Prosthetics

Prosthodontics is a field of dentistry that involves:

• replacing missing teeth,
• rebuilding damaged hard tissue of individual teeth,
• improving the aesthetics of our smile by changing the shape, colour and position of teeth and removing permanent discolouration,
• restoring the proper function of the masticatory system.

Consequences of not replacing missing teeth

Consequences of not filling gaps in the dentition:

• development of malocclusion
  • shifting and tilting of adjacent teeth towards the missing tooth due to lack of support,
  • so-called passive eruption, i.e. gradual protrusion of the opposing tooth from the tooth socket;
  • bone tissue loss in the place of the lost tooth, resulting in the face acquiring senile features, such as:
    • shortening of the lower part of the face,
    • sagging of the lips,
    • formation of wrinkles around the mouth.

Fig. Aesthetic defects caused by missing teeth.

In the case of more extensive tooth loss, the following occurs:

• disorders in the temporomandibular joints,
• pain in the facial muscles and head in the temple area,
• premature formation of deep wrinkles,
• facial deformities characteristic of old age, shortening of the lower part of the face,
• gastrointestinal disorders.

The degree of change depends on the age and location of the lost teeth.

Choice and types of prosthetic restorations

The choice of prosthetic restoration depends on the patient and their:

• individual needs and expectations,
• general health,
• condition of the remaining teeth,
• occlusal conditions,
• the cause and number of lost teeth,
• the condition of the bone and periodontium,
• age,
• oral hygiene habits.

In the case of significant loss of hard tissue in lateral teeth (extensive caries, teeth after root canal treatment), their resistance to chewing forces is significantly reduced. As a result, the tooth wall may fracture or even the entire tooth may crack along with the root, leading to its loss.

An INLAY/ONLAY restoration allows the remaining hard tooth tissue (which is lost during preparation for a prosthetic crown) to be preserved, while restoring the function and aesthetics of our teeth.

After cleaning the caries and properly preparing the tooth, we take an impression with a plastic mass, on the basis of which a technician casts a model in the prosthetic laboratory and makes an Inlay/Onlay filling. At the ARTIMEDICA Centre, we most often use Inlays and Onlays made of composite material with ceramic filler.

After appropriate preparation in the laboratory, it acquires properties similar to those of hard tooth tissue. We obtain a finished restoration with:

• maximum hardness and abrasion similar to tooth tissue,
• accurately reconstructed tooth anatomy (cusps and fissures),
• perfectly reconstructed contact points, so important for the protection of gingival papillae located in the interdental spaces,
• eliminated polymerisation shrinkage of the material, which means increased tightness of the filling.

Inlay/Onlay fillings can also be made of gold alloys, porcelain or a combination of gold and ceramics. They are indicated for use in cases requiring specific properties, for example:

• high abrasion resistance in the case of ceramic crown inlays,
• bacteriostatic properties of crown inlays made of gold.

The root portion of the implant is cemented into the root canal, while the crown portion serves as a pillar for rebuilding lost tooth tissue.

These can be metal inserts (made of base metal alloys or gold alloys), ceramic inserts and fibreglass inserts.

The type of crown-root inlay used in a specific case is determined by the doctor on the basis of clinical and radiological examination.

A crown is a prosthetic restoration in the shape of a “cap” that is permanently cemented onto a prepared tooth. This may be a living tooth weakened by a large number of fillings, a tooth that has suffered trauma, or a tooth that has undergone root canal treatment and has been reinforced with a crown-root inlay.

Depending on the type of material used to make the crown base, we distinguish between:

1. Porcelain-veneered crowns on a base made of precious metals – gold alloys.

The main advantages of using precious metals:

• they do not irritate periodontal tissues – precious metals have bactericidal and bacteriostatic properties,
• they provide a much better aesthetic effect compared to base metals – the colour of porcelain is warm and more natural,
• they very rarely cause allergic reactions,
• do not cause grey-blue discolouration of the gums at the edge of the crown.

2. Porcelain-veneered crowns on a base of base metals:

• are a cheaper solution because the materials used for the crown base are made of base metals,
• guarantee high durability,
• are inferior in terms of aesthetics to crowns based on precious metals and all-ceramic crowns,
• over time, they cause discolouration of the gums in the form of a grey rim at the edge of the crown,
• may cause allergic reactions in the form of redness of the gums around the crown, burning of the tongue, unpleasant taste and others.

We strongly advise against using base metal restorations in the anterior region, where solutions ensuring high smile aesthetics are necessary, and for people with periodontal disease (commonly known as gum disease).

3. All-ceramic crowns, as the name suggests, do not have a metal base:

• in terms of aesthetics, they allow for optimal colour depth and translucency, perfectly imitating natural teeth,
• eliminate allergic reactions, as ceramics are completely inert to our body,
• are made using CAD/CAM technology – computer-aided design and manufacturing, which allows for highly precise, tight prosthetic work.

Bridges consist of prosthetic crowns cemented onto abutments (natural teeth or implants), connected to each other by spans – crowns that fill in the gaps. This is where the name comes from – prosthetic bridge.

In order to make a prosthetic bridge, it is necessary to grind the abutment teeth – they must meet the appropriate requirements to provide good support for the future work. The process of making a bridge on implants is different.

Depending on the location of the missing tooth, based on a clinical examination and aesthetic requirements, our doctors may offer the patient:

• porcelain-veneered metal bridges – made on a base of precious metals (gold) or base metals (steel),
• all-ceramic bridges – made on a zirconium oxide base,
• adhesive bridges  – usually allow for the replacement of only one missing tooth; made of composite material on fibreglass; do not require grinding of abutment teeth; are attached to adjacent teeth using fibreglass tabs in several ways
  • placed in the fillings of adjacent teeth,
  • glued to the healthy surfaces of adjacent teeth, so-called Maryland bridges used in the case of a missing front tooth,
  • placed in specially prepared “recesses” in adjacent teeth without fillings.

Adhesive bridges can be treated as permanent or temporary restorations (during implant healing).

During prosthetic treatment, in order to ensure comfort while waiting for the final restoration, we place a temporary bridge on the ground teeth.

Porcelain veneers are thin porcelain laminates bonded to the front surfaces of teeth. They allow for exceptional aesthetic results.

Thanks to the use of modern techniques and high-quality materials, we achieve the colour, structure and shine of a naturally beautiful tooth, while ensuring its adequate strength. The durability of ceramic veneers also depends on the care of the teeth and gums.

We most often use veneers to:

• mask enamel cracks or permanent, whitening-resistant tooth discolouration,
• close excessive spaces between teeth (diastemas),
• rebuild broken (chipped) tooth fragments,
• improve the appearance and position of unsightly front teeth (erosion, discolouration, tooth wear),
• correct developmental defects (conical teeth, enamel defects).

Veneers are made by slightly grinding the teeth within the enamel (approx. 0.5-0.8 mm) and applying thin porcelain sheets to this area, prepared individually for the patient in a prosthetic laboratory based on an impression taken.

There are several types of dentures:
Acrylic dentures

Partial dentures, as the name suggests, replace several missing teeth and use the existing teeth in the mouth for support.

• complete, they remain in the mouth by suction to the soft tissues; this is a popular prosthetic solution, whose undoubted advantage is its relatively low cost; However, significant disadvantages include considerable discomfort during use and a negative impact on the jawbone (atrophy of the alveolar process), as well as the need to replace them every few years.

Nylon dentures

These are made of nylon. They are highly flexible, adhere well to the base and do not contain any metal components, which means that they can be adapted more quickly. They do not cause allergies. Unfortunately, they also have significant disadvantages: they absorb odours and dyes from the oral environment.

When deciding on this type of prosthetic restoration, it is therefore important to remember to take exceptional care of your oral cavity and dentures.

Skeletal dentures

These are used for partial tooth loss. They are made of acrylic or nylon elements connected by a thin metal skeleton that is as comfortable as possible for the patient. With the help of anchoring elements, such a denture rests mainly on the teeth and the chewing forces are transferred physiologically through the periodontium to the bone. This results in significantly less bone loss than with conventional dentures.

Skeletal dentures are secured with small clasps and barbs that rest on the remaining teeth in the mouth. Unfortunately, they are often visible when talking. It is possible to use other retaining elements, such as slides, clasps and telescopic crowns. This requires the placement of crowns on the teeth adjacent to the denture, which ensures a fully aesthetic appearance without any metal elements visible when smiling.

Overdentures

These are restorations that meet aesthetic requirements, protect the jawbone from atrophy and provide great comfort for the patient. They are attached to the patient’s own tooth roots or implants using: clasps, magnets, telescopic crowns or bar attachments.

Implant prosthetics is the most modern method of replacing missing teeth, allowing for:

• achieving an excellent aesthetic effect and natural appearance of the teeth,
• ensuring complete physical and psychological comfort for the patient,
• restoring the full function of missing teeth,
• avoiding the need to grind teeth to attach a bridge.

The implant procedure involves the surgical placement of small titanium screws into the jawbone, in the place of the lost tooth. They then form the foundation for a new porcelain tooth crown, bridge or denture.