Prosthodontics

People can lose teeth or have missing teeth for various reasons.  Periodontal disease, advanced tooth decay, traumatic injuries or severe clenching can lead to tooth loss.  This can create unnatural spaces between teeth, making biting and chewing more challenging, as well as affecting your speech and appearance.  Less obvious, but still problematic is that remaining natural teeth may slowly migrate while the underlying jawbone may shrink down.  When this happens, misaligned teeth become difficult to clean and are subject to more unfavorable forces. This can result in a potential cascade of problems including periodontal disease, dental decay, heavier wear and temporomandibular disorder so we recommend replacing missing teeth to prevent these problems.

Fixed Bridges

A fixed dental bridge consists of a false tooth anchored to surrounding teeth to hold it in place, essentially "bridging the gap".  There are different types of bridges commonly used today.

• traditional fixed bridges - These are the most common type of bridges in which crowns are placed over surrounding teeth to anchor the replacement tooth (pontic) in place.  These can be made with any of the restorative materials used for crowns, such as gold, ceramometal, porcelain and zirconia.
• cantilever bridges - These are used when teeth are present only on one side of the space where the tooth is missing or if we are able to anchor the pontic to only one tooth.  These are typically used in the mouth that undergo less stress.
• resin-bonded bridge - These are used in areas that undergo less stress, such as the front of the mouth.  The pontic is anchored by metal flaps bonded onto the surrounding teeth, preserving much of their tooth structure.

A minimum of two visits is required for placing a fixed dental bridge.  Similar to crowns, during the first visit, we prepare the teeth, take impressions and cement a temporary bridge.  On the final visit, the temporary is removed, the laboratory-fabricated bridge is seated and adjusted, you check the appearance and we permanently cement or bond it in place.

Removable Dentures

A denture is a removable prosthesis for missing teeth and the tissues connected to those teeth.  Its base is often made with acrylic and can sometimes have attached porcelain and metal material, while the teeth are made of a hard reinforced plastic or porcelain.  Dentures can closely resemble natural teeth and gum tissue.

The process of making dentures usually takes a month during which we make four to six weekly appointments.  We need to take accurate impressions and records of how your jaws align.  You will get to see the fit and appearance of your denture before they're processed and ready for delivery.

• Complete dentures - When all teeth have been lost, a "full set" of dentures are made to restore your smile and provide some chewing function.  Conventional dentures are made for people who have been missing teeth for awhile or when all the gums are healed after teeth have been removed.  Immediate dentures can be made to be inserted at the time teeth are removed to allow you to have teeth to smile and function during the early healing stages.  Immediate dentures may protect tissues and reduce bleeding after extractions, but eventually need replacement or relining.
• Partial dentures - Removable partial dentures are made when patients still have some remaining natural teeth.  Partial dentures often are made with an acrylic base attached to a metal framework.  The framework is anchored on to the natural teeth to help hold it in place.  Other types of partial dentures can be made with only conventional acrylic or with newer flexible base materials.

New denture wearers need time to get accustomed to their new "teeth" because even the best fitting dentures may feel awkward at first.  While most patients can speak normally within a few hours, many patients feel discomfort with eating for several days or weeks.  Changes in facial appearance, increased salivary flow and minor irritations may also be noticed.  It will often take many weeks to develop neuromuscular control to chew comfortably and not have dentures loosen as you speak or chew.

As time goes by, the tissues under a removable denture can change and shrink due to not having natural teeth to support as well as the pressures applied on them by the dentures.  Removable dentures may become loose and unstable, but this can often be corrected by a reline.  This procedure is usually done by a laboratory which will use our impression to add a little more denture base, allowing it to better adapt to your tissue to make them more retentive and comfortable.

Dental Implants

Dental implants have become a popular method for replacing missing teeth as they can be used to replace a single tooth or as an alternative to dentures.  Implants are usually made of titanium and are cylindrical fixtures placed directly into the jawbone which fuse (osseointegrates) together.  This modern versatile procedure can be used to provide very strong and reliable anchors for:

• Single tooth implants - A single missing tooth and be replaced by placing an implant to act as the "root" for the "false" tooth.  It's possible to have more than one in different areas of your mouth.  They are an excellent way of replacing a single missing tooth rather than involving surrounding teeth such as conventional fixed bridges.
• Multiple tooth implants -  This is sometimes called an implant-supported bridge and are done to replace two or more consecutive missing teeth.
• Full arch restorations - When a patient is missing teeth in an entire arch, two or more implants may be used to serve as anchors to hold a prosthesis in place,  Numerous types of attachments allow them to support anything from removable dentures to fixed dentures permanently attached to the implants.  Each individual case is different and we must assess your health, your jawbones and oral tissue to determine what your options may be.  There is also a wide range of functionality and costs so it depends on what your expectations are for replacing your missing teeth.

Dental implants are usually made of three components:

• The implant - This is the titanium fixture placed in the jawbone that serves as the "replacement root".  We usually refer the surgical placement of these to an oral surgeon or periodontist.  It typically takes three to six months for the bone to solidly integrate with the implant.
• The abutment - These are the attachments that are placed directly onto an implant that a crown, bridge or denture will connect onto.  These precision made parts allow the versatility of implants by enabling things from a single crown to an entire fixed bridge to attach and function with long term stability.
• The crown or prosthesis - A conventional crown used for typical dental restorations can be cemented onto the abutment.  Depending on what type of attachment is placed, a wide range of removable dentures or fixed bridges can be made to fit very accurately onto the abutment for improved function.