Prosthetic Treatment

Dental Prosthetics

Prosthetics deals with the reconstruction of lost tooth tissue (using inlays, onlays and crowns) and most of all – missing teeth. Modern procedures and high prosthetic standards allow for an effective prevention of the maxillofacial area, for a successful treatment and for restoring the oral cavity functions and a beautiful full smile of our patients. Our dental professionals have extensive knowledge of modern prosthetics, and cooperate with renowned prosthetic laboratories to solve any prosthetic problem, even a most complicated one. In our clinic, we offer crowns supported by implants, bridges, partial dentures: (cast metal, precision dentures), overdentures and full dentures. All restorations are prepared using the latest materials and technologies available.

Veneers

A veneer is a thin porcelain shell bonded to the front of the tooth to improve its appearance, fabricated by a dental technician from a dental impression. The tooth enamel is being trimmed off to a depth of approx. 0.8 mm. This precise treatment results in a beautiful and lasting effect. The veneer does not change colour, darken, and is stain resistant. Veneers are used for imitating the natural look of the teeth with the perfect shape and colour even if the natural teeth were misaligned, crooked or spaced.

Crowns

Prosthetic crowns are single-tooth restorations – caps – used in cases of a severe destruction of the tooth’s crown that otherwise hard to rebuild. Prosthetic crowns can be single restorations or be a part of a larger construction – a dental bridge. Crowns supplement and replace destroyed fragments of natural teeth and take over their natural functions. If properly forged, they are no different in their form from natural crowns. Crowns can be made from porcelain-fused-to-metal (metal-ceramic), or all-porcelain or all-ceramic (more on all-ceramic restorations – see Lava System). For a crown placement, the tooth needs to be filed down along all surfaces. It is being conducted in local anaesthesia, making the procedure completely painless.

Types of Crowns

Prosthetic crowns can be made from various restoration materials and procedures: Forged from a homogenous material – for example all-metal, resin composite or porcelain. Resin and acrylic composites are nowadays used only for temporary crowns. Forged from mixed materials – the main part (the bottom shell) is built of metal, and the surface is coated with a material resembling natural teeth – usually ceramic or composite. Owing to the shape and colour durability, excellent translucency, biocompatibility and mechanical strength, the first choice nowadays is porcelain. Acrylic composite, though cheap in comparison, is prone to discolouration, tearing and absorbing odours and thus fails miserably. The most recent development in aesthetic prosthetic, also available in our clinic, are all-ceramic (all-porcelain) crowns designed and forged in a computer-driven LAVA system from zirconium oxide.

Dental Bridges

If one or more teeth are missing, dental bridges are one of the possible restorations. A dental bridge is built from a pontic – a “dummy” or false tooth restoring the functions of the edentulic area, and the abutment teeth – crowns that are placed on adjacent existing teeth (roots) or implants. The supporting abutments may be crown inlays, roots or crowns. To be eligible for a dental bridge treatment requires good oral conditions – the proper amount, quality and placement (on both sides of the gap) of the abutment teeth. The mastication forces are transferred from the pontic entirely to the abutments. Sometimes cantilever bridges are constructed which are placed on one abutment only, usually mesially. However, such solutions are not recommended, especially in the posterior region. As the mastication capacity cannot be restored, the supporting tooth undergoes a bio-mechanic overload over time, which leads to its loosening. Metal – ceramic bridges are commonly used for posterior teeth, whereas the all – ceramic ones are built in the anterior region, where aesthetic is crucial. (For more information on all – ceramic bridges, see Lava System).

Extensive edentulism makes fixed prosthetic restorations (bridges) impossible. To replace missing teeth and restore mastication capacity, removable dentures are used which can be removed from the mouth. Note that all teeth losses should be supplemented as soon as it is possible after the extraction, because every single gap poses a threat to adjacent teeth. These tend to drift out of their position towards the gap. Long – term teeth loss leads to temporomandibular joint (TMJ) damage. There are two main types of removable dentures: full or complete removable acrylic dentures (used in cases of complete edentulism) and partial removable dentures – conventional acrylic or metal based cast partial dentures (to replace one or several tooth loss). No ready – made patterns for preparing restorations for patients exist, therefore every patient is being treated individually for a prosthesis that meets his or her needs.

Complete Dentures

Complete dentures are acrylic tissue – borne dentures consisting of an acrylic base and embedded false teeth. The main characteristic is a broad base plate which covers the palate almost completely for a better distribution of masticatory forces during chewing on the greatest surface possible, thus preventing gum overloading leading to irritation and inflammation. Complete dentures, being tissue – borne, tend to collapse in the gums over time and require mandatory relining to prevent further damages. Complete dentures remain on the prosthetic surface mainly due to adhesion, hence they tend to displace in the mouth of the patient and cause extreme discomfort in use. At our clinic we offer so – called overdentures in order to ensure a better denture fit. They are used in case of severe partial edentulism, teeth abrasion and complete edentulism (after the implant treatment). The overdenture is acrylic-based without visible clasps and restores all missing or worn down teeth, holding on to either the remaining roots or implants by means of special ball or telescopic crown attachments. The telescopic crown attachment is placed on the natural tooth after its splinting or after a crown – root placement, and consists of a tightly fitting cap (the inner or primary telescopic coping) permanently fixed to the abutment, and a congruent detachable outer or secondary telescopic crown connected with the denture. Both inner and outer telescopic attachments are perfectly matched and ensure a very stable denture fit (for more information go to IMPLANTOLOGY page).

Partial Dentures

A removable partial denture, or RPD, is basically composed of a denture base, connective elements – clasps, connectors, direct and indirect retainers, rests and prosthetic false teeth. The design and shape of the RPD’s components vary significantly depending on the extension of the restored deficiencies. The differences include mainly the extent of the base and the lack or presence of occlusal rests. The more extensive the edentulous ridge is, the wider the denture base resting on the foundation tissues (the palate and alveolus) must be. The usage of occlusal rests is dependent on the number of the remaining teeth and the periodontal status. There are two basic types of RPD’s – acrylic and metal based cast partials. The main difference between the two lies in the width or absence of the major connector or denture base and the presence of clasps and occlusal rests. Only the base for prosthetic teeth is made of acrylic, the rest of the metal cast denture are metal clasps which not only “hold on” to adjacent teeth but also transfer the load generated during chewing. This is the reason metal based dentures cause far less gum loss than tissue – borne dentures, however, the clasps are often visible. Hence, precision partial dentures are the option for aesthetic reasons, where the means of retaining the denture in the mouth are not clasps but mechanical interlocking components – telescopic crowns, bolds and precision clasps. Theses fixing attachments are placed on the crowns of the prosthetic teeth. Similar attachments can be also fixed on implants. Such dentures are very stable and easily retained in the mouth.

Combination Dentures

Combination dentures are prosthodontics restorations using a combination of fixed and removable partial dentures, involving precision attachments like locks, bars, pins and telescopic crown attachments. Lock or bar – attachment dentures involve a combination of a porcelain bridge and a cast metal partial. They are used in partial edentulism cases. The most important advantage of such dentures is their high aesthetics – lack of visible retention elements like clasps braces. The dental bridges are equipped on both sides with retaining elements – bars, which hold the removable partial in place. Telescopic partial dentures: The telescopic attachments are used in cases of few teeth remains, when the use of porcelain bridges or other combined work is no longer possible The telescopic crown attachment is placed on the natural tooth after its splinting, an implant, or after a crown – root placement, and consists of a tightly fitting cap (the inner or primary telescopic coping) permanently fixed to the abutment, and a congruent detachable outer or secondary telescopic crown connected with the denture. Both inner and outer telescopic attachments are perfectly matched and invisible and thus add to a great aesthetic effect. (for more information on combined dentures – see IMPLANTOLOGY).