Defects in shape, structure, color, or position of the teeth can lead to esthetic concerns. An advanced caries or a traumatic tooth structure loss may not be possible to treat with filling. Noneruption of a tooth due to developmental reasons or receding of the tooth due to medical causes, leads to gaps (diastema) in the mouth.Those gaps cause poor esthetic appearance as well as:
• Difficulty in eating
• Difficulty in speech (inability to pronounce letters accurately)
• Psychological problems (shyness, loss of self-confidence, restraining oneself from laughing)
• Further deterioration of oral health (repositioning, abrasion of teeth; caries etc..)
• Pain, sound, and movement disorder in TMJ (Temporomandibular joint disorder)
• General health problems (gastric diseases and nutritional deficiencies due to failure to efficiently grind foods)
Prosthetic dental treatment combines medicine and art in order to bring solutions to the cosmetic and functional requirements of people for treatment and rehabilitation.
Removable Prostheses (Dentures)
In cases where there are wide gaps of missing teeth that can not provide support, removable prostheses are used. If there are teeth that can be used as support, it is called as partial prosthesis; if there are no teeth left, then it is called total prosthesis. Partial prostheses (denture) are supported by teeth and tissues. In order to use tooth support, clasps are attached to the supportive tooth. Tissue support is provided by the surface that prosthesis is placed on. Thus, the force is distributed to the tooth and tissues.
Removable Partial Prostheses (Dentures)
Removable partial dentures are employed when there is a lack of required supportive teeth. They are teeth/tissue supported prosthetic practices. In order to use tooth support, clasps are attached to the supportive tooth. Tissue support is provided by the surface that prosthesis is placed on. Thus, the force is distributed to the tooth and tissues.
Precision Attachment Prostheses
Clasps of the removable partial entures may disturb anterior teeth. Moreover, in teeth with inadequate gingival health, the force applied by the clasp may lead to tooth loss. In such cases, the force to be applied on one tooth can be distributed over others by bonding the teeth to each other. Metal clasps may cause damage and abrasion on healthy teeth. Precision attachment prostheses provide support to the diastemas by removable dentures, whereas the color, shape, and position problems of the present teeth in the mouth are corrected with fixated prostheses. Supportive teeth are prepared. While making fixed crowns, precision attachments are placed into the areas close to the gaps. Thus, an esthetic appearance is obtained with no visible clasps on the crown.
Fixed Prosthesis (Denture)
Prostheses that are bonded permanently on a tooth which are structured and built after models prepared in compliance with the measurements and examinations carried out beforehand.
Disadvantages of Fixed Dentures
• Bone loss develops in sites where natural teeth are lost.
• Requires preparation of healthy adjacent teeth to support the bridges
• Potential gingival discomfort aggravates
• In long-term, gingiva may recede
• Maintaining an oral hygiene is difficult owing to places around the bridge that bacteria can accumulate
• Presents a potential for foul mouth odor
• Caries may form in teeth and in their roots located under the bridge
Total Prosthesis (Denture)
If there is no teeth left in the mouth that can provide support; retention, support, and force distribution are established by placing the denture on the tissue surface. Prosthetic procedures that are only tissue-supported are termed as total prosthesis or denture.
In some instances, there might be teeth with longer or angulated structure that are incompatible with the denture. Rather than extracting those teeth in order to apply the denture, their height may be shortened and left under the denture by placement of telescope crowns or precision attachments. These are called as over denture prostheses. Leaving the tooth root in the mouth, avoids osteoporosis and preserves intraoral secretion functionality.
In presence of more than one missing teeth, dental restoration can be performed by placement of fixed structures supported by the adjacent teeth. However, supportive teeth should be healthy and present at an adequate distance to be able to resist the applied force.
In cases where single anterior tooth is missing, Maryland bridges may be an option as well. Prior to preparation of the adjacent teeth in both sides of the missing tooth, surface retention is achieved by placement of wings into the back side.
Crown is preferred for tooth structure loss concerning a single tooth and cosmetic problems. The tooth is prepared and the denture model is sent to technician who prepares first the supportive metal infrastructure and then esthetic superstructure made of porcelain (or acrylic which is a less preferred material nowadays).
Discolorations; position, structure, and shape disorders or gaps between teeth, cause esthetic concerns. Laminate veneer is the prosthetic approach that is performed only on the anterior surface of the tooth, within limits of the enamel, with a little preparation. As a result of the recent advances in filling technology and bonding mechanisms, laminate procedures can be applied with filling materials, as well. In presence of teeth grinding, deep bite, inadequate crown height and enamel thickness, standard crown approach should be conducted.
Full Porcelain Crown
The disadvantage brought about by the opaque reflection of metal from beneath anterior teeth, is not a problem anymore thanks to the full porcelain crown application which includes no metal.
In presence of teeth presenting incompatibility with a certain part of the denture, rather than losing those teeth, their height can be shortened, and telescope crowns or precision attachments can be applied.
Onlays, inlays are large fillings built in the laboratory for restoration in cases where dental material loss is excessive. Inlay can be used if loss of tooth structure is below ¾ and cusps are not lost, onlays can be applied in cases where loss of tooth structure is more than ¾ including the cusps.
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