Dental Caries: The Disease and Its Clinical Management by Ole Fejerskov, Bente Nyvad, Edwina Kidd

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51 SECTION 6 TOOTH RESTORATION WITH CROWNS, BRIDGES OR VENEERS Crowns Aftercare of Crowns Bridges Aftercare of Bridges Veneers Aftercare of Veneers 52 REASON FOR PROCEDURE Each time a tooth is restored with a filling some of the tooth tissue is removed. Eventually, this will compromise the strength of the remaining tooth and it may begin to fracture under normal occlusal forces. This occurs especially when teeth have been root treated, and so it is usual for heavily filled and root-filled teeth to be crowned before fracture occurs.

The impression material of choice is alginate, which is sufficiently elastomeric to be accurate as well as being relatively inexpensive. Correctly sized stock trays are adequate to hold the impression material, and a wax wafer bite allows the accurate positioning of the two models produced. In more complicated cases, the models are often mounted on an articulator so that jaw movements can be reproduced and a more in-depth occlusal analysis can be carried out. Technique • The patient is seated upright in a dental chair • A protective bib is placed • All removable prostheses are taken out of the mouth, unless their presence is required for the occlusal analysis • A wax wafer bite is taken, if necessary, using warmed pink wax • Upper and lower stock trays are sized to the patient’s dental arches, so that each arch is fully covered by the tray without being uncomfortable or choking the patient • A stiff, bubble-free mix of alginate is prepared, loaded into one of the trays and inserted into the patient’s mouth to fully cover one of the dental arches • The patient is advised to breathe through the nose, not to swallow and to keep the lips and cheeks in a relaxed state • Once set, the impression is carefully removed from the mouth in the tray and disinfected as necessary • The process is repeated for the opposing arch • Study models are cast from the impressions in dental stone, ideally within 24 h of the impressions being taken 41 SECTION 5 TOOTH RESTORATION WITH FILLINGS Amalgam Fillings Composite Fillings Glass Ionomer Fillings Aftercare of Fillings REASON FOR PROCEDURE When a tooth is attacked by caries, a process of demineralisation occurs in the hard tissues of the tooth, starting in the enamel outer layer.

This provides a clear field of vision for the dentist, as well as making the 54 patient more comfortable by removing water, saliva and tooth debris from the mouth. 3 Localised gingivitis owing to incomplete cement removal at crown fit 55 AFTERCARE OF CROWNS As with fillings, microscopically, all fixed prosthetic restorations provide a surface area for the attachment of plaque and oral bacteria. 4). A consistently high standard of oral hygiene around crown margins is therefore imperative. This will involve good toothbrushing using a good quality fluoride toothpaste, and successful interdental cleaning using floss or tape.