What does restorative dentistry involve?

The definition, and the sequence

Restorative dentistry involves the diagnosis and management of the oral environment, to rehabilitate health, function and aesthetics.

It encompasses every avenue of dentistry — general dentistry, cosmetic dentistry, periodontics, endodontics, prosthodontics and oral surgery.

Those three words in the definition — health, function, aesthetics — are not a list. They are the order of work, and the rest of this article follows it. If you want the catalogue of restorations rather than the sequence, what does restorative dentistry mean? sets out each option and what it costs you in tooth structure.

You start with a general dental practitioner, who formulates a treatment plan to work towards the desired outcome. Understanding your treatment covers how those plans are presented, and complex dentistry explains when the plan is coordinated across several specialists rather than delivered by one clinician.

Stage 1: health

The health of the teeth, supporting structures and soft tissues is fundamental to the restorative process.

Gum disease, decay and dental abscesses must be addressed first.

This is the stage patients most want to skip, and the one that determines whether everything after it lasts. A crown placed on an infected tooth, or a bridge anchored in diseased bone, fails — and it fails after you have paid for it.

There is independent evidence behind that ordering rather than just clinical preference. A long-term study of root-canal-treated teeth followed in private practice for up to 37 years found that the most significant prognostic factors associated with tooth extraction were the presence of deep (greater than 6 mm) periodontal pockets, the presence of pre-operative apical radiolucency, and the lack of occlusal protection (Long-term tooth survival and success following primary root canal treatment, Clinical Oral Investigations, via PMC). In other words: untreated gum disease, untreated infection and an unprotected bite are what take these teeth out — not the quality of the porcelain sitting on top.

Gum disease

If your dentist diagnoses gum disease, they may recommend a dental hygienist or a periodontist, depending on severity. What is gum disease? describes the early, reversible stage; what is periodontal disease? covers the point past which bone loss does not come back. Bleeding gums is usually the first sign anybody notices.

It is also common enough that it is worth screening for before any large plan. A review in Diabetologia reports that severe periodontitis, of the kind that threatens tooth retention, affects 10 to 15 per cent of adults in most populations studied, and that moderate periodontitis is more common again at 40 to 60 per cent. Those are international figures rather than Australian ones, but they are the reason a periodontal assessment comes before, not after, the restorative plan.

Decay and damaged teeth

Fillings may be needed to remove decay, or to restore cracked or broken teeth.

Many filling materials are used — amalgam, composite resin, ceramic (CEREC) and gold. Your dentist will discuss which is best suited to your needs, which depends largely on the size and position of the restoration and the forces it will carry. Porcelain, amalgam or composite resin? walks through that comparison, and the differences and costs puts figures beside it.

Whether a filling is needed at all is a fair question at the margins — can you reverse tooth decay? sets out where remineralisation stops being an option.

Abscesses

If a dental abscess is present, the tooth may need root canal treatment or removal.

You may be referred to an endodontist for root canal treatment, or an oral surgeon for extraction. What is a tooth abscess? explains how the decision is made, and can a dental abscess affect your general health? is the reason it is not something to sit on. If it is hurting now, emergency dentistry is the route in.

Stage 2: function

Restoring function is the next stage.

Weak teeth may require a crown, to make the tooth fit for purpose and eliminate the risk of it breaking. What types of dental crown are available? covers the material choice.

The same long-term endodontic literature is unusually direct about why this stage is not cosmetic. A systematic review summarised in that study identified the quality of the coronal restoration as one of the most significant post-operative prognostic factors for endodontic success, and the lack of a crown restoration after root canal treatment as one of the most significant factors for failure. The restoration is not the finishing touch on the root canal treatment; it is part of whether the root canal treatment holds.

Missing teeth can be replaced with a bridge, implants or a denture. Bridges, implants or dentures compares all three on cost, invasiveness and lifespan; implant versus bridge for a single tooth narrows it to the most common decision.

Orthodontic treatment moves misaligned teeth into a more favourable position.

Orthodontics sits in the function stage rather than the cosmetic one for a reason. Moving teeth before restoring them often means less tooth structure has to be removed — a tooth in the right position needs less correction from the restoration sitting on it. That is worth raising early, because it changes the whole plan: braces and Invisalign both take months, and retrofitting them after the crowns are made is not practical.

If you grind, say so at this stage rather than after the porcelain is in — TMD and teeth grinding explains why the load matters to what is chosen, and night time tooth grinding and clenching covers what can be done about it.

Stage 3: aesthetics

Finally, restorative dentistry addresses aesthetic concerns.

It may be as simple as whitening, done either in the surgery (using Zoom, for example) or at home with a tray system (such as Pola White). The difference between in-chair and take-home whitening explains how to choose between them.

Your dentist may recommend porcelain veneers or crowns to achieve the appearance you are after. Composite bonding is the less invasive alternative where the change needed is small.

Whitening comes before veneers and crowns in this stage, not after. Ceramic restorations do not whiten — they are matched to the shade of your teeth at the time they are made. Whitening afterwards leaves them looking dark against the natural teeth. I want to whiten my teeth but one of my front teeth has a porcelain crown sets out what it costs to unwind that, which is the best argument for getting the order right first time.

A mock-up before any irreversible preparation lets you see the proposed result while you can still change your mind, and I want a smile makeover — where should I start? works through the whole sequence from the patient's side.

Afterwards

Restorative dentistry is an interactive management of the oral environment, coordinated by your dentist.

Once the treatment plan is completed, maintain regular check-ups every 6 to 12 months.

That is not a formality at the end of a large investment. Restorations have finite lifespans and defined failure modes — margins that leak, cement that washes out, bites that shift. Most of those are cheap to correct when found early and expensive when found late, which is exactly the pattern that brought you to restorative treatment in the first place. How long do dental fillings last? and how long do porcelain veneers last? give realistic figures to plan around.

It is worth knowing what that maintenance buys. In the 37-year study cited above, cumulative survival of root-canal-treated teeth was 97 per cent at 10 years, 81 per cent at 20, 76 per cent at 30 and 68 per cent at 37 years, with the corresponding success rates 93, 85, 81 and 81 per cent. Those patients were in a recall programme of at least one visit a year, which is the condition the figures came with rather than an incidental detail. The same study identified the use of a night guard as a protective factor — one more reason to raise grinding early rather than late.

Cost and sequencing

A staged plan spreads across months, and so does the cost. Published fees are in the price guide. Payment plan options are available. Where a plan is advertised as interest free, that describes the plan term only — a deposit may be required, an establishment fee and ongoing account fees may apply, and charges can apply if the balance is not cleared within the agreed period. The applicable terms depend on the provider and the amount financed, and are set out in writing before you commit — ask what the deposit and the establishment fee are, in dollars, and what the total will be by the end. Payment Plans.

If a plan proposed elsewhere does not sit right, or the sequence above was not followed, a second opinion is a reasonable step.

Common questions

Is "restorative dentistry" a dental specialty?

No, and it is worth knowing why, because the word is used loosely in dental advertising. The Dental Board of Australia states that "there are 13 dental specialties in Australia which are approved by the Australian Health Workforce Ministerial Council". They are dento-maxillofacial radiology, endodontics, forensic odontology, oral and maxillofacial surgery, oral medicine, oral and maxillofacial pathology, oral surgery, orthodontics, paediatric dentistry, periodontics, prosthodontics, public health dentistry (community dentistry) and special needs dentistry.

Restorative dentistry is not on that list, and neither is cosmetic dentistry. Both describe a field of work rather than a registration category. Several of the recognised specialties do sit inside a restorative plan — endodontics, periodontics, prosthodontics, orthodontics and oral surgery among them — which is why a complex plan may involve more than one clinician.

The register is the check, not the wording on a website. To hold specialist registration a dentist must already hold general registration, must have "completed a minimum of two years general dental practice", and must meet the Board's specialist registration standard. Anyone can look a practitioner up on AHPRA's public register and see the division and any specialty recorded against their name. Our own registered specialists are identified as such within the full team.

Do I really have to do it in that order? I only want the front teeth fixed.

You can always decline treatment, and a plan should be explained well enough that declining is an informed choice rather than a guess. But the order is not an upsell, and the long-term data explains why. In the 37-year study of root-canal-treated teeth cited above, the factors most strongly associated with a tooth eventually being extracted were deep periodontal pockets of more than 6 mm, a pre-existing radiolucency at the root tip, and the absence of occlusal protection. All three are stage-one and stage-two problems. None of them is visible in a photograph of the front teeth.

The practical consequence is that cosmetic work done over unresolved disease tends to be paid for twice. If cost or time is the reason for wanting to skip ahead, the more useful conversation is which items are stabilising the mouth and which are elective — ask for the plan to be split that way, in writing, and deal with the first group first.

Why is the quote so different from one I was given elsewhere?

Because Australia has no government-set schedule of dental fees, and practices set their own. The Australian Dental Association's own fee survey, drawn from 3,819 responses from dentists in private practice as at 1 July 2022, found "considerable variation in the fees charged within and between states" — variation within a state, not only between them. Across the 122 items surveyed, average general-practitioner fees had risen 3.7% over the preceding two years, with the smallest rises in preventive services and periodontics (1.6%) and the largest in orthodontics (6.9%).

So a difference between two quotes is not by itself evidence that one is wrong. What makes two quotes comparable is the item numbers: ask for the plan itemised, and check whether the two plans actually contain the same procedures on the same teeth. A cheaper quote that proposes a filling where another proposes a crown is not a discount, it is a different treatment. Understanding your treatment covers what you are entitled to be told before you agree, and the price guide lists published fees here.

How many x-rays will this involve, and is that a lot of radiation?

A staged plan usually needs more imaging than a check-up does, because the stage-one assessment has to see bone levels and root tips that cannot be seen by looking. The doses involved are small. The International Atomic Energy Agency gives typical effective doses as 1 to 8 microsieverts for an intraoral dental x-ray, 4 to 30 microsieverts for a panoramic examination, and 50 microsieverts or below for cone-beam CT with a small or medium scanning volume (100 microsieverts for large volumes). The IAEA notes that intraoral doses are "usually less than one day of natural background radiation", and that panoramic doses even at the high end are comparable to a chest radiograph.

The principle that matters more than the numbers is justification: each image should be taken because it will change a decision. You are entitled to ask what a particular film is for and what it will show that is not already known. How safe are dental X-rays? covers the question in full, including pregnancy and children.

Practical details

Written by Dr Madeleine Hoopmann. The full clinical team and the registered specialists are listed by name.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495.

Published 1 December 2018. Suitability, results and longevity vary between individuals; all treatment carries risks that should be discussed with your clinician. Survival and success figures quoted are from published studies of other patient groups and are not a prediction for any individual tooth. Figures attributed to the Dental Board of Australia, the Australian Dental Association and the International Atomic Energy Agency are drawn from those published sources. General information only; it does not replace advice from your treating practitioner. Payment plan terms are set by the credit provider and change; confirm current terms directly before you commit.

Smile Solutions trades under ABN 28 193 514 103.