Dentures: what to expect for the patient

Expectations vs reality: how to find understanding

In my practice, I often deal with unreasonable expectations of patients. This happens because a person goes to the dentist for “new teeth” and receives a prosthesis, and these are not the same thing at all. The main functions of the prosthesis include:

chewing (accordingly, the prosthesis should reproduce the natural shape of the tooth with all irregularities);
maintaining the height between the upper and lower jaws;
tying several movable teeth into a single unit for the purpose of strengthening them.

Only after all these main functions are embodied in the prosthesis, it is possible to talk about restoration of aesthetics. This is certainly an important function for an orthopedic dentist, but it is far from the primary one. At the same time, the aesthetic qualities of the prosthesis are often the most important for the patient, because he came for “new teeth”, which should first of all look Flawless. Even if this person did not have a good smile throughout his life and never found time to visit an orthodontist, now that there are not enough teeth left to chew, he wants from the dentist precisely “new perfect teeth”.

Thus, the dentist-orthopedic sees the result of the treatment in his own way, and the patient sees it in his own way. These two visions, as a rule, do not coincide. Therefore, the most important stage of dental prosthetics is not the actual manufacturing of the prosthesis, but the consultation, during which the doctor tells the patient in detail (perhaps with the help of phantom works or photographs) how the prosthesis will be designed and how it will look. At the same time, the patient’s task is to describe to the doctor his expectations from prosthetics as fully as possible.

During the consultation, the doctor must understand whether it is possible to satisfy all the wishes of the patient, and the patient, in turn, must hear all the dentist’s explanations and adjust his own expectations. In this way, a compromise is reached regarding the treatment plan and a joint path to the desired goal begins.

So why the compromise? Is it impossible to make a prosthesis as the patient wants? There are a number of reasons that stand in the way, which we will now consider.

Why is successful prosthetics a compromise?

In some people, the teeth do not grow in equal rows, but have deviations from the correct position. The denture, which is fixed on these teeth, is clearly tied to their place, so the height and width of the teeth in the denture may not always look aesthetically acceptable. And you either have to come to terms with this, or undergo orthopedic treatment before prosthetics to give the remaining teeth the correct position. Then the denture will be functional and aesthetic.

Teeth are in the mouth for a reason, but grow out of the jawbone, which performs a supporting function and has a certain volume. After the loss of a tooth, bone tissue loses this volume and atrophies. When we make a prosthesis for a missing tooth or teeth, it must rest on the remaining teeth. At the same time, crowns are put on the teeth, and those that are missing are fixed between them. In this way, the illusion of a continuous tooth row and the chewing function are restored. The peculiarity of this design is that in the place of the missing teeth, a hole remains on the gums, and the artificial tooth seems to hang in the air. Even when it is adjacent to the gums, it has an unusually elongated shape. If we are talking about chewing teeth, this solution looks quite acceptable. But if these are front teeth, then the aesthetic effect is, to put it mildly, unsatisfactory. To solve this problem, a surgeon can be involved who, using special surgical techniques, will restore the lost volume of the jaw bone and mucous membrane, and then the intermediate (missing) tooth will enter the restored volume of the mucous membrane, which will create the effect of a tooth that has cut through the gums .

So we can conclude that, although aesthetics do not play a decisive role for a dentist, they are of great importance. That is why dozens of means of improving the aesthetic qualities of prostheses and gums have been invented. Yes, it’s clear! In modern dentistry, the term “red and white aesthetics” has even been introduced.

We have already mentioned that teeth are not just in the mouth, but grow out of the gums. And an artificial tooth cannot look beautiful and natural against the background of an irregular mucosa. The composition is disturbed and visual dissonance appears. So you see, there is a place for artistic terms in dentistry too!

The meaning of all that was said above is that you will not always get “new perfect teeth” after visiting the dentist. Sometimes, for the desired effect, you will have to undergo a long-term comprehensive dental treatment. This is both time and additional costs, in addition to the actual manufacture of the prosthesis, and patients are not always ready for this. Therefore, the treatment plan can be a compromise…

Removable dentures

Now that we’ve covered the ins and outs of prosthetics planning, it’s time to move on to specific types of prostheses. Removable prostheses are divided into two large groups:

• lamellar (they are alternately hard and elastic);
• buckles (on a clip, lock fastening or on fastening with the help of telescopic crowns).

Also, removable prostheses are divided into full ones, which restore the entire dentition, and partial ones, which restore one or several missing teeth. For a better understanding: plate dentures are the same artificial teeth that our grandparents put in a glass of water overnight. Today, it is still the most budget-friendly and least convenient option for prosthetics. Who would like to keep their teeth in a glass or be afraid that they will fall out right during a kiss with a loved one? However, such prostheses are an acceptable temporary option if it is not possible to install implants now (we will talk about them separately later).

Removable brace prostheses are more complex designs than lamellar prostheses. First of all, because they are combined and consist of a metal frame and actually missing artificial teeth. The metal frame allows you to make the prosthesis less bulky and more comfortable to wear, and it is also an endless field for the creativity of both the patient and the dental technician. After all, the frame that connects the missing teeth can have any shape, from standard to arbitrary. Vines, flowers, spider webs, a dragon, any fantastic shapes – anything your imagination can imagine! If there is no desire to experiment, the standard form will also work well.

It is not necessary to put the removable denture in a glass of water overnight – it can be in the mouth all the time. It only needs to be removed after eating to clean. Yes, the problem with all removable prostheses, without exception, is that food gets under them. But despite this, a removable brace prosthesis is an excellent compromise solution compared to other types of prosthetics, which has maintained its popularity for almost two centuries both in Ukraine and in many countries of “old Europe”, in particular in Germany.

Fixed dentures

As the name implies, these prostheses are in the mouth all the time, attached to teeth or implants, and can only be removed by a specially trained person (in most cases, a dentist). Fixed dentures include:

• bridge-like prostheses;
• single crowns;
• veneers

Bridge-like prostheses replace a missing tooth or several teeth. For this, the teeth on which it is attached are filed and given the shape of a truncated cone. Artificial teeth that replace missing teeth are attached to these crowns and are, so to speak, suspended above the gums. In this way, a bridge-like structure is formed, which restores a complete dentition.

Single crowns are essentially caps that are put on a tooth when it has been destroyed by more than half its volume. If you try to restore such a tooth with a filling material, it will not last long. The crown reproduces the anatomical shape of the tooth and strengthens it.

Today’s fashionable veneers (they are inlays, overlays, onlays) are linings that cover a separate part of the tooth. They are made in order to restore the damaged part of the enamel on the front or chewing surface of the tooth.

Recently, it has become fashionable to make veneers on completely healthy teeth in order to change their shape and color. Is it good? I’m sure not. First, it is rarely possible to make and install veneers without damaging your own tooth enamel, as they say, a plus. In most cases, healthy teeth have to be filed. Secondly, the hygiene of teeth covered with veneers (if they are installed incorrectly) becomes difficult, and the teeth begin to deteriorate. I had to deal with patients who, a few years after the installation of veneers, came to total prosthetics, that is, covering all those teeth with crowns. Moreover, some teeth even had to be removed. Of course, sometimes a perfect smile is part of the profession, for example if you are an actor or a TV presenter… But is it really necessary? In the end, it’s up to you to decide. But you should be aware of the possible consequences.

Bridges, single crowns and veneers can be made from a variety of materials. These are alloys of cobalt and chromium, alloys of precious metals, combined designs where the base is a metal alloy, and the outside is a facing ceramic (metal-ceramic). Modern fixed prostheses can be made of zirconium dioxide using CAD/CAM technology, or pressed ceramics reinforced with leucite. Each of these structures can be installed both on teeth and on implants (we will talk about them separately) and deserves a separate article. But it is important to remember that all prostheses have their indications and contraindications, and the patient has something to choose from.

It is not for nothing that we often used the term “compromise” in this article. Such diversity is primarily intended to help the patient regardless of his financial situation and the time he has. A consultation with an orthopedic dentist is not a sentence, and there is always a chance to find a compromise solution. Sirius Dent Medical Center manufactures all existing types of prostheses and is always ready to provide qualified medical assistance.