Types of dentures
Anyone who has lost one or more teeth usually wants them replaced as quickly as possible so that they can carry on with their normal life. The best type of denture and whether it is a good idea to have one at all will depend on a number of different factors – such as whether there are still neighboring teeth on both sides of the gap in the teeth and how healthy they are, and whether a complete set of upper or lower teeth remain. Other things to consider include oral health and oral hygiene, age, and lifestyle. The importance of aesthetics, pronunciation and being able to chew properly require individual consideration, and cost is an issue too.
There are fixed and removable types of dentures. Crowns and bridges, for example, are fixed permanently to the teeth, but there are also different types of removable dentures available. Artificial teeth can be attached to remaining teeth or dental implants. Dental implants are artificial roots anchored in the jaw. The various types of dentures can also be combined in different ways: A crown might be attached atop a dental implant, and then a partial denture could be affixed to that.
Before suggesting the best type of denture, your dentist will first examine your teeth to see how large the gap in the teeth is, where it is located, and where neighboring teeth are. The dentist can also check how healthy your jaw and neighboring teeth are.
In the German health care system, your dentist puts together a treatment plan and cost overview and submits it to your health insurer before treatment can begin. Approval of the treatment plan and cost overview will describe what part of the treatment costs the insurer will pay. If your dentist has recommended very expensive procedures it may be a good idea to get a second opinion from another dentist. Statutory health insurers also provide advice on dentures and artificial teeth.
Fixed dental restoration
Crowns are artificial teeth made of metal, porcelain or plastic. They are placed on remaining teeth to stabilize and preserve them. Full crowns cover the entire tooth, and partial crowns only cover part of the tooth. In order to create a well-fitting crown, the dentist first needs to grind the remaining tooth so that a mold can be made.
Bridges can replace one or several teeth, and are usually used for smaller gaps, but they are only an option if there are enough remaining stable teeth or dental implants can be put in first. These can be used as abutments for the artificial teeth to close the gaps. The same rules that apply to real bridges also apply here: If the abutments are not sturdy, the bridge can collapse.
Different types of bridges may be needed depending on the location and size of the gap. A fixed bridge can be used to close a gap between two teeth. It is fixed on both ends to two abutment teeth, which provide support for the bridge. Cantilever bridges are often used for a missing molar where there are no teeth on one side that would have otherwise supported the bridge. To make sure that the bridge is stable, it is supported by at least two teeth on the other side.
There are various ways of putting in and fixing a bridge. The abutment teeth might be recontoured and then fitted with crowns, so that a bridge can be put in with an artificial tooth in the middle. Inlay bridges are kept in place using special fillings rather than crowns. Resin-bonded bridges (also called Maryland bridges) bond the artificial tooth to the backs of the neighboring teeth using short metal “wings.”
Dental implants are artificial tooth roots made of metal (titanium) which can hold different types of artificial teeth, including crowns or bridges. Dental implants are anchored in the jawbone much like wall plugs are used in a wall. The bone tissue there fuses with the surface of the dental implant to provide a stable foundation for the artificial tooth. Artificial teeth that are supported by dental implants are also referred to as superstructures.
Partial dentures made of plastic and metal can be used if several teeth are missing, but there is still a nearby group of remaining teeth. They are fixed to natural teeth or dental implants, but can be taken out again any time.
There are different ways of keeping removable dentures in place. Partial dentures can be hooked to remaining teeth using metal clips. This can be done using anchors that have very small mechanical connectors that are hardly visible. Removable dentures can also be retained by using double crowns (telescopic crowns) that are put on natural teeth to serve as a mechanical clasp. This technique can also be used with bridges.
Complete dentures replace all of the natural teeth in the upper and/or lower jaw. Ideally, they look just like natural teeth and can make chewing easier and improve pronunciation. Complete dentures are usually made entirely of plastic. A good match to the jaw is the key to properly fitted complete dentures. They can also be anchored on the roots of teeth or dental implants – they are called hybrid dentures.
Reitemeier B, Schwenzer N, Ehrenfeld M. Einführung in die Zahnmedizin. Stuttgart: Georg Thieme Verlag; 2006.
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