Production of an individual dental crown, bridges for the replacement of several teeth, partial tooth replacement or full tooth row replacement dentures of the upper of lower jaw is a medical procedure of highly aesthetic value and precision.
The most important factor is the appearance of the tooth or tooth aesthetics, which, apart from high technical knowledge, requires every prosthodontist to possess an artistic talent to ensure that your new smile or part thereof is in harmony with the current situation, or, in the event of more extensive prosthetic work, - in harmony with your facial contours and personality.
Jaw muscles are very strong, since they are intended for chewing food. As research conducted in 1994 demonstrates, the average strength of bite of a male jaw fluctuates from 43 kilograms per 1 tooth in the front teeth to 120 kilograms per 1 tooth in the back teeth (https://pubmed.ncbi.nlm.nih.gov/7744385/), which means that the slightest imprecision in the process of dental crown, bridge or denture production may result in damage to the crown as well as harm to the oral cavity health of the patient.
In general, 2 basic types of tooth prosthetics can be identified:
- Dental crown prosthesis that replaces 1 tooth;
- Dental bridge, in daily life also called a dental prosthesis, which is used to replace several natural teeth in cases where the production of a dental crown prosthesis of each individual tooth is impossible;
Meanwhile, dental bridges (prostheses) can be classified as follows:
- Removable dental bridges (prostheses);
- Fixed dental bridges (prostheses).
Removable dental prosthesis that replaces a large number of teeth and can be removed independently:
- Fixed dental prosthesis that replaces a large number of teeth and cannot be removed independently.
Dental prosthetics is an individualised and complex process; however, the following basic phases can be identified:
- During one or two initial consultations, your wishes are discussed with you, an X-Ray examination and photographs are taken, the therapy plan is discussed and costs are calculated;
- During the next visit, the polishing of the tooth surface, if the construction of the prosthesis is based on the natural tooth, and three-dimensional scanning or obtaining of a spatial impression by using impression material specially designed for these purposes is performed, as well as the determination of the occlusion is performed, if required. The next visit is scheduled to fit and commission the prosthesis, if it complies with your needs and the outcomes planned by your physician. If the prosthesis is based on dental implants, at least 2 intermediate visits will be required to perform the implantation procedure;
- Then your prosthodontics specialist performs the analysis of the obtained data and forwards them together with additional indications to the dental technical laboratory for three dimensional modelling and production of the crown, which is then followed by communication of your prosthodontics specialist with the dental technical laboratory to produce the prosthesis;
- When the prosthesis is ready, the fitting of the produced prosthesis will be performed at a prescheduled visit and if the prosthesis complies with your idea and that of your physician, the prosthesis will be fixed and the procedure shall be completed.
Temporary dental crown
In most cases, temporary dental crowns are made of plastic or a composite material to temporarily replace the missing natural teeth, while the dental prosthetic procedures are being performed.
Dental crown prosthesis
The dental crown is produced for 1 tooth; it can be fixed on the existing natural tooth or an inserted tooth implant, which performs the function of the dental crown.
Implant is a recommended option for the support of a dental crown in the event of tooth loss, since, being constantly loaded it will considerably reduce the risk of jaw regression; furthermore, it is functionally and aesthetically more suitable.
Most commonly, dental crown prosthesis is made of the following materials:
- Porcelain. This material ensures the best aesthetic outcome. Porcelain crown is practically indiscernible from a natural tooth, because, like a natural tooth, it is translucent. The drawback of porcelain crowns is lower durability of the crown;
- Zirconium oxide. To resolve the problem of low durability of porcelain crowns, computerised milling of durable aluminium oxide or zirconium oxide crown frames is performed, which are then covered with a porcelain coating. Zirconium dental crowns ensure as high an aesthetic result as porcelain crowns, while providing high durability, because the zirconium oxide frame is equivalent to metal in terms of durability, while its aesthetic result is much better thanks to the translucency of zirconium ceramic. Currently this is the most popular material in prosthodontics;
- Metal (metal ceramic). The core of the crown consists of a thin layer of metal, which is covered with porcelain. Currently they are primarily used for the prosthetics of the lateral and posterior teeth;
- Plastic or composite material. These crowns are characterised by the early appearance of cracks and change in colour. They are mainly used as temporary crowns;
- Metal composite or metal acrylate. These crowns are similar to plastic or composite material crowns, except for a thin layer of metal inside the crown to ensure its durability, which is covered with composite material, which is a light material that has the colour of a tooth;
- Cast metal. These crowns are durable, but their main drawback is their metallic glow, which reduces aesthetic properties, which is why they are commonly used for the restoration of lateral teeth.
Dental bridge or prosthesis
This is a type of dental prosthesis that is used in the following cases:
- When one or several adjacent natural teeth are missing and they cannot be replaced with individual tooth crowns that are supported by implants;
- When none of your natural teeth remain in your mandible or maxilla.
The bridge, as well as the crowns can be made from zirconium oxide and metal, which is covered with a layer of porcelain, metal composite or plastic.
Fixed dental bridges (prostheses)
These dental prostheses are either based on the existing teeth or implants, which means that the respective dental prosthesis, after the insertion thereof, is not removable and does not move, which provides psychological and functional comfort, because fixed prostheses best resemble natural teeth in terms of functionality and aesthetics.
Removable dental bridges (prostheses)
The use of removable prostheses can only be recommended in the event, where, due to some reason, the production of fixed dental prostheses is impossible. This means that dental prostheses are not firmly fixed in the mouth and can be constantly removed and replaced again.
The principal drawbacks of this type of prostheses are:
- Your psychology, due to the sensation of a foreign body in your mouth;
- Instability of the prosthesis;
- Loss of jaw bone mass is possible, which is a natural process due to the fact that the removable dental prosthesis does not load the bone sufficiently;
- When you smile, clamps that are used to fix the removable prosthesis to your natural teeth, are visible.
Removable prostheses are made of special plastic or a combination of metal and plastic. This limited selection of materials is based on the inability of other materials to ensure sufficient mechanical durability.
Removable dental prosthesis on implants
If the removable prosthesis is the only way to replace missing natural teeth, implants are used for fastening them to reduce the drawbacks of removable prostheses, which ensures comfort that is similar to the comfort provided by non-removable prostheses.
These prostheses are mainly used in the cases with a high number of missing natural teeth, or, where all natural teeth in one or both jaws have been lost. Read more on this issue in the FAQ section “Total denture, ALL on 2 and all on 4”.