It is one of the specialties of dentistry which has undertaken a heavy mission including many disciplines such as removable and fixed prostheses, implantology, jaw-facial prostheses, etc. It is the science and art of filling and completing the missing parts of teeth, missing teeth and related missing tissues with appropriate items in order to restore functionality, aesthetics, comfort and health.
Occlusion (closure) principles are the most important issues that need to be paid attention for us regardless of what type of prosthesis is made.
We can think of them as artificial devices that substitute for missing teeth and also implantable and removable by patients.
Removable prostheses are applied when abutment teeth cannot carry the burden, many teeth are missing, there are missing teeth areas that do not end with teeth or there are no teeth in mouth.
Removable Partial Prosthetics
They are teeth and tissue assisted prosthetic applications. Arms called clasp are applied to the portion of the tooth under the curved area near the gingiva and attachment is achieved in order to sustain dental support. The tissue surface on which the prosthesis is located provides the tissue support. Thus, the pressure is distributed to the tooth and tissue.
If there is no tooth left in mouth to use as a base; pressure transmission, support and attachment are achieved by locating the prosthesis on the tissue surface. Complete tissue assisted prosthetic applications are called complete prosthetics.
Clasps in removable partial prosthetics might create aesthetic discomfort especially in the front teeth. As well as, the pressure applied from clasp to the tooth with insufficient gingival health can cause the loss of the tooth. In this case, the pressure of a single tooth can be distributed by connecting the teeth with crowns. Metal clasps may cause damage and abrasion of the healthy teeth. Precision attachment prosthesis is a combined prosthesis type in which toothless cavities are supported by removable prosthesis, shape, color and position defects and teeth in mouth are restored with fixed prosthesis. The teeth to be used as bases are prepared. When the fixed crowns are made, the materials called precision attachment are located to the parts close to the toothless area. Thus, instead of non-aesthetic clasp that is located on crown, the attachment system that does not disturb the aesthetic appearance and cannot seen in mouth is provided.
When there are excessive crooked, overgrowth teeth that will cause incompatibility with the part to be implanted, instead of losing these teeth, their length is shortened and telescopic crowns or precision attachments can be applied on them. These kind of prosthetics that abutment tooth is in the prosthesis and removable prosthetic structure is applied on it are called overdenture prosthetics. Keeping the tooth root in the mouth will prevent bone loss and ensure that oral perception function is preserved.
The structures prepared on the models obtained from the measurements taken after preparation on teeth are adapted to the mouth, and glued on the tooth to remain fixed. These are called fixed prosthetics. Metal alloys, full ceramic materials and zirconium are generally used in the substructure of prosthesis' ceramic materials.
Crown is made for agent losses and aesthetic problems related to one tooth. The measurements are taken from teeth and a model is sent to the technician who prepares the substructure sustaining the durability and then the porcelain (or now less preferred acrylic) as the superstructure providing the aesthetic appearance.
In case of multiple missing teeth, the teeth closest to the toothless area are used as abutment to compensate the gap and the structures used to practice this procedure are called bridgeworks that are permanent in mouth. However, the teeth to be used as abutment should be healthy enough and in sufficient distance to endure the pressure.
Maryland Brides (Adhesive Bridges)
Maryland Bridges may also be an option in the absence of a single front tooth. The teeth on both sides of the toothless area are not cut, only superficial attachment is sustained with the wings located at the back side of the teeth.
In the front teeth; color changes, position, structure and shape deformations or the existing space between teeth cause aesthetic problems. Laminate veneer is a prosthetic approach that is performed by applying only a very little preparation on the frontal surface of the tooth within the enamel limits. Thanks to the development of filling technology and bonding mechanisms in recent years, laminate applications are also made with filling materials.
If there are excessive crooked, overgrowth teeth that will cause incompatibility with the part to be implanted, instead of losing these teeth, their length is shortened and telescopic crowns can be applied on them.
Inlay – Onlay Fillings
Inlay – Onlay are large filling structures prepared in laboratories to compensate for the loss of material when the loss of material in teeth is excessive. If material loss is small and tubercles are not lost, inlay is practiced, if the material loss is large and the loss includes tubercles, onlay is practiced.
It undertakes the duty of refunctioning of function, aesthetic and phonetic tasks of teeth lost due to various reasons with implant supported prostheses. Dental implants are tissue friendly artificial roots made of screw-shaped titanium placed on the jawbone to ensure the function and aesthetic appearance of deformed teeth. Dental implants are commonly used for single missing tooth, multiple missing teeth, edentulous patients and orthodontics anchorage purposes.
A - Removable Implant Prosthesis
B - Fixed Implant Prosthesis