What restorative dentistry covers

Five treatments account for most of this work. Which one suits you depends on how much of the tooth remains, on the condition of the bone and gums, and on what you are prepared to maintain day to day.

  • Dental implants. A post placed in the jawbone to take the place of a missing root, which can then carry a crown, a bridge or a denture attachment.
  • Crowns and caps. Full coverage for a tooth that is too cracked, worn or heavily filled to hold a filling.
  • Fixed bridges. A cemented replacement that takes its support from the teeth on either side of the gap.
  • Dentures and partial dentures. Removable replacements for several teeth or for a whole arch, including versions that attach to implants.
  • Root canal therapy. Treatment for infection inside a tooth, allowing a tooth that would otherwise be removed to remain.

Smaller repairs are handled with bonded tooth-colored fillings under cosmetic dentistry, and where the tooth shows when you smile, see porcelain crowns.

Deciding between saving a tooth and replacing it

The choice usually rests on two questions: whether the tooth can be kept, and whether the repair will last. A natural root in healthy bone, with a ligament around it that senses pressure, justifies real effort to save. A tooth that has split below the bone, that has lost much of its support to gum disease, or that has canals which cannot be sealed is a harder case, and rebuilding it can become a series of appointments that only postpones the extraction.

The assessment covers how much sound tooth remains above the gumline, because a crown needs something solid to hold; whether a crack extends into the root; how much bone still supports the tooth; what role it plays in your bite; whether you grind; and whether the finished result can be kept clean. We will tell you which category your tooth falls into and how we reached that conclusion, and when the decision is close we will tell you that as well.

Rebuilding a tooth compared with extracting it

A general comparison rather than a rule. The particular tooth determines the answer.

Consideration Keep and rebuild Extract and replace
What you keep The natural root and the ligament around it, which senses pressure and provides feedback while chewing. None of the original tooth. The replacement either sits in the bone or rests on top of it.
Bone Bone around a working root stays loaded and tends to hold its shape. The ridge shrinks after an extraction. An implant loads that bone again, while a bridge leaves it unloaded.
Time and neighboring teeth Often a few weeks, and the teeth on either side are left untouched. An implant takes months, most of it healing. A bridge is quicker, and it requires preparing both neighboring teeth for crowns.
If treatment fails later Extraction and replacement remain available later, though some bone may be lost in the interval. Fewer options remain once the tooth is gone, and the decision is difficult to reverse.

What happens when a missing tooth is not replaced

A gap at the back of the mouth, where nobody sees it, still causes problems, and those problems often appear years later in a different tooth.

  • Neighboring teeth drift. They tip into the space over months and years, creating food traps that are difficult to clean.
  • The opposing tooth over-erupts. With nothing biting against it, it continues to move out of the bone until it interferes with the bite, and it can be lost even though nothing else was wrong with it.
  • The bone under the gap resorbs. Bone keeps its volume partly because it is loaded. The ridge shrinks fastest in the months after an extraction, which narrows the options later on.
  • The remaining teeth carry more load. Fewer teeth taking the same force can mean more cracked cusps and more failed fillings. If your jaw also aches, that load should be assessed.
  • Chewing and speech change. Foods that are difficult to chew tend to be avoided once back teeth are missing, and several missing front teeth reduce lip support.

A gap benefits from a plan rather than being left open indefinitely. Call the office to discuss the options and a reasonable timeline.

The order of treatment

Sequence matters, because crowns and bridges built over active disease tend not to last.

  1. Examination and records

    A full examination, x-rays, periodontal charting and an assessment of how your teeth meet. Knowing the bone level and the bite comes before any decision about what to rebuild.

  2. Relieving pain first

    Anything acute is treated before anything elective. An abscessed tooth is treated with root canal therapy or removed. If you are in pain now, see dental emergencies.

  3. Treating disease before rebuilding

    Decay is removed and the gums are treated until they are stable. Gum disease is a common reason restorations and implants develop problems years later, and it is easier to treat first.

  4. Rebuilding in the order healing allows

    Extractions and grafts come first, because bone takes months to heal. Implants are placed and then left to integrate, and crowns and bridges on natural teeth can often be made during that time.

  5. Fitting, adjusting the bite, and maintaining the result

    An even bite helps keep porcelain from chipping and prevents one tooth from taking more than its share of the load. New dental work also makes regular cleanings more important. See preventive dentistry.

Common questions about restorative dentistry

How do I know whether to save a tooth or replace it?

It depends on how much sound tooth remains, how much bone supports it, whether a crack extends into the root, and whether the finished result can be kept clean. Borderline teeth involve judgment, and you will receive our reasoning along with the alternatives.

How long does restorative treatment take?

A single crown is usually two visits a few weeks apart. Where extractions, grafting and implants are involved, treatment can run for months, and most of that is healing time rather than time in the chair.

What does a crown or an implant cost in Oakhurst?

Fees depend on the material, on whether a build-up or a graft is needed first, and on how many teeth are involved, so a figure quoted without an examination is only an estimate. We will review the fee with you before treatment begins. See financing.

Can all of this be done in one office?

Much of it. Dr. Brosi is a general dentist and treats teeth that are damaged, failing or missing. Where a case is better handled by a specialist, such as a difficult surgical extraction, unusual canal anatomy or advanced gum surgery, we will refer you and take care of the restorative work afterward. The surgical stage of implant treatment is planned case by case and may be carried out here or by a specialist. Ask when you call and we can explain how your case would be handled.

When are you open?

Monday through Wednesday from 8:30 am to 5:00 pm and Thursday from 7:30 am to 4:00 pm, closed Friday through Sunday. Call (559) 683-4694 or use the contact page.

In this area of treatment

Each of these has its own page with the detail that does not fit here.

  • Dental Implants

    A titanium root placed in the jaw to support a crown, bridge or denture without altering neighboring teeth.

  • Dental Crowns and Caps

    Full-coverage restorations that hold a cracked or heavily restored tooth together under chewing load.

  • Fixed Dental Bridges

    A cemented, non-removable replacement for one or more missing teeth in a row.

  • Dentures and Partial Dentures

    Removable replacements for several or all teeth, including implant-retained options that are held more firmly.

  • Root Canal Therapy

    Treatment that removes infection from inside a tooth so the tooth can be kept rather than extracted.