Prosthodontics is the dental specialty responsible for the diagnosis, treatment planning, rehabilitation and maintenance of patients with complex clinical conditions using biocompatible substitutes, including implants, to replace missing or deficient teeth and/or craniofacial tissues. Prosthodontics is one of the nine dental specialties recognized by the American Dental Association (ADA).
Prosthodontists are dental specialists trained in the art and science of the restoration and replacement of teeth and supporting structures. After completing four years of dental school, a prosthodontist must complete extensive training in an ADA accredited graduate education program. Missing natural structures are replaced using porcelains, alloys and acrylics.
Issues emphasized include appearance, speech, mastication, and swallowing as well as the physical and biological knowledge required to assure a healthy, stable and comfortable oral health for patients.
As the designer and provider of dental restorative care, a prosthodontist co-ordinates care with general dentists, other specialists, and health care providers to insure a pleasing and functional result suited to each individuals needs.
Persons with few or many loose, crooked or missing teeth and receding gums are ideal candidates for prosthodontic care. Those with no natural teeth may also benefit from the care of a prosthodontist. They need to be informed of services available and recommended, alternatives, associated costs, time required for placement and usual and customary warranties.
Long term stability of an individual’s oral health consists of the appropriate awareness of a patient’s general health and the assurance of no contribution of systemic issues to one’s dental well being. Furthermore, local oral issues which may require corrective therapy such as oral surgery, endodontics, periodontics and orthodontics must be addressed prior to the restorative phase of care. Some aspects of such care follow.
Finally, maintenance is crucial and most important to everyone’s oral health stability. Conscientious and thorough home care and regular professional follow-up care is mandatory for uneventful longevity.
Common Procedures:
BONDING
Bonding is the process by which a dental adhesive is used to bond a composite material to a tooth surface. The tooth is first chemically treated with a special dental acid which causes microscopic porosities in the enamel. The adhesives form a bond with the bonding material. These materials come in various shades. There are also flowable and dough-like materials. The dentist chooses the one he feels best suits the procedure he is performing. The materials at present are highly polishable, are very strong and most last quite a long time. Some even contain fluoride which aids in preventing new cavities from forming. Bonding uses include restoring chips, filling holes, spaces or discolorations.
COMPOSITES
Composites are a plastic-like material in the resin family used to fill teeth. The traditional composite resins are made up of a large amount of inorganic filler particles bound by an organic polymer matrix or mesh. The newer generation composites have superior properties which include higher strength, hardness, elasticity, abrasion resistance and high polishability to make the restoration appear lifelike. Uses include cosmetics, filling cavities, correcting size, color and shapes of teeth.
PORCELAIN VENEERS
Veneers are porcelain wafers that are laboratory fabricated and are bonded onto the tooth. They are highly esthetic and lifelike. They are designed to correct colors, sizes, shapes, spaces and alignments of teeth. They are stronger and more durable than composites.
CROWNS (CAPS)
Crowns are caps that are placed on damaged teeth to provide strength. The tooth may have been damaged by decay, or have a previous restoration that has fractured. Root canalled teeth are also crowned if too much tooth is missing or if the dentist feels that the tooth will last longer by protecting it with the crown. This involves several phases. One in which the dentist prepares the tooth and a temporary is fabricated and used to temporize the tooth while the crown is being processed in a dental laboratory. The second step is inserting the permanent crown. Failing to return to have the permanent crown placed can cause damage to the underlying tooth due to weakness and poor fit of the temporary crown.
POSTERIOR PORCELAIN INLAY/ONLAY
This is a highly esthetic, non-metallic restoration that is bonded on the prepared tooth to restore the beauty, strength and function of the tooth. The procedure is similar to that of a crown; however, due to new techniques of minimal invasiveness, the dentist tries to maintain as much sound tooth structure as possible. An accurate impression is taken of the tooth, a temporary filling is placed and a porcelain restoration is fabricated by the dental laboratory. Upon return, the tooth is chemically prepared, and the inlay/onlay is bonded onto the prepared tooth. The bite is adjusted and polished. The tooth is once again functionally restored to its almost natural form.
SILVER (AMALGAM) FILLING
Silver fillings contain amalgam. Amalgam is formed from particles that contain silver, copper, tin and mixed with mercury. It is packed into the cavity before it hardens into a strong alloy.
DENTURES
Dentures are removable or fixed prostheses that are custom fabricated and used to replace more than one missing tooth (white) and associated gum and bone structures (pink) as necessary. They are commonly called bridges or partials. Fixed bridges are cemented and cannot be removed by the patient. The materials used are made of acrylic resins alone or in conjunction with various alloys and porcelains. A partial denture replaces some teeth where the patient has some remaining permanent teeth. A complete or full denture replaces all teeth. An immediate denture, whether complete or partial, involves placing the appliance the same day the teeth are removed.
DENTAL IMPLANTS
Dental implants are designed to provide the foundation for the restorative dentist to replace missing teeth to form and function. Facial contours and tooth space is also maintained by replacing missing teeth. Implants are fabricated of titanium posts which are inserted into the jaw bone in place of the missing teeth. There are many different types of implants and the determination is made on examination and the degree of space, amount of remaining bone and individual choice of dentist. Once the implant is placed, a healing time is needed, which may take three to six months. Once the implant is ready, it acts as a root substitute, where the dentist can now perform the restorative treatment.
MOUTHGUARDS - athletic
A mouth guard may be an appliance made to protect teeth and surrounding tissue from oral trauma during athletic or physical activities. The mouth guard can be prefabricated or stock, or custom made by a dentist. Custom fitting mouth guards have been shown to be more comfortable. For children, they must be changed as new teeth erupt. It is known that mouth guards can prevent serious injuries such as jaw fractures, neck injuries, concussions, and teeth fractures. Studies have reported that concussions can be decreased by almost 50% by wearing a mouth guard. Any activity where there is a strong chance for contact, it is recommended that the mouth guard be worn.
MOUTHGUARDS - therapeutic
Tempromandibular disorders or dysfunctions are a set of conditions whereby teeth, jaw muscles, temporomandibular joints and the nerves associated with speech, chewing and emotion cause pain in the area. Severe conditions may result in “referred” pain. TMD affects women twice as much as men. The causes include overuse of jaw muscles and trauma. The symptoms can include jaw pain, especially in morning, earache without infection, jaw clicking when opening, difficulty in opening, stiff or locked jaw. The treatment would include resting the jaw, anti-inflammatory drugs (non-aspirin), stress management, eating soft foods, wearing a splint or mouth guard and avoiding chewing gum. More comprehensive treatment may be required.
Livingston District Dental Society
P.O. Box 587, Brighton, Michigan 48116