Prosthodontics

WHAT IS A PROSTHEDONTIST?

A prosthodontist is a specialist in the replacement or restoration of teeth and jaw structures utilizing artificial materials. A prosthodontist must complete three to four additional years of training in a prosthodontics program accredited by the American Dental Association, to obtain the skills required to be considered a specialist in the field. This extensive training provides prosthodontists the knowledge of creating tooth replacements, understanding the dynamics of a great smile and preserving a healthy and beautiful smile.

WHY CHOOSE PROSTHEDONTICS?

Known as the architects of restorative treatments, prosthodontists work closely with general dentists and other specialists to provide solutions in restoring your teeth and mouth to proper functionality and aesthetics.

Highly trained in state-of-the-art techniques and procedures, prosthodontists are experts in treating diverse, and many times complex, dental conditions such as jaw joint problems, missing teeth, sleep disorders, traumatic injuries to the mouth and teeth, congenital defects, oral cancer reconstruction and problems arising from neglect.  To treat these conditions, prosthodontists provide the following services:

  • Crowns and bridges
  • Veneers
  • Complete and removable partial dentures
  • Dental implants
  • Full mouth reconstruction using prostheses
  • Congenital defect correction using prostheses

Prosthodontists focus on the development and placement of customized prosthesis to replace missing teeth, damaged dentitions or defects. Prostheses can be constructed from a variety of materials including metal, porcelain and acrylics, depending on the function and desired aesthetic results of the piece.

DENTAL IMPLANTS

A dental implant is an artificial tooth root used to replace a single tooth or multiple missing teeth. Because an implant looks and functions like a natural tooth, it is a great alternative to a bridge or dentures that don’t fit properly.

The process for placing an implant occurs in stages, and thus takes many months to complete. Dental implants may be a good treatment option for you if:

  • You are missing one or more teeth
  • Your gums are healthy and you have enough bone to which the implant can be secured
  • You jawbone is fully developed

A bone graft may be needed before your implant surgery if your jawbone is too soft or not thick enough to support the implant.

Implants can be placed in an office or hospital setting. During the procedure, your gum is cut to expose the bone. Then a hole is drilled in the bone for the titanium implant root to be placed. It takes about six months for the implant to fuse to the jawbone, a process known as osseointegration. After this, the abutment is placed, which is what the artificial tooth (crown) will be attached to.

If properly cared for a dental implant can last for many years. Proper maintenance includes daily brushing and flossing, a healthy diet and regular dental visits.

FULL MOUNTH RECONSTRUCTION

If you are missing one or more teeth due to injury or decay or have severely worn teeth and jaw pain due to bite problems, your prosthodontist may recommend you have a full mouth reconstruction to restore the health and beauty of your smile. Full mouth reconstruction is actually a combination of procedures that is completed in phases. Full treatment may take up to a year to complete. Other dental specialists may be involved in your treatment.

A full mouth reconstruction may include:

  •  Orthognathic (corrective jaw) surgery
  •  Gum contouring
  •  Crowns
  •  Bridges
  •  Veneers
  •  Inlay/Onlay
  •  Implants
  •  Bone or tissue grafting

After a thorough exam of your teeth, gums, as well as jaw muscles and joints, your prosthodontist will determine what procedures are necessary to rebuild your smile.

FIXED PROSTHODONTICS

Crowns

Your prosthodontist may recommend a dental crown or cap to restore a decayed, damaged or cracked tooth. A crown can also be used to enhance discolored or badly shaped teeth.

Types of crowns available include:

  • Metal
  • Porcelain-fused-to-metal
  • All-resin
  • All ceramic or porcelain

Metal crowns are durable and require little removal of the tooth structure. The metallic color makes this type of crown a suitable option for restoring back molars. Porcelain-fused-to-metal crowns can be matched to the natural color of your teeth. However, they cause more wear and tear to opposing teeth. Compared to other types of crowns, all-resin crowns are least expensive, but they are more susceptible to fractures. All ceramic or porcelain crowns generally have the most natural appearance, but are often less durable.

The process for placing a custom-made crown generally consists of 2-3 office visits. At the first visit, your prosthodontist may examine the roots of the tooth by taking X-rays of the tooth structure and surrounding bone. If decay is present or there is a possibility that infection or injury will develop in the pulp, a root canal treatment may be necessary.

Treatment plan for a patient receiving a crown

  1. Numbing the tooth to remove the decay in or around it.
  2. Re-shaping the tooth to provide an ideal fit for the crown. (The amount of tooth structure removed depends on the type of crown
  3. Making an impression of your teeth in order to create a custom-made crown (usually takes one to two weeks).
  4. Making a temporary crown out of acrylic resin and fitting it onto the tooth during the interim period when the custom-made crown is being fabricated.
  5. Applying the crown (when received from the lab) by removing the temporary crown and fitting the custom-made one onto the tooth.

After ensuring that the crown has the proper look and fit, your prosthodontist cements it into place.

Following the procedure, proper dental hygiene, including daily brushing and flossing, is necessary to maintain healthy, bacteria-free teeth, gums and crowns. This helps in the prevention of gum disease. Given proper care, your crowns can last a lifetime.

Bridges

If you are missing one or more teeth, you may find it difficult to chew or speak properly. Your prosthodontist can remedy these and other problems by placing a bridge. A bridge is a dental device that fills a space previously occupied by a tooth, and may be required to prevent:

  • Shifting of the teeth, which can cause bite problems (occlusion) and/or jaw problems and resultant periodontal disease.
  • Bridges preserve the integrity of existing teeth and help maintain a healthy, vibrant smile. 

Bridges can be manufactured from porcelain, gold, alloys or a mixture of these materials.

Three main types of bridges:

  • Fixed bridge- this is the most common type of bridge. It consists of a pontic (filler tooth),  which is attached to two crowns that fit over the existing teeth and hold the bridge in place.
  • The “Maryland” bridge, also known as a resin-bonded bridge, is commonly used to replace missing front teeth and consists of a filler that is attached to metal bands that are bonded to the abutment teeth. The metal bands consist of a white-colored composite resin that matches existing tooth color. This is the least expensive type of bridge.
  • The Cantilever bridge is often used when there are teeth on only one side of the span. A typical three-unit cantilever bridge consists of two crowned teeth positioned next to each other on the same side of the missing tooth space. The filler tooth is then connected to the two crowned teeth, which extend into the missing tooth space or end.

Practicing good oral hygiene and seeing the dentist regularly ensures the longevity of your bridge.

Inlays/Onlays

Inlays and onlays are indirect restorations. They are a great alternative to traditional metal fillings, primarily because less of the tooth structure needs to be removed. Inlays and onlays are suitable for treating mild to moderate decay, and can be used to restore a cracked or fractured tooth if the damage is not extensive enough to require a crown.

Generally, inlays are small restorations that fit within the contours of the biting surface of a tooth, while onlays cover a portion or the entire chewing surface.

Inlays and onlays can be made from porcelain, gold or composite resin. Once fabricated, they are securely bonded to the tooth.

Advantages of inlays and onlays

  • Since they can be fabricated from tooth-colored materials, inlays and onlays are aesthetically pleasing. Unlike traditional metal fillings, the restoration is virtually invisible.
  • Less removal of the tooth structure is required to achieve optimal results.
  • They do not cause excessive wear and tear to opposing tooth structures.
  • Inlays and onlays prevent the need for more significant treatment in the future.

The process for placing inlays and onlays generally requires two or more office visits. Initially, once the decay is removed, your prosthodontist will take an impression of the tooth. A temporary restoration is placed until the custom made inlay/onlay is manufactured in a laboratory.

Following a proper oral hygiene regimen daily, ensures the success and longevity of your new restoration.  

Implants

If you are generally healthy and have healthy gums and an adequate jawbone to support an implant, your prosthodontist may recommend implant treatment as suitable option for replacing missing teeth.

Originally developed half a century ago by a Swedish scientist named Per-Ingvar Branemark, implants initially arose from the patient’s need to secure loose-fitting dentures. Engineering and enhancements to the implant have enabled dentists to expand its’ usefulness, including the replacement of missing or lost teeth.

Implants are made of titanium and other biologically compatible materials.

Today, implant techniques offer a broad range of replacement solutions including: 

  • Single Tooth Replacement
  • Anterior Replacement
  • Posterior Replacement
  • Full Upper Replacement

Types of Implants
There are three main types of implants:

  • The root implant
  • The plate form implant
  • The subperiosteal implant

The root implant is by far the most popular. It is a highly effective treatment option; enabling your prosthodontist to place a tooth that mirrors the shape and size of your natural tooth. This procedure is generally a three-part process. First, your prosthodontist will surgically place the implant or artificial root into the jawbone following local anesthesia. It will take approximately three to six months for the implant to heal and fuse with the bone. This process is known as osseointegration. Once this happens, a post will be attached to the implant. Once the gum tissue heals around the post, the implant is fitted with a crown.

The plate form implant is ideal in situations where the jawbone is so narrow that it could not adequately support a root implant. The plate form implant is flat and long, so it can anchor into thin jawbones. It is inserted the same way as a root implant. In certain cases, the plate form implant is immediately fitted with the restoration without waiting for the healing process to run its course.

The subperiosteal implant is used when the jawbone has receded to the point where it can no longer support an implant. There are two methods for placing this custom made implant.

Post Implant Care

Although proper oral hygiene is always recommended for maintaining good dental health, it is especially important when a patient has received a dental implant. Bacteria can attack sensitive areas in the mouth when teeth and gums are not properly cleaned, thus causing gums to swell and jaw bones to gradually recede. Recession of the jawbone will weaken implants and eventually make it necessary for the implant to be removed. Patients are advised to visit their dentists at least twice a year to ensure the health of their teeth and implants. Dental implants can last for decades when given proper care.

Veneers

Veneers are a great aesthetic solution to enhance your smile that may even help you avoid orthodontic treatment. Veneers can be used to make subtle improvements to your smile. In most cases, veneer application is completed in only two office visits.

Veneers are thin, semi-translucent “shells” typically attached to your front teeth. Veneers are customized from porcelain material that is bonded to your teeth. Veneers are a great alternative to otherwise painful dental procedures to improve the appearance of your smile.

Common problems that veneers are used for:

  • Spaces between the teeth
  • Broken or chipped teeth
  • Unsightly, stained or discolored teeth
  • Permanently stained or discolored teeth
  • Crooked or misshapen teeth

    Please contact our office if you have any further questions on veneers.

REMOVABLE PROSTHODONTICS

Replacing your missing or damaged teeth will benefit not only your appearance but your overall health. Using state-of-the-art technology and updated materials, dentures can now be custom designed to look more natural and feel more comfortable.  

It may take some time to adjust to your dentures. Speaking and eating may feel different at first, but these regular activities will resume normally once you are accustomed to your dentures.

Complete Dentures

Complete dentures are artificial, removable replacements for the natural teeth of the upper or lower jaw or both.

  • Upper dentures

Upper dentures are held in place by a vacuum created between your appliance and the palate of your mouth.

  • Lower dentures

Lower dentures are horseshoe-shaped to accommodate the tongue, and, due to lack of suction, are often held in place by implants placed in the jaw for support.

  • Partial Dentures

Partial dentures are removable appliances that replace missing teeth by attaching via a metal framework to your natural teeth.

Caring for your removable appliances:

Proper denture care is essential to the durability of your dentures and the overall health of your mouth.

  • Brush your dentures daily with a soft-bristled tooth brush. (Don’t forget to brush your gums and tongue as well.)
  • While not being worn, keep your dentures in denture solution and/or water (not hot) to prevent warping.
  • Handle with care and keep out of the reach of children and pets
  • If your dentures become loose, chip, break or crack, see your prosthodontist.

COMMON PROBLEMS

Tooth Decay

Caries, or tooth decay, is a preventable disease. While caries might not endanger your life, they may negatively impact your quality of life.

When your teeth and gums are consistently exposed to large amounts of starches and sugars, acids may form that begin to eat away at tooth enamel. Carbohydrate-rich foods such as candy, cookies, soft drinks and even fruit juices leave deposits on your teeth. Those deposits bond with the bacteria that normally survive in your mouth and form plaque. The combination of deposits and plaque forms acids that can accumulate and damage the structure of teeth and the bone supporting the teeth and gums.

Loss of Natural Teeth

Missing teeth can lead to more serious problems including tooth decay, an uneven bite, and stress on adjacent teeth. A bridge is used to replace a missing tooth or teeth when there is a tooth on either side of the missing tooth.  A false tooth is joined to the natural teeth with cement, forming a bridge that cannot be removed by the patient.  When a patient is missing all of his/her natural teeth, complete dentures are used to restore function and appearance. For patients who experience lack of stability and poor chewing function with dentures, dental implants may be used. Replacing missing teeth not only improves the appearance of your smile, but it can also improve your overall oral health. 

Teeth Grinding

Because of the forces exerted on the teeth and Temporomandibular Joint, teeth grinding can cause extensive damage to your teeth.  It is a habit that most patients are not aware of since it occurs during sleep.  Stress is one reason why many people grind their teeth at night; however, there are several other reasons for this condition. Problems with jaw alignment and the way teeth come together are often factors for teeth grinders. Using a custom-made night guard can not only protect the teeth, but relieve pressure on the TMJ as well.

Congenital and Developmental Mouth Defects

Congenital and developmental mouth defects can include cleft lip and palate, birth defects of the jaws, lips and palate as well as growth disturbances of the jaws. Patients with developmental defects have missing and misshapen teeth because their teeth never developed properly or at all.  Others have teeth with a poorly developed tooth structure throughout the mouth. Prosthodontists are well trained in the replacement and restoration of teeth as well as facial reconstruction. 

Cleft Palate

A Cleft lip and palate is one of the most common major birth defects, affecting approximately 1 in every 1000 births.  This condition occurs when the tissues that usually form the lip and roof of the mouth fail to grow together, leaving a gap or hole.  While most clefts can be closed with reconstructive surgery, there are some patients who require an obturator. An obturator is a prosthetic device used to close a cleft, improving the patient’s speech and swallowing. Cleft patients generally require long term follow up care to ensure proper dental and speech development.

TMJ

TMJ refers to the painful symptoms related to Temporomandibular Joint dysfunction, or your complex jaw joint. Some symptoms may include a clicking, popping or pain in the front of the ear, headaches, pain in the joint itself, teeth that no longer touch when you bite and limited movement of the lower jaw.  Also, if it is hard to use your front teeth to bite or tear food and if your teeth seem sensitive, loose, broken, or worn, you may have the symptoms of TMJ. 

Sleep Apnea

Sleep apnea is a disorder in which people stop breathing for at least 10 seconds at a time while they are sleeping. These short stops in breathing can happen up to 400 times every night. The periods of not breathing may cause disruption from deep sleep and lead to restlessness and fatigue. One solution is the use of a night guard which improves airflow by repositioning the lower jaw.

Congenital and Developmental Mouth Defects

Congenital and developmental mouth defects include:

  • Cleft Lip – An opening in the lip due to incomplete development in the early stages of pregnancy.
  • Cleft Palate – An opening in the roof of the mouth due to incomplete development in the early stages of pregnancy. 
  • Hypodontia – One or more missing teeth.
  • Hyperdontia – Extra (supernumerary) teeth.

Prosthodontists are skilled at treating these and other deformities.

OTHER SERVICES

Teeth Whitening

Your teeth will darken over time, as a result of wear and tear and the buildup of stains. Staining can be caused by such factors as the food and beverages consumed (like coffee, tea and soda) or due to childhood medications or illnesses, tobacco use or inadequate oral hygiene. 

Our office offers a variety of solutions for whitening your smile, including in-office techniques and professional take-home whitening kits. We are trained professionals using industry-approved methods. One of the methods used by our practice is a gentle hydrogen-peroxide gel-activated solution. This method will whiten your entire smile in one visit.

Whitening is not permanent. Avoiding foods and beverages that cause staining may help to prolong the effects of treatment.

The degree of whitening varies, depending on the severity of the stain, the condition of the teeth, as well as the type of whitening product and how long is it used.

Tooth whitening services are growing in popularity. In fact, it’s one of the most requested services offered by our practice.

Everyone sees the growing consumer market focused on whiter teeth. While over-the-counter whitening products are readily available, the reality is that “too good to be true” solutions typically don’t work.

Call us today for a professional whitening evaluation.

COMPOSITE BONDING

Composite bonding is a common solution for:

  • Fixing or repairing chipped or cracked teeth
  • Reducing unsightly gaps or spaces between teeth
  • Hiding discoloration or faded areas on the tooth’s surface
  • Repairing decayed teeth

Often used to restore the appearance of your teeth and enhance your smile. As the name indicates, composite material, either a plastic or resin, is applied to a tooth and hardened with a special light, which “bonds” the material to the tooth. Generally no anesthesia is required, and unlike veneers or crowns, little, if any, of the original tooth structure is removed.

Composite bonding has many advantages:

  • Unless several teeth are involved the procedure can be completed in one office visit. It typically lasts less than one hour.
  • It does not reduce the tooth’s original structure and is relatively inexpensive.
  • Composite resins come in many different shades and provide better matching of shades to the natural color of your teeth.

Disadvantages:

  •  Compared to crowns and veneers, composite bonds are not as durable and long-lasting, and may need to be replaced or re-touched in the future.
  • They stain easily. Common staining elements include coffee, tea, tobacco, foods and candy.

In order to ensure the longest possible duration of the bonding, brush your teeth at least twice a day, floss at least once a day and see your dentist for annual professional cleanings. Because composite bonds can chip, avoid biting your fingernails, chewing on pens and ice or other hard objects. Depending on your oral habits, composite bonds can last from three up to nearly ten years.