Common Prosthodontics Procedures
Prosthodontics procedures revolve around two main objectives – ensuring proper function and creating an attractive appearance for the patient’s teeth. A prosthodontist can replace a missing tooth, restore damaged teeth, and improve the aesthetics of healthy teeth. Most of these treatments involve fitting one or more dental prosthetics. Here are some of the most common prosthodontics procedures:
Patients who wish to replace metal amalgam fillings with a tooth colored material may see a prosthodontist for a resin filling. This dental composite material isn’t necessarily white. It is matched to the color of the tooth being filled so it looks as natural as possible. A tooth-colored filling is most likely to be used in front teeth for small cavities. It isn’t suitable for large fillings in teeth that experience a lot of pressure during chewing. The procedure for filling a cavity with composite is more complex than installing a metal filling; but it still takes just one visit to complete.
Porcelain inlays and onlays are the preferred material for restoring large areas of decay in molars. These ceramic prosthetics are used when the tooth is not damaged severely enough to warrant a full crown. An inlay or onlay can be placed with less removal of healthy tooth structure than a large metal amalgam filling. In fact, it may actually strengthen the structure of the tooth instead of weakening it. As with any prosthodontics procedures that involve ceramics, this is usually a two step treatment. On the first visit, the prosthodontist makes a mold of the tooth to send to the fabrication lab. On the second visit, the prosthetic inlay or onlay is affixed to the tooth with a dental adhesive.
Prosthodontists specialize in placing all types of crowns – metal, ceramic with a metal base and full ceramic. Each type of material has its own pros and cons. For example, ceramic can be matched to the color of the tooth and is biocompatible (won’t react with the tissues in the mouth). However, gold alloy may be somewhat more durable. With each type of crown, the tooth that will be “capped” is ground down on all sides to create a post over which the crown will fit. If the tooth is severely decayed, a filling may be installed before the crown is placed.
With both metal and ceramic crowns, the crown is made at a dental fabrication lab. The prosthodontist will glue on a temporary acrylic crown for the patient to wear while waiting for the fabricated crown to arrive. The “permanent” crown is fitted to the tooth and fixed in place with dental cement and cured with a lamp to harden the adhesive. Crowns are not lifelong restorations and will eventually need to be replaced in most cases.
Dental Composite Bonding
Some patients have front teeth that are slightly chipped, cracked or misshapen. A prosthodontist may use tooth colored composite resin to build up the tooth and restore it to an attractive shape. The composite is sculpted onto the tooth by hand and cured to harden the material. This procedure is done in one visit. This makes it an attractive option for patients who are put off by the time and expense involved in veneer placement. However, the material may discolor over time and is not a long lasting solution for a damaged tooth.
A dental veneer (laminate) is a very thin piece of ceramic material that is glued to the tooth. Veneers are used in prosthodontics procedures for masking many tooth imperfections including chips, cracks, crookedness and permanent staining. Veneers are only used on the teeth that are visible when the patient smiles. The different brands of dental veneers are made of porcelain with varying degrees of translucency.
The procedure involves a consultation along with computer imaging to show what the final result should look like. The teeth are prepared to receive the veneer by removing a small portion of the enamel (the prosthodontist will preserve as much natural tooth structure as possible). This creates room for the veneer to be placed without making the tooth look too thick. A crooked tooth may be shaved down more on one side than the other so that the veneer will make the tooth look straight. The prosthodontist may apply temporary veneers for the patient to wear during the wait time for fabrication.
Since porcelain veneers are translucent, the prosthodontist will determine the correct shade of dental cement to use under the veneer to match the patient’s desired tooth color during the veneer installation. The final fitting may also include slight adjustments to the shape of the veneer to achieve a natural and even appearance.
If a tooth is missing or requires extraction, it may be replaced with a bridge. This procedure involves grinding down and capping (placing crowns on) one tooth directly on either side of the missing tooth. These crowns are used as the anchors to hold the bridge in place. Treatment often involves several visits. This includes preparing the abutment teeth (the ones that will be crowned), placing the crowns after they are fabricated, placing the bridge temporarily, making adjustments for proper fit and bite alignment, and cementing everything in place permanently.
Prosthodontists may place a dental implant to restore a missing tooth. This solution is often much longer lasting than a crown and does not require crowning adjacent teeth. Instead, the prosthodontist drills a small hole in the patient’s jaw bone and inserts a post (a cylinder of titanium). The bone is allowed to grow back around the post over a period of several months. Then, an abutment is installed on the post to serve as a support for the crown. A couple of weeks later when the gums have healed sufficiently, a crown is added to complete the restoration.
Partial dentures are used to replace two or more teeth that are missing due to congenital defects, oral disease, or accident. A prosthodontist may create either permanent or removable dentures depending on the patient’s needs. A partial denture can be helpful for patients who are missing too many teeth to be corrected with a bridge. Modern dentures are often anchored to dental implants to keep the dentures from shifting out of place and to increase patient comfort. This option is only available to patients who have sufficient jawbone integrity to hold the titanium posts. Some patients may need bone grafting to restore the shape and function of the jaw to support dentures properly.