Dental prostheses
We can replace decayed teeth or missing teeth using a prosthesis thus recuperating the look, function and strength of the original teeth. We have at our disposal a raft of options: removable prostheses made of resin or metal (these can be taken out of the mouth and are known as false teeth, fixed prostheses (which are supported just by the teeth which are called crowns or caps and can be of metal/porcelain, just porcelain or zircon, as well as other materials, or a mixed prosthesis (a combination of fixed and removable).
Taking into account the state the teeth are in we can make a decision over a partial or total design for your new teeth.
Removable prosthesis
This is a prosthesis that you can take out to clean and they are held by the mucous membrane, gums and teeth. Often these are made for people who need the teeth quickly and have not enough bone for implant placement.
Removable prostheses, in time, need readjustment which means return visits to the surgery are necessary after fitting. Many patients resort to fixatives such as creams or pads to ensure better hold.
A fixed prosthesis over teeth
This is a very interesting option when the tooth has been damaged by trauma or with decay for example. We need to sculpt the tooth into shape both in height and width to form what is known as a stump so that afterwards the crown or dental cap can fit over it. It can be cemented so that it is firmly fixed. These are not only used to cover a single tooth but can also replace various missing teeth. This type of prosthesis is known as a fixed dental bridge.
Fixed prostheses over an implant
These are teeth which fit over implants previously carried out by a surgeon. For this reason the implant has a thread inside so that the crown can be fitted with a small screw. This prosthesis offers a number of restoration possibilities, not just for a complete jaw which has no remaining teeth, but also to replace individual pieces or groups of pieces with crowns or bridges over implants.
A fixed prosthesis is very comfortable and offers the patient almost natural mastication, speech and appearance. Moreover, it is not necessary to take it out to clean it, nor does it move, but it does mean more care needs to be taken with daily dental hygiene by the use of toothbrush and irrigators, and more frequent checks by the odontologist, above all for possible retraction of the gums.
Removable multi-implant support
These are completely removable dentures that are held in the mouth by means of a bar or fixed to implants, which vary in number according to the quality of the bone (two to four implants).
These prostheses are used when the surgeon is obliged to fit only a few implants in a patient without teeth, normally because of lack of bone. A toothless mouth can be reinstated with four implants in the upper jaw or at least two in the lower jaw, to these a denture can be added that encompasses the whole mouth. This type of denture fixes onto the implants although the patient is able to take it out for cleaning. The fact that it is placed over the implants means that the prosthesis does not move at all and it is not necessary to include the palate for fixture, so it is much smaller and more comfortable than other removable prostheses.
Frequently asked questions
What difference is there between a crown over an implant or over a natural tooth?
As the name indicates, crowns on top of implants are those which are fixed over implants previously inserted by a surgeon. Once the necessary time has passed for the implant to become integrated, the dentist will take some measurements for the crown to be put in position. As we have mentioned previously, many tests need to be carried out to ensure an excellent result for all concerned. These prostheses over implants can be screwed or cemented. If they are screwed into position the specialist is easily able to take them off for example in case of breakage.
Crowns which are placed over a natural tooth, however, are placed over the patient’s own teeth. In the majority of these cases, this type of prosthesis is used due to a trauma in a tooth or because of extensive tooth decay which has destroyed a large quantity of dental tissue and for this reason in order to be reconstructed, needs a cap or crown which protects the remaining healthy tissue at the same time as making it function well and look good.
How long do you have to wait between the insertion of an implant and the dental prosthesis?
The correct time for the integration of the implant into the bone is between two and four months before mastication is restored to normal strength.
Then the permanent prosthesis can be made. For the front of the mouth or in the case of the whole jaw a provisional prosthesis can be made (i.e. implant and tooth the same day) for the patient’s convenience. The implantologist will establish the time factor involved for completing the treatment. This will normally depend on the state of the bone where the implant is placed, the type of implant and if a bone graft was used. Also same day implants require special care when eating in the months spent waiting for the permanent one.
An implant placed in a bone of an acceptable quantity and quality means we can allow less time before the permanent implant is inserted. In the case of the bone being narrow or of bad quality, the waiting time will be longer as the implant needs a little more time to become integrated into the bone. Without doubt, respecting the integration time of inserted implants means that when the prosthetic specialist is ready to finalise the work, the implant is perfectly integrated into the jaw. With dental implants we must be as careful as we are with our own teeth. As well as the normal brush cleaning at home, interdental brushes and dental floss should be used and a maintenance programme put into place.
It is also important to see a professional hygienist every four to six months. Good hygiene habits at home and regular visits to our hygienist will help your implants last a long time.
What materials are the most suitable for a dental prosthesis?
That depends on the type of dental prosthesis. A removable prosthesis contain a great deal of resin possibly reinforced with metal.
A permanent fixed prosthesis is made of porcelain with or without a base of a noble metal. Sometimes they can be made of resin over a metallic structure (hybrid prosthesis).
To achieve a good restoration of the affected part the prosthetic specialist has to examine the area. and talk to the patient to hear their aesthetic/functional requirements and take X-rays to see the state of the tooth that is going to be restored. These are essential tests to enable the selection of the type of material to use.
As we have mentioned many times, advances in technology offer us a range of possibilities when we are going to restore an affected tooth. More aesthetic materials would be our choice for the front of the jaw. On the other hand we would opt for stronger materials when restoring molars as they are subject to more wear and tear.
Good groundwork is the key to successful treatment.
Which is better a fixed bridge or a dental implant?
Nowadays thanks to the advances made in integrating the implant into the bone, the majority of professionals recommend the use of implants rather than bridges fixed to natural teeth.
The most important factor that we need to take into account with a dental bridge is the need to use the adjacent healthy teeth to make it, as these teeth have to be shaped to support the bridge, this means that we are going to sculpt healthy teeth a little. A bridge is a less conservative treatment than an implant. another negative consequence of dental bridges is the reabsorption of the jaw bone. As this is not being stimulated by a natural or artificial root it loses thickness and length, spoiling the appearance and compromising the possibility of placing implants in that area in the future.
On account of durability, we prefer a prosthesis fixed over an implant, as the dental bridge depends on neighbouring teeth which can still run the risk of dental problems such as decay. Also dental implants afford easy access for cleaning between the teeth.
What care is necessary for dental prosthesis?
These prostheses need to be cleaned carefully daily as dental plaque gets into the mouth every day. A patient wearing a prosthesis should be instructed on how to clean it well and to attend the clinic at least once a year so that the dentist can check and clean it thoroughly.
Often patients tend to think that once the prothesis has been fitted, it needs practically no maintenance. This could not be further from the truth; a dental prosthesis needs similar care to that which we give our own teeth. Correct hygiene is essential so that it remains in perfect condition in the patient’s mouth for years to come.
Moreover, regular checkups are essential, as we have already mentioned, so that the specialist can check for any adjustment and ensure the good condition of the soft tissue.