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Prosthodontics

 

Denture

A denture replaces missing teeth and adjacent tissues. Unlike dental implants, a denture is removable. Made of resin and porcelain, complete dentures are used to replace all the teeth. When some healthy teeth remain, a partial denture can be used. A partial denture also keeps the remaining healthy teeth from shifting positions in the mouth.
Dentures made by a cosmetic dentist do more than replace the teeth. They are fit "neuromuscularly," meaning that they are precision-fit to provide the most optimum position for your jaw and bite, assuring comfort. Full and partial dentures improve chewing ability and speech, and support facial muscles. Dentures also enhance appearance.

Benefits of Dentures                                 

  • Prevents existing teeth from drifting into surrounding space of the missing teeth
  • Teeth out of position can damage tissues in the mouth
  • Helps to chew food  

Complete denture

Complete dentures or Full dentures are used when all the teeth are missing . Complete dentures can be either "conventional" or "immediate". The framework of complete dentures may be made of resin, metal or a combination.
Implant supported overdentures are an alternate to conventional dentures whereby a full dentures is placed over the dental implants with metal bar/balls that gives better retention.

Partial denture


Partial dentures are used when some natural teeth remain. A removable partial denture usually consists of replacement teeth attached to a pink or gum-colored plastic base, which is connected by metal clasps or precision attachments that holds the denture in place in the mouth. Precision attachments are generally more esthetic than metal clasps and they are nearly invisible

Conventional Dentures and Immediate Dentures

Conventional Dentures are made after the teeth have been removed and the gum tissue has begun to heal. Conventional dentures are ready for placement in the mouth about 8 to 12 weeks after the teeth have been removed.
Immediate dentures are made in advance and can be positioned as soon as the teeth are removed. As a result, the wearer does not have to be without teeth during the healing period. However, bones and gums shrink over time; especially during the healing period following tooth removal therefore immediate dentures would usually require more adjustments to fit properly during the healing process and generally should only be considered a temporary solution until conventional dentures can be made. The healing process as it can take months for your bone and tissue to stabilize after tooth extractions.

Procedure for Conventional Dentures Treatment

  • First Evaluation and dentures site preparation
  • if tooth extraction is required, the teeth are extracted and left to heal
  • Making the dentures
  • Once the gums are healed and healthy, an impression of the mouth is taken for a wax-up
  • The wax-up is used to determine the most optimal position of the jaw and teeth dimensions (size, shape, length, width)
  • The wax up is sent to a dental laboratory to construct a "try-in" set of denture
  • Trial of "try-in" set of dentures and re-adjustments
  • The "try-in' denture are placed in the mouth to assure comfort, fit, bite position and appearance
  • The "try-in" dentures are re-worked in the labs and trail fitted during next visits until the color, shape and proper fit is obtained for the final set of dentures to be cast
  • Fitting of final dentures

For immediate dentures, impression-taking and the wax-up is first done before tooth extraction.  

Recovery Expectations

Recovery from getting dentures may be a two-step process. If extractions are necessary, patients can expect the recovery of their gums to take up to 4 weeks or longer.
Once healed and the dentures are placed, the patient will need time to adjust to the new teeth. While patients can speak normally within a few hours, they may experience minor discomfort when eating or chewing. This discomfort may last from several days to a few weeks until the muscles of your cheek and tongue learn to keep them in place and you get comfortable inserting and removing them. It is recommended that patients with new dentures eat soft foods until they become comfortable with chewing.
It is not unusual for minor irritation or soreness to occur and for saliva flow to increase when you first start wearing dentures, but these problems will diminish as your mouth adjusts to the new denture. 

Care for Dentures

  • Dentures should be removed at night to give the gums a rest and to reduce the pressure on the underlying bone or as directed by your dentist
  • Regular denture care includes brushing your denture with a denture brush and a denture paste after eating. Dentures can collect plaque and food stains
  • Keep your dentures in water to avoid drying out and distorting.
  • Dentures can and may break if dropped onto a hard surface, thus be careful when handling them.
  • Clean and massage your gums and tongue with a regular soft-bristled toothbrush to help keep them healthy.
  • Don’t forget to attend your dentist for yearly check ups (even if you have full dentures)
Dental Crown



Porcelain crowns and caps
Dental crowns are restorations that protect damaged, cracked or broken down teeth. A crown strengthens your existing, damaged tooth so as to preserve its functionality. Dental crowns are also commonly known as caps (because a crown sits over your existing tooth, covering the entire outer surface).
Crowns can be all metal, porcelain fused to metal (PFM), or all ceramic crowns. Metals include gold alloy, other alloys (palladium) or a base-metal alloy (nickel or chromium). The all-metal or PFM crowns are stronger and are better choices for back teeth. PFM and all-ceramic crowns look just like normal teeth.

 

Benefits of Dental Crowns

  • Protects severely damaged tooth or tooth weakened by decay, fracture, large fillings or root canal therapy from fracturing. Teeth with large fillings tend to "flex more" forcing the tooth apart possibly causing stress fractures
  • Holds together cracked or weaken teeth and seal the tooth from decay
  • Covers discolored and irregularities in teeth in improving cosmetic appearance
  • Helps preserve the natural function and position of the teeth
  • Restores tooth with large decay, cavities or filings
  • Supports the replacement teeth in a bridge
  • Restores and maintains natural bite
  • Covers a dental implant
  • Restore your smile

 

Procedure for Dental Crowns
The course of treatment described here is one of several options available at our dental clinic. Consult your dentist to find out what the best solution is for you, given your specific condition.
Preparing a tooth for a crown usually requires two dentist visits, the first step involves examining and preparing the tooth, the second visit involves placement of the permanent crown.

First Visit: Evaluation and crowns tooth preparation

  • A few X-rays may take to check the roots of the tooth receiving the crown and surrounding bone. If the tooth has extensive decay or if there is a risk of infection or injury to the tooth's pulp, a root canal treatment may first be performed.
  • Local anesthesia is administered at the region for crown tooth preparation
  • The natural tooth is reshaped to receive the new dental crown
  • If a large area of the tooth is missing (due to decay or damage), a filling material will be used to "build up" the tooth to support the crown.
  • Records are taken and approved with the patient to determine the color, bite, length and shape of the crown
  • An impressions taken for a replicate model of the teeth
  • This model is sent to the dental laboratory where the individual personal crown is fabricated (The crown usually return from laboratory in 3 to 4 days).
  • A temporary crown is placed on while the permanent crown is made
  • Fitting the crown on delivery

Second Visit: Receiving the permanent dental crown

  • The temporary crown is removed
  • A quality assurance including check the fit and color of the permanent crown is done for any re-adjustments of the dental crowns
  • If everything is acceptable, a local anesthetic will be used to numb the tooth and the new crown is permanently cemented in place.

Postoperative care Instructions for Dental Crowns
Both the preparation and placement of the temporary crown as well as the bonding of the permanent crown may cause some minor tenderness in the area. Some individuals may experience sensitivity in teeth. This sensitivity will disappear gradually over a few days to weeks.

  • Avoid chewing on or eating hard foods on the restorations for 24 hours from the time they were cemented
  • To help with discomfort or swelling rinse your mouth 3 times a day with warm salt water. (1tsp. of salt in 8oz of water)
  • Keep crown area clean to maintain tissue compatibility (the contour of the prosthesis must allow the surrounding tissue to conform to a natural, healthy position)
  • Some sensitivity in teeth may be experienced by certain patients. This sensitivity will disappear gradually over a few days to weeks. If teeth are sensitive
    • Avoid hot, cold or acidic food and beverages
    • Pain medication be taken as directed as long as there is no medical contradiction based upon your medical history
    • Use fluorides rinse and toothpaste for sensitivity teeth
    • Clean teeth properly

Care for Dental Crowns
Dental crowns require the same regular and consistent home and professional dental care, as your natural teeth to prevent decay at the tooth-dental crown junction. To provide optimum longevity for your restorations, please follow the home care tips below:

  • Brush after eating and before bedtime around the crown with a soft toothbrush, especially where the crown meets the gum line. At the gum line harmful bacteria can be accumulate to cause decay and gum disease.
  • Floss at least once to twice a day. Use the proxy brush or dental floss to remove plaque under and around these areas to maintain good oral hygiene. Build up of food debris and plaque on your teeth and gums can become infected.
  • Rinse with fluoride rinse before bed. Swish the fluoride rinse vigorously in your mouth for at least one minute. Do not swallow any of the rinse and do not eat or drink anything for 30 minutes
  • Be careful about chewing toffees, gum, grainy rolls and tough food in this area
  • See your dentist for regular professional check-ups and cleanings

Types of Dental Crowns

  • Metals used in crowns include gold alloy, other alloys (palladium) or a base-metal alloy (nickel or chromium). Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, they rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.
  • Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown's porcelain portion can also chip or break off.  Porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown's porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.
  • All-resin dental crowns are less expensive than other crown types. However, they wear down over time and are more prone to fractures than porcelain-fused-to-metal crowns.
  • All-ceramic or all-porcelain dental crowns provide the best natural color match than any other crown type and may be more suitable for people with metal allergies. However, they are not as strong as porcelain-fused-to-metal crowns and they wear down opposing teeth a little more than metal or resin crowns. All-ceramic crowns are a good choice for front teeth. The all-ceramic crowns used at Patong Smile Dental Clinic clinic include the IPS Empress system and the new e-max crowns from Ivoclar Vivadent, Procera Nobel Esthetics from Nobel Biocare, and Cercon Smart Ceramic (Zirconium Crown) from Dentsply.
  • Temporary versus permanent. Temporary crowns can be made in your dentist's office whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by the dental laboratory.

Dental Bridges
Before After

Bridges
Dental bridges are meant to replace missing teeth by "bridging" the gap between two remaining teeth. This involves creation of a pontic, or false tooths with a dental crown on either side. The crowns are fitted over the remaining teeth to hold the false tooth in place.

Benefits of Dental Bridges


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Replace missing tooth/teeth.

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Helps balance a normal bite.

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Helps prevent undesirable stress on the dental ridge.

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Prevents over-eruption of the opposing teeth.

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Prevents drift and tilt of adjacent teeth.

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Prevents tooth decay in adjacent drifted teeth

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Retards onset of gum diseases

Types of Dental Bridges

Traditional bridges Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic in between. Traditional bridges are the most common type of bridge.

Cantilever bridges Cantilever bridges are usually used when there are adjacent teeth on only one side of the missing tooth or teeth.

Maryland bridges Maryland bridges also called a resin-bonded bridges or a Maryland bonded bridges. Maryland bridges supported by a metal framework which have metal wings on each side of the bridge are bonded to the back of existing teeth.  

Types of Dental Bridge Materials
There are three basic types of materials for dental bridges:

  • Porcelain fused to metal dental bridges
  • All porcelain dental bridges
  • All metal dental bridges (Gold)

The all porcelain dental bridges and porcelain fused to metal (PFM) dental bridges are tooth colored bridges. PFM dental bridges are usually used to restore back teeth where the forces of chewing and grinding are strongest. All porcelain dental bridges are the most aesthetic and are used almost exclusively for front teeth where the need for strength is not as critical. Gold dental bridges are the most durable and offer the most precise fit. Gold dental bridges do not chip.

The porcelain bridges used at Patong Smile Dental clinic include the IPS Empress e-max from Ivoclar Vivadent, Procera Nobel Esthetics from Nobel Biocare, and Cercon Smart Ceramic (Zirconium Bridge) from Dentsply. 

Procedure for Dental Bridges Treatment
The course of treatment described here is for traditional bridges, one of several options available at our dental clinic. Consult your dentist to find out what the best solution is for you, given your specific condition.
First Visit: evaluation and bridge tooth preparation

  • Local anesthesia is first administered at the region of bridge tooth preparation
  • The natural teeth adjacent to the missing gap is reshaped to receive the dental bridge
  • Records are taken and approved with the patient to determine the color, bite, length and shape of the bridge
  • An impressions of your teeth are made, which serve as a model for dental technician.
  • This model is sent to lab where the individualized bridge is fabricated
  • A temporary bridge is placed on to protect the exposed teeth and gums while the permanent bridge is made
  • Fitting of bridge on delivery

Second Visit: Receiving the permanent dental crown

  • The temporary bridge is removed
  • The new permanent bridge will be checked and adjusted, as necessary, to achieve a proper fit.
  • A quality assurance check is done for any re-adjustments of the dental bridge. Multiple visits may be required to check the fit of the metal framework and bite. This is dependent on each individual's case.
  • The permanent bridge is fitted and cemented into place on the teeth

Postoperative care Instructions for Dental Bridges
Both the preparation and placement of the temporary bridge as well as the bonding of the permanent bridge may cause some minor tenderness in the area. Some individuals may experience sensitivity in teeth. This sensitivity will disappear gradually over a few days to weeks.
Replacing missing teeth should actually make eating easier but until you become accustomed to the bridge, eat soft foods that have been cut into small pieces.

  • Avoid chewing on or eating hard foods on the restorations for 24 hours from the time they were cemented
  • To help with discomfort or swelling rinse your mouth 3 times a day with warm salt water. (1tsp. of salt in 8 oz of water)
  • Keep crown area clean to maintain tissue compatibility (the contour of the prosthesis must allow the surrounding tissue to conform to a natural, healthy position)
  • Some sensitivity in teeth may be experienced by certain patients. This sensitivity will disappear gradually over a few days to weeks. If teeth are sensitive :
  • Avoid hot, cold or acidic food and beverages
  • Pain medication be taken as directed as long as there is no medical contradiction based upon your medical history
  • Use fluoride rinse and toothpaste for sensitivity teeth
  • Clean teeth properly

Care for Dental Bridges
Dental bridges require the same regular and consistent home and professional dental care, as your natural teeth to prevent decay at the tooth-dental crown junction. It is important to keep your remaining teeth healthy and strong to provide optimum longevity for your restorations since the bridge long term success depends on the solid foundation offered by the surrounding teeth. To accomplish that, please follow the home care tips below:

  • Brush after eating and before bedtime around the bridge with a soft toothbrush, especially where the bridge meets the gum line. At the gum line harmful bacteria can be harbored to cause decay and gum disease.
  • Floss at least once to twice a day. Use the proxy brush or super floss to remove plaque under and around these areas to maintain good oral hygiene. Build up of food debris and plaque on your teeth and gums can become infected.
  • Rinse with fluoride rinse before bed. Swish the fluoride rinse vigorously in your mouth for at least one minute. Do not swallow any of the rinse and do not eat or drink anything for 30 minutes
  • Be careful about chewing toffees, gum, grainy rolls and tough food in this area
  • See your dentist for regular professional check-ups and cleanings
 
 
 
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