Treatment options

Our tooth consist of three main parts :

1. The outermost layer – Enamel – Strongest and hardest layer protecting dentin and pulp
2. Second layer – Dentin – Acts like a shock absorber – protects the pulp
3. Innermost part – Pulp – Contains blood vessels, nerves and stem cells for any regenerative repair

I.Restoration of carious lesions not too deep – involving only enamel and dentin layer

1. Amalgam – Oldest and most durable filling. Metallic/silver in colour. Indicated for back teeth and in those teeth where saliva control will be a problem while filling
2. Composite – Matches the tooth colour. Can be used to fill any teeth. Even the front teeth can be filled with this; as it matches excellently with the tooth when appropriate shade is used.
3. Glass ionomer cement – This is indicated in areas where esthetics is required but proper fluid control is questionable; like areas of the tooth near the gums.
4. Inlay/onlay – If cavities are too wide or affecting the space between the teeth then a small filling fabricated externally in the lab will be fitted onto the prepared cavity. The filling can be either metal or ceramic depending on patient needs

II. Restoration of carious lesions quite deep – involving enamel, dentin layer with close approximation to the pulp. In such cases we need a substitute for dentin which can protect the pulp as well as possess the potential to replace the lost dentin tissue (Regeneration/ Remineralization). Hence we need to give a medicament like layer of protection on top of which the above mentioned fillings can be placed

1. Mineral trioxide aggregate (MTA) – Grayish white in colour – Serves to remineralize dentin
2. Dycal – Potential is fine but not as good as MTA. Economical.

III. Restoration of carious lesions involving the pulp. The tooth is dead? Don’t worry we can still save it!!

1. Root canal therapy. In this therapy the caries will be completely removed and access will be obtained to the root part of the tooth. The infected pulp will be completely removed and cleaned by appropriate instruments and disinfecting agents. Subsequently, the root portion will be filled with a filling called gutta percha along with a sealing material made of zinc oxide eugenol. Following this, a post endodontic restoration is required depending upon the loss of tooth structure.
2. Composite – If the cavity Is very small and there is no loss of any wall
3. Onlay – If one wall is missing. The crown can be either metal/ ceramic depending upon patient needs
4. Crown – More than one wall is missing. The crown can be either metal/ ceramic depending upon patient needs.
5. Post plus crown – When more than two walls are missing.

IV. Endodontic Surgery: Surgery might be indicated at times when the infection at the root cannot be controlled by root canal therapy / in case of any foreign body retrieval from the root end

V. Treatment for discoloured teeth

1. Bleaching

2. Veneers – a filling or small cap like structure will be used to mask the discolouration

VI. Treatment of unaesthetic gap between teeth or malshaped front teeth

Tooth coloured composite fillings can be used to reshape the crown portion of the tooth.