Prosthetics

Prosthetics is the process of artificially recreating when they previously for any reason been lost. The loss of a tooth can lead to injury, illness and other factors. Therefore, the service is enough demand for prosthetics in the dental practice.

Ways to restore lost tooth or teeth there are many. To determine the specific technology, the doctor should examine the condition of the bone tissue, the degree of neglect of the disease, to assess the integrity of the dentition and healthy gums.

In addition, the financial aspect is no less important when choosing a dental prosthesis.

Necessary examinations before the beginning of prosthetics

Modern prosthetics is, first and foremost, a comprehensive survey applied to the clinic of the patient. For diagnosis should be used modern equipment. The more carefully and complete the doctor will perform an initial assessment of the condition of the teeth and oral cavity, the best results will be given to the patient ultimately.

Diagnosis before choosing a method of prosthetics of teeth must include:

• Visual inspection of the oral cavityand the maxillofacial area of a patient. Dentist-orthopedist needs to evaluate dental health, the quality of their hygiene, condition of oral mucosa, the degree of neglect of existing diseases, etc. in addition, the doctor evaluates the functioning of the masticatory muscles, the condition of the temporomandibular joint and posture of the patient;
• The implementation of x-ray. This will allow you to visualize the condition of the periodontium and in the upper and in the lower jaw alveolar crest. X-ray examination also provides an opportunity to estimate the length and growth direction of physician interest roots, the size of the tooth cavity, the state of the channels and roots;
• Evaluation of the tonus of the masticatory muscles and their activity is performed using diagnostic methods such as electromyography and electromotoare;
• Taking impressions, which will be modeled next project. Study of the generated model will allow to study the peculiarities of occlusion, pre-grinding, etc.

After conducting the examination, the doctor discusses with the patient the possible types of prosthetics.

There are two main types of dentures: removable and fixed restorations. Each of these types, in turn divided into subtypes with defined advantages and disadvantages.

Dentures

A removable prosthesis is used most often in the case when the patient has a lack of several teeth: three pieces or more. And missing teeth should go in a row, one after the other. The main feature of the removable denture is in his name, that is, periodically it must be removed from his mouth for the implementation of the hygiene procedures.

Removable dentures can be of the following types:

• Clasp;
• Plate of acrylic plastic;
• Nylon.

Partial dentures

The phrase “partial denture” has German roots. “Clasp” in German means “bulge”, that its shape repeats the prosthesis. This type of prosthesis can be applied only in the case where in the mouth the patient has at least two teeth, as it will be attached to them.

Material, acts as a base for the manufacture of removable partial denture, may be the following: titanium, nylon, acetal, chromium-cobalt based alloy, zirconium, a cermet.

A fixed prosthesis can through various devices:

• The attachment system is a double fastening, when one half of microsemi is located in the inner part of the prosthesis, and the second in metal-ceramic crown, which fits over the tooth-support. Shut when putting on the prosthesis. Wherein the prosthesis is securely fixed, the locks are not visible when you smile during the meal, and the service life of prostheses varies in the range of 5 to 7 years. However, the clasp prosthesis on attachments will cost more expensive than their counterparts with other types of attachment. The fact that the attachments are imported from USA and Germany, which causes their high cost;
• Clasps is the hook, made from metal. They are a continuation of the arc of the prosthesis and are fixed directly on the teeth that were supportive. Undoubted advantages of such dentures is their low cost and preserving the integrity of tooth enamel. However, there are such structures and their drawbacks. First of all, it concerns the aesthetic side, as often Klammer cannot be only on the front surface of the base of the tooth. In this case, it falls into the smile line and will be visible at the outcrop of the teeth;
• Telescopic crowns. This kind of clasp dental prosthesis is the most expensive. The prosthesis made by a prosthodontist, a high-level, has a maximum aesthetics. Crowns of this type is still fixed on patient’s own teeth the lower part, and they shall be fitted with the prosthesis. It is with high precision and falls directly into the recesses present in the crowns. When the combination is reached, will only snap locks helps to lock the design;
• Splinting clasp dentures are used when there is no tooth-bearing on one side of the jaw with periodontal disease, the displacement of the teeth in conditions of the dentition, when teeth roots exposure. The design is made in a curved shape, and the clasps will fix each tooth. Advantages sineroides types of fastening are that the gums and mucosa of the oral cavity will be protected from mechanical damage during chewing food, the teeth are loosened. The disadvantages of these prostheses is that they are quite difficult to manufacture, and it will definitely affect the price;
• Bugel prosthesis with fixation on implants applicable in the case when the patient has no terminal teeth. Instead of missing teeth in the presence of the jaw bone in the desired thickness, the man put the implants in. They subsequently serve as a support for the prosthesis.

Undoubted advantages of immediate dentures are:

• Low cost;
• Reliable fixation in the mouth;
• The possibility of installation in the presence of mobile teeth;
• The strength of the structure;
• No need to remove the denture at night time;
• Easy to care;
• Long service life with proper maintenance.

However, removable partial processes have the following disadvantages:

• This type of prosthesis cannot be set up if in the mouth will not be healthy teeth, consecutive to each other;
• Often, these prostheses require a long time to get used to them, sometimes the adjustment period is prolonged to several weeks;
• The gums can be rubbed with the anchors of the prosthesis.

The indications for use clasp prostheses consider:

• The substitution of one or more teeth;
• The existence of the defect in the tooth row;
• The presence of end defect;
• The need for curvature correction of the dentition;
• Therapy of periodontal disease with the use of technology by splinting.

Contraindications to bugel prosthesis are:

• The absence of teeth acting as a fulcrum;
• Diabetes, cancer;
• The acute phase of diseases of the cardiovascular system;
• Mental disorders;
• Inflammatory processes in the oral cavity in the acute stage;
• Respiratory system illness in the acute stage.

Acrylic dentures

Dentures made of acrylic are traditional removable dentures.

They can be divided into several types:

1. Full removable. This type of prosthesis is installed, if the patient has missing teeth completely. Instead use a reference tooth alveolar process of the mandible. On the upper jaw, the prosthesis is additionally fixed in the sky. In this case the fixation of such prosthesis is not entirely reliable, since a person has no teeth.
2. Partially removable dentures made of acrylic can be applied in the case when the patient has at least one healthy tooth. Naturally, it will act as a support.
3. Conditionally removable or cover prostheses with fixation on implants. These dentures will hold a pre-implanted in the jawbone of a patient mini-implants. Their number is calculated in each case individually.

Of course, that acrylic prostheses have both advantages and disadvantages.

One of the advantages can be identified:

• The light weight of the prosthesis;
• The variety of shades;
• No need for pre-piping;
• Easy operation;
• The ease of implementation of hygienic measures;
• Low cost;
• Easy to repair;
• The maximum term of operation till 5 years.

The disadvantages of dentures made of acrylic include:

• The fragility of the prosthesis;
• For a long time the patient’s adaptation to the prosthesis;
• The possibility of allergic reactions to components of the prosthesis;
• Change in the diction;
• Reduced sensitivity;
• The presence of the porous structure, which is a favorable environment for bacteria;
• The probability of injury to the soft tissues of the oral cavity, the risk increases parallel to the number of missing teeth;
• The destruction of the support tooth over time.

Indications for use of acrylic prosthesis:

• Partial and full adentia;
• Correction of bite in children in case of untimely loss of primary teeth;
• Temporary replacement of the dentition with dentures fixed structures.

Contraindications to the use of acrylic prosthesis:

• The presence of allergic reactions to components of the prosthesis;
• Severe resorption of the jaw bone, which leads to flattening of the alveolar part (prosthesis will simply not hold);
• Gag reflex in the patient.

Nylon dentures

Dentures made of nylon about 20 years ago replaced plastic prostheses, which were used as replacement teeth for people with complete absence.

Dental nylon allows you to accurately simulate the gums, as the material is soft, stretchy, translucent. This makes it much more comfortable to use compared to rigid plastic prostheses.

Dental crowns, which are attached to a nylon denture is made from either ceramics or Zirconia.

To strengthen the finished denture, the dentist will be one of the following ways, depending on the condition of the patient’s mouth:

• If you own a number of teeth missing completely, the prosthesis will be attached to the gum. Reliability is ensured due to the suction effect after applying to the prosthesis a special gel;
• If the denture replaces only some teeth, nylon construction equip multiple hooks of the same material. They are fixed on the abutment teeth, direct around their base. In this case the abutment teeth do not need such a painful procedure as the facing.

The undoubted advantage of nylon dentures is that the addiction to him comes after a week of regular wear. The material has hypoallergenic properties, not colored over time and does not require complicated manipulations to care. If the rules of operation are violated will not be, such a prosthesis can last up to 8 years.

High aesthetic characteristics of the prosthesis is ensured by the fact that the clasps are the color of the gums and the teeth almost imperceptible. Therefore, the prostheses nylon prostheses are often called the invisible.

However, we should also mention the disadvantages of dentures, made from nylon, including:

• Injury to the gums, located in the region of extreme teeth. Since the clasps are not made from metal and nylon, they are not able to fully transmit the pressure exerted during chewing on the tooth-base. So the pressure falls on the mucous membrane of prosthetic bed. This will lead to the destruction of bone tissue that is beneath it, and the height of the gums will decrease. In the end, the prosthesis will subside in this place, and its clasps will crash into the mucous membrane of the preserved teeth. As a result, the development of the inflammatory process, pain;
• The larger the prosthesis, the greater its elastic deformation during chewing of food. That is because of the softness of nylon prosthesis, the load will be distributed only to the other side of the jaw, which a person chews. In the end, the bone tissue will quickly atrophy from this side, and the process of chewing and biting food will begin to cause discomfort, causing pain. However, if the nylon denture replaces only 2 teeth, the lack of such a patient will not experience;
• The accelerated subsidence of the prosthesis as a result of atrophy of the bone underneath;
• The difficulty in polishing of the prosthesis. Inside the prosthesis is not polished at all, that is incorporated by the technology itself. In the end, if it is not subject to rigorous hygiene, under it will accumulate microbial plaque and dental deposits appear. This, in turn, will provoke the appearance of unpleasant smell from the denture and it will be impossible to insert in the mouth;
• The high cost of manufacture;
• Multiple correction because of the sagging gums.

Indications for use of nylon dentures are:

• The absence of 1-2 teeth if the patient does not want to grind the tooth substrate;
• Partial or complete absence of teeth;
• Allergic reaction to components included in the acrylic prostheses;
• Prosthetic stomatitis.

Contraindications to the use of nylon dentures are:

• Periodontal disease, periodontitis;
• Insufficient height of the existing teeth;
• The mobility of the mucous membrane covering the gums;
• Atrophy of the gums more than 20%.

Fixed dentures

Fixed dentures can be fixed either on the tooth that is next to or on the artificial root of the tooth to the implant.

Fixed dentures can be of the following types:

• Dental crowns, which represent a cap on the tooth, completely mimicking its shape. Dental crowns can also be worn on the prosthetic teeth which are fixed to the artificial root;
• Bridge dentures are a set of crowns that are placed on your teeth or on teeth roots;
• Implants are tooth roots made of titanium or zirconium. They are set in order to wear the crown or bridge;
• Inlays, veneers, Lumineers are fixed structures, the main purpose of which is to improve the appearance of the tooth or dentition.

Dental crowns

Dental crown is a prosthetic tooth made in accordance with its anatomical shape with the fixation of the tooth-stump.

They can be made from the following materials:

• Crowns made from metal. They are made of different alloys and precious metals. All-metal crowns can be installed in the case, if there is the need to restore posterior teeth.Distinguish:
  1. Solid metal crowns, the basis for them is the alloy of chromium and cobalt, sometimes these crowns cover the gold plating, the main disadvantage is considered low aesthetic characteristics;
  2. Forged crownmade of shells, which shape the tooth with a small hammer. They have a lot of shortcomings, lead to various diseases of the oral cavity (in modern dentistry is practically not used);
  3. Gold crowns arevery expensive to install them I can only state clinics.
• Crowns made from metal. They are sturdy enough, look aesthetically pleasing, which gives the opportunity to install them on the front teeth. However, for the installation of a crown will require much grind the tooth and remove the nerve. The lifespan of a crown can reach 10 years;
• Ceramic crownsmade from ceramic mass, the base of which is either porcelain or Zirconia. Porcelain crowns have a high aesthetic appeal, but they are very expensive and can produce only a single. Crowns based on zirconium dioxide have a greater similarity with the natural teeth, but in addition, they are strong and durable. The only drawback of such crowns is its high price;
• Metal-composite crowns are an alloy of chromium and cobalt, the front part is covered with plastic. They possess excellent aesthetic qualities and are inexpensive. From the disadvantages include the fragility of the structure, the possibility of allergic reactions, rapid loss of the original color and odor of the mouth due to the high absorption of the liquid;
• Metal crowns are one of the obvious advantages are low cost, however the lifespan of these crowns will not exceed 5 years. The fact that the layer of plastic applied to the frame of metal and already after a short time it changes its original color. Another common drawback of such crowns is a fast bundle plastic.

Bridge dentures

A dental bridge is a structure which is fixed by means of bearings on natural or implanted bases. The size of the bridge varies depending on how many missing teeth need to be replaced.

The method of fixation to distinguish bridges dentures:

• C mount healthy neighboring teeth (requires prior turning);
• C mount on implants (without prior turning);
• C mount special plates – adhesive bridge prosthesis (turning is not necessary, but the lifetime of such prostheses does not exceed 5 years);
• C mount on the lock when the tooth or implant support is required.

Depending on what material is used for manufacturing of the bridge, there are:

• Metal-ceramic bridge prostheses. Their core consists of a metal, which is covered with ceramics. The service life of these products is up to 7 years;
• The plastic bridges with the base made of metal, which is covered with plastic. The service life of such products is usually limited to three years;
• Bridges with a combined composition. Such structures can be made of zirconium oxide, aluminium. This is the most modern prostheses that serve long time, up to 15 years, and are of high quality materials.

The main advantage of the installation of the bridge prosthesis is the opportunity to make up for the lack of several teeth. In addition, quality bridge prosthesis will serve for a long period of time, subject to compliance with all medical recommendations and care rules. Other advantages and disadvantages will depend on the type of material constituting the prosthesis. The pros and cons of plastic, metal-ceramic and other types of bridge prosthesis is similar to the pros and cons of dental crowns made of the same materials.

If we consider the disadvantages of bridge prostheses in General, they are as follows:

• The facing of their own teeth used as a support. This requires the installation of any bridge, except the adhesive. He, in turn, is not as reliable a fixture;
• The necessity of having your own healthy teeth or implant;
• The development of the mobility of those teeth which serve as a support. This is due to the excessive load on them;
• Possible atrophy of the jaw area, which is under the jumper.

Dental implants

Dental implantation is an installation pin that will perform the function of a tooth root, and on top of him and then wear and fasten the crown. In the end, people will find new durable artificial tooth. In 99% of cases it is perfectly survives and does not cause any undesirable consequences from the health. The materials used to make dental implants is a metal (chrome alloy, titanium, stainless steel) and ceramics.

The implant resembles the natural tooth root of a person (read more about implants). It screwed in the jaw, and after engraftment is established, the intermediate part (abutment), on top of which is fixed a crown from the chosen material.

Positive aspects in the installation of the implant are:

• The elimination of the defect without any harm to dental health, located in the neighborhood;
• High aesthetic properties;
• Long service life (15 years or more);
• Stop the process of resorption of bone tissue due to the lack of the tooth.

Disadvantages of the procedure are:

• A long time of engraftment of the implant, which can be up to six months;
• The development of complications such as swelling of tissues, pain, the development of bleeding, rejection of a foreign body;
• A large number of contraindications.

The indications for implantation are:

• The loss of one or more teeth;
• End defects of dentition;
• The absence of teeth (fully edentulous);
• Intolerance to removable dentures because of a pronounced gag reflex or if you have individual hypersensitivity to plastics.

Absolute contraindications to implants:

• Psychoemotional disorders (depression, hypochondria, psychopathy, psychosis);
• Seropositive infection (syphilis, tuberculosis, etc.);
• Systemic diseases of blood, bone and connective tissue;
• Endocrine pathology;
• Heart disease and blood vessels of chronic;
• Cancer the process of malignant character.
• Diseases of the mucous membranes of the mouth.

Inlays, veneers, Lumineers

A separate type of prosthesis is microprosthetics teeth, using such methods as the installation of inlays, veneers and Lumineers. These products include fixed dentures and can last for a long time, sometimes up to 10 years. None of the retail cannot replace the lost tooth, they focus on his recovery, elimination of defects and improving aesthetic qualities.

So, the inlays is a retail, which can either be regenerative (restore the color and shape of the tooth), or kultovymi (restored coronal part of the tooth).

They are:

• Metal (used on the chewing teeth) and they are not visible when talking or during a smile;
• All-ceramic Zirconia or pressed ceramics;
• Metal-ceramic;
• Composite.

The service life of such tabs can be up to 10 years, which is their unquestionable advantage. In addition, tabs are often used for chipped tooth.

Veneers are a thin plate that attached to the front part of the teeth located in the smile zone. These teeth can be made of composite, porcelain or Zirconia. They are designed to hide the huge number of aesthetic disorders: chips, change the color of the enamel, gaps between teeth, scratches, curvature. The attractive appearance of the teeth after the installation of veneers is their primary advantage.

The disadvantages are the following:

• The fragility of the structure;
• Pre-facing front teeth, with the result that they will never be the same as before.
• The need for wearing veneers throughout life, or replacement of natural teeth by dentures.

Lumineers are a type of veneers, but their distinguishing feature is their increased strength. Lumineers last longer than veneers, and can be set for 20 years. Depending on the patient’s wishes, Lumineers can be secured without pre-piping. The disadvantage of these dentures is their high cost.

What kind of denture in dental prosthetics better?

The choice of the best prosthesis will depend on a number of factors. First and foremost, it’s the execution of the main function of the prosthesis is chewing. In addition, it needs to have aesthetic appeal. The price issue is also important for most patients.

The choice of prosthesis depends on the number of missing teeth, the condition of the patient’s mouth and So on to determine what type of prosthesis in dental prosthetics better in a dentist office.

Prosthetics in the absence of a large number of teeth

The prosthetics in this case may be of the following types:

• Crowns;
• Installation of bridges;
• The installation of the prosthesis;
• The installation of implants;
• The installation of laminar prosthesis in the case when teeth are missing completely.