Prosthetics involves both supplementation of missing tooth tissues and a missing tooth or teeth. The loss of even a single tooth has some effect on the masticatory function, to say nothing of aesthetic considerations. Such a loss should be supplemented as soon as possible, as the teeth provide such a consistent system that failure to do so may lead to migration and rotation of teeth adjacent to the missing one, "elongation" of the corresponding opposite tooth and bone atrophy. All the phenomena may lead to the loss of subsequent teeth and temporomandibular joint disorders.

INLAYS

There are numerous kinds of inlays, used to fill cavities. Cast metal inlays have been used in dentistry for 100 years. First a tooth is appropriately prepared, and then a wax impression of a gypsum inlay is made. Finally a metal, composite resin or ceramic inlay is cast. A hardened inlay in its final form is cemented in a cavity or glued with a special adhesive material. Using inlays enables reconstructing the chewing surface of a tooth, thanks to which the tooth is actively and fully used in chewing food; moreover, it is possible to restore contact points and maintain appropriate tooth and mouth care.

ONLAYS

In order to fill huge cavities, also in lateral teeth treated previously with a root canal therapy (not to be treated with implant-borne prosthetic crowns yet) the so-called onlays or overlays are used, which cover the whole chewing surface of a tooth. Composite resin structures are modelled in a lab, where the high-temperature polymerisation process is carried out using a special machine. An onlay is cemented to the dental tissues with adhesive resins, which results in a complete filling of a cavity thanks to eliminating the effect of polymerisation shrinkage which occurs after filling a dental cavity at the dentist's office.

Inlays and onlays are made of composite resin, porcelain or gold, the porcelain ones being the most modern solution. The indirect method, used to model onlays in a lab, enables achieving almost ideal reconstruction of the anatomical profile of a tooth and its contact points. Even better results are obtained when cast porcelain or pressed porcelain is used. Onlays and inlays made of gold are as efficient a solution as porcelain ones. Gold is an ideal material for dental reconstructions, as gold objects help prevent secondary caries due to bacteriostatic properties of the metal, the only disadvantage being aesthetic factors: gold inlays or onlays are visible because of a different colour.

FULL DENTURES

These are removable restoration made of acrylic plastic. The main indication for their use involves toothlessness or extensive tooth loss, where the application of other dentures (skeletal, permanent, implant-based ones) is impossible.

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OVERDENTURES

Overdenture is a removable prosthetic restoration that covers the whole surface of the roots of remaining teeth, or implants. Such dentures are fixed on the roots or implants by a system of locks (usually ball ones). This type of restoration fulfils aesthetic needs, protects the jaw bone from atrophy and provides the patient with acceptable comfort. However, a prerequisite for the use of such dentures is for the patient to acquire principles of perfect oral hygiene and regular check-up visits.
It should be noted that in toothless patients the overdenture may be supported on only two implants in the upper and lower jaw, which improves comfort in use enormously for a relatively low price, compared to full dentures.

IMMEDIATE DENTURES

An immediate denture is a removable prosthetic restoration given to the patient just after tooth extraction, when the patient is still under anaesthesia. All the activities related to the preparation of such a denture are done before extraction of the tooth. Such management allows the patient to avoid the discomfort related to the lack of teeth, as well as providing normal living conditions and the possibility of containing professional work. It also promotes and improves healing of post-extraction wounds. However, the use of such a solution requires strict observation of the dentist's recommendations, frequent check-up visits and maintaining perfect hygiene of the oral cavity and denture.

SKELETAL DENTURES

Skeletal denture is modern removable prosthetic restoration. Such a denture is supported not only on the gums and mucous membrane, but also on teeth; thus, it does not cause increased atrophy of the gums and bone tissue. Such a denture, if properly made, may be used by the patient for many years. The basic elements of the skeletal denture involve a metal base (skeleton) and acrylic elements replacing the missing tissues (teeth and base).

CONVENTIONAL BRIDGES

A bridge is a restoration permanently fixed in the oral cavity. Such a solution provides the patient with an excellent aesthetic and functional effect. The main inconvenience related to conventional bridges is the necessity of grinding of at least two teeth adjacent to the gap. Depending on the patient's preferences and localisation of the missing tooth/teeth, metal, porcelain or complex bridges are used; the last consists of a metal framework covered with aesthetic material (porcelain, acrylic, composite) that simulates the shape and colour of the missing dentition. This type of restoration may be supported on both natural teeth and implants.

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ADHESIVE BRIDGES

In our clinic a system of adhesive bridges, ENAMEL PLUS, has been successfully used; the system allows the necessity for grinding, normally healthy, tooth tissues in the case of single missing teeth, in particular frontal ones to be avoided. It provides excellent aesthetic results and patient comfort. The method itself consists of the reconstruction of the missing tooth with a new-generation composite material and fixing it to lingual (internal) surfaces of the adjacent teeth by means of strong and extremely durable glass fibre. The ENAMEL PLUS system may also be used for the construction of ceramic veneers and any aesthetic corrections of tooth crowns.

PROSTHETIC CROWNS AND ROOT-CROWN INLAYS

A prosthetic crown is a permanent denture covering a damaged tooth crown or replacing it, if completely lost. On the other hand very damaged teeth or these weakened by canal treatment are strengthened with root-crown inlays, which may be compared to a metal "pin" fixed in the root canal and covered with a prosthetic crown. Depending on the patient's preferences and clinical condition, metal or composite crowns are used. A prosthetic crown may be placed on both natural teeth and implants.

IMPLANT-BASED PROSTHETIC RESTORATION

The introduction of implants into dentistry has revolutionised modern prosthetics, enabling completely novel therapeutic solutions. With implants used as the base, various types of prosthetic restoration, such as full overdentures, bridges replacing complete or partial loss of dentition, or single teeth may be applied (see also IMPLANTOLOGY).

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COURSE OF TREATMENT

- At the first visit the dentist takes a general and specialised medical history from the patient to obtain information on general diseases that may affect the planned prosthetic treatment, cause of tooth loss, and notes the oral hygiene practices, as well as needs and expectations of the patient. The next stage in the diagnostic process is a clinical examination allowing determination of the condition of the dentition, gums and mucous membrane, bite conditions and localisation of missing teeth. Frequently an additional X-ray examination, usually panoramic one, is necessary. Also during the first visit impressions needed for diagnostic models are routinely taken. Once all the above-mentioned elements have been completed, the treatment plan may be developed..
- At the second visit the dentist presents to the patient the treatment plan, possible therapeutic options and their advantages and disadvantages; then the patient decides to accept or refuse the offer presented.
- Pre-prosthetic treatment; before the actual treatment, the preparation of the oral cavity is necessary which may include:
- surgical treatment, i.e. removal of teeth that are unsuitable for reconstruction, hinder or would make appropriate prosthetic treatment impossible, and preparation of the bone base and mucous membrane for prosthetic treatment;
- conservative treatment, i.e. healing of carious lesions, professional tooth cleaning;
- orthodontic treatment, i.e. closing gaps between teeth or changing the position of the teeth.
- Actual treatment; this stage of the treatment has various courses depending of the treatment plan.
- Check-up visits. The time of completion of the prosthetic restoration is not the end of dental treatment. To take full advantage of a good prosthetic restoration, the patient has to observe the dentist's recommendations and to come for check-ups, during which the dentist assesses any changing conditions in the oral cavity and functions of the denture, and performs necessary corrections and repairs.

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WARTO WIEDZIEĆ

1. Is it necessary to replace any missing teeth?
2. What does the choice of the prosthetic restoration depend on?
3. What options for the replacement of missing teeth are available in the case of complete toothlessness??
4. How are hygienic principles modified in the case of permanent dentures?
5. How are hygienic principles modified in the case of removable dentures?
6. What are the dietary requirements for patients under prosthetics treatment?
7. Is it possible to repair a prosthetic restoration by oneself?
8. Is the use of denture adhesive beneficial?

1. Is it necessary to replace any missing teeth?

Any missing teeth, even a single one, should be restored as soon after the time of loss as possible. The loss of even one tooth may lead to negative consequences within the whole masticatory system, such as migration of the adjacent teeth (inclination, rotation) and "elongation" of the corresponding opposite tooth that strives to make contact. Other complications include temporomandibular joint disorders that manifest themselves as morning muscular pain within the temple areas, as well as alimentary tract disorders. The other problem is aesthetic defects, such as an incomplete smile, shortening of the lower face, collapsing lips and increased wrinkles around the mouth.

2. What does the choice of the prosthetic restoration depend on?

The choice of prosthetic restoration being suitable for a given patient depends on many factors, such as:
- number of missing teeth;
- number and quality of remaining teeth;
- localisation of the tooth loss;
- condition of bone base, gums and mucous membrane;
- features of occlusion (bite);
- patient's age;
- patient's preferences;
- patient's financial situation.

3. What options for the replacement of missing teeth are available in the case of complete toothlessness?

For many years the generally used solution in such a case has been a full denture. The advantages of such a solution include its availability, low price and satisfactory aesthetic effect. On the other hand, its disadvantage is low comfort in use. The denture simulates the masticatory function only to a small extent, and significant surface area of its plate covering the palate compromises the sensation of taste. Implant-based prosthetic restoration provides an alternative option that replaces missing teeth much more efficiently; such restoration includes:
- overdentures supported on 2-4 implants in the upper and lower jaw;
- bridges supported on at least 6 implants in the upper jaw and 5 implants in the lower one.

4. How are hygienic principles modified in the case of permanent dentures?

To prolong the durability of permanent denture to the maximum extent, special hygienic procedures have to be implemented which involve the use of additional hygienic tools apart from the toothbrush. The perigingival area of crowns and bridges requires special attention due to the tendency of build-up of bacterial plaque which is difficult to remove. Recommended equipment includes:
- super floss, rigid dental floss with a foamy thickened segment; the rigid portion is to be pulled under the cleaned denture element, and then the element is to be cleaned with the foamy portion;
- dental irrigator, a device producing a water stream that massages gums and cleans spaces which are difficult to reach.

5. How are hygienic principles modified in the case of removable dentures?

In the case of removable dentures, the denture itself should receive particular attention, apart from conventional care of the remaining teeth. A removable denture should be cleaned after each meal (at least twice a day). When the denture is removed from the patient's mouth, it should be cleaned with a soft toothbrush and toothpaste, liquid soap or special cleaning agent. Special two-sided denture brushes are preferable, as the special shape of their bristle allows cleaning of even those places of the denture which are the most difficult to reach. Moreover, there are various cleaning agents, such as powder or tablets which dissolve in water, creating a liquid for denture cleaning. Such agents are particularly recommended to individuals with some physical disability.

6. What are the dietary requirements for patients under prosthetics treatment?

In general the diet of patients having permanent dentures is not changed, contrary to patients with removable ones. Patients who start using removable dentures, in particular full sets, should eat only liquid and semi-liquid food in the initial period and gradually introduce to more solid meals. Patients should eat smaller portions and avoid very hard and sticky food. In general, the meal time is significantly prolonged.

7. Is it possible to repair a prosthetic restoration by oneself?

Independent repair or correction of denture by the patient is not allowed; such an approach may destroy the restoration and lead to injury to the oral tissues. If the denture causes any discomfort, the patient should visit the dentist immediately.

8. Is the use of denture adhesive beneficial

Agents which improve denture fixation are usually available in the form of powder that forms a sticky mass when mixed with the saliva. Such products may be periodically used in the initial period of getting used to the denture, and also by singers or actors during a show. In all other cases the use of denture adhesive is not advisable, as it may conceal possible imperfection of the denture, which should be detected and corrected in the surgery.

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