Prosthetics of the anterior teeth. using filling materials. Sharakhutdinova O.S.

Some ten or fifteen years ago, complete adentia, or the absence of all teeth, was a real verdict and meant only one thing - the so-called "false jaw". The loss of one or more teeth was replenished in some cases with removable, and most often with non-removable prostheses, which rested on the remaining teeth. However, progress does not stand still, and today the most popular method of restoring lost and missing teeth is implantation. Amirov Arslan Ruslanovich tells about all the advantages of implantation.

What threatens the long absence of teeth?

The loss of one, and even more so several, not to mention all teeth, leads to a number of functional and aesthetic disorders. First of all, in the place of the lost tooth, a decrease begins bone tissue jaw, the so-called resorption. The teeth adjacent to the defect begin to move, trying to occupy the vacant space, which leads to a displacement of the dentition, a violation of the closure of the teeth, and also a curvature of their position.

With all this, the temporomandibular joint suffers, which is fraught with jaw clicks, headaches, constant tension of the facial and lingual muscles, malocclusion and deterioration in the quality of chewing food. In the absence of front teeth, diction is seriously affected, saliva is sprayed when talking. With the loss of teeth in the lateral parts of the cheeks, they begin to sink, which not only makes the face look older, but also causes permanent microtraumas of the mucosa - simply “biting” the cheeks. By the way, negative changes in appearance, provoking, among other things, psychological problems, are a separate important aspect of the consequences of partial and complete edentulous.

What are the hallmarks of proper dentures?

The main rule in the restoration of missing teeth is a harmonious and effective recreation of both aesthetics and functionality of the dentition. For 100%, only one can cope with this task. modern technique, namely - dental implantation. Today it is the best option for dental prosthetics.

What is meant by restoration of function and aesthetics? From an aesthetic point of view, a denture should not differ externally from natural teeth: it must have the same color and transparency of the enamel as the neighboring ones; repeat the anatomical shape of the tooth (this item also applies to functionality, as it ensures the correct closure of the dentition), it should fit snugly soft tissues gums, the contour of which should be natural and neat (the so-called "pink" smile aesthetics).

As for the function, here we are talking about the full participation in chewing and speech, as well as the correct distribution of the load. When prosthetics rely on adjacent teeth, the entire load falls on them, which leads to their destruction and bone resorption under the prosthesis, the formation of “pressure sores” on the oral mucosa and poor hygiene. When restoring teeth by implantation methods, an artificial tooth completely takes on all the functions of a natural one and does not differ in appearance from the neighboring natural teeth of the patient.

What are the pros and cons of dental implants?

Unlike traditional prostheses based on adjacent teeth, the implant does not interact with them in any way, contributing to the correct distribution of the masticatory load. One hundred percent efficiency in restoring functions and aesthetics is the main and indisputable plus of implantation. In addition, the conditions of our clinic and the qualifications of doctors make it possible to reduce the treatment time using a gentle implantation technique (minimally invasive) without additional bone growth, by installing implants immediately after tooth extraction. At the same time, chewing efficiency and aesthetics are not lost, since temporary crowns are made for the patient during the engraftment of implants. Among the minuses, a higher price compared to traditional prosthetics is usually called, however, in terms of a long term, implantation is not only not expensive, but even a much more economical measure. The fact is that, unlike classical prostheses, a dental implant serves its owner throughout life.

How exactly is traditional prosthetics different from implantation?

Prosthetics differs from implantation in the way the prosthesis is installed, all other differences are a consequence of this. First, both removable and fixed prostheses(with the exception of the false teeth, which we will talk about separately) are installed based on adjacent teeth. To do this, in most cases, these support, initially healthy teeth depulpated, that is, they lose the nerve. A tooth without a nerve is dead tooth, it is easy to guess that soon it will begin to collapse, and in a few years it will take new prosthesis replacing, among other things, the once perfectly healthy abutment teeth. Thus, the answer to the question: "Which is better - prosthetics or implantation?" becomes more and more obvious.

Secondly, between the gum and a removable, as well as a fixed prosthesis, in most cases there is a certain gap in which plaque, bacteria and food debris accumulate, which negatively affects the gum under the prosthesis.

Thirdly, as already mentioned, the load during chewing in the case of traditional prosthetics is unevenly distributed, which leads to accelerated destruction of the supporting teeth and irreversible changes in the structure of the jawbone, in other words, to its loss. By the way, the only way to restore a resorbed bone is through surgery.

As for a complete removable denture, here the loss of bone tissue becomes catastrophic, and reliance on the gum mucosa (due to the absence of supporting teeth) leads to constant rubbing and chronic diseases oral cavity. And if bridges and clasp prostheses simply cause inconvenience, both aesthetic and functional, then the false jaw is a real disaster: it constantly moves inside the oral cavity, falls out, rubs, interferes with speaking, does not allow you to fully chew food.

Is implantation always possible and are there indications for traditional prosthetics?

A few years ago there were strict contraindications to implantation, however, with the improvement of techniques and the development of medicine, these contraindications have practically disappeared. As regards such systemic diseases, then diabetes, coagulation disorders (blood clotting) and some others used to mean one thing: only traditional prosthetics, no implantation. Taking into account the fact that today, the implantation of dental implants is also possible in these cases, the only difference is that the doctor performing the operation must have the knowledge and skills appropriate to the situation, and the patient must undergo careful preparation to implantation and strictly follow the recommendations and listen to own body during the rehabilitation period.

We compare service life: what is more durable - prosthetics or implantation?

As mentioned above, a titanium root implanted in the jaw during implantation serves its owner throughout life due to the phenomenon of osseointegration - the ability of bone tissue to fuse with the implant body. A crown placed on an implant lasts from 10 to 15 years, depending on whether it is a posterior or anterior tooth. As for bridges or clasp prostheses, they require a complete replacement on average every 5-7 years, and the abutment teeth underneath, which are prone to destruction, increase the length of the required prosthesis over time. Removable dentures require regular relining and periodic complete replacement.

Dental prosthetics and implantation - which prices are higher?

As mentioned above, in terms of long term implantation turns out to be no more expensive, and even more economical than installing a traditional prosthesis. This is due to the fact that the implant is paid for by the patient only once, and the crowns on it need to be replaced very rarely, while the usual removable or fixed dentures, each of which is cheaper than the implant itself, must be completely renewed much more often, which ultimately rises to more than a large amount.

Reflecting on what is better - prosthetics or implantation, let's compare conventional prosthetics. A reliable implant together with a ceramic or ceramic-metal crown, indistinguishable from a natural tooth, will cost an average of 50,000 rubles and will last the rest of your life. A bridge that replaces just one missing tooth costs about 30,000 rubles. Further - simple mathematics: the next installation of the bridge, which will be required in 5-7 years and will restore not one, but most likely two or as many as three teeth, will reduce all the "savings" to nothing.

Which is better - prosthetics or dental implants?

Before you finally decide on the choice in favor of prosthetics or implantation, we would like to draw your attention to one important point, which is of paramount importance in any treatment. This is the presence of specific indications and contraindications for prosthetics or implantation in your case. And to form a clear idea of ​​the advantages and disadvantages of these procedures, we suggest that you familiarize yourself with the table below.

Prosthetics

• Restoration of chewing functions and aesthetics of a smile.
• Easy to install prostheses.
• Fast result.
• Affordable price.

• Depulpation of teeth, reducing their life expectancy.
• Turning adjacent abutment teeth and their further destruction due to an increase in chewing load on them.
• Deterioration of the condition of the gums due to the accumulation of bacteria under the prosthesis.
• The fragility of orthopedic structures.

Implantation

• Effective restoration of chewing functions and aesthetics of a smile.
• Prevention of further atrophy of the jawbone.
• No need to replace implants throughout life.

• High price.
• Long terms of engraftment of implants.

Summing up, we can say that the most effective method restoration of lost teeth is implantation. Traditional prosthetics are slowly but surely becoming a thing of the past. Conscientious specialists prefer not to contact him even in case of complete edentulousness: a modern solution to this problem is the installation complete denture on 2, 4 or 6 implants or mini-implants. However, implantation has its pros and cons, which the doctor must take into account when choosing one or another treatment method.

From this article you will learn:

• Which crowns are best for front teeth?
• pros and cons different options crowns,
• how much does it cost to insert anterior tooth.

When prosthetics of the anterior teeth, patients always make rather high demands on aesthetics. The most important of them is that crowns for the front teeth should not be visible against the background of your own teeth, matching them in shape, color and transparency.

To date, there are only a few aesthetically acceptable options for prosthetics of the anterior teeth. These include - prosthetics with metal ceramics, zirconium crowns, as well as E-max crowns (glass ceramics). Moreover, patients are equally often dissatisfied with both metal-ceramic and ceramic crowns, and we will tell you why this happens.

Crowns on the front teeth: photo

The reasons often lie not only in the low quality of work, but also in the initial wrong choice type of crowns, for example, not taking into account the level of transparency of the patient's tooth enamel. The complexity of the choice also lies in the fact that each of the types of crowns mentioned above (depending on the quality of the materials used and manufacturing features) can have both good and bad aesthetics.

For example, the aesthetics of standard ceramic-metal crowns (made from inexpensive materials, costing about 6,000 rubles) will be very different from the aesthetics of metal-ceramic crowns with a “shoulder mass” for 13,000 rubles. We understand that within each type of crown there are manufacturing options, and therefore even the choice of expensive ceramic crowns will not be an unconditional guarantee that you will get good aesthetics.

1. Metal ceramics on the front teeth -

The aesthetic problem in the prosthetics of the front teeth with ceramic-metal is associated with the presence of a metal frame under the surface layer of porcelain. To give the crowns an aesthetic appearance, layers of porcelain are applied to the surface of the metal frame, which must be necessarily opaque (otherwise the metal frame will shine through the ceramic layer).

In turn, the tissues of the teeth have a certain translucency - the enamel is able to transmit about 70% of the light, and the dentin lying under the enamel - about 30%. Such optical properties give the crowns of the teeth a certain degree of transparency, which is especially visible in the region of the cutting edges and lateral surfaces of the tooth (especially in bright light).

Clinical case No. 1 - before and after photos

Clinical case No. 2 - before and after photos

It should be noted that the different people the transparency of the enamel of the teeth may vary slightly. Therefore, with a high transparency of enamel, cermet will not suit you at all. But if your teeth have low enamel transparency, then a well-made metal-ceramic can be good option. But in any case, keep in mind that in bright natural light, the difference in color and transparency between metal-ceramic crowns and living teeth will be most noticeable.

Disadvantages of cermets on anterior teeth –

However, the lack of translucency is not the only aesthetic problem with metal-ceramic crowns. Many patients almost immediately after prosthetics note that the gum around the crown has become cyanotic (Fig. 7). Also, after 3-5 years, many patients notice that the gum has receded, exposing the subgingival margin of the crown at the neck of the tooth - which looks like a “dark line” (Fig. 8).

Patients react calmly to such things if they occur in the area chewing teeth. But on the front teeth, especially if the patient has a gingival type of smile (i.e., the gums are exposed during a smile), this is a serious aesthetic problem. All this arises due to the fact that the edge of the metal frame of the metal-ceramic crown is in contact with the gum in the area of ​​​​the neck of the tooth - slightly below the level of the gum. It is the metal that leads to a change in the color of the gums, and also helps to reduce the level of the gums.

However, such problems with the aesthetics of the gums are typical only for standard metal-ceramic crowns of the economy class. There are also highly aesthetic metal-ceramic crowns.

Metal ceramics of increased aesthetics -

Important : The minus of metal-ceramic crowns with a shoulder mass is their cost, which is 2 times more than standard metal-ceramics, approaching the cost of ceramic crowns. But apart from aesthetic problems metal-ceramic still has other disadvantages in comparison with metal-free ceramics, regarding the thickness of the turning of the teeth, the service life of the crowns. Read more about all this in the article -

2. Prosthetics with zirconium crowns -

Metal-free ceramics include several types of materials, one of which is zirconium dioxide. Porcelain crowns made of this material do not have a metal frame, which allows them to look more like real teeth - compared to metal-ceramic crowns. However, the most important advantage of zirconia crowns is their strength, not aesthetics.

Unfortunately, many patients with prosthetic anterior teeth remain dissatisfied with the aesthetics of zirconia crowns. What is it connected with? The fact is that zirconium crowns, although they do not have a metal frame, they still have a rather weak light transmission, i.e. transparency, which is very different from the natural transparency of the tissues of the tooth (enamel and dentin).

As a result, zirconium crowns for anterior teeth are not the best alternative for those patients who have a high transparency of the enamel of their remaining teeth. This means that in such patients, the artificial zirconia crown will not merge in color and transparency with adjacent teeth, and will stand out from their background. However, in patients with low enamel translucency, the aesthetic result can be very good.

Clinical case #4 -

Important : zirconium dioxide crowns are manufactured using CAD/CAM technology, which means milling crowns from zirconium dioxide blocks on a CNC machine (according to a 3D model of the patient's teeth). Moreover, in most cases, the crowns do not consist of monolithic zirconium dioxide, but also as in metal-ceramic crowns - at first only the zirconium frame is milled, which is later covered with layers of porcelain mass.

This technology has a big disadvantage. In advertisements for zirconia crowns, they usually say that they are very reliable, because. zirconium has the strength of a metal. The strength of the zirconium frame is indeed more than 900 MPa, but the strength of the porcelain layer on its surface is only about 100 MPa. This creates a high risk of porcelain chipping. According to statistics, after 3 years, chips occur in at least 6% of patients with zirconium crowns, after 5 years - at least 10% of patients.

Esthetically enhanced zirconia -

Standard blocks of zirconia, from which crowns are milled, are bright white and completely opaque. That is why finished crowns made of this material often look similar - they have an unnatural milky color and do not have transparency. It is these blocks of zirconium dioxide that are used by most dental clinics due to economy.

However, in last years A number of manufacturers have developed translucent zirconia blocks, as well as pre-colored zirconia blocks with a color and transparency gradient. All this allows you to create an artificial crown that is practically indistinguishable from real teeth, because all natural teeth have such a gradient of color and transparency (from the neck of the tooth to the cutting edge).

Clinical Case #6 -

Clinical Case #7 -

3. IPS E.max crowns –

IPS E.max is a metal-free lithium disilicate ceramic for crowns and veneers. E.max is a glass-ceramic with translucency/transparency values ​​almost identical to those of tooth enamel. As a result, lithium disilicate crowns and veneers can be completely indistinguishable from real teeth.

There are 2 main materials for E.max crowns. Firstly, it is "E.max PRESS", which is designed for the manufacture of crowns and veneers by injection molding at high temperature and pressure. Let's say right away that this material is the best if you want to make a single crown, veneer or a bridge of 3 crowns on the front teeth.

Secondly, it is "E.max CAD", designed for the manufacture of crowns and veneers using CAD / CAM technology. Compared to E.max PRESS, this material is already slightly less durable and is no longer suitable for the manufacture of bridges and thin veneers. Another disadvantage is that E.max CAD has a significantly smaller range of material shades, which limits the ability of the dental technician to really blend in color with adjacent teeth.

Clinical Case #8– photo before and after

Comparison between E.max and zirconia crowns –

When choosing ceramic crowns for front teeth from zirconium, it is necessary to ask the doctor for information about the manufacturer of zirconium dioxide blocks from which your crowns will be milled. These should be exactly translucent/pre-colored zirconia blocks, for example, from manufacturers such as Katana ® UTML (Japan) or Prettau ® Anterior (Germany).

However, even crowns made of such cutting-edge zirconia will be slightly inferior in aesthetics to E.max glass-ceramic crowns. This is due not only to the translucency of the materials, but also to the fact that E.max PRESS ceramics have a much wider range of material shades compared to the choice of shades in the manufacture of zirconia crowns. And besides, a single E.max pressed ceramic crown is much more resistant to chipping than a single zirconia crown.

Summary: which crowns are better to put on the front teeth

And now the most difficult thing remains - it is accessible to answer the question about best choice crowns on front teeth. By the way, if you do not go into the question of price, the choice will be quite simple (the cost of all the above types of crowns - see the links above). So, we look at different clinical situations ...

• If you need a single crown on the front tooth - pressed ceramics from E.max,
• bridge of 3 units on the anterior teeth - pressed ceramics from E.max,
• bridge of 3 units on chewing teeth - zirconium crowns,
• if you need a bridge of 4 or more units for any group of teeth - only zirconium crowns.

If you have a limited budget –
choose a more aesthetic version of cermet - cermet with a shoulder mass. However, here it is necessary to warn that the cost of the latter in some clinics can even reach 15,000 - 20,000 rubles for 1 crown (on average - 12,000 rubles). At the same time, the cost of E.max in a number of economy class clinics starts from only 16,000 rubles.

If this is also expensive for you, the option remains with ordinary cermets, the prices for which are on average about 6000 - 7500 rubles. for 1 crown. In a number of clinics, you can find cermets even for 4,500 rubles, but in this case (whatever they tell you) it will be made from cheap materials from Russian or Belarusian production, a low-skilled dental technician. Therefore, do not be surprised later on by ceramic chips, poor aesthetics, or the fact that after a few years the tooth tissues under the crown can simply rot, and the crown will fall out.

From the point of view of aesthetics, the situation when you prosthetize symmetrical teeth with crowns (for example, 2 central incisors at once or all front teeth at once from canine to canine) is simpler, and in this case you can choose more economical options. The most difficult are the options when you need to take under the crown only 1 front tooth or 2-3 teeth located on one side of the dentition.

No entries found.

In this case, a ceramic-metal bridge helped to restore two missing teeth supported by two adjacent ones. As a result, 4 units were obtained: 2 crowns and 2 ceramic-metal teeth. The abutment teeth are additionally reinforced with stump tabs.

Photo:

1 - stump tabs

2 - temporary crowns

3 - finished work

Repeva M.V., Korsakov M.S. - teeth whitening followed by aesthetic restoration and prosthetics

AT dental clinic"Aesthetics" appealed to a girl with a complaint of aesthetic defects and unsatisfactory appearance smile line teeth. The problem was exacerbated by some distrust of doctors and doubts about the possibilities of treatment. Our doctors drew up a treatment plan, which we managed to start already on the first visit.

1. The first stage was carried out professional hygiene of the oral cavity with the removal of dental deposits, which returned the original color to the teeth. have also been cured problem teeth and casts were taken for manufacturing individual mouthguards.

2. Next, remineralizing therapy was carried out using individual trays. This procedure helps to normalize the mineral composition of the hard tissues of the teeth, strengthen them and reduce the risk of further caries.

3. At the third stage, it was decided to start whitening the teeth of the upper and lower jaws. The patient was very pleased with the outcome of the procedure.

As a gift from "Aesthetics" she got a course home whitening NiteWhite, as well as ReliefGel for remineralizing therapy at home using individual trays. Two weeks after the whitening procedure performed in the clinic, the patient fixed and enhanced the result with the home whitening system.

4. The final stage was the aesthetic restoration of the anterior teeth and the manufacture of all-ceramic crowns, taking into account the new color.

Thus, in just a few weeks, the patient acquired not only a new excellent smile, but also faith in herself and dentists, and for us this is beyond praise!

(Review of our patient who underwent this work, taken from the site https://prodoctorov.ru)

Korsakov M.S. - metal-free ceramic crown made of press-ceramics (e-max)

Patient R. was referred for prosthetics by a dentist-therapist after endodontic treatment of the tooth.

The tooth was depulped, and such teeth always become more fragile, less reliable, and large fillings often crumble and fall out. As a result, this can lead to a fracture of the walls and complete destruction of the tooth. Therefore, it was recommended to cover the tooth with a crown.

Together with the patient, an all-ceramic restoration was chosen.

This option has many advantages compared to metal-ceramic crowns:

low trauma. The metal-free design is much thinner than metal-ceramic analogues, grinding of teeth and irritation of the gums by the edges of the crown is minimized;

biocompatibility (no metal). Due to the low thermal conductivity under the ceramic crown, there is no discomfort when eating hot and cold food.

excellent aesthetic qualities and natural appearance. Through dental crown the metal frame does not shine through, and the gums do not darken under the influence of oxidative reactions.

The teeth look perfect and practically do not differ from natural ones.

1: After endodontic treatment, the tooth is prepared for a crown.

2: Temporary crown.

3-4: Permanent crown on the model and on the tooth.

We got an excellent result: reliability, biocompatibility, aesthetics.

It took two visits in total. Production took 1 week.

The patient is only at the beginning of aesthetic rehabilitation. So this work is only the beginning of the journey! Microabrasion and whitening are planned ahead. Another photo before and after prosthetics:

Korsakov M.S. - prosthetics of the upper jaw with ceramic-metal bridges and removable clasp prostheses

Patient B. came to the clinic with complaints of missing teeth, tooth mobility, bleeding gums, dark plaque on the teeth, and difficulty in chewing food.

An examination was carried out, X-ray studies were additionally made, a detailed anamnesis was collected. This allowed us to make a diagnosis and draw up a rehabilitation plan for the patient.
Comprehensive treatment included three stages:

1. Therapeutic stage (Treatment of caries - fillings and periodontal treatment - treatment of gums).

2. Surgical stage(tooth extraction).

3. Orthopedic stage - prosthetics.

At the first stage, all teeth were cleaned from soft plaque and supra- and subgingival dental deposits (stones), hygiene training. Then the treatment of dental caries was carried out. Periodontal pockets were cleaned with the Vector apparatus. Splinting of anterior teeth mandible completed therapeutic and periodontal treatment.

In order not to leave the patient "completely without teeth", it was decided to combine tooth extraction and prosthetics. How? Like this: under anesthesia, 4 teeth were ground to upper jaw, and two were removed, a temporary bridge was made. This took about two hours. The teeth turned by us a few years ago in another clinic were depulped and sealed with high quality, retreatment was not required.

On the picture: initial situation- teeth were ground, removed - temporary bridge prosthesis

With the first temporary bridge (made from an impression of his teeth), the patient took 4 weeks. Given time- the minimum necessary after tooth extraction for restoration before prosthetics.

On the next visit, the remaining teeth were slightly sharpened, impressions were taken, and a new temporary bridge was made (similar in shape and color to the final metal-ceramic bridge).

After one and a half to two weeks, a fitting of a metal-ceramic prosthesis was carried out and its delivery - fixation on permanent cement. On the same visit, impressions were taken for the manufacture of a removable clasp prosthesis with clasps.

A week and a half later there was a fitting of the prosthesis. A week later, the prosthesis was completely made. The prosthesis was fixed in the oral cavity, the patient was taught hygiene and the rules for caring for the prosthesis, and a memo was issued.

Now the patient has to learn how to use the "new teeth", the period of adaptation to removable dentures takes from 2 weeks to 6 months. In this case, rapid addiction was predicted, which happened.

Now the patient can eat, smile (the clasp or in the people "hooks" are practically invisible here and the patient is not embarrassed).

But our cooperation does not end there: constant preventive examinations, 2-4 times a year professional teeth cleaning and gum treatment. This is the only way to guarantee a long period of operation of prostheses and to delay tooth extraction due to periodontitis (inflammation of the gums, tooth mobility) as much as possible.

Another before and after photo:

Sharakhutdinova O.S. - prosthetics of the chewing group of teeth

The patient came to the clinic "Aesthetics" with a desire to replace stamped prostheses with titanium nitride coating installed more than 10 years ago with modern metal-ceramic constructions.

Initial situation in the oral cavity.

Our doctor made stump inlays first on teeth 23, 26, 36, and then on teeth 15 and 16. All inlays were covered with temporary plastic crowns.

Temporary crowns on teeth 23, 26, 36.

Temporary crowns on teeth 15, 16.

The jaw models, meanwhile, were sent to the dental laboratory of our clinic for subsequent fabrication. metal-ceramic prostheses.

Finished restorations made of Duceram Kiss ceramic mass, made in Germany.

After that, new constructions were fixed in the oral cavity, and the patient was very pleased with the result.

Finished work in the oral cavity.

Sharakhutdinova O.S. - prosthetics of frontal and lateral teeth

The patient came to the clinic "Aesthetics" with a rather difficult situation in the oral cavity.

Teeth 12, 22 (lateral incisors) absent. 13 and 23 (canines), respectively, are shifted to the place of the missing ones. Teeth 23 (canine on the right) and 11 (central incisor on the left) are pushed forward. 45 and 46 are also missing.

First of all, our experts proposed orthodontic treatment with subsequent prosthetics, but for personal reasons the patient refused the intervention of an orthodontist, so it was decided to immediately proceed with prosthetics.

The treatment plan included: fabrication of a ceramic-metal bridge for teeth 47-43 supported by 47,44,43; ceramic bridges on zirconium oxide frames 14-11 supported on 14,12,11 and 22-24.

Temporary prostheses.

Teeth 13,11,23 were restored with stump inserts, teeth 47,44,43,14,24 - with fillings with fiberglass pins.

Wax Up modeling of future prostheses - preliminary modeling result using wax prostheses on a plaster model in special device- articulator.

Finished prostheses in the oral cavity. The right central incisor 21 stands out from the picture because he is his own. They did not begin to prosthetic this tooth in agreement with the patient herself.

Tikhonova T.N. - prosthetics with a metal-ceramic crown

The patient came to the clinic after a complete fracture of the coronal part of the central incisor. First, the tooth was depulped, after which a cast stump pin was made. metal tab and metal ceramic crown.

Umanskaya L.V. - ceramic crown on zirconium oxide

A ceramic crown on zirconium oxide was placed on the central upper incisor.

That is, first, a cap of zirconium oxide is made from a cast from a machined (turned) tooth. Then a ceramic mass is applied to it, repeating the color and shape of the natural tooth.

One of the main advantages of this type of prosthetics is excellent aesthetic qualities and natural appearance. Through such a crown, the metal frame will not shine through. The gums will not darken under the influence of oxidative reactions.

Zirconia crowns are hypoallergenic. The occurrence of galvanic reactions and the appearance of third-party tastes in the mouth are excluded. Due to the low thermal conductivity, neither under porcelain nor under zirconium crown there is no discomfort when eating hot and cold food. At correct staging crowns on zirconium oxide last up to 15-20 years.

1 photo - a tooth treated for a crown

2 photos - a tooth with a zirconium oxide cap

3 photos - a finished ceramic crown on zirconium oxide is installed in the oral cavity

A patient came to us with a crown on the 22nd tooth (upper lateral incisor). stamped metal crown with a plastic facet was in poor condition. It was decided to replace it with a metal-ceramic crown.

But beforehand, the retreatment of the root canals of the tooth was required. After that, the tooth was restored with a stump tab (first photo). Then a metal-ceramic crown was made and installed (second photo). At the time of manufacture, a temporary plastic crown was installed (third photo).

Intermediate stage - temporary crown:

Complex treatment of the oral cavity with metal-ceramic prosthetics

The patient came to the clinic with such a situation, complaining about the loss of a filling with a pin, the poor condition of the front teeth in the upper jaw (displacement, destruction, abrasion), bleeding gums, carious cavities, the presence of dental deposits.

We spent complex treatment oral cavity, including the following steps:

1. Sanitation of the oral cavity (treatment carious lesions and removal of dental deposits, training in oral hygiene) - dentist Ermakova Anna Alekseevna.

2. Removal of the root of the left upper lateral incisor that cannot be restored - dentist Sviridov Sergey Borisovich

3. Depulpation of the upper right incisors and retreatment of the root canal of the left upper central incisor;

4. Prosthetics:

A. Production of cast stump inlays for the remaining incisors of the upper jaw;

B. Making a temporary plastic bridgefor a period of 1-2 months;

B. Fabrication of a ceramic-metal bridge.

Photos before and after:

Bottom line: a comprehensive treatment of the patient was performed, despite this, constant monitoring by a dentist 2-4 times a year is required (hygiene control 2-4 times a year, removal of dental deposits 1-2 per year), which will minimize caries and gum disease.

Sharakhutdinova O.S. - metal-ceramic prosthesis

The patient complained of decay of 17, 16 teeth, food stuck between them, discoloration of 14 teeth. On examination, it turned out that the 15th tooth was also missing. The teeth are so destroyed that it is necessary to cover them with crowns. A missing tooth needs to be restored because prolonged absence tooth leads to adverse consequences.

It was decided to make a ceramic-metal bridge for 17, 16 and 14 teeth. After retreatment of the root canals of 17 and 16 teeth, 17 was restored with a stump tab, 16 and 14 - with fillings with fiberglass pins. Temporary crowns were placed while the dentures were being made.

Intermediate stage - temporary prosthesis:

The result is a view from a different angle:

Korsakov M.S. - all-ceramic press-ceramic inlay

The patient complained of periodic chipping of the restoration on the chewing tooth of the lower jaw on the left.

In another clinic, she was recommended to make and install a cast stump insert and cover the tooth with a metal-ceramic crown. We have proposed an alternative. Production of all-ceramic inlays from press-ceramics.

Read more about this work.

Photos before and after:

Sharakhutdinova O.S. - cantilever prosthesis made of metal-ceramic on the stump tab

A patient came to us with a defect in the region of the lateral upper teeth on the right. On examination, it turned out that the 14th tooth was missing, and the adjacent 15th strong tooth was destroyed (by 2/3 of the crown) and changed in color. It was decided to make a cantilever metal-ceramic prosthesis for the 15th and 14th teeth (supported by the 15th tooth). A cantilever prosthesis is a type of bridge prosthesis when not 2 adjacent to the missing teeth are used for support, but only one (or two) adjacent ones. In this case, it was a good alternative for not "touching" the healthy 13th tooth.

The canals in the destroyed 15th tooth were re-treated. The tooth was restored with a stump tab. A temporary plastic crown was made. Then a metal-ceramic prosthesis was fabricated and installed.

Situation before the intervention

Stump tab

Temporary plastic crown

Finished porcelain restoration

Before and after

Korsakov M.S. - production of all-ceramic crowns on the anterior teeth

A patient came to us who was trying to make ceramic veneers in another clinic. But unfortunately, the result was unsatisfactory. Temporary plastic veneers were left on the teeth. They looked unaesthetic (photo):

After a detailed examination, it was decided to make two all-ceramic crowns, since the previous "turning" of the teeth left no chance for high-quality ceramic veneers. The teeth were again prepared for prosthetics. On the newly "turned" teeth, temporary plastic crowns were made:

On the next visit, all-ceramic crowns were fixed:

Other angles:

Conclusion: the patient was very satisfied!

Tikhonova T.N. - prosthetics with complete removable dentures

Prosthetics with complete removable dentures (in the absence of teeth), photos before and after:

Tikhonova T.N., - prosthetics with ceramic-metal prostheses, restoration of chewing function with the help of a clasp prosthesis

The patient came to the clinic complaining of aesthetic defect difficulty chewing food.

After sanitation of the oral cavity, we proceeded to prosthetics. It was decided to install metal-ceramic bridges and a clasp prosthesis on the upper jaw. Temporary plastic crowns were installed for the period of prosthetics.

Photos before and after:

View with temporary crowns:

Bottom line: the patient is satisfied with the result and is happy to return to our clinic for periodic dental examinations, despite the distance to the clinic of more than 100 km!

Korsakov M.S. - complete removable plastic dentures

Patient P. complained of complete absence teeth in the upper and lower jaws. The last remaining teeth were removed about a month ago. Previously, P. had already had a prosthesis in our clinic and was satisfied, so he turned to us again.

In this case, there are only two options for prosthetics:

1. Non-removable with the use of implantation.

2. Complete removable dentures:

a) removable dentures with fixation on implants;

b) or "simple" removable dentures.

The last option was chosen. It takes 4-5 visits to make this design. After 2-3 weeks, complete removable dentures were made.

Korsakov M.S. - all-ceramic crowns on the anterior teeth

The patient complained about the aesthetic appearance of the anterior teeth in the upper jaw. Old metal-ceramic crowns had bad view There was a gap between the front teeth.

The following plan for the aesthetic rehabilitation of the patient was proposed:

1. Removal of old m/c crowns

2. Production of temporary plastic crowns for 6 front teeth of the upper jaw

3. Manufacturing of 6 all-ceramic crowns.

Prosthetics was carried out in accordance with the plan. This was the initial situation:

Color selection. Central lower incisors - all-ceramic crowns, made about a year ago in our clinic:

View with temporary crowns.

All-ceramic crowns are made. Model view:

Crowns installed in the oral cavity:

Smile appearance:

Sharakhutdinova O.S. - zirconia crowns on front teeth

The upper anterior teeth (2 central incisors) were restored with core inlays and ceramic crowns on a Prettau zirconia framework.

Tikhonova T.N. - bridge prosthesis

The patient came to the clinic complaining of an aesthetic defect due to the absence of a tooth. The abutment teeth were depulpated, and a bridge-like prosthesis was installed in place of the missing one.

Korsakov M.S. - prosthetics with ceramic (metal-free) crowns E-max.

Ceramic (metal-free) E-Max crowns (6 upper teeth), before and after photos and photos on the model.

The patient complained of an aesthetic defect in the 4 front teeth of the upper jaw. On examination, it was found that the old fillings are in bad condition and require replacement.

It was decided to use e-max all-ceramic crowns.

Preparations for prosthetics began, and old fillings were also replaced. The teeth remained "alive", the nerves were not removed. Temporary crowns were made. On the fourth visit, the prosthesis was completed, the crowns were fixed.

Initial situation:

Comparison of e-max all-ceramic crowns and metal-ceramic crowns. Crown thickness.

Crowns on the model:

Photos before and after:

Photos of the result from a different angle:

Sharakhutdinova O.S. - metal-ceramic bridge prosthesis

Ceramic-metal bridge made of Duceram Kiss mass (Germany) - 5 units. Inlays are used to restore teeth.

Tikhonova T.N. - prosthetics with single metal-ceramic crowns.

The patient came to the clinic with complaints about the destruction of 2 teeth of the upper jaw on the right.

After diagnosing the patient's oral cavity, it was carried out:

1) Treatment of 2 teeth: 1.4 and 1.5.

2) Production of cast stump inlays.

3) Dental prosthetics 1.4; 1.5. metal-ceramic crowns.

Photos before and after:

Once again the result:

Korsakov M.S. - e-max all-ceramic crowns

The patient came to the clinic "Aesthetics" with complaints about the aesthetic deficiency of the upper front teeth, chipped composite veneers. As a result, 6 all-ceramic e-max crowns were made. Temporary crowns were placed for the duration of the prosthesis. All teeth remained "alive" (nerves were not removed)!

initial situation

Photo with temporary crowns:

Crowns on models:

Immediately after fixation of crowns:

Compare: initial situation - view with temporary crowns - result:

It took 4 visits:

1 visit: diagnostics

2 visit: preparation of teeth for prosthetics, fabrication and installation of temporary crowns

3rd visit: delivery of work, fixation of crowns.

Sharakhutdinova O.S. - ceramic veneers and ceramic-metal crown

Porcelain veneers were installed on the two upper central incisors, and a ceramic-metal crown was placed on the lateral incisor on the left.

Korsakov M.S. - pressed ceramic crown (e-max)

The patient complained of an aesthetic defect in the central incisor in the upper jaw after endodontic treatment of the tooth. Restoration with filling material was not possible.

The tooth is prepared for prosthetics - restored for a crown with a light-fiber pin - photo 1.

Temporary crown - photo 2

A permanent pressed ceramic crown (e-max) was made and fixed for the 2nd visit. Photo immediately after fixation - photo 3.

Crown before installation:

General view with a smile :)

Korsakov M.S. - clasp prosthesis of the upper jaw with fixation on attachments

The patient came to us in connection with a fracture of old metal bridges.They were taken down. It turned out that some of the teeth were destroyed and highly mobile. Teeth that could not be saved were removed. Others have been curedendodontic treatment, fillings).

After that, a temporary removable plastic prosthesis was made for the upper jaw. Two cast crowns and two cast stump inlays (with bredent "uni" attachments).

A clasp prosthesis of the upper jaw was made with fixation on attachments (locks).
Photo of crowns and inlays in the oral cavity - 1.
Photo of the prosthesis - 2 and 3.
Photo of the prosthesis in the oral cavity - 4.

Sharakhutdinova O.S. - metal-ceramic bridge prosthesis

Sharakhutdinova O.S. - zirconia crown

Single crown made of Prettau zirconia.

Four single metal-ceramic crowns on the anterior teeth of the upper jaw. Photos on models and in the oral cavity

Sharakhutdinova O.S. - fabrication of a metal-ceramic crown with a stump inlay

The patient came to the clinic with a complaint of unsatisfactory aesthetics due to tooth decay. It was decided to restore aesthetics with a metal-ceramic crown.

In order to strengthen the structure for the patient, a cast stump tab was made and installed. Then - a metal-ceramic crown.

At the time of fabrication of the necessary structures, the patient was made and installed a temporary crown. The whole process took 10 days.

Korsakov M.S. - front teeth prosthetics

Two metal-ceramic crowns mounted on 2 maxillary incisors (left).

Korsakov M.S. - front tooth prosthetics

The patient came to the clinic complaining of an aesthetic defect due to the absence of the crown part of the tooth in the upper jaw (photo 1).Therapeutic preparation was carried out (refilling of the rootcanal of the tooth neighboring tooth filling material restored the cutting edge.

Prosthetics included:

1. Production of a cast stump pin insert.

2. Making a temporary plastic crown.

3. Manufacturing of a ceramic-metal crown.

Korsakov M.S. - front teeth prosthetics

A few years ago, due to an injury, the patient lost several of his upper teeth. As a solution to the problem,a bridge-like prosthesis was made of metal-ceramic. The photographs show before and after prosthetics.

Korsakov M.S. - production of metal-ceramic crowns

The patient came to the clinic with complaints about the unsatisfactory condition of old fillings, lack of contact between the teeth, permanent chipped fillings. He was sent by a dentist-therapist to make m / c crowns for the teeth of the upper jaw. The photographs show the finished structure.

Umanskaya L.V. - metal-ceramic bridge prosthesis

The patient came with a defect (missing tooth) in the anterior part of the lower jaw. The doctor installed a metal-ceramic bridge supported by 2 teeth.

Sviridov S.B. - metal-ceramic prosthetics

Initial situation: teeth were partially missing on the left side of the upper and lower jaws. Treatment plan: fabrication of metal-ceramic prostheses. Temporary crowns were placed while the dentures were being made. The photo shows the initial situation (teeth prepared for prosthetics) and a view with temporary crowns.

As a result, porcelain-fused-to-metal crowns are fixed in the oral cavity.

Korsakov M. S. - complete removable denture on attachments

Complete removable prosthesis on attachments (prosthesis with a stronger fixation system, improved aesthetics and functionality)

Combined dental prosthetics, including prosthetics on implants

The patient complained of pain under dentures in the area of ​​three teeth on the right and three teeth on the left (34, 35, 37, 43, 45, 47).

On the CT scan, it was found that two teeth (45 and 47) had decayed roots, and the teeth needed to be removed. Teeth 34 and 37 were also badly damaged - these teeth were restored. One - with the help of a tab, the other (37) with the help of a seal.

A single metal-ceramic crown was installed on 43 teeth. Further, 3 implants were installed from this side (in the area of ​​​​the 45th tooth - simultaneously with the extraction of the tooth). The Swedish Astra-Tech system was chosen. Next, metal-ceramic prostheses were installed on them.

On the other side of the lower jaw, a ceramic-metal prosthesis of three units was installed in the area of ​​34, 35, 36 and 37 teeth supported by 34, 35 and 37 teeth.

Photos before and after:

More details of the treatment:

A broken, worn or destroyed tooth brings physical and psychological discomfort. Damaged tissues open access for bacteria, deteriorate neighboring organs, appear bad smell from the mouth, eating becomes painful due to hypersensitivity. Damaged front teeth make a person complex.

It is always useful to know which teeth can be restored. Almost any destroyed unit can be made functional again. Photos on the Internet allow you to assess the advanced level of modern medicine. There are three exceptions for restoration:

• severe inflammation of the root, not amenable to treatment;
• destruction has spread deep under the gum;
• the tooth is loose.

Why do teeth break?

Dental problems are primarily caused by caries. The dentoalveolar rows are subjected to a heavy load every day: chewing, acidic environment, pathogenic microorganisms gradually destroy the enamel even with careful care. Factors are conditionally divided into external (mechanical and temperature effects, poor hygiene) and internal ( various diseases bodies and unbalanced diet). Chipped or decayed teeth are provoked by:

• jaw injuries from bumps and falls;
• low quality enamel with a lack of calcium, phosphorus;
• sudden weight loss;
• pregnancy
• bruxism;
• diseases genitourinary system and gastrointestinal tract;
• improper diet that excludes important vitamins and minerals.

Methods for the restoration of worn or destroyed teeth

This article talks about typical ways to solve your questions, but each case is unique! If you want to know from me how to solve exactly your problem - ask your question. It's fast and free!

About whether there is a chance to restore a chipped, broken tooth, you need to find out immediately after the injury. Dentists try to preserve the tissue as much as possible without removing the root, since its natural in the human body is always better than an artificial substitute. If the incisor or molar has fallen apart, the dentist can offer 2 methods of restoration, depending on the condition of the tissues:

When a tooth has been removed and an installation is required artificial structure, its service life with proper operation will be 20-25 years. At the same time, careful care and regular examination by a specialist is important.

Building

Restoring a tooth with an extension is a rather unpleasant procedure for the patient, it is performed under local anesthesia (we recommend reading:). The drug is injected into tissues close to the affected organ oral cavity in which the nerves are preserved. Many patients after a serious injury are interested in the question: is it possible to build up a tooth if only its root remains? This method restorations are often performed in the smile zone, it is also used for small child on milk incisors and molars. The method of restoring a destroyed frontal tooth involves maintaining the aesthetics of the front rows. Methods are applied:

1. The use of a heliocomposite. The technique is effective when the root below the gum remains intact, and the crown part is destroyed. A pin is placed in the tissue, around which an organ is built up, repeating the shape of the real one.
2. Working with composite material without a pin. The method is used when a strong load is not expected on the tooth, and its walls do not need to be further strengthened. The composition is applied in layers, hardening is carried out under the action of a UV lamp.

Pin installation

• ceramics;
• carbon fiber;
• titanium.

Fiberglass structures are used to make a tooth in the front if it has broken off - the material has a color and properties similar to dentin. It reduces the risk of root fracture after restoration and does not react with saliva and crowns. Before installing the anchor pin, the dentist prepares the root canal and restores the coronal part with a composite.

What to do if the tooth is broken, and only the root remains? The installation of a pin will also help here, if the tissue is not inflamed, and it will be difficult to restore it. It is mounted only after complete reorganization, after which an extension is carried out or a crown is placed.

Microprosthetics

Implantation

After tooth extraction, implantation can be performed - it will allow you to recreate the anatomical shape of the organ and not injure neighboring units, as when installing a crown. Immediately after the operation, the doctor implants the implant into the jaw tissue. After its fusion with the periosteum, a support and a ceramic crown are placed on it. The structure can be made of zirconia, titanium or Roxolid. Extracted tooth is replaced by an artificial one, looks aesthetically pleasing and retains its function.

Enamel restoration

Enamel is a shield against caries, it contains 95% inorganic substances. When defects appear, sensitivity increases, so dentists recommend using the remineralization procedure. For this, several methods are used:

• coating with varnish containing fluorine;
• self-application of a cap at home;
• one-time use of trays at the dentist with fluoride gel.

For each patient, silicone caps are made separately so that the device repeats the anatomical shape of the dentition. The specialist will offer a medical paste or coating with a fluorine-containing substance for minor enamel defects.

Is it possible to restore a broken or completely destroyed tooth in a child?

What to do if a child of 3-4 years old or a preschooler has collapsed, a tooth has broken off or there are slight injuries (we recommend reading:)? Milk units also need treatment: their untimely loss leads to the development of bite defects. The doctor chooses how to repair a broken or decayed tooth based on the type of damage, location, and number of units:

• drilling and restoration with photocomposites;
• installation removable dentures(console, plate, bridge, sliding).

When the crown of a tooth breaks down to the root, it is worst case, in which it is almost impossible to do without removing the part remaining in the gum. It is important to try to save the organ in the child, since nearby teeth can change location after removing the damaged one.

Rules for caring for restored teeth

For those restored after the destruction of various reasons teeth required permanent care. They are less reliable than natural ones, so meticulous hygiene is important: flossing, mouthwash, regular brushing, and getting checked out by a doctor.

Careful eating is important:

• using a fork and knife to separate small pieces of food;
• avoiding biting off too hard foods (especially after restoration of the frontal organ);
• exclusion from the diet of seeds, nuts and crackers;
• quitting smoking, drinking coffee, tea, red wine.

Prevention of repeated damage

Tooth decay can be stopped, as well as preventing the emergence of new problems that require serious material costs to restore the organs of the oral cavity. Preventive actions include:

• daily care;
• application medicinal pastes strengthening enamel;
• taking vitamins for teeth;
• compliance with the rules of proper nutrition;
• obligatory use of hard and soft food;
• control of chronic gastrointestinal pathologies.

If a tooth is broken to the base of the gum, or the visible part is completely destroyed, in most cases it is restored. When there is no pain in pathological processes, the patient should consult a specialist. A hidden problem and subtle damage can cause serious harm in future.

With significant carious lesions, destruction of teeth for other reasons, it is not at all necessary to get rid of them and put a prosthetic structure. Modern dentistry owns the methods of their restoration from functions to appearance, even if only one root remains from the organ.

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Conditions required for growth

It should be understood that building up or restoring teeth implies the preservation of the rest of it.

This means that in order to carry out manipulations with the expectation of desired result certain conditions must be met:

Video

Teeth extension methods

An organ of which only his Bottom part, needs first of all to be strengthened in order to restore working capacity. Already then it is necessary to think about returning the tooth to its appearance.

Use of pins

The pin is a durable rod made of a hypoallergenic material that is biologically compatible with human tissues. There are transparent fiberglass, titanium fixtures, as well as those made from other alloys. The pin is designed to strengthen the tooth, increase its height above the gum and serves as a support for restorative structures or materials.

It allows you to save functions and appearance of even a more than half-destroyed tooth. To restore the anterior organs are usually used fiberglass pins that do not shine through restorative material and do not let outsiders know of their presence.

Restoration of teeth with their help takes place in several stages, the duration of which will fit in one visit to the dentist:

• The rest of the body is freed from bacteria and carious tissue, if it is, it is sealed;
• A hole is made in the cavity for installing the pin. Its dimensions and designs must match. The pin is firmly fixed in place so that its part remains above the gum. Its size should not be larger than that which is hidden in the depths of the tissues. Depending on the type of pin, it can be fixed in the bone tissue using the thread on it, or due to a special composition. With severe tooth decay, the first method is preferable. To restore the front, one rod is enough. Molars that have many roots can be restored with multiple pins;
• The crown part of the tooth is restored with composite materials that match the color of your own enamel. To give more natural look polished. If this is a molar tooth, it is more expedient to restore it with a crown, for which an impression is first made.

Extension using pins allows you to save it for 3-4 years. At the same time, the tooth looks quite aesthetically pleasing and remains functional.

The principle of tooth restoration in this way similar to a pin. At the root, a structure called stump tab, but unlike him, it is made according to individual parameters of the patient and in accordance with all configurations of the destroyed organ. A similar design is made smaller than a tooth, since it is covered on top composite layers or a crown. This is a more expensive recovery option, but it also
more reliable, allows the organ to serve for a long time, thanks to a uniform chewing pressure. The stump tab is monolithic or two-piece fixture made of ceramic, metal alloy, zirconium. One-piece structures are usually used for single root restorations. Collapsible is preferable for building multi-rooted.

The procedure for restoring a tooth using a stump tab looks like this:

1. At the appointment with the dentist, the ability of the tissues to withstand the installation of the structure is determined. Then the root canals are cleaned and processed. Casts are taken from both jaws, which will help to determine the shape of the restored tooth, as well as the features of its contact with neighboring organs and antagonists. While the stump tab is being made on the basis of plaster models and auxiliary wax, the tooth is closed with a temporary filling and crown;
2. The following operations are performed on the second visit. A temporary filling is removed from the root canals, they are re-sanitized and dried. The lower part of the tab is placed in the resulting space. The remaining empty space is refilled dental material, which will serve permanent basis. The filling will protect the root canals from bacteria and hold the tab more firmly. Above the gum, the upper one joins its lower part. It looks like a tooth stump. Once this has happened, an impression is made from the top of the tab, which is needed to create a crown. If the clinic has modern equipment, this stage is carried out using computer modeling, which allows you to determine the required configuration of the future tooth more accurately. A temporary crown is placed on the inlay. If it is not supposed to be worn, use composite materials. Of them form upper part teeth, grind and polish;
3. On the third visit to the dentist, after the crown is made, it is attached to the inlay with dental cement. Before fixing for permanent wear, try on. In total, the process of restoring a tooth with the help of a stump tab will take at least a week.