Cleaning procedure, Scaling

Tooth scaling involves the mechanical use of a dental instrument that scrapes away bacterial plaque and calculus from the tooth. Sometimes this device may be electric, known as an ultrasonic or sonic scaler. Scaling is performed on the part of the tooth that is exposed, the crown of the tooth, as well as the portion that is normally covered by, but not attached to, the gum. Scaling the tooth surface that is in this gum pocket is an effective treatment for early periodontal disease.

Restoration of teeth

Destroyed tooth structure does not fully regenerate, although remineralization of very small carious lesions may occur if dental hygiene is kept at optimal level.
For the small lesions, topical fluoride is sometimes used to encourage remineralization. For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth.

Generally, early treatment is less painful and less expensive than treatment of extensive decay. Anesthetics — local, nitrous oxide ("laughing gas"), or other prescription medications — may be required in some cases to relieve pain during or following treatment or to relieve anxiety during treatment. A dental handpiece ("drill") is used to remove large portions of decayed material from a tooth. A spoon is a dental instrument used to remove decay carefully and is sometimes employed when the decay in dentin reaches near the pulp. Once the decay is removed, the missing tooth structure requires a dental restoration of some sort to return the tooth to functionality and aesthetic condition.

Restorative materials include dental amalgam, composite resin, porcelain, and gold. Composite resin and porcelain can be made to match the color of a patient's natural teeth and are thus used more frequently when esthetics are a concern. Composite restorations are not as strong as dental amalgam and gold; some dentists consider the latter as the only advisable restoration for posterior areas where chewing forces are great.
When the decay is too extensive, there may not be enough tooth structure remaining to allow a restorative material to be placed within the tooth. Thus, a crown may be needed. This restoration appears similar to a cap and is fitted over the remainder of the natural crown of the tooth. Crowns are often made of gold, porcelain, or porcelain fused to metal.

A tooth with extensive caries eventually requiring extraction.

In certain cases, root canal therapy may be necessary for the restoration of a tooth. Root canal therapy, also called "endodontic therapy", is recommended if the pulp in a tooth dies from infection by decay-causing bacteria or from trauma.
During a root canal, the pulp of the tooth, including the nerve and vascular tissues, is removed along with decayed portions of the tooth. The canals are instrumented with endodontic files to clean and shape them, and they are then usually filled with a rubber-like material called gutta percha.
The tooth is filled and a crown can be placed. Upon completion of a root canal, the tooth is now non-vital, as it is devoid of any living tissue.

An extraction can also serve as treatment for dental caries. The removal of the decayed tooth is performed if the tooth is too far destroyed from the decay process to effectively restore the tooth.
Extractions are sometimes considered if the tooth lacks an opposing tooth or will probably cause further problems in the future, as may be the case for wisdom teeth. Extractions may also be preferred by patients unable or unwilling to undergo the expense or difficulties in restoring the tooth.

Root canals are the long passages full of soft tissue deep within the dentin of a tooth, adjoining the pulp chamber. In dentistry, a pulpectomy is an endodontic treatment to cure an infection of the root canal; informally a root canal. A root canal, coupled with internal tooth bleaching, is also used to fix teeth that have blackened because of infiltration of decayed soft tissue into the dentin in the teeth, most often seen in frontal incisors that have been injured through a sudden impact.

Crown refers to the restoration of teeth using materials that are fabricated by indirect methods which are cemented into place. A crown is used to cap or completely cover a tooth.

Traditionally, the teeth to be crowned are prepared by a dentist and records are given to a dental technician to fabricate the crown or bridge, which can then be inserted at another dental appointment. The main advantages of the indirect method of tooth restoration include:
fabrication of the restoration without the need for having the patient in the chair
the utilization of materials that require special fabrication methods, such as casting
the use of materials that require intense heat to be processed into a restoration, such as gold and porcelain.

The restorative materials used in indirect restorations possess superior mechanical properties than do the materials used for direct methods of tooth restoration, and thus produce a restoration of much higher quality.

As new technology and material chemistry has evolved, computers are increasingly becoming a part of crown and bridge fabrication, such as in CAD/CAM technology.

A temporary crown is a provisional, short term restoration used in dentistry. Usually the temporary crown is constructed from a chemical-cure composite, although alternative systems using aluminium crown forms are occasionally used by older practitioners. The temporary material is shaped by the dentist to form a tooth shape that protects the prepared tooth, prevents damage to the periodontal tissues (gums) and disguises the prepared tooth to a degree until the final, definitive restoration can be made by a dental technician.

A temporary crown will usually be cemented in place with a soft temporary dental cement, such as Temp-Bond NE. This allows easy removal when fitting the definitve restoration.

If a temporary crown becomes decemented, it is important that a dentist examines the patient as overeruption of the opposing teeth may prevent accurate fitting of the final crown.

A bridge, also known as a fixed partial denture, is a dental restoration used to replace a missing tooth by joining permanently to adjacent teeth or dental implants.

There different types of bridges, depending on how they are fabricated and the way they anchor to the adjacent teeth. Conventionally, bridges are made using the indirect method of restoration however, bridges can be fabricated directly in the mouth using such materials as composite resin.

A dental bridge is fabricated by reducing the teeth on either side of the missing tooth or teeth by a preparation pattern determined by the location of the teeth and by the material from which the bridge is fabricated. In other words, the abutment teeth are reduced in size to accommodate the material to be used to restore the size and shape of the original teeth in a correct alignment and contact with the opposing teeth. The dimensions of the bridge are defined by Ante's Law: "The root surface area of the abutment teeth has to equal or surpass that of the teeth being replaced with pontics"

The materials used for the bridges include gold, porcelain fused to metal, or in the correct situation porcelain alone. The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. The recipient of such a bridge must be careful to clean well under this prosthesis.

When restoring an edentulous space with a fixed partial denture that will crown the teeth adjacent to the space and bridge the gap with a pontic, or "dummy tooth", the restoration is referred to as a bridge. Besides all of the preceding information that concerns single-unit crowns, bridges possess a few additional considerations when it comes to case selection and treatment planning, tooth preparation and restoration fabrication.

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