Removable and fixed dental structures are the two pillars on which prosthetic dentistry stands. No two clinical situations are alike, and there is no one-size-fits-all method of tooth reconstruction. When a patient comes to see a prosthodontist, he or she expects to get a solution to the problem. And the doctor offers at least 5-6 ways to replace lost teeth. But:
- some patients are intimidated by the grinding of teeth,
- others are intimidated by the possibility of wearing a removable jaw,
- others are intimidated by the cost of orthopedic treatment,
- and some of the above.
We would like to add that many are afraid of pain, which has not been experienced by visitors to clinics for a long time. At the doctor’s disposal is a choice of local anesthetic drugs for children, people suffering from hypertension, allergic people. In dental centers, sedation is used to reduce anxiety and enhance the effect of anesthetics. Sometimes sedation is made deep, and the patient falls asleep for the entire duration of treatment.
When prostheses are necessary
The short answer to this question is: “Never”. After all, these prosthetic devices are designed to recreate the anatomical shape, size, color, etc., inherent in the lost teeth. Dentures are not required only in cases where:
- The patient does not wish to improve oral health;
- if the tooth can be restored by therapeutic methods (e.g. inlay).
What is a denture
The term “denture” means an artificial structure that compensates for the lost units. If the crown part of one tooth is destroyed, it is a single denture. The familiar name is dental crown. If a tooth is extracted, and even more so, extended adentia is detected, fixed or removable prostheses are ordered. They are necessary to restore chewing, bite, improve the aesthetics of the smile and symmetry of the face.
Veneers and ceramic inlays are also microprostheses, with the difference that they are applied only on the vestibular or chewing surface.
Types of dentures
Dentures are difficult to divide. There are two categories – removable and fixed structures. These in turn have many subcategories.
Non-removable designs:
- Single crowns and post artificial teeth;
- Cushion inlays;
- bridges;
- veneers;
- ceramic inlays.
Removable products:
- Partial removable (PRPP);
- conditionally removable;
- total (PSPP).
Often the methods of removable and fixed prosthetics are combined.
Removable Dentures
Removable dentures are designed to restore small (2 to 4 units) defects on one or both sides of the jaw.
- When 1 chewing (not end) unit is lost, a “tooth inlay” is used. Artificial, with two metal legs is not glued to the gum, but cemented with glue in the grooves of neighboring teeth. The patient himself will not be able to remove this construction, but the doctor will easily do it.
- The construction for the replacement of 1-2 teeth is called immediat. It is appointed for the time of preparation for implantation or fabrication of a bridge for 3-4 units.
- Appliances for reconstruction of a tooth segment with a unilateral end defect are called sectorial. An example of such a design is a unilateral attachment bracket. To make it fit tightly in the mouth, the two outermost teeth are supported and covered with crowns with built-in locks.
- In case of combined and included defects (including terminal defects), either bilateral brackets with a clammer or attachment installation are used, or BSPS.
- A variation of the clasp is the telescopic crown prosthesis. Due to the fact that the patient himself removes from the mouth, they belong to removable constructions. But they sit tightly on the gums because the supporting teeth have crowns with locking mechanisms.
- Plate prostheses consist of a metal arc-shaped framework, covered with acrylic lined with artificial. In addition to acrylics, nylon is used. The BSPPs are retained by clasps – metal or plastic (sometimes nylon) hooks worn on the support. It is possible to fix the ČSSPPs with locks, then they are ground and covered with crowns with locking mechanisms.
- In the case of edentulous jaws, a PSPP is fabricated. It can be acrylic or nylon. Retention occurs due to the suction effect and a base clearly adapted to the size and shape of the alveolar ridge.
Advantages
The advantage of removable products is that they are easy to remove for hygiene procedures, disinfection, repair and relocation. It is also important that they can be used to repair dental defects without resorting to expensive prosthetics or implants.
Disadvantages
Of the disadvantages, the same ease of removal from the mouth is not the first place. Over time, atrophic phenomena in the jaw lead to a decrease in the size of the alveolar ridge, so the removable structure becomes less stable. To correct this, the prosthesis is relined. In the case of breakage of the base or anchoring element, breakage of the artificial tooth or “failure” of the own tooth, it is repaired or replaced with a new one.
Another disadvantage of plate constructions is the average level of cosmeticity, especially if it is installed due to metal clammers. In some cases, monomers of acrylic plastics used for lining the base, cause allergic reactions or irritation of the mucosa, and then products made of nylon become an alternative.
Fixed dentures
Fixed structures are made of metal, plastic, ceramic or a combination. The material determines the level of aesthetics. Fixed products are cemented, so only the doctor can remove them.
Advantages
The advantages of fixed structures are described simply: “Put it on and forget about its existence”. All, except for metal ones, are inconspicuous, do not require care. They do not form plaque on them, do not change the original color. Plastic in this respect is inferior to ceramic and metal bridges, but the level of aesthetics is high.
Metal crowns made of gold are hypoallergenic, so they are suitable for people suffering from metal intolerance. Non-precious metal constructions with or without sputtering are hardly noticeable in the mouth, as they are placed only on the far standing teeth.
Disadvantages
Metal crowns and bridges require prior endodontic treatment. The thickness of the framework and ceramic mass forces the dentist to do a lot of grinding to reach the horns of the pulp chamber. To prevent further development of pulpitis, prosthetics are done only on non-vital teeth. If prosthetics are made with a bridge, the two neighboring teeth are depulped and ground down, as they will support the structure.
Ceramic constructions are allowed to be placed on vital teeth, but the disadvantage is different. They do not have the strength of metal-ceramics. Therefore, under the influence of mechanical stress, ceramics will break off. Ceramic crowns and bridges are recommended for frontal or premolars.
Veneers
Artistically executed superimposed ceramic plates are called veneers. The task is to change the color, size of the causative tooth. The onlays are placed on the vestibular surface. Therefore, another direction in which they are used is the closure of photopolymer restorations of the anterior, or the closure of the discolor of the individual unit after previous treatment.
Advantages of veneers
Veneers are made in factory conditions according to casts of the patient’s teeth, so they completely repeat the parameters of the neighboring ones. Tremes, frequent chipping of the incisors’ cutting edge, poor shape of canines, asymmetry of sizes – these problems can be solved with the help of overlay plates. Low thickness allows you to work with living teeth.
Disadvantages of veneers
Veneers are afraid of hard food and objects. They should not be placed in case of bite disorders, bruxism, restorations on the front, as well as people with an increased risk of trauma to the facial area.
Dental inlays
The role of metal stump inlays is to reinforce the endodontically treated and replace the severely destroyed crown part. The stump is covered with an artificial crown.
Ceramic inlays are used instead of fillings on the masticatory surface. In cases where the filling falls out or cannot be placed due to the destruction of the crown, ceramic analogs – inlays – are used.
Advantages of inlays
Ceramic inlays have an identical color, so only the dentist can detect after cementation. Stump inlays are covered by the crown, so they have the advantages of the materials from which it is made.
Disadvantages of inlays
Ceramic inlays cost more than restorations with filling materials. Fabrication requires impressions to be taken, as well as several visits to the dentist.
Inlays have similar disadvantages – the cost of restoration compared to reinforcement with posts, a long laboratory phase and repeated visits to the clinic.
Artificial crowns and bridges
Single crowns are used for the restoration of individual crowns, bridges are used to fill extended (but not more than 4 units) defects.
Advantages of crowns
After the tooth has been treated or the crown defect has been restored with filling materials, the likelihood of trauma increases many times over. Depulped, or with little tissue, crowns are fragile. Therefore, covered with an artificial prosthesis, they get a second life.
Artistic are considered ceramic crowns, bridges. Next in beauty are metal products. It has several levels of aesthetics. To the uncouth are stamped and cast metal products. Therefore, they are put only on the lateral areas of the jaw.
Disadvantages of bridge-like prostheses
A bridge design cannot be placed without an end support or on severely wobbly supporting teeth. Crossbite, lack of antagonists, parafunction of masticatory muscles – these prohibitions for fixed prosthetics, forcing the doctor and the patient to look for other ways to eliminate adentia.
Which dentures are better to put
This question can only be answered by the doctor. Based on the inspection data, diagnostic tests, the dentist offers several options, explaining the advantages, disadvantages. The role is played by the financial capabilities of the patient. Requirements for aesthetics, work.
If you briefly answer the question: “What is the best?”, it is correct to say – the one that satisfies the patient, fulfills the functions assigned to it.