Fixed Prosthetics

The prosthetic restoration must be adequately biologically integrated while respecting both the gingival tissues and the pulpal organ during the stages of tooth preparation, impression taking, temporary placement, and cementation of the restorations.

The loss of dental elements or the lack of reliability of existing natural elements leads the clinician and patient most often to choose prosthetic solutions anchored on osseointegrated implants, which can effectively replace missing elements.

In any prosthetic rehabilitation, whether limited to a sector of the oral cavity or extended to the entire mouth, periodic and scrupulous monitoring of the rehabilitation performed, as well as careful and systematic control of the patient's oral hygiene, will be of paramount importance for the maintenance over time of the restorations made.

Causes of missing tooth:

• The tooth element was extracted because it was heavily attacked by caries that resulted in pulpitis that was not treated in time, and the patient decided to replace it with a bridge;
• due to traumatic fracture (accident) of not only the crown but also the root of the tooth;
• Major dental abscess;
• old age;
• severe periodontitis that resulted in the instability of the tooth element that the dentist had to arrange for extraction.

Why replace the missing tooth?

• To restore proper chewing;
• To prevent displacement of adjacent teeth causing malocclusions;
• to restore the aesthetics of the patient who would feel uncomfortable in his social relationships;
• In the case of the dental implant, it helps to significantly delay bone regression.

Dental Crowns

Dental crowns are fixed prostheses made of various materials:

• ceramic (pure porcelain)
• zirconium
• metal-ceramic (alloy-ceramic)
• metal-resin
• metal
• resin (they are usually temporary crowns)

When are dental crowns recommended?

• When teeth are affected by decay, they are chipped or broken and cannot be restored with fillings;
• when teeth are devitalized, because after devitalization they become weak and can become damaged;
• When teeth are affected by diseases that are destroying their enamel;
• When we need to cover a plant.

Modern crowns replace the old metal crowns that have as their biggest disadvantage the lack of translucency at the gingival level, since the rays of incident light, unlike the natural tooth, are blocked by the presence of the underlying metal, and this, even in well-executed crowns, causes frequent blemishes.

The capsule-tooth finishing area, moreover, consists of a metal beading, often coated with an opacifying material, which transpires through the gingiva, ruining the naturalness of the smile. These problems, combined with the ever-increasing esthetic demands of our time, have led to the production of all-ceramic or zirconium crowns that have enabled excellent results precisely because, without a metal core, they reproduce the transparency of the natural tooth.

The treatment

Before proceeding with encapsulation, the tooth is prepared. Tooth preparation includes the following steps:

• when required the tooth is devitalized, to avoid suffering and pain;
• then the tooth is ground down, until the necessary thickness for encapsulation is obtained (obviously the part of the tooth removed will be equal to the thickness of the crown to be fitted);
• impression is taken, the color is chosen, and the artificial crown is prepared;
• the last step would be the cementing of the final dental crown (if a temporary crown has been applied in the meantime). The crown can be cemented with a specific dental cement that also acts as a sealant to hold the crown firmly in place.

The treatment is painless. The crown will be made to match the other teeth, and the color shade of the neighboring teeth will be used to make the crown fit as naturally as possible between the other teeth.

A provisional crown, usually made of plastic material, will be mounted on the prepared tooth while waiting for the final crown to be ready. These temporaries may look less natural than the final crown and therefore may be more noticeable, but we must remember that they are made to last only a few weeks.

Bridges

A dental bridge is a fixed prosthesis used to replace one or more teeth that are missing for different reasons. To restore optimal chewing function and aesthetics, dentistry offers two solutions:

• Bridge supported by adjacent teeth that act as abutments;
• crown on an osseointegrated dental implant that serves as an artificial root on which to secure a prosthetic crown.

It is up to the dentist to evaluate the case at hand and describe to the patient the advantages and disadvantages of the two dental procedures.

Unlike the implant, which involves inserting a screw into the gum bone with an artificial tooth on top, the bridge is a rootless artificial tooth that is placed directly on the gum where the natural tooth used to be. The dentist then anchors it to the contiguous teeth.

What is the procedure for applying a dental bridge?

During the first visit, the abutment teeth are prepared. Preparation involves recontouring these teeth by removing a portion of enamel to make room for a crown over them. Next, an impression of the teeth is taken that serves as a model from which the bridge, intermediate element, and crowns will be created by a dental laboratory.

The temporary is then made that can immediately give comfort and protection to the exposed teeth and gums while the preparation of the final bridge is in progress.

The temporary also allows the gingival shape to be shaped and conditioned and the final result to be previsualized: the final work is actually a copy of the temporary.

Next, a precision impression will be taken and given to the dental technician to make all the necessary aesthetic and functional tests. The bridge can then be cemented in place.

Multiple visits can be made to check the fit of the metal structure and especially the bite.

Recall that dental bridges require scrupulous home hygiene. In order to avoid periodontal disease and caries, careful brushing of the gingival edges and the space below the bridge are essential; in addition, the area where the bridge is placed will also need to be cleaned by flossing with a specific dental floss - superfluoss - in order to prevent food residues from triggering infection, abscesses, inflammation or any pathological process.

Inlays

Inlays have taken the place of the old amalgams, or gray dental fillings, the so-called plumbings, which besides having an ugly aesthetic impact, contain 50 percent mercury, one gram of which is enough to contaminate 20,000 kilograms of food (current EEC regulations).

The danger of old dental amalgams consists essentially of chronic exposure to low levels of mercury that affects the brain, thyroid, bone marrow, kidney, liver, heart and other tissues, according to recent epidemiological studies.

Inlays are actually lab-made composite or ceramic fillings that are then cemented into the previously prepared tooth cavity.

They are used for posterior teeth (premolars and molars) where cavities are more likely to be large. The tooth is prepared as for a filling, which, instead of being made by the dentist, is made by the dental laboratory on a precision impression. The inlay is then cemented in place.

Today, the use of composite or all-ceramic inlays represents an opportunity to limit the invasiveness of restorative methods, keeping the margins of the restoration out of the gingival sulcus and effectively restoring the biomechanical characteristics of the treated elements.

Inlays have a very high esthetic performance, they are long-lasting, and the point of contact between inlay and tooth is more precise than normal filling.

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