"Our objective should be the perpetual preservation of what remains rather than the meticulous reconstruction of what is lost"
-- Dr. Muller DeVaan, Prosthodontist
I heard this quote at a continuing education class recently and immediately wrote it down. As a dentist I spend most of my day trying to reconstruct teeth. Whether it is something simple like filling a cavity, or replacing a whole arch of teeth, I am constantly trying to restore patients' mouths to their natural state. I bold the word "restore", because almost everything we do in dentistry is to restore you to a previous state of function or aesthetics. Sometimes we attempt to improve on your existing state (i.e. orthodontics or cosmetic dentistry), but even that treatment is based on what teeth "should" be like. The quote above was someone who specialized as a Prosthodontist - in lay terms a "prosthetic dentist" - the specialty that made false teeth before implants were a viable option. They should be the experts in dental reconstruction, but this prosthodontist is reminding us that we can do the best dentistry in the world, and it will never be as good as the original. Dental implants are amazing. They are a tool that allows us to start with nothing and reconstruct an entire mouth's worth of teeth, but they will never be as good a teeth.
Saving teeth is always my first priority. There are many tools to achieve this:
Cleanings, both regular and deep (where we numb you and clean under the gums), and more importantly at home brushing and flossing!
Reconstruction of diseased tooth structure (i.e. a cavity) - fillings, crowns, inlays/onlays, etc.
Root canals to clean the infected nerve chamber
When saving teeth becomes impossible, unreasonable, impairs our ability to restore/reconstruct another area of the mouth, we begin to explore the options for replacing missing teeth (implants or a bridge). My wish for all of my patients first and foremost is that they never need an implant because they maintain all of their natural teeth in perfect condition. In agreement with Dr. DeVaan, my goal is the perpetual preservation of your natural teeth, rather than reconstruction of missing teeth.
Jonathan Geleris, DDS, FICOI
Disclaimer and disclosures: I'm a dentist who performs dental implant treatments, and general dentistry in Walnut Creek, California. I don't work for any dental companies (other than my practice). Nobody pays me to write this. As much as possible, I hope to present factual information supported by solid science, however, humans are complex, and the science in this field is constantly evolving. Some of what I present may be based on my opinion.