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Prosthodontics
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Introduction
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Prosthetic dentistry is the speciality branch of dentistry that is concerned with
the replacement of missing, congenital absence or acquired loss of oral tissues
and related maxillofacial structures by removable and /or fixed artificial devices.
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Prosthodontics has three main branches: removable prosthodontics, fixed prosthodontics,
and maxillofacial prosthetics.
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Why Need a Special Care In Prosthetic Dentistry??
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Patients, who have severely damaged or missing dentition, need a prosthodontist
who can listen well, carefully diagnose and plan treatment, and perform the quality
treatment needed to provide the best possible results.
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The reasons for a missing tooth or teeth can be many, but the question of utmost
importance is that, is it necessary to replace them?
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A lost tooth compromises the function of the oral cavity, namely speech aesthetics
and, it hampers the overall health of the dentition. A lost tooth can cause the
drifting of adjacent teeth in the area of tooth loss, thus causing forces on adjacent
teeth detrimental to their health. The health of the tooth supporting tissues can
be greatly affected due the detrimental forces acting on them and altered food flow
direction along the tooth surface.
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So now you know reasons to replace them.
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Firstly, for the health of your dentition And secondly that you have an excellent
option to get them replaced at Global Dental Care.
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Prosthodontics, Health, and the Quality of Life
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Functional teeth or dental substitutes help to maintain general health and well
being. Proper mastication of food is essential, especially as you grow older. The
inability to properly and thoroughly chew food may result in poor nutrition, gastrointestinal
disorders, health compromises and a loss of the quality of life. Much more than
a necessity, dining is a fundamental social function which grows in importance as
we age. To be able to eat without the embarrassment or pain associated with poor-fitting
dentures or poorly constructed dental prostheses is a major goal of prosthodontic
treatment.
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Tooth Replacements at Global
Dental Care.
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The cosmetic and dental health ramifications of missing teeth show that it is imperative
that one replaces missing teeth as soon as they can. There are three basic ways
to fix a missing tooth or missing teeth: fixed bridge, removable appliance, and
dental implant. By replacing missing teeth, you will be able to restore the healthy
look of your teeth and prevent further dental problems caused by missing teeth.
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Even a slight change in your smile helps you to project an image of self-confidence
and high personal esteem. When you feel good about yourself, it shows in your appearance.
Today’s advanced techniques and materials at our clinic make a real difference.
We offer a variety of option to choose from for your oral rehabilitation.
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Removable Partial Denture- it’s a prosthesis designed to be removed by the wearer
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These dentures are the cheapest tooth replacement options. They can be used for
both single and multiple tooth replacements. But one may confront the difficulties
of stability and functional appropriateness with this prosthesis. Cause they mainly
derive their support from the surrounding structure unlike the teeth that are embedded
inside the bone itself.
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Partial dentures can also be used as a transitory means of tooth replacement till
a fixed appliance is given.
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Steps In Preparation Of A Partial Denture |
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1. Diagnosis and treatment planning, and mouth preparation.
2. Making of primary impression and primary cast.
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A thorough examination of your teeth, soft tissue (gums and cheeks), remaining bone
and surrounding anatomy is done. The examination should also include x-rays (radiographs)
or impressions to make models of the mouth.
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3. Designing the prosthesis.
4. Prosthetic mouth preparation.
5. Secondary Impression and master cast preparation. |
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The foundation of the partial denture can be plastic or a combination of plastic
and metal. There are different methods used to secure the partial denture in your
mouth. Metal clasps are the most common and they may or may not be visible. Where
the appearance of metal clasps are not wanted (as along your upper front teeth),
there are precision attachments that can be used to hide the partial denture attachments
and provide a secure fit. We will indicate which design will be most appropriate
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6. Teeth selection.
7. Try in of RPD.
8. Denture processing.
9. Denture insertion
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We will select the select the teeth for your RPD the best available in market in
terms of durability and natural look. After a complex laboratory procedure the final
outcome will be the best you can have, to restore the form and function of the lost
teeth.
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Complete Dentures
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Natural teeth and the underlying bone provide a framework that supports the structures
of your face including your lips, cheeks, and nose. When teeth are lost the ability
to eat and chew properly is impaired, and it becomes difficult to maintain a proper
diet. Without support from your teeth, the face will sag creating a look of premature
aging. Additionally, without teeth we cannot speak clearly and distinctly. |
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The steps of fabrication of the complete denture are almost similar to the fabrication
of the removable partial dentures.
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A Fixed Bridge
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A Bridge replaces missing teeth with artificial teeth. A Bridge literally bridges
the gap where one or more teeth may have been missing.
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A fixed bridge can be compared to having three crowns. The two adjacent teeth on
either side of the missing tooth are prepared for crowns and a false tooth is attached
between these two crowns to fill the space left by a missing tooth. The benefit
of a fixed bridge is that it proves stability and that it is fixed in a person’s
mouth.
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At Global Dental Care, the look of the fixed bridge is similar to a real tooth and
most observers will be unable to notice that there were teeth missing in the first
place. However, since a fixed bridge requires that three teeth need to be worked
on, then dental work may have to be performed on perfectly healthy teeth.
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The fabrication of bridges involves a series of complex professional procedures
which later is the teeth. The bridge must be fabricated very precisely to ensure
correct bite and to match the opposing tooth, impressions of the teeth are taken
and sent to a lab where the bridge will be constructed.
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Fixed bridges are typically cemented to the natural teeth next to the space left
by the missing tooth. A pontic (false tooth) replaces the lost tooth. Crowns, which
are cemented onto the natural teeth, provide support for the bridge. The attachment
procedure usually takes two or three appointments to complete. At the first appointment
our doctors will prepare the teeth on either side of the gap by removing a portion
of the enamel and dentin.
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The skill, experience and commitment of our practice using a unique combination
of science and artistry can literally redesign your smile.
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Removable Dentures
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A an alturnative to bridges and implants, dentures can be used to replace several
missing teeth.
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It is possible to get either full, or partial dentures. Full denturesremain in place
by form fitting to the gum ridges.This creates a strong suction that is usually
enough to keep them comfortably in place
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Partial dentures often have additional ridges that fit around the natural teeth
helping them stay in place.
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It can take several visits in order to be properly fit with a denture. we will take
several impressions of the gums, and send these to a dental lab. The lab uses these
impressions to construct your dentures. we will check the dentures to ensure that
your bite is correct and that the dentures meet your approval.
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Removable Partial Denture
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A removable partial denture (RPD) is for a partially edentulous dental patient who
desires to have replacement teeth for functional or aesthetic reasons, and who cannot
have a bridge (a fixed partial denture) for any number of reasons, such as a lack
of required teeth to serve as support for a bridge (i.e. distal abutments) or due
to financial limitations.
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The reason why this type of prosthesis is referred to as a removable partial denture
is because patients can remove and reinsert them when required without professional
help. Conversely, a "fixed" prosthesis can and should be removed only by a dental
professional.
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Partially edentulous conditions
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Depending on where in the mouth teeth are missing, edentulous situations can be
grouped under four different categories, as defined by Dr. Edward Kennedy in his
classification of partially edentulous arches.
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- Class I (bilateral free ended partially edentulous)
- Class II (unilateral free ended partially edentulous)
- Class III (unilateral bounded partially edentulous)
- Class IV (bilateral bounded anterior partially edentulous)
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Kennedy Class I RPDs are fabricated for people who are missing some or all of their
posterior teeth on both sides (left and right) in a single arch (either mandibular
or maxillary), and there are no teeth posterior to the edentulous area. In other
words, Class I RPDs clasp onto teeth that are more towards the front of the mouth,
while replacing the missing posterior teeth on both sides with false denture teeth.
The denture teeth are composed of either plastic or porcelain.
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Class II RPDs are fabricated for people who are missing some or all of their posterior
teeth on one side (left or right) in a single arch, and there are no teeth behind
the edentulous area. Thus, Class II RPDs clasp onto teeth that are more towards
the front of the mouth, as well as on teeth that are more towards the back of the
mouth of the side on which teeth are not missing, while replacing the missing more-back-of-the-mouth
teeth on one side with false denture teeth.
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Class III RPDs are fabricated for people who are missing some teeth such that the
edentulous area has teeth remaining both posterior and anterior to it. Unlike Class
I and Class II RPDs which are both tooth-and-tissue-borne (meaning they both clasp
onto teeth, as well as rest on the posterior edentulous area for support), Class
III RPDs are strictly tooth-borne, which means they only clasp onto teeth and do
not need to rest on the tissue for added support. This makes Class III RPDs exceedingly
more secure as per the three rules of removable prostheses that will be mentioned
later, namely: support, stability and retention.
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However, if the edentulous area described in the previous paragraph crosses the
anterior midline (that is, at least both central incisors are missing), the RPD
is classified as a Class IV RPD. By definition, a Kennedy Class IV RPD design will
possess only one edentulous area.
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Class I, II and III RPDs that have multiple edentulous areas in which replacement
teeth are being placed are further classified with modification states that were
defined by Oliver C. Applegate. Kennedy classification is governed by the most posterior
edentulous area that is being restored. Thus, if, for example, a maxillary arch
is missing teeth #1, 3, 7-10 and 16, the RPD would be Kennedy Class III mod 1. It
would not be Class I, because missing third molars are generally not restored in
an RPD (although if they were, the classification would indeed be Class I), and
it would not be Class IV, because modification spaces are not allowed for Kennedy
Class IV.
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Components of an RPD
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Rather than lying entirely on the edentulous ridge like complete dentures, removable
partial dentures possess clasps of metal or plastic that "clip" onto the remaining
teeth, making the RPD more stable and retentive.
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The parts of an RPD can be listed as follows (and are exemplified by the picture
above):
- Major Connector (the thick metal "U" in the RPD above is a lingual bar, a type of
major connector)
- Minor Connector (the small struts protruding from the lingual bar at roughly 90
degree angles)
- Direct Retainer (examples are in the upper left of upper photo and lower right of
lower photo; the clasp arms act to hug the teeth and keep the RPD in place. The
metal clasp and rest immediately adjacent to the fake teeth is also a direct retainer.)
- Indirect Retainer (example is the little metal piece coming off the "U" at a 90
degree angle near the top of the upper photo, which is a cingulum rest on a canine.)
- Physical Retainer (this is a mesh of metal that allows the pink base material to
connect to the metal framework of the RPD. Some consider physical retainers their
own component (making a total of seven), while others consider them within the indirect
retainer category (thus making a total of six components.)
- Base (the pink material, mimicking gingiva)
- Teeth (plastic or porcelain formed in the shape of teeth)
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Clasp Design
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Direct retainers may come in various designs:
- Cast circumferential clasp (suprabulge)
- Akers'
- Half and half
- Back-action
- Ring clasp
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- Wrought wire clasp
- Roach clasp (infrabulge)
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Both cast circumferential and wrought wire clasps are suprabulge clasps, in that
they engage an undercut on the tooth by originating coronal to the height of contour,
while Roach clasps are infrabulge clasps and engage undercuts by approaching from
the gingival.
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In addition there are a couple of specific theories which include the clasp design:
- RPI: mesial rest, distolingual guide plate, I-bar
- Described by Kratochvil in 1963 and modified by Kroll in 1973
- An illustration of the RPI design function
- RPA: mesial rest, distolingual guide plate, Akers' clasp-style retentive arm
- RPC: mesial rest, distolingual guide plate, other type of cast circumferential clasp
- So named in response to the RPI Philosophy introduced by Kratochvil and Kroll.
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Complete Dentures
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A denture or a complete denture as it is often called, is an appliance that is inserted
in the mouth, replaces natural teeth and provides support for the cheeks and lips.
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Most dentures are made of acrylic and can be fabricated two different ways. A conventional
denture is made after all teeth have been extracted and the tissues (gums) have
healed. An immediate denture is fabricated and inserted immediately after the teeth
are extracted and the tissues are allowed to heal under the denture. An upper denture
has acrylic, usually flesh colored, that covers the palate (roof of the mouth).
A lower denture is shaped like a horseshoe to leave room for the tongue. The teeth
are made of plastic, porcelain or a combination thereof. Dentures can be fabricated
to fit over endodontically treated teeth and a complete denture can be attached
to implants to allow for a more secure fit of the appliance. Dentures over a normal
course of time will wear and need to be replaced or relined in order to keep the
jaw alignment normal. The alignment will slowly change as the bone and gum ridges
recede or shrink due to the extraction of the teeth. Regular dentist examinations
are still important for the denture wearer so that the oral tissues can be checked
for disease or change.
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Fixed Dentures |
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Fixed bridges are bonded into place and can only be removed by a dental professional.
Removable bridges, as the name implies, can be taken out and cleaned. Fixed bridges
offer more stability than their removable counterparts. |
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Crowns
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Most dentistry looks like dentistry. Our goal is to provide dentistry that is undetectable.
We replace existing crowns and fillings with restorations that look and feel like
your natural teeth.
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Where damage to a person's teeth is extreme, and apparently beyond repair, we can
use porcelain or porcelain "pasted on gold" crowns to make the smile appear "as
new". This is an extremely reliable technique for repairing the most severe of dental
problems, even permanently replacing missing teeth to offer a complete smile and
a functional bite. We are renowned for the quality of our work and the fantastic
changes we make for people using this technology. These treatments are used for
a long lasting correction of major dental problems. It is usual for these treatments
to last for 20 to 30 years, which is as close to permanent as dental treatment can
get.
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How Long Does it Take?
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Fitting a crown requires at least two visits to our office. Initially, we will remove
decay, shape the tooth, and fit it with a temporary crown of either plastic or metal.
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On the subsequent visit we will remove the temporary crown, and then fit and adjust
the final crown. Finally, we will cement the crown into place and you have a new
beautiful looking tooth.
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Key Benefits
- Replaces missing teeth
- Offers support to misshapen teeth or badly broken teeth
- Looks completely natural
- Fixes "smile" and functional chewing problems
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What are the Capabilities of Crowns?
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Crown and bridgework is a very reliable solution for major dental problems caused
through accidents, diseases or wear and tear. Major problems can usually be corrected
using these techniques. Material used in these repairs is either high- grade porcelain,
or porcelain bonded to gold. A higher strength of the porcelain and gold materials
is recommended to treat the most serious of dental problems. Where accidental damage
has occurred, resulting in lost teeth, or where teeth have broken away through excessive
wear, or as the result of old fillings breaking, crowns and/or bridges can be used
as a long-term solution.
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Many people have unexplained pain from filled back teeth, which is usually due to
hairline cracks in the chewing part of the tooth. Placing crowns on these teeth
relieves the pain and allows a return of full dental function for these teeth. In
front teeth, older fillings can both weaken the teeth and cause "appearance" problems
due to staining or chipping. Porcelain crowns and bridges are suitable in cases
where porcelain veneers are not. In teeth with root canal fillings, crowns can prevent
breakage.
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Bridges
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All of your teeth play an important role in speaking, chewing and in maintaining
proper alignment of other teeth. Tooth loss doesn't necessarily have to occur as
you age, but if you do lose teeth, they must be replaced to maintain proper function
of your mouth. Fortunately, there are options for correcting tooth loss.
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Options
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A bridge — a device used to replace missing teeth — attaches artificial teeth to
adjacent natural teeth, called abutment teeth. Bridges are either permanently attached
(fixed bridges), or they can be removable.
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Fixed bridges are applied by either placing crowns on the abutment teeth or by bonding
the artificial teeth directly to the abutment teeth. Removable bridges are attached
to the teeth with metal clasps or by precision attachments.
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If you're missing one or more teeth, you may be aware of their importance to your
appearance and dental health. Your teeth work together for many daily functions
from eating to speaking. With missing teeth, it's difficult to do these things.
Missing teeth can and should be replaced. Fixed bridges are a great way to restore
your dental health and appearance.
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Why Do I Need a Bridge?
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Oral functionality and appearance are important reasons for wearing a bridge. A
bridge helps support your lips and cheeks. The loss of a back tooth may cause your
mouth to sink and your face to look older.
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Dental health is the most important reason for a bridge. Teeth were designed to
complement each other. Unusual stresses are placed on the gums and other oral tissues
when teeth are missing, causing a number of potentially harmful disorders.
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Increased risk of gum disease has proven to be one of the worst side effects of
missing teeth and can be minimized with a bridge.
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Missing teeth can cause speech disorders as they are used to make many of the sounds
we use to speak clearly.
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How is a Bridge Attached?
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The attachment procedure usually takes two or three appointments to complete. At
the first appointment our doctors will prepare the teeth on either side of the gap
by removing a portion of the enamel and dentin.
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Since the bridge must be fabricated very precisely to ensure correct bite and to
match the opposing tooth, impressions of the teeth are taken and sent to a lab where
the bridge will be constructed.
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Fixed bridges are typically cemented to the natural teeth next to the space left
by the missing tooth. A pontic (false tooth) replaces the lost tooth. Crowns, which
are cemented onto the natural teeth, provide support for the bridge.
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What Materials are Used?
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Bridges can be constructed from gold alloys, non-precious alloys, porcelain, or
a combination of these materials. Porcelain is often bonded to either precious or
non-precious metal. |
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How Do I take Care of my Bridge?
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A strict regimen of brushing and flossing will keep the bridge and surrounding teeth
clean. This is of critical importance as the bridge relies on the neighboring teeth
for support. |
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Dental Implants
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Dental implants are designed to provide a foundation for replacement teeth that
look, feel and function like natural teeth. The person who has lost teeth regains
the ability to eat virtually anything and can smile with confidence, knowing that
teeth appear natural and that facial contours will be preserved. The implants are
tiny titanium posts, which are placed into the jawbone where teeth are missing.
The bone bonds with the titanium, creating a strong foundation for artificial teeth.
In addition, implants can help preserve facial structure, preventing the bone deterioration
that occurs when teeth are missing.
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Dental implants are changing the way people live! With them, people are rediscovering
the comfort and confidence to eat, speak, laugh and enjoy life.
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Evaluation
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If, like many others, you feel implant dentistry is the choice for you, we ask that
you undergo a dental/radiographic examination and health history. During these consultation
visits, your specific needs and considerations will be addressed by either our doctors
or by an Oral and Maxillofacial Surgeon referred by our practice. Your questions
and concerns are important to us and our team will work with you very closely to
help make your procedure a success.
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Procedure
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Dental implants are metal anchors, which act as tooth root substitutes. They are
surgically placed into the jawbone. Small posts are then attached to the implant,
which protrudes through the gums. These posts provide stable anchors for artificial
replacement teeth.
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For most patients, the placement of dental implants involves two surgical procedures.
First, implants are placed within your jawbone. For the first three to six months
following surgery, the implants are beneath the surface of the gums, gradually bonding
with the jawbone. You should be able to wear temporary dentures and eat a soft diet
during this time. At the same time, your restorative dentist designs the final bridgework
or denture, which will ultimately improve both function and aesthetics.
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After the implant has bonded to the jawbone, the second phase begins. The surgeon
will uncover the implants and attach a small healing collar. Our doctors can then
start making your new teeth. An impression must be taken. Then posts or attachments
can be connected to the implants. The replacement teeth are then made over the posts
or attachments. The entire procedure usually takes six to eight months. Most patients
do not experience any disruption in their daily life.
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Know More about implants >> |
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Inlays & Onlays
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Traditional fillings can reduce the strength of a natural tooth by up to 50 percent.
As an alternative, inlays and onlays, which are bonded directly onto the tooth using
special high- strength resins, can actually increase the strength of a tooth by
up to 75 percent. As a result, they can last from 10 to 30 years. In some cases,
where the damage to the tooth is not extensive enough to merit an entire crown,
onlays can provide a very good alternative. |
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Inlays |
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Sometimes, a tooth is treatment planned to be restored with an intracoronal restoration,
but the decay or fracture is so extensive that a direct restoration, such as amalgam
or composite, would compromise the structural integrity of the restored tooth by
possibly undermining the remaining tooth structure or providing substandard opposition
to occlusal (i.e. biting) forces. In such situations, an indirect gold or porcelain
inlay restoration may be indicated. When an inlay is used, the tooth-to-restoration
margin may be finished and polished to such a super-fine line of contact that recurrent
decay will be all but impossible. It is for this reason that some dentists recommend
inlays as the restoration of choice for pretty much any and all filling situations.
While these restorations might be ten times the price of direct restorations, the
superiority of an inlay as a restoration in terms of resistance to occlusal forces,
protection against recurrent decay, precision of fabrication, marginal integrity,
proper contouring for gingival (tissue) health, ease of cleansing and many other
aspects of restorative quality offers an excellent alternative to the direct restoration.
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Onlays
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Additionally, when decay or fracture incorporate areas of a tooth that make amalgamor
composite restorations essentially inadequate, such as cuspal fracture or remaining
tooth structure that undermines perimeter walls of a tooth, an "onlay" might be
indicated. Similar to an inlay, an onlay is an indirect restoration which incorporates
a cusp or cusps by covering or onlaying the missing cusps. All of the benefits of
an inlay are present in the onlay restoration. The onlay allows for conservation
of tooth structure when the only other alternative is to totally eliminate cusps
and perimeter walls for restoration with a crown. Just as inlays, onlays are fabricated
outside of the mouth and are typically made out of gold or porcelain. Gold restorations
have been around for many years and have an excellent track record. In recent years,
newer types of porcelains have been developed that seem to rival the longevity of
the gold. Either way, if the onlay or inlay is made in a dental laboratory, a temporary
is fabricated while the restoration is custom made for the patient. A return visit
is then required to deliver the final prosthesis. Inlays and onlays may also be
fabricated out of porcelain and delivered the same day utilizing techniques and
technologies relating to CAD/CAM Dentistry.
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When more than half of the tooth’s biting surface is damaged a dentist will often
use an inlay or onlay.
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What are Inlays and Onlays?
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Inlays and onlays can be made of porcelain, gold, or composite resin. These pieces
are bonded to the damaged area of the tooth. An inlay, which is similar to a filling,
is used inside the cusp tips of the tooth. An onlay is a more substantial reconstruction,
similar to the inlay but extending out over one or more of the cusps of the tooth.
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Traditionally, gold has been the material of choice for inlays and onlays. In recent
years, however, porcelain has become increasingly popular due to its strength and
color, which can potentially match the natural color of your teeth.
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How are they Applied?
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Inlays and onlays require two appointments to complete the procedure. During the
first visit, the filling being replaced or the damaged or decaying area of the tooth
is removed, and the tooth is prepared for the inlay or onlay. To ensure proper fit
and bite, an impression of the tooth is made by the dentist, and sent to a lab for
fabrication. The dentist will then apply a temporary sealant on the tooth and schedule
the next appointment.
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At the second appointment, the temporary sealant is removed. Our doctorswill then
make sure that the inlay or onlay fits correctly. If the fit is satisfactory, the
inlay or onlay will be bonded to the tooth with a strong resin and polished to a
smooth finish.
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Recall
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Our responsibility does not end after your treatment is over. We schedule regular
recall appointment for our patients to evaluate their response to treatment and
also condition of the restoration. |
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