Intended for healthcare professionals

Clinical Review ABC of oral health

Improving occlusion and orofacial aesthetics: tooth repair and replacement

BMJ 2000; 321 doi: (Published 12 August 2000) Cite this as: BMJ 2000;321:438
  1. Ken Hemmings,
  2. Brigitte Griffiths,
  3. John Hobkirk,
  4. Crispian Scully

    There have been tremendous advances in restorative dentistry, particularly with the development of adhesive materials to replace lost tooth structure and jaw implants on which to place prostheses securely.

    Patient with badly worn and spaced teeth (top) and appearance after restoration (bottom)

    Repair of teeth

    Individuals vary in tooth shade and shape, and teeth yellow with age. Teeth are damaged by caries, wear, failed restorations, trauma, and congenital and developmental defects. Patients usually demand treatment for pain, when appearance is compromised, or when there are occlusal problems (see previous article).

    Restorative dental care is indicated to treat pain, poor aesthetic appearance, and poor occlusal function


    Most older adults have had restorations (fillings), but, with the benefits of health education and fluoride, many younger people have unrestored teeth.

    Tooth damage by trauma (top) and appearance after restoration (bottom)

    Most restorations are placed to treat caries. The decay is removed mechanically, the cavity shaped to retain the filling, and material is packed into the cavity and then sets hard. Even high quality restorations have a finite life span. If the pulp is diseased, root canal treatment is necessary, which involves removing the pulp and cleansing and filling the chamber.


    Amalgam contains silver, copper, tin, and zinc mixed with mercury, and sets within a few minutes. Exposure to mercury vapour is hazardous. Mercury is neurotoxic, and even in people with low level chronic exposure, subtle preclinical effects on symptoms, mood, motor function, and cognition have been identified. Pregnant dental staff have special concerns related to any daily occupational exposure to mercury (or nitrous oxide).

    Dental amalgams and a composite restoration in molars to treat caries

    However, any risk to patients from dental amalgams is less clear. Twenty two million amalgams are placed annually in the United Kingdom, with no reliable evidence of associations with systemic disease, …

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