The Courtyard - Blog

White Fillings

As you may know The Courtyard only places white fillings.

We have not placed metal amalgam fillings since 2009 and Marcos has been placing white composite fillings for almost 10 years at the practice with less than 3% of these needing replacing over this time.

Amalgam metal fillings were invented over 50 years ago and have 50 year old science behind them. They are still widely used in dental practice despite a number of drawbacks.

Metal fillings are stronger than the teeth they are placed in. The longer they are in teeth the more force they place on the supporting walls of the tooth leading to cracks and fracture.

Metal fillings are not glued into a cavity. A small microscopic gap is present between the filling and your tooth. This is big enough to allow bacteria and food particles to seep in and cause decay to occur at the margin of the filling and the tooth. This is called leakage.

Metal fillings are often left fairly flat in the tooth cavity. This lack of tooth shape causes the tooth above to over grow and cause interferences when you chew food or grind your teeth. This causes further damage to the teeth and recession of the gums.

White fillings are not stronger than the teeth they are placed in. They are designed to wear at the same rate as natural teeth.

White fillings are bonded in place. Not only does this mean that there is no possibility of bacteria getting into the tooth but also holds together the outside walls of the tooth preventing fracture.

White fillings are carved and contoured to look and function like natural teeth. This preserves the intricate way that your upper and lower teeth meet.

White fillings are white. They are tooth coloured. They look like teeth. Which we believe is an important quality.

When we replace metal fillings with white fillings we are mindful of the fact that amalgam metal fillings contain mercury. Mercury is a toxic substance and we want to avoid you coming into contact with it, inhaling the vapours or swallowing it. For this reason we place a rubber sheet over the tooth we are working on to isolate the tooth from you and the rest of your mouth. This is called a rubber dam. We use rubber dam when placing any white fillings. We also use high volume suction to remove all the vapours released from the filling as the filling is removed.

Sensitivity and root treatment

It is normal to experience some temperature sensitivity for a few weeks after we have placed a white filling. This is a result of the nerve being sensitised by the removal of the decay and old metal filling. This sensation usually settles within a few weeks but can persist for longer if the filling was particularly large.

If it persists for a long time or symptoms worsen it may be that the nerve in the tooth is not going to recover and that a root treatment may be required. The inside of a tooth contains small nerves and blood vessels. If the tooth suffers from decay this allows bacteria to get into the nerve system causing pain and toothache. The bigger the filling or the greater amount of decay the more chance that this has already happened.

When the metal filling is removed we need to remove an additional amount of decayed and infected tooth to provide clean tooth to bond our white filling to. Sometimes this additional trauma causes the nerve to become inflamed requiring a root treatment.

Whenever possible we will advise from the outset if we feel a root treatment is sensible to be carried out in conjunction with the new white filling. If we feel that a metal filling is sufficiently large or the tooth has suffered too many cracks already we may feel the root treatment is best carried out in advance of any potential symptoms developing.

However sometimes we cannot predict how a tooth will respond to a required treatment and if symptoms do develop then additional treatment at additional cost will be required. This is not the fault of the treatment but purely a biological response to required treatment.

Invisalign Frequently Asked Questions

This document includes some instructions for wearing your invisalign and some answers to our most commonly asked questions.

Q. Is it painful?

Invisalign wear is not painful. When placing a new aligner you will experience a tight feeling on your teeth and a slight ache. This is because each aligner is effectively the wrong fit for your teeth and your teeth will move to fit each new aligner. This ache disappears after the first day or 2 and does not usually require any pain relief.

Sometimes people experience some soreness when the lips rub against the edges of your aligners. This is uncommon but if it occurs it usually disappears after 4 or 5 days when the skin toughens up. This can also be remedied by using a nail file on the offending edge of the aligner.

Q. How do I keep them clean?

Toothbrush and water. Do not use boiling water as it will warp your aligner!
Tablets are available to purchase from our reception to keep retainers clean but most patients just use a toothbrush and water. By the time the aligner is beginning to get a little stained it is usually time for your new aligner.

Q. How often do I change my aligners?

Change your aligners after 10 days wear. Always keep your old aligners back in their bags just in case we run into any complications.

Q.
How do I take my aligners out?

Stick one finger in at the back corner of your mouth and unclip the aligner from your very back tooth. Do the same on the other side and then peel the aligner away from your teeth. A reasonable amount of force is required for this. Don’t be shy. You won’t break your teeth and you won’t break your aligners. Over time you will develop your own knack of getting them in and out but this is a good beginners guide.

Q.
What if I lose an aligner?

Firstly try and avoid losing them. The most common way people lose their aligners is by not putting them in their carry case when not in use. Commonly people out for a meal haven been known to stick them in a napkin and they get thrown away. Or put them in their pockets. Or in the kitchen. If you place them in their carry case this won’t happen. If you do lose one simply skip on to the next aligner.

Q.
Can I drink with them in?

Clear fluids are fine. We would suggest you avoid fluids that would stain the aligners more readily. Red wine, tea and coffee are probably best avoided (unless it is the last few days of aligner wear and you are due to change soon).

Q.
What dentistry is required?

Attachments and IPR.

Attachments act to aid in achieving some of the tooth movements required in certain cases. If you were having your teeth straightened with metal wires the orthodontist glues metal brackets onto your teeth so the wire can move your teeth about. With invisalign the tight fitting nature of the appliance is usually enough to carry out the movements required. However if we are trying to pull a flat tooth down we need to place an attachment so the appliance can achieve this movement. If we are trying to rotate a round tooth we need to place an attachment to achieve this movement. Attachments are like little white blocks of filling that we bond to your tooth as prescribed by invisalign. They are very discrete, do not harm the tooth and are removed at the end of treatment.

IPR stands for inter proximal reduction. This means removal of some tooth tissue between the teeth. The maximum amount of IPR prescribed by invisalign is 0.5mm per site. This means 0.25mm from each surface of the tooth. This is a quarter of a millimetre. No anaesthesia is required and it is a comfortable procedure.
IPR is carried out to create a little bit of space between the teeth to allow the teeth to move freely past each other. In addition it creates some space where crowding is present for the teeth to fit into the jaw space.

Both IPR and attachments are optional but are usually required in anything but the mildest of cases. They are used to create the best smile for our patients by having the greatest degree of control as to where we move your teeth in your smile.

Q.
Will my teeth move back after invisalign?

In our experience most patients require invisalign to straighten their teeth for one of two main reasons. The muscles in their face exert strong force on the teeth to pull them into the tongue space resulting in crowding. Alternatively night time grinding habits called bruxism are present causing the teeth to move in the direction of this grinding. As you can imagine both these conditions will most likely continue after invisalign has successfully straightened your smile. As such, retention is required to maintain the smile in the position we move the teeth to.

Retention

At the end of treatment we advise our patients buy invisalign retainers at an additional cost of £289 for 3 sets. This works out as £48 per retainer. We advise 6 month full time retainer wear at end of treatment followed by night time wear thereafter. You will need to wear your retainers every night forever or for as long as you want your teeth to remain straight. We cannot guarantee the longevity of our results unless this protocol is followed.

Q.
Does treatment always go according to plan?

We always achieve the result that we were aiming for. On occasion complications can arise which make the treatment take longer than first hoped. There are certain tooth movements that are difficult to achieve and it is these that need to be managed carefully. Pulling teeth down (extrusions) and twisting teeth (rotations) are difficult to achieve and always need attachments placing. If we run into difficulties in a case there are tricks that Marcos has developed through working on over 300 cases to help achieve our end result.

If aligners stop fitting altogether then new impressions for new aligners and a revised course of action may be required. That said invisalign is always developing and improving their aligners and attachments, and treatments are now quicker and more predictable than ever.

The main factor that can affect treatment success is that the aligners are worn. If the aligners are living in their box more than on the teeth we will not achieve our goal. It is essential that unless the patient is brushing their teeth or eating that the aligners are worn at all times.

Q.
How often will I need to come for appointments?

After your initial consultation and records being taken you will have the opportunity to view your case in a 3D simulation to ensure we will be creating the smile you want. This is called a clincheck and takes 3 week to create. At this appointment we will both review your new smile. We will not accept the case and get the aligners made until you confirm you are happy with the case.
Following this appointment and fabrication and delivery of your aligners we will contact you to arrange your fit appointment. This process can take approximately 8 weeks depending on demand at that time. At your initial fit appointment no dentistry will be done. We will simply fit your aligners and deliver a tutorial to inform you how to wear your aligners. After this visit we will see you 1 month later to place attachments and carry out any IPR.
Following these initial 5 visits we will review you every 3 months to ensure treatment is progressing smoothly.

Q.
What if I don’t like the end result?

You will always like the end result as you will have agreed to what your case would look like at your initial clincheck appointment. However should you wish to do any minor changes or improvements to your smile at the end of treatment invisalign have developed refinement.

Refinements.

Included in your invisalign package is the opportunity once you are finished to fine tune the end result. This is called a refinement and you are entitled to 3 refinements to your treatment. These are free of charge to you and your dentist and allow us to pursue the best result possible. It is not uncommon for goal posts to move slightly once you have finished your treatment and to get a bit picky. In addition Marcos is a perfectionist and he often advises refinements that you may not mention in order to achieve the best result possible.

You are able to change your aligners every 7 days when in a refinement phase and we often try to do these phases without attachments wherever possible so treatment progresses quickly and easily.

Q.
How long has Marcos been placing invisalign?

Marcos has been placing invisalign for over 3 years and is regarded as one of the leading invisalign providers in the UK. He has worked on over 300 cases, many of these extremely complex cases. He has attained Platinum Elite status which is a reflection of his experience in the field on invisalign He is one of only 4 dentists to be featured on a leading invisalign website www.theinvisalignguide.co.uk.