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Treatment

Prosthetic treatment

Prosthetic treatment Prosthetic treatment

Tooth tissue restoration with crowns

If the natural tooth is only slightly damaged, it can be renewed with different filling materials. But often there are cases where a tooth is badly sealed or part of the crown has broken off completely. In these cases the natural tooth tissue the remains is very small or none at all. To restore a tooth in these situations we use artificial crowns.
When applying an artificial crown, the natural tooth tissue is polished of approximately 1.5 - 2 mm. After polishing the doctor takes an impression and sends it to the dental laboratory where the artificial crown is made; the doctor then cements the crown onto the polished tooth. To make an artificial crown a patient requires several visits, therefore usually temporary crowns are made so the patient throughout the treatment can smile, eat, and also to protect the polished tooth from sensitivity.
Artificial crowns can be made of different materials:

  • Plastic or composite material. These are the simplest and least costly crowns. They tend to crack quickly and change colour. These crowns are often used as a temporary option because they are precisely made but have a high degree of wear.
  • Metal composite or metal acrylate. These crowns are the same as plastic or composite crowns except that the inside of the crown is covered with a thin metal layer to increase its strength; the outside of the crown is made of composite – a light-coloured material similar to the natural tooth colour.
  • Cast metal. These crowns are durable, but their main drawback is the metallic lustre, which reduces the aesthetic qualities, therefore they are commonly used for side-tooth restoration.
  • Metal ceramic. Inside the crown is a thin metal layer that is coated with light-coloured porcelain (ceramic). This is one of the most common crown restoration methods due to its aesthetically high quality and the renewed strength of the crown.
  • Pure porcelain (pressed porcelain). This method provides the highest attainable standard aesthetically. A porcelain crown is virtually indistinguishable from natural teeth, as similar to natural teeth it lets light pass through. The disadvantage is lower crown strength.
  • Zirconium oxide. To solve pure porcelain crown low-strength issues, a computerized mill makes aluminium oxide or zirconium crown frames to which a porcelain coating is applied. These crowns provide the same high-quality aesthetic result as porcelain crowns, while also ensuring great strength, as zirconium oxide carcass strength is equivalent to the metal strength, but the aesthetic result is much better due to zirconia’s light transmission. This is the most expensive restoration method, but at the same time provides the highest aesthetic results and sustainability of the crown.

Teeth surface restoration with porcelain plates

This is a very aesthetic and tooth tissue considerate restoration. A porcelain plate is a thin ceramic layer which coats the tooth surface to improve tooth colour, shape, size, position, etc.
Porcelain plates (veneers) are made if:

  • The tooth is sealed from the visible side,
  • The tooth has changed colour,
  • The tooth has visible pigmentation defects,
  • The tooth has lost its natural form,
  • Tooth gaps between incisors and other teeth are enhanced,
  • Teeth are uneven, etc.

When applying veneers approximately 0.5 mm of tooth tissue is polished from the outer (visible) tooth surface. After polishing, the doctor takes an impression and sends it to a laboratory where various types of porcelain plates are made. Between fitting visits the patient receives a temporary plate. The prepared veneers are fixed to the tooth surface with particularly resistant cements. Porcelain plates are usually made for incisors. The transparency of a porcelain plate successfully imitates the natural tooth enamel and can be likened to the necessary/existing tooth colour. Porcelain plates do not discolour, and nicotine, tea, and other external factors do not cause spots. In terms of price, porcelain plates are comparable to the price of zirconia and ceramic crowns.

Replacement of missing teeth with non-removable prosthesis

In the absence of one or more teeth you need to replace them with artificial teeth as soon as possible. This is desirable both for aesthetic reasons and for greater efficiency of mastication, as well as due to the fact that teeth do not always stay in one place – the teeth closer to the lost tooth area can begin to move, as well as teeth of the opposite jaw can sink into the free space. Such tooth movement sometimes leads to bite deformations.
Non-removable constructions are the most convenient to replace a patient’s missing teeth. This means that the restoration, after emplacement in the mouth, remains there at all times - it cannot be removed by the patient and it does not move. Patients feel psychologically comfortable and secure, as well as a restoration of this size is similar to natural teeth placement. This is essential because one of the most important tasks of the dental prosthetist is to create a replacement structure as similar to the natural teeth as possible, because any "excess" often causes discomfort to the patient.
There are several types of non-removable structures:

  • Bridge – a type of denture to be applied when a patient is missing one or more of the adjacent teeth. A dental bridge is a prosthesis that locks to the patient's healthy teeth, replacing the missing teeth. For placement of a bridge a natural tooth is polished. The bridges are manufactured in a dental laboratory. A plus of this restoration is that it is non-removable, a minus – the polishing of natural teeth. Bridges, like crowns, can be made of plastic, cast metal, metal composite, metal ceramic, and zirconium oxide.
  • Implant – this might be called an artificial tooth root. An implant is made from heavy-duty materials - titanium alloys, etc. The implant is in the shape of a screw; under anaesthesia it is screwed into the jawbone. Depending on the situation it Osseointegrates (grows into) the bone in 3-8 months. After this time the implant can be used as a support for the next structure – a crown, which can be made of the above-mentioned materials. Usually crowns are made of metal ceramic and porcelain. The implant-based design is an optimal restoration option, as it does not affect and harass existing natural teeth (this system functions independently), as well as the implant in a number of situations is the only way to avoid removable structures.

Replacement of missing teeth with removable partial dentures

Missing teeth can also be replaced with removable structures.
Removable dentures are made for patients with some missing teeth, which for some reason cannot be reconstructed with non-removable structures. This means that the artificial teeth are not firmly locked in the mouth, but are removable for hygienic procedures and must be replaced afterward. This is done by the patient at home.
Removable dentures, compared with non-removable structures, are much cheaper. The main downside of this kind of a denture is a comparative psychological discomfort due to a foreign body sensation in the mouth, as well as the instability of the dentures. The aesthetic aspect must also be mentioned as one of the drawbacks, namely, when the patient is smiling one can often see the design of the removable clamps that surround the natural teeth, which ensure their stability.
A modern solution for a denture clamp bridge is an attachment (key) system. When using an attachment system the removable dentures are held to the natural teeth without an externally visible clamp – the entire linking mechanism is hidden. It should be noted that the attachment system greatly increases the cost of removable denture construction.
Removable dentures are made of:

  • Plastic,
  • Metal and plastic combined.

Full teeth replacement (total denture)

A total removable denture is used when there are no remaining teeth in the patient's maxilla and/or mandible.
This denture is made of a composite material and replaces the lost teeth. The denture inside the patient's mouth holds on to soft tissue (gums) and hard tissue (jaw bone).
The total denture is not firmly fixed in the mouth and should be removed for daily hygiene procedures.

To get a total removable denture the patient needs at least six visits to the dental prosthetist:

  • 1st visit. Initial consultation and jaw and teeth impression made to obtain the general form (generatrix) for manufacture. Generatrix will be used to manufacture a special individual "impression spoon".
  • 2nd visit. Using the individual "impression spoon" a patient's functional teeth and jaw imprint is taken. This imprint helps the dental prosthetist to understand the range of motion of the patient's mouth. Based on the impression, the dental technical laboratory prepares a special wax base that during the next visit will be used to determine the patient's bite specifics.
  • 3rd visit. Defining the patient's bite specifics. The result is sent to the laboratory, where based on the information gathered artificial teeth are fixed in the wax base matching the patient's bite characteristics. The result is sent to the dental laboratory for making the final denture.
  • 5th visit. The final denture is fitted and minor adjustments are made if necessary. After the procedure the next follow-up visit is set.
  • 6th visit. The obtained result is assessed through a discussion with the patient; it is important to assess if the denture puts too much pressure on a particular area, isn’t too loose, etc.

The patient should note that after the loss of the teeth, the jawbone has a tendency to "retreat" therefore a precisely manufactured total denture, after a certain time, may become unstable causing discomfort. In this case the denture can be secured using implants that provide more stability and reduce discomfort, because the denture will hold on to not only the patient's soft and hard tissue, but also on to the implants.

Restoration of partial tooth crown damage with inlays and onlays

Laboratory made inlay and onlay fillings can be used if the natural tooth has lost relatively little tissue.
Inlays are good for restoration when at least one healthy natural tooth cusp has remained, while onlays completely cover the biting surface.
The doctor takes an impression of the tooth prepared for restoration, and an inlay or onlay is made at the laboratory; the prepared inlay or onlay is then cemented into place.
Inlays and onlays can be made of composite, porcelain and various metal alloys - such as gold alloy.

Restoration of complicated bite (occlusion) defects

If replacing missing teeth is a very complicated process it may be necessary to have the process done by a dental prosthetist, as well as a number of other specialist services.

For root canal treatment a visit to an endodontist may be necessary, for gum health improvement – a periodontist, for bite correction – an orthodontist, for implant insertion – a surgeon, and for plaque removal – an hygienist.

In these complicated cases each specialist working at our clinic does a particular job or procedure to achieve the best possible overall outcome with great aesthetic and functional results, ensuring the patient the highest psychological comfort of the results achieved.

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