Inlays and onlays are prosthetic alternatives to tooth filling. A prepared tooth is impressed and a tooth model is formed from the dental cast. Afterwards, a dental technician uses the model in order to manufacture the missing piece of the defective tooth from an arbitrary material. The piece is then cemented into the tooth. The advantage of this treatment lies in high-quality materials like gold, plastic (composite) and porcelain. The procedure requires more than one session in order to complete the treatment.
A dental technician can be replaced by modern technology (CAD-CAM), wich can reduce the entire treatment process to a single session. We prepare the tooth, record it on camera and virtually design an adequate substitute, using the optical impression from the recording. Afterwards, the substitute is precisely crafted from a porcelain block by a milling machine, resulting in a high-quality product of topmost aesthetic features. Lastly, the substitute is suitably processed and glued into the tooth. The procedure takes two hours. This way, we can fabricate porcelain inlays, crowns and veneers. This kind of treatment is accordant with the highest possible standards of modern stomatology.
When the tooth is no longer treatable with fillings or inlays, it is necessary to fabricate a new dental crown. The procedure is similar to the manufacturing of inlays, although in this case the dental crown is treated as a whole. Prosthetic crowns are made from various materials.
Crowns made from plastic materials are suitable for short- and long-term temporary use. They are not an adequate lasting solution, since the plastic materials do not withstand the bite pressure for long, causing considerable attrition.
A classic faceted crown is made from metal and plastic. The tooth is usually made of metal, with a plastic facet – veneer glued to the frontal side for aesthetic effect. The veneer wears with time. Its colour changes, causing it to lose aesthetic appeal and become increasingly noticeable. A plastic veneer is less resistant to dental plaque accumulation than a porcelain one. It is aesthetically and qualitatively surpassed by a metal-ceramic crown. This, too, has a metal basis, although it is covered with porcelain on all sides, which makes the whole tooth appear white.
Porcelain is the best material for tooth-fabrication. It is hard, long lasting and does not change its features and appearance. The quality of both kinds of crowns is influenced by the choice of metal alloy.
The pinnacle of aesthetic dental care are full porcelain crowns. They do not have a metal basis and are made entirely of porcelain. Depth, colour, as well as transparency, phosphorescence and many other optical features of porcelain almost fully resemble those of a tooth enamel. The appearance of full porcelain crowns is unsurpassed by any other material used in dentistry. Even experts find it difficult to distinguishing a well-crafted full porcelain crown, inlay or veneer from a natural tooth. They are suitable for the treatment of frontal teeth.
One or more lost teeth can be replaced by a bridge. It is made up of prosthetic crowns attached to two or more anchoring teeth, and an element or to replace the lost tooth between them. The materials used are the same as with crowns, except for a few limitations.
Plastic materials are only a temporary solution for the treatment of smaller gaps. Although they are of high aesthetic value, full ceramics are not suitable for filling larger gaps, however, they are appropriate for replacing individual frontal teeth.
Due to those facts, most dental bridges are composed of metal with plastic veneers and, most often, of metal-ceramics with cobalt-chrome allooys as the metal basis. Using this type of prosthetic replacements, we can fill very long gaps.
Partial dentures are used to replace missing teeth when they cannot be replaced by dental bridges, which most often occurrs with the loss of the rare anchoring teeth or when the teeth, though enabling an association with a dental bridge, are not suited for that role. Partial dentures are a financially affordable alternative to bridges.
The fabrication of partial dentures is simple and their handling user-friendly. They can be cleaned easily and efficiently. At first, the prosthesis represents a foreign body in the oral cavity, hindering one's speech and chewing process, although it is easy to get accustomed to and quickly becomes a »body part«.
We distinguish two types of prostheses according to its base materials. We can use acrylate or cast the denture base using a suitable metal.
An acrylate denture is attached to the other teeth with wire clasps. It is fairly thick and much less efficient than a denture with a cast metal base. Chewing pressure is usually applied to the jaw-bones and can cause the loss of the supporting bone, which is why such prostheses are only suited for temporary use.
A better and more expensive alternative is a prosthesis with a cast metal base. The denture's framework contains clasps and precision attachments , forming a rigid entity with the teeth, with the bite pressure being evenly distributed among the teeth and the jaw bone, which enables a long life span for the prosthesis, the teeth and the supporting bone. Due to the use of metal, the denture base is very thin, making it easier to adjust to.
A denture with a metal base can be associated to the other teeth by various linking elements other than clasps, since those are sometimes visible and thus aesthetically impairing. In that case, the remaining teeth are restored with dental crowns containing connective elements. This fixed/removable hybrid prosthetic treatment is a very common practice in dentistry.
The remaining parts of the denture and teeth are made of acrylate. Artificial teeth exist in a variety of shades, shapes and sizes, so a harmonious blend with natural teeth is always achieved. They can be reshaped and functionally adjusted. The prices of artificial teeth vary according to the quality and mode of fabrication from acrylate.
The fabrication of a prosthesis includes several phases and dental visits.
Complete dentures are worn by patients who are missing all of their teeth in the upper and/or lower arch. It can be made of acrylate or manufatured with a cast metal base, which is recommended in partial dentures. The choice of materials in making a complete denture is not as important.
When the upper arch has one or two remaining teeth, it is better to remove them and fabricate a complete denture. The upper complete denture is very stable, since it has a larger contact surface to attach to. It is a highly successful way of rehabilitation. Because of changes in the jaw, it has to be re-adjusted from time to time.
In the lower arch, complete dentures are not as efficient due to the dynamic environment and a smaller contact surface inhibiting its stability. Denture stability requires a balance between the muscles of the bottom of the oral cavity, tongue and chewing muscles. To achieve that, one needs to have time and patience. When the conditions for applying a complete denture in the lower arch are extraordinarily bad, it is recommended to use a combination with dental implants, which add to the stability of the prosthesis.
The patient can choose between various combinations of quality, colour, shape and teeth-placement, yielding good aesthetic and functional outcomes.
The fabrication of a complete denture requires several dental visits.