Fixed Prosthodontics is the branch of dentistry which includes all restorations permanently placed in the mouth. Restorations like these are crowns on teeth or implants and bridges (fixed partial dentures) also applied on teeth and implants. In the same branch restorations like Onlays-Inlays or Veneers are also included but are classified as more aesthetic orientated. Aesthetic solutions like onlays-inlays or veneers are more conservative considering the needed preparation of the tooth but their application is not always reliable and in these cases a full-coverage dental crown or a dental bridge are indicated as the best long-term solutions.
A dental crown is used to cover and fully protect a tooth from mastication forces when too less tooth substance remains due to decay or fracture of the tooth. Crowns can be applied at both front and back teeth.
A dental crown is usually necessary in the following cases:
- To cover (and protect in this way) a largely decayed tooth that has lost a big amount of healthy tooth substance
- To correct an aesthetic problem of a tooth if that is not possible with more conservative restorations
- To restore a dental implantAt our disposal are materials that replace the old materials that had many time as a problem, especially at front tooth area, the presence of the unaesthetic gray line at the border of a dental crown of bridge with the gums. Nowadays apart from metal-porcelain solutions, we have metal-free restorations to choose from. Metal-free restorations have the ability to reflect light and give a more natural and appearance of a restored tooth that makes the appearance of a whole smile much brighter!
Bridges or Fixed Partial Dentures (FPD) are used to replace one or more missing teeth. They can be supported on the adjacent teeth (which should also be prepared to accept a dental crown each) and after final placement compensate for the gap of the missing tooth or teeth. The simplest case is a 3-piece bridge where only two adjacent abutment (supporting) teeth and an intermediate to make up for the empty space. In some other cases, the missing teeth are more and in this case to ensure a good prognosis and a long-term survival rate of the bridge more abutment teeth can and should be used to rehabilitate more missing teeth.
The same applies to implants. In the case of implants the advantage is that a missing tooth may be replaced with a single implant without any intervention at the adjacent teeth. This means that one gap can be restored with the placement of one implant and a crown on it and not a 3-piece bridge where two more teeth need to be involved in order for one single gap to be filled.
When there are more missing teeth then a bridge on implants can be supported by two or more implants. This can only be decided according to the length of the edentulous area (area with no teeth) and the bone provided to judge how many implants can be placed. A fixed partial denture on implants provides the patient with great stability during chewing or speaking and is also considered as a very aesthetic solution in comparison to solutions of the branch of Removable Prosthodontics where cheaper but less aesthetic solutions can be found.
The same as with crowns the materials of choice can be porcelain fused to metal solutions or metal-free all-ceramic solutions which are much aesthetic. The material we choose is decided according on the area needed to restore (front more aesthetic or back) or on other factors such as habbits of the patient (e.g bruxism). Of course solutions of metal-free restorations are always based on the financial possibilities of our patient.