Prosthodontics deals with the reconstruction of badly damaged teeth and complementation of lost teeth due to decay, pulp disease or injury. Most of the dental complements are performed to reproduce the shape, function and aesthetics of teeth which were treated conservatively before. Creation of fillings in indirect method, what means in the dental laboratory, allows for excellent reproduction of occlusion between the teeth and the contact points.
Depending on the extent of lost tissues we have: crowns, bridges, dentures, implants.
They are a popular form of treatment for broken or damaged teeth. Crowns are kind of teeth replacements and they look exactly like natural teeth. Sometimes it is difficult to judge whether somebody has his own teeth or crowns. In addition to the aesthetic role, crowns also restore chewing function.
What is a crown?
It is an artificial tooth, which is produced from a variety of materials and has a similar shape and color to the natural tooth. All-ceramic dental crowns (without metal) are by far the most popular nowadays. They are completely biocompatible and not harmful to other tissues. Any work done in the CAD / CAM system which is based on 3D construction, shows excellent precision, tightness and durability, has full documentation and the company offers a 5-year warranty on their work. Biomechanics of these materials allows making an individual crown, extensive bridges and aesthetic reconstructions on implants. Ceramic crowns are considered better than other crowns; there is no porcelain fused to metal. Plus- they have a natural look and match better with real teeth.
The advantages of aesthetic crowns
There are many benefits of having a crown, which include repairs of the damaged or broken teeth due to an accident or injury, hides the results of teeth grinding (bruxism), strengthens teeth after root canal treatment, strengthens teeth destroyed by teeth decay. Crowns function for about 15 years.
Dental crown procedure
There are usually two stages: The first visit is the preparation (shaping) of the tooth or teeth under local anesthesia, taking the impression and placing a temporary crown. The second step is cementing the porcelain crown into place. Taking care of the aesthetics of the works for our patients, we often perform them directly with the patient and dental technician.This procedure eliminates any imperfections and allows preparing works which are identical to the natural teeth or those that the patient dreamed of, especially when we provide complex aesthetics corrections. Dental crown procedure takes 4-5 days.
Porcelain-fused-to-metal crowns (“PFM”)
It is the cheaper alternative, but rather dedicated to back teeth. The problem is that the metal base is slightly visible. Especially with age when the gums cut back. For this reason many patients decide to exchange these crowns for all-ceramic restorations. Gold crowns (and metal ones in general) are not a very popular choice among patients, however, if the conditions for reconstruction require it, then such crowns are recommended to the patient.
Prosthetic bridges allow for the reconstruction of missing teeth by using patient's remaining teeth. Natural teeth that have been located under the prosthetic bridge are called abutment teeth. The prosthetic crowns are placed over the abutment teeth and the missing teeth between the abutments teeth are filled with a span fixed between the crowns of the abutment teeth, hence the name prosthetic bridge. Prosthetic bridges are kind of fixed restorations i.e. those that are permanently anchored to the natural teeth in the mouth- after they are cemented by the dentist, the patient cannot remove them by himself. Prosthetic bridges move chewing force in a physiological manner, on the periodontium of abutments, what makes them easy to be accepted and they provide also a great comfort. As we do not feel the difference while biting using teeth with fillings, in the same way we can bite with comfort using prosthetic bridges. Prosthetic bridges are permanently fixed, which also makes them easier to be accepted and improves the comfort for users. Prosthetic bridges are aesthetic additions (they are made with usage of porcelain crowns or all-ceramic crowns).Properly made bridge does not stand out during the smile.
Due to the above advantages prosthetic bridges are an excellent alternative to dentures (removable) wherever their execution is possible (there should be the right quantity and quality of abutment teeth as well as the correct location of them). For this reason, prosthetic bridges are made only for the reconstruction of the interdental gaps, because only in such case there are mutually available abutment teeth. In the case of deficiency of the wingers (e.g., when the teeth arch ends earlier, for example on premolars) prosthetic bridges cannot be used. In this situation, removable dentures or implants should be used.
A separate group of prosthetic bridges are bridges based on implants. In such case implants are having a function of abutment teeth. Extent of prosthetic bridges is given in the form of a number of points. The point in the bridge is one prosthetic crown, both pillar (established on the abutment tooth) as well as rebuilt (in the span of the bridge). For example, bridge rebuilding one tooth will have three points (two pillar crowns and one in the span) and bridge rebuilding two missing teeth – accordingly four points (two pillar crowns and two in the span). There is also a possibility to make longer bridges which are connected with more abutments.
Disadvantages of prosthetic bridges
The disadvantages include the requirement of grinding and crowning the abutments. This drawback is offset by the circumstances in which the abutment teeth no matter what were intended to be crowned because of other indications (see indications for prosthetic crowns). Then, by the way, prosthetic crowns planned to rebuild the missing tooth or teeth as prosthetic bridge are used.
Another disadvantage of prosthetic bridge is common to all dental restorations with the exception of the implants. It is the disappearance of the appendix marrow under the bridge span so in a place deprived of direct stimulation of the chewing forces. Bone, like any living body, requires stimulation and when there is a lack of stimulation, it gradually fades. It is a natural feature of a living organism. Under natural conditions the bone stimulation is provided by the forces acting on the tooth and transmitted through its root. Lost of a tooth means the lack of stimulation in the area. Accordingly, it comes to the bone loss under the movable fillings and spans of the bridges. Only implants are deprived of this drawback as they are inserted directly into the bone. As a result, implants transmit chewing forces directly to the bone stimulating it in a natural way and preventing from atrophy.
If the patient has retained residual dentition and single teeth or roots, then overdenture prosthesis can be performed without any obstacles. It is a great solution if there are some obstacles to the execution of implantation process. The use of non-clamps dentures is to use very precise coupling elements to the natural teeth. Because clamps in no way are seen from the labial side, they are one of the favorite solutions chosen by our patients. Keep in mind, however, that the possibility of its application depends on the natural conditions in the mouth.
Dental implants are making a stunning career nowadays.