care together with adequate plaque control at home should avoid any need for treatment.

Decayed teeth

For decayed teeth or teeth with repairs that no longer effectively seal off your tooth (2), it is necessary for us to first remove the decay or any old fillings in order to determine the appropriate course of treatment:

• If the cavity is small, a composite filling is a perfectly adequate solution and provides an aesthetic result. For environmental reasons, we amalgam is no longer used (since 1997).
• When a significant amount of dental tissue has been destroyed, a ceramic inlay can be a preferable alternative to reconstruction with composite. For larger cavities, composite has several disadvantages (it can contract during polymerization, it can seal less effectively over time, it is not very resistant to wear, and it can become discoloured). By using a ceramic inlay or onlay, we can avoid resorting to a crown that might result in greater deterioration of the tooth.

Iinlays-onlays

Advantages of inlays/onlays:

• better mechanical resistance is achieved through a better distribution of pressure during chewing;
• less deterioration of the tooth is caused than with a crown;
• contact with neighbouring teeth is optimized;
• a better interface between the tooth and the filling material is achieved;
• a more natural look can be obtained, and a more durable and effective seal is achieved through optimal cementing.

If the decay has already contaminated the pulp, root canal treatment will be necessary.

Devitalized teeth

Research has shown that crowns extend the useful life of devitalized teeth (3), thereby postponing the need for extraction. However, thorough root canal treatment is required before reinforcing a tooth with a crown.

Once the pulp has been removed, reconstruction is required using posts together with a suitable core build-up or a cast post and core. There are two types of post & core techniques:

Inserted

A direct technique involving a composite core combined with fibrous posts;

Cast

An indirect technique involving a cast metal post manufactured in the dental laboratory.

NRoot canals previously filled during endodontic treatment are used for retention.

Dental crown

There are various types of crown, depending on the materials used to manufacture them:

Metal crowns

Whose price and colour will vary depending on the metal used (depending on whether gold is used);

Metal-ceramic crowns

Metal-ceramic crowns consisting of a metal shell covered with a ceramic of the same colour as the teeth.

Ceramic crowns

Which involve a very advanced design process. They consist of an exceptionally strong ceramic substructure covered with a ceramic of the same colour as the teeth. A ceramic crown is a very high-quality prosthesis and will provide the most aesthetic result.

When a tooth is extracted (4), it needs to be replaced to avoid overloading and damaging the neighbouring teeth and to prevent them from moving.

The replacement can be fixed or removable according to your wishes.

Every solution comes with advantages and disadvantages, and we will explain the options and the costs involved.