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Concerns About Dental Prosthetics
The field of Dentistry dealing with prostheses is called Prosthodontics. Prostheses are used to replace missing teeth so that both form and function are restored. As a dental office in Spring, TX, our office sees a lot of patients who needs dental prostheses and below we share some of the most common questions patients have asked us.
What kind of dental prostheses are there?
Dental prostheses come in two varieties, fixed and removable. The goal of both types is to restore function and form for patients who are missing teeth, either one or multiple. Most of the time when people discuss dental prostheses, they refer to the removable option and this form is generically referred to as ‘dentures.’
What is a ‘fixed’ dental prosthesis?
Fixed dental prosthesis, or FPD in short, refers to a class of dental restorations colloquially known as dental ‘bridges.’ This option has been used for decades and is really useful at replacing one or a few missing teeth. The ‘bridge’ is done by using the teeth flanking the missing space as anchors and then placing crowns on these teeth, and then using these crowns as attachment points to hold a replacement tooth. Since the crowns on these anchor teeth are cemented permanently, the replacement tooth is also in place permanently. FPDs are therefore an excellent option to replace missing teeth while at the same time avoid the hassle of insertion/removal of a device, as well as offering excellent aesthetics. However, the drawback is that FPDs in general cannot replace more than 2 teeth, and home care is a MUST to avoid decay to ANY of the anchor teeth. If decay takes place in any of the anchor teeth, the bridge would need to be redone.
What is a ‘removable’ dental prosthesis?
Removable dental prostheses include both complete and partial dentures. These are devices used to replace a larger number of missing teeth or as a ‘cheaper’ option to missing teeth when patients cannot afford a FPD. Generally, when well-fabricated and well-cared for, removable prostheses are still excellent options. However, they can be a hassle in their use as they require insertion/removal and cosmetically, they may not be perfect. They also require good hygiene as well, as any decay to an anchor teeth or any remaining teeth present may necessitate a remake of the prosthesis.
What removable prosthesis would I need if I just miss several teeth
and want to hold onto the remaining teeth?
A partial denture would be good in this case, provided that 1) the remaining teeth are in good shape and can serve as anchors, 2) the patient can be counted upon for good home care, and 3) the patient can tolerate the wear of a prosthesis. A partial denture can come in either a more traditional metal form, or a more modern, flexible form. The metal form is used when more resistance and support is needed but has the drawback of feeling ‘bulky’ to some people; the more modern, flexible ones feel a lot lighter but may not be strong enough when many teeth replacements are needed. Exactly which one is the right one for a patient should be decided on a case-by-case basis in consultation with the patient.
What about the cosmetic aspect of partial dentures? Can people tell that I am wearing them?
Most partial dentures make use of clasps to help them stay in the mouth, so depending on where they are located, how thick they are, and the patient’s smile line, they may range from barely visible to very much so. In general, do expect some kind of show but compared to the original condition of missing teeth most people would consider a partial denture to be an upgrade. Since Valplast partials make use of pink plastic, in general their clasps show less and are camouflaged better than the metallic ones.
If I am already missing too many teeth or my teeth are all really bad in general, then what can I do?
In this case, complete denture would be the best option, unless the teeth are restorable and the patient is willing to spend a lot of time and money to do so. Here, all of the remaining compromised teeth would be removed and a complete denture fitted. However, before proceeding to such an option, a patient must be aware of the limitations of complete dentures (denture consent form); in general, patients must understand that complete dentures take considerable time to adapt to and there are certain functional aspects will remain forever compromised (chewing strength, taste ability, etc.). However, when fabricated well and with patient understanding, complete dentures can be an excellent alternative, both functionally and cosmetically.
I have heard that some long-time denture wearers can lose bone and eventually get the ‘Popeye’ look, is that true?
Yes, this is true of traditional complete dentures. With these dentures, the pressure from chewing over long periods of time, coupled with the absence of teeth, causes the residual bony ridge that the dentures sit on to eventually shrink and disappear over time. This process is usually very gradual and take place over decades, but can produce a noticeable ‘Popeye’ appearance given time where the patient’s top jaw seems to shrink, causing a pronounced lower jaw appearance. This is a result of the loss of the bony ridge and other supporting bony tissue over time. Appearance aside, the shrinkage and loss of the bony ridge also means wearing dentures become more and more difficult with time as it becomes progressively looser. Denture paste can usually counter this effectively but patients do notice a more difficult time functioning with bone loss.
What can I do to avoid this bone loss? Is there anything that can be done?
As a matter of fact, there is. To forestall or minimize the bone loss, one can place dental implants at strategic locations in the residual bony ridge to help maintain the presence of bone and minimize the resorption with time. Bone loss may not be completely averted but the rate will at least be drastically reduced. The implants, just as importantly, can also serve as anchors to help tether the dentures to the ridge during wear. This is an extremely important benefit as it will help to keep the dentures in place and avoid any looseness or use of denture paste. In fact, implant-supported dentures are the current state-of-the-art technique for denture users and we highly recommend it. However, to do so requires a lot of money and time.