Treatment : Crowns & Bridges - Fixed Prosthesis

Replacement of Missing Teeth

In case of failure to replace a missing tooth, you could end up loosing all your teeth. Each tooth has two parts - Crown and Root. Crown is visible in the mouth whereas the root is embedded in the bone. Molars have two or three roots whereas the front teeth are usually single rooted.

Loosing A Tooth

As shown in the picture extraction of a lower molar has created a space ‘X’ . Upper tooth 6 is now useless because it no longer has a tooth to chew against. Therefore loosing one tooth can result in the loss of two or more teeth.

COMPLICATIONS

Supra-Eruption

Back teeth have a lifetime tendency to ERUPT. Only the presence of a tooth to chew against keeps a back tooth from supra-erupting. In the above case the upper 6 has supra-erupted. The resulting unevenness among the upper back teeth has created areas between the teeth that trap debris. Despite the best efforts to brush and floss it is difficult to keep uneven areas clean. Thus gum infection and tooth decay start in these areas. The lower tooth wedges food in the space created in between the upper teeth. This causes the upper 7 to move backwards. As the space further increases infection increases.

Tilt and Drift

Back teeth have a lifetime tendency to TILT and DRIFT towards the front of the mouth. Thus in the above case the lower 7 is drifting and tilting forward.

Gum Pocket formation and bone loss

A tilted tooth develops a Gum pocket along its front tooth. Gum pockets are narrow abnormal spaces or clefts that develop between the gums and the tooth root. These pockets trap food debris and bacteria. A gum pocket is a problem as it is very difficult to keep it clean, even with the best brushing and flossing. The debris and bacteria that collect in the pocket lead to worsening of the gum infection. This gum infection finally infects the adjacent bone which softens and slowly begins to disappear. Thus the lower is lost due to gum infection and the upper 6 and 7 eventually lost because of tooth decay and infection.

Conclusion

Failure to replace a single molar tooth may start a chain of events: Supra-eruption, Tilt, Gum pockets, Decay, Bone loss. Over the years this can lead to the loss of all your teeth. Inserting a false tooth today will avoid grief and much greater expense tomorrow.

Crown & Bridges

Sometimes teeth have been so badly damaged by decay or wear that cosmetic fillings are no longer a viable option. Under these circumstances the tooth can be saved and protected by a crown or a cap.

Crowns can also be used on either side of a gap so that a bridge can be constructed to replace one or more missing teeth without the use of implants.

Occasionally, patients who have crowded or malaligned teeth and who are unable to commit themselves to orthodontic treatment can have their problems solved by the use of crowns or veneers which can be used to disguise the appearance of the teeth and provide a beautiful smile for life.

Many of our patients come to see us very unhappy at the appearance of crowns or bridges, fitted by another dentist. Their crown are often of good quality but have failed to please the patient because of simple error - lack of communication between the various people involve in their construction. At Rishi Multispeciality Dental Clinic & Dental Implant Centre; we pride ourselves in our team approach. We believe that constructing a crown is a combination of technical expertise and artistic flair. From the outset we involve our highly skilled technician in the planning and designing. We encourage as much communication as possible among the patient, technician and dentist to ensure that the final result is exactly as expected.

Often we begin by constructing models of the finished restorations so that the patient is able to see what his or her mouth would look like before any work is started.

We actively encourage friends or family to attend with the patient so that they can contribute to the final result. Thus patients are able to feel relaxed with the knowledge that we will achieve their desired appearance.

Naturally, if the desired appearance is not achievable (which only happen occasionally); we would explain the problems and suggest alternatives.

How Tooth is Crowned or Capped?

 

  • Front view of the tooth to be crowned.

 

  • One half of the tooth has been prepared so you can see approximately how much tooth structure has been reduced.

 

  • The tooth has now been fully prepared to make room for the porcelain (and most times an underlying layer of metal for support).
  • Then two sides of the tooth are prepared with only a slight taper to help hold the crown in place.

 

  • The new crown is being put into place. Notice the way it will fit up under the gum tissue to hide the margin ( junction ) between tooth and crown.

 

  • The final crown is shaped as much as possible like the natural tooth to look and feel good. It is attached with special dental cements.

Types of Crown

Type Advantages Disadvantages

Porcelain fused to Metal Crown - PFM

  • Strongest type of esthetic crown.
  • Doesn't fracture or chip as easily as alternative esthetic type crown.
  • Usually most economical esthetic crowns.
  • Metal may be visible if tissue shrinks.
  • Metal may be visible if tissue is thin.
  • Metal may affect color of porcelain.
  • Possible bluish tint of gum if gum tissue is thin and metal shows through.
     

Metal Crown with Porcelain Butt Joint


  • Esthetic
  • No metal shows from front
  • Strong
  • Metal usually visible from inside view only.
  • Underlying metal may affect color of porcelain.
  • Porcelain margin more susceptible to chipping than metal.
  • More costly to make.
     

Porcelain or Cast Glass


  • Most esthetic throughout crown life.
  • No metal shows.
  • Not as strong as ceramco metal crown.
  • Margin may be more susceptible to chipping.
  • More costly to make.
     

Full Metal


  • Strong crown.
  • Very Economical.

 

  • Esthetically dissatisfactory

How Bridge Replaces a Missing Tooth?

  • A conventional three-unit bridge will be used to replace the missing central incisor.

  • One tooth on either side of the missing tooth is prepared to retain the fixed bridge.

  • Porcelain is normally fused to a metal framework.
  • Here the metal framework is being tried in the mouth.

  • The final porcelain-fused-to-metal bridge is fitted over the teeth and just under the gum tissue to hide the seam between the porcelain and metal.

 

Comments

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  • Kazi FaridGood
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