DIRECT RESTORATIONS   

           Direct restorations (fillings) are so called because they are accomplished entirely chair side in the mouth. Examples of this type of restoration are composite (bonded) or amalgam (silver) fillings. These are different from an indirect restoration where a provisional restoration of some kind is needed while the definitive one is being fabricated at a dental laboratory. Examples of indirect restorations would include crowns (caps), bridgework and inlay/onlays. Inlay/onlays are the indirect equivalent of fillings. They are used when patients wish to have the chewing surfaces of their back teeth, that do not need crowning, restored with tooth colored materials. Direct restorations are normally placed after the removal of decay from a tooth that has never or just moderately been filled before. An indirect restoration, such as a crown, is usually needed when an extensively filled tooth exhibits recurrent decay or fractures and often when the tooth in question will anchor a partial denture.

1. After the decay has been removed and before the restoration is completed, Dr. McArdle places an insulator in the tooth to protect the tooth from temperature sensitivity. If the filling is extensive, temperature sensitivity may still occur and take days or weeks to subside as the nerve in the tooth becomes used to a new neighbor conducting outside temperatures inward. The nerve in a tooth, normally surrounded by hard tooth structure only, is accustomed to body temperature alone. It becomes stimulated when subjected to temperatures more than ten or so degrees away from body temperature. The only sensation that a nerve in a tooth responds with when stimulated, in varying degrees, is pain. Just cold sensitivity is usually not a cause for concern unless it is particularly severe or lingers after the source of the cold, such as a drink, is gone. Cold and hot sensitivity in equal amounts is similarly not a concern. However, if you experience greater sensitivity to hot than cold or if you experience extreme hot sensitivity that is relieved by cold, this may indicate inflammation of the nerve. If this occurs, call Dr. McArdle immediately.
   
2. Dr. McArdle checks your occlusion (bite) with articulating paper after the restoration is finished to make sure that your natural bite has not been altered by the new filling. You should not eat any solid food for at least half an hour after a filling has been placed and preferably not until after any numbness has subsided. Some patients, when they have been numbed with Novocain for the procedure, do not come together into their normal bite when Dr. McArdle performs this check because they cannot feel a portion of their mouths. This may prevent Dr. McArdle from detecting any alterations of your bite when he checks it. If, after the numbness wears off, you notice that the tooth which was restored hits first ("feels high") when you bite together, call Dr. McArdle so he can adjust it. This is important because a premature contact (as the filled tooth hits first when you bite together) can cause pain on chewing or biting together as well as temperature sensitivity if not corrected. brush and floss directly restored teeth as usual.
   
3. Sometimes, when you are numbed to have a restoration placed on the lower arch, half of your tongue will become numb. This can make it very difficult to feel your teeth with your tongue. If, after a filling has been placed and the Novocain wears off, you notice any roughness or a sharp edge that annoys you, call Dr. McArdle so he can smooth it for you. This is generally a simple matter, like adjusting a premature contact, that takes only a minute or two to rectify.

The 2 marks on this new silver amalgam filling indicate "high"

spots that need to be adjusted or the tooth will be sensitive.

INDIRECT RESTORATIONS
           An indirect restoration, such as a crown, entails first preparation of the tooth and then placement of a provisional crown after an impression of the prepared tooth has been taken. The impression is then sent to a dental laboratory where it is poured in stone to create a model on which the definitive crown is made. When the definitive crown returns to this office from the laboratory, you will be called to schedule an appointment where the provisional crown is removed and the definitive one is inserted.

1. Temperature sensitivity, as described earlier, is much less common with permanent indirect restorations, such as crowns or bridgework. This is because tooth preparation is ordinarily not as deep and the margins of these restorations are frequently under the gum line where cold sources cannot reach. Such sensitivity can occur more often with provisional crowns or bridges if they are worn too long and the temporary cement holding them in place begins to dissolve. For these and other reasons, it is imperative that the insertion of your definitive indirect restoration be done as soon after your first visit as practical. The cement used to secure definitive indirect restorations is substantially stronger than provisional cement and insulates better as well. As stated previously, inlay/onlays are the indirect equivalent of fillings and so teeth restored with them are somewhat more likely to be temperature sensitive than with other definitive indirect restorations.
   
2. Sections 2 and 3 under the previous heading can apply to provisional and definitive indirect restorations as well. However, Novocain is rarely needed for the insertion of definitive indirect restorations, so patients generally can judge well the bite's accuracy and the restoration's smoothness before they leave the office after that appointment. Do not eat any solid food for at least half an hour after insertion.
   
3. When you wear a provisional indirect restoration (crown, bridge or inlay/onlay), there are a few simple rules to follow. Do not eat any hard or sticky foods such as nuts or taffy. Provisional materials are not nearly as strong as their permanent counterparts and can fracture or loosen much more easily. When flossing, after sawing the floss through the contact point between teeth, draw it out sideways instead of pulling it back through the contact point. Doing the latter may dislodge a provisional indirect restoration. Be sure not to eat any solid food for at least half an hour after a provisional indirect restoration is placed and preferably not before any numbness has resolved. Remember that often the finish lines (margins) of a crown or bridge are located beneath the gum line, so the gum around teeth prepared for either may be sore for a few days. Take ibuprofen (Advil) or acetaminophen (Tylenol) for this soreness. It is not usually encountered with inlay/onlays. These precautions are needed for provisional indirect restorations only.
   
4. Caring for indirectly restored teeth at home is the same as for other teeth with one exception for bridgework. Brush and floss crowned or inlay/onlayed teeth as usual. When flossing underneath the pontic (replacement tooth) of a bridge between the anchor teeth, you must use a floss threader. You will be instructed in its use when the temporary bridge is placed. Floss normally on either side of a bridge. You must use a floss threader nightly for both the provisional and definitive bridges to avoid problems with decay and gum disease occurring around the bridge.