Indent - Prosthodontics; Dr. Med. Dent. Fagaras Octavian phd/dds

Prosthodontics

What is the prosthodontics?

As dentistry purposes, prosthodontics refers to dento-maxillary morpho-functional and aesthetic restoration methods using artificial prosthetic appliances / dentures.

Prosthodontics analysis the state of dental arches and of muscular and joints balance, often altered by the loss of one or more teeth (edention) or even by excessive dental attrition, and finds the most appropriate treatment solutions to restore the dental arches integrity in an aesthetic and functional way in perfect harmony with the other dental cavity structures, making use of “artificial teeth” created outside the oral cavity by dental technicians.

How are dentures conceived?

Dental prosthesis are designed and conceived within an individualised treatment an intervention plan  - focused on each patient problems; plan realised based on the close interdependence between prosthetics and the other dentistry disciplines / branches:

  • dental radiology / imaging – provides therapeutic diagnosis and evaluation tools in prosthodontics
  •  periodontics – offers the therapeutic means addressed to the majority dentures’ support , to the interaction between dentures and the remaining teeth’ periodontium
  • restorative odontotherapy, endodontics and dental prosthetics, together, provide solutions for the preservation on the arches of those teeth with severe crown/ root destruction,  and also to establish the frontiers between the fillings done through direct intraoral techniques and the unitary fixed prosthesis.
  • orthodontics offers, both, therapeutic alternatives for dental prosthetics and optimising solutions for dental prosthesis support, aesthetics and reliability. In reverse, dentures can solve some teeth positioning abnormalities or, sometimes, can stabilise the orthodontic treatment results.
  • dentoalveolar and periodontal surgery provides, besides the support for the prosthetic rehabilitation on implants, also therapeutic means for the functional and aesthetic improvement of prosthetic restorations.

Prosthetic treatment is established by the dentist, based on patient’s clinical and radiological (x-rays, possibly CT) examination, on facial and intraoral photographs analysis, but also on study models mounted in an articulator (special tool that reproduces in the laboratory both the report between the dental arches, the maxillary arch and skull and the movements produced in the temporo - mandibular joints).

All of these require a permanent communication with the dental technician handling the case, also involving him in the aesthetic and functional foreshadowing of the future restorative treatment (ex: wax-up).

What means edentation?

The edentation is a result of one or several teeth’ loss, or even of all teeth on one or both dental arches (total edentation).

Why a missing tooth should be replaced?

The loss of even a single tooth (edentation), entails a number of disorders of the teeth, maxillary bones and consecutively at the temporo – mandibular joints and muscles level. 

The teeth are suffering small movements their entire life, trying to find stability through contact with both adjacent teeth and also the corresponding teeth on the opposite arch.

Once a tooth is missing, the others are continuously trying to compensate the loss, and by this generating a cortege of events:

  • tilting of adjacent teeth towards edentulous space (the space vacated by one or more teeth extraction)
  • antagonist teeth eruption (growth/elongation) towards the edentulous space. No longer existing a correspondent tooth (due to its loss) to realise the mastication, the tooth on opposite arch will “erupt” trying to find itself an antagonist.

The remaining teeth position changes will lead to the following:

  • occlusal problems (difficulty in masticatory dynamic due to appearance of abnormal contacts produced by dental migration)
  • consecutive muscles tensions and in time, also disorders at temporo-mandibular joints level
  • all these seemingly “insignificant” changes can cause postural disorders accompanied by pain at head, neck, back and limbs level
  • periodontal problems due to the appearance of retentive spaces/areas hard to clean, accompanied by gingival inflammation, which, uncontrolled, can affect the afferent teeth support structure (periodontal disease)
  •  dental problems: pathologic attrition of dental enamel with consecutive appearance of sensitivity phenomena and increasing susceptibility to caries
  • not at least,  after extraction, the bone will suffer a resorption/atrophy phenomena, which can be translated into physiognomic damage (lack of support for the lips, cheeks) giving an old appearance to the person (ie: total edentulous appearance) .  As much delayed, as higher the atrophy will become, by this aggravating the future restorative treatment, either being the classic one or the dental implant one.

What is dental attrition?

Attrition represents the tooth substance loss due to the mechanical effect produced by antagonist/opposing arches contact.

Bruxism is included among the most common attrition causes. This is a function characterised by excessive compression and friction between the dental arches. Most times, this is an involuntary habit, having a psycho-emotional trigger.

Should dental attrition be treated?

Even it might seem strange, some patients can experience a pathological generalised attrition of all teeth, with the reduction of dental size to half or even to gum level, by this giving to the concerned person an old look in disagreement to biological age.

Leaving aside the unpleasant appearance, the most serious are those functional disturbances that appear at muscle and temporo-mandibular joints levels.

Teeth are normally presenting a specific anatomic relief/landscape that allows physiological mandibular movements (food incision, crushing by laterality movements, etc). Following attrition, the teeth will present dull surfaces, perfectly flat and well circumscribed, that will not allow anymore a normal masticator dynamics, forcing the muscles and joints to abnormally act for facing these disturbances and by this resulting a serious imbalance of the whole dento-maxillary apparatus.

For these reasons, dental attrition should be considered similar to edentation, finding the best way for an anatomic and functional restoration of the teeth’ masticatory surfaces, in harmony with the whole muscular and joints/articular complex, obviously following the dento-facial aesthetic guidelines.

Today, dentistry must generally offer an aesthetic treatment, whatever labour is done, but without neglecting the fact that aesthetics cannot exist in functionality absence.

What are the dentures / dental prosthesis?

Dental prosthesis/dentures are rigid parts, regularly made outside the oral cavity (in the dental technician laboratory and sometimes in the clinic) from various materials (acryl, composite, metal, ceramics, zirconium), which are then anchored in the mouth, by this restoring the integrity and functionality of the dental arches and the whole dento-maxillary apparatus. In addition to their functionality, the prosthesis will restore as much anatomic and as much natural, the features of a pleasant smile and appearance.

Types of denture (prosthesis)

According with the anchoring style, dentures can be:

1. Fixed (for one tooth - crown or more teeth – bridge):

  • Dental crowns restore the morphology of a single destroyed tooth and are bonded/anchored by cementation.  In the fixed one tooth restoration category we can include also:
    • Vestibular ceramic veneers (cosmetic re’contouring)
    • Palatal ceramic veneers and occlusal ceramic onlays’ (functional rebalancing)
    • Ceramic inlays
  • Dental bridges are prosthetic devices compensating the lack of one or more teeth, and are anchored/bonded by cementation on an edentation adjacent teeth.  

Fixed prosthetic devices can be realised from:

  • full ceramic
  • ceramic on zirconium support
  • ceramic on metal support
  • precious or semi’ precious metals (not aesthetic)
  • acrylic / composite (temporary dentures)

2. Mobilizable (are indicated/advisable  in case of extensive edentation, that no longer allow dental bridges): anchored with special systems on the remaining teeth, but can be voluntarily removed for cleaning by the patient itself). Ex:  skeletal prosthesis, telescopic dentures.

3. Mobile (total prosthesis / dentures): extensive devices realised in case of total edentation and are supported by the oral cavity bone structure.

4. The development that dental implants have gained in dentistry led to the description of a fourth subdivision of dental prosthetics -  prosthetics on implants

  • Crowns on implants  - Such as a missing tooth does not require anymore the preparation of the edentation adjacent teeth for future dental bridge bonding. The implant will play an artificial root role and will support the future dental crown, fixed by cementation (or screw).
  • Bridges on implants - There is also the possibility to realise prosthetic devices anchored on both implants and natural teeth.

For patients wearing dentures or those who should reach this situation (total edentation), there are now implant – prosthetic solutions that will certainly improve the quality of life by simply not talking anymore about unsupported mobile devices/dentures, but talking about fixed or mobilizable devices.

Among the advantages of these prosthesis, are:

  • increased comfort: more delicate and less bulky than the classical dentures
  • safety: no more denture movement or sliding
  • improved phonation (speech)
  • enhanced sense of taste
  • natural mastication (you can bite and chew naturally; you can again enjoy your favourite food)
  • enhanced self confidence

Denture bonding is ensured/done by:

  • screws (the device can be removed only by the dentist) – this system is the current trend in dentistry
  • cement (the device can not be removed

Denture anchoring is ensured/done by:

  • special systems (bar, locators, telescope), that gives a fix support to the actual denture but allows the patient to daily remove it for cleaning

Most dental prosthetic systems are done by means of the dental technique laboratory, requiring several treatment sessions and waiting periods of several days, as execution technology of these “dental jewelry” is extremely laborious and precise. Nowadays dental technique became a real art, the art of reproducing exactly the naturalness of human teeth.

 For one tooth prosthetic devices, our clinic now offers a revolutionary computerised system to realise these devices (inlay, crowns) in-house, in only one treatment session:

CEREC (CEramicREConstruction) – a technical miracle in dentistry; the spearhead of dental prosthetics and aesthetics

  • No more classical prints!!
  • No more provisional!!
  • No more visits to the technician and no more test sessions!!
  • A single appointment!!
  • A single anaesthesia!!
  • Ceramic REConstruction!!
    • Superior aesthetics!! (large range of colours, translucent)
    • Resistence!! (ready made ceramic material)
    • Precision!! (Perfect marginal adaptation – reduced risk of carious infiltration on the reconstructed tooth, the guarantee for dental health and long-term treatment success)
    • Excellent Bio-compatibility!! (anti-abrasive ceramic, resistant to bacterial plaque adherence)

What is CEREC?

CEREC system made the headlines from it’s beginnings by allowing a tooth restoration through a prosthetic device in a single visit, by this eliminating the intermediate visits (actually not a few) necessary due to the collaboration with the dental technique laboratories. So, the patients could resume to their daily activities in the shortest time possible, and in the same time benefiting of higher quality dental restorations.

CEREC (Economical Restoration of Aesthetic Ceramics) is a computerized system with which you can design and produce, in a single session, an extremely precise, aesthetic and resistant single-tooth prosthetic device.

Indications?

CEREC represents the latest solution for extended dental defects restoration, being an excellent alternative to:

  • un-aesthetic metal or composite fillings (less resistant on long term)
  • dental crowns (metallic, metal-ceramic or full ceramic) realised in the dental technique laboratories in a higher number of treatment sessions

History, clinical and scientifically relevance

CEREC technology has a history of 20 years of successful scientific research and clinical experiences. Globally, until present there have been realised more than 8 million of restorations using CEREC Technology.

We believe that all our clients must have rapid access to the most beautiful smile and this can be solved with CEREC technology.

Dr. Octavian Fagaras has the longest experience with this technology in Romania, with several thousand restorations in portofolio, starting to work with CEREC 3D already from 2003 (date of the system’s appearance on the market)