Treatments
What can be done about a tooth that is damaged, discoloured or missing?
Damaged teeth are usually rebuilt with bonded restorations or veneers, discoloured teeth whitened or resurfaced, and missing teeth replaced with a fibre bridge, conventional bridge, denture or implant. The right option depends on how much sound tooth remains.
What is the difference between restorative and aesthetic treatment?
Restorative treatment repairs a tooth that has lost structure — to decay, fracture, wear or an old filling that has failed. Its job is mechanical: rebuild the tooth so it can take chewing force again without splitting.
Aesthetic treatment changes how a tooth looks — its colour, shape, length or alignment — in a tooth that may be structurally sound. Whitening and veneers sit here.
In practice the two overlap constantly. A front tooth with a large discoloured filling needs both. Modern bonded materials mean the same restoration usually does both jobs at once, which is why the two are treated as one discipline rather than two departments.
How is a damaged tooth rebuilt?
The first question is how much healthy tooth is left. That decides everything else, and it is why an examination with radiographs comes before any quote or plan.
Where enough sound structure remains, the damaged tissue is removed selectively and the tooth is rebuilt with adhesive materials bonded directly to what is left. Nothing healthy has to be cut away to make room for the restoration, because the restoration holds on by bonding rather than by shape.
Where too little sound tooth remains for bonding to be reliable, a crown or an indirect restoration may genuinely be the better answer. A conservative approach means removing as little as the problem allows — not refusing to remove anything, and not pretending a badly broken tooth can be patched.
If you have been told a tooth needs a crown and want to know whether something less destructive would work, ask for a second opinion with radiographs. That question has a specific answer for your tooth, not a general one.
What are the options for replacing a missing tooth?
There are four broad routes, and they differ mainly in how much they ask of the teeth around the gap.
- Fibre-reinforced bridge — a replacement tooth bonded to the neighbouring teeth using woven Ribbond fibre. Only a shallow retention groove is cut; the neighbouring teeth are not crowned.
- Traditional bridge — the two teeth either side are reshaped and crowned, and those crowns carry a false tooth between them. Well proven, but it commits two teeth.
- Denture — a removable acrylic or chrome-framework replacement. Suits multiple missing teeth and does not require surgery.
- Implant — a titanium post placed in the jawbone to carry a crown. It stands alone and does not involve the neighbouring teeth, but needs adequate bone and several months of healing.
What can be done about the colour or shape of a tooth?
Discolouration that sits within the tooth substance often responds to professional whitening, which lightens the existing tooth without removing any of it. It is the least invasive option available and the sensible first thing to try.
Where the shape is wrong, the tooth is worn or chipped, or the discolouration is a stain that whitening cannot reach, composite bonding can reshape the tooth directly in the chair. Veneers — thin facings bonded to the front surface — address the same problems where a larger change is wanted.
The order matters. Whitening is usually done before any bonded or ceramic work, because bonded materials and ceramics do not change colour with whitening gel. Restorations placed first would end up darker than the teeth around them.
How is the right option chosen?
By working out what the tooth and the surrounding bone can actually support, then choosing the least destructive option that will hold.
The assessment covers how much sound tooth structure remains, whether the neighbouring teeth are healthy or already heavily restored, how you bite and whether you grind, the condition of the gums and bone, and what you want the result to do — chew reliably, look right at conversational distance, or both.
A dental professional who reaches for the same treatment regardless of the answers to those questions is not planning; they are defaulting. Expect the reasoning to be explained, and expect to be told when a cheaper or simpler option would serve you equally well.
What drives the cost of restorative treatment?
Chair time, laboratory involvement and materials, in roughly that order. A directly bonded restoration built in the chair carries no laboratory fee. A bridge, denture or implant crown is made by a technician and that work is a real and separate cost.
The number of teeth involved matters more than most people expect. Replacing one missing tooth and replacing three are not proportionally priced, because the design of the restoration changes.
Medical aid dental benefits vary widely between plans, and many limit the number of restorations or units covered in a benefit year. Bring your plan details to the consultation so what is claimable can be checked before treatment starts rather than after.
An accurate quote needs an examination. Cost depends on findings that cannot be assessed without radiographs, so any figure given before that is a guess.
Common questions
Can a discoloured front tooth be fixed without a veneer?
Often, yes. Whitening, internal bleaching of a root-treated tooth, or direct composite bonding can each address discolouration without the tooth reduction a veneer usually involves. Which applies depends on why the tooth is discoloured, so it needs to be examined.
How long do restorations last?
There is no fixed lifespan. Longevity depends on how much sound tooth remained, the size of the restoration, your bite, whether you grind your teeth, and your oral hygiene. No restoration is permanent, and all of them are eventually replaced.
Does medical aid cover aesthetic treatment?
Restorative work is often partly covered; purely cosmetic work usually is not. The line between the two is drawn by your plan, not by the practice. Check your benefit schedule, and ask for treatment codes in advance so you can confirm with your scheme.
Should whitening be done before or after other work?
Before. Whitening gel lightens natural tooth structure but has no effect on composite, ceramic or crowns. If restorations are placed first and the teeth are whitened afterwards, the restorations will no longer match and may need replacing.
Can several treatments be combined in one plan?
Yes, and often they should be, because the sequence affects the result. Whitening, then restorative work, then any replacement of missing teeth is a common order. A written plan setting out the stages is reasonable to ask for before starting.