Prosthodontics

Prosthodontics, According to the European Prosthodontic Association, is a dentistry specialty that involves the restoration of missing teeth and associated soft and hard tissues through prosthetic devices such as crowns, bridges, and dentures, which may be removable or fixed and supported by implants.

A Prosthodontist is a specialized dentist who focuses on the replacement of missing teeth and jaw or mouth structures through the use of dentures, bridges, or prostheses. They undergo an additional three years of training after completing dental school to acquire the necessary expertise in this field. (1)

Definition and Overview

Prosthetic dentistry is a specialized field of dentistry that focuses on dental prostheses, recognized by the ADA National Dental Specialties Recognition and Certification Boards. The ADA defines prosthodontics as the dental specialty that deals with the diagnosis, treatment planning, rehabilitation, and maintenance of oral function, comfort, appearance, and health of patients with clinical conditions related to missing or deficient teeth and/or oral and maxillofacial tissues, using biocompatible substitutes.

A prosthodontist is a dentist who has undergone three years of additional training in various aspects of restorative dentistry, such as dental implants, crowns, bridges, complete and partial dentures, esthetics, occlusion, and facial and dental birth developmental defects. Prosthodontists also receive training in the technical and technological aspects of laboratory production of complex dental prostheses, as well as the restoration of dental and facial aesthetics.

Maxillofacial prosthetics is a subfield of prosthodontics that requires an additional year of fellowship training, with an emphasis on treating patients who have acquired congenital defects of the head and neck region due to cancer, trauma, surgery and birth defects. (2)

Procedures

Prosthodontic procedures aim to achieve an optimal balance between functionality, durability, and aesthetics. These treatments comprise a variety of approaches, which are as follows:

• Esthetic Reconstructive Dentistry

Esthetic Reconstructive Dentistry represents the most sophisticated method for delivering the most comprehensive and cutting-edge implantology treatments to fully or partially edentulous individuals, who are missing one or more sections of teeth. The primary objective of this approach is to optimize the structural and functional interplay between the dental implant and the living bone, thereby achieving the highest level of implant integration.

• Dental Veneers and Other Bonded Restorations

Dental veneers and other types of bonded restorations are considered part of the field of cosmetic dentistry, which is focused on improving the aesthetic appearance of teeth. These interventions are utilized to achieve a more radiant and symmetrical smile, with teeth that are well-contoured and brilliantly white.

• Ceramic and Metal Ceramic Dental Crowns

Ceramic and metal-ceramic dental crowns are prosthetic teeth that are customarily used to restore damaged teeth. These crowns are typically crafted using materials such as metal, porcelain, or a composite of both metal and porcelain, to ensure optimal durability and aesthetic appeal.

• Dental Bridges

Dental bridges are restorative devices that are used to address the issue of missing teeth. These prosthodontic structures can be either supported by natural teeth (tooth-supported), which is the more prevalent approach, or alternatively, by dental implants (implant-supported).

• Removable Complete Dentures

Removable complete dentures are dental prostheses that are intended to replace all the teeth in the mouth for fully edentulous people. These devices are designed to assist individuals who have lost all of their teeth due to reasons such as poor oral hygiene or dental trauma.

• Removable Partial Dentures

Removable partial dentures are dental prostheses that are intended to replace missing teeth in partially edentulous people. Fixed partial dentures, commonly referred to as dental bridges, are typically preferred over removable partial dentures. However, some partially edentulous individuals may not meet the criteria for fixed partial dentures, due to a lack of supporting tissues to which the fixed dentures can be attached.

• Fixed Partial Dentures

Fixed partial dentures are dental prostheses designed for individuals who are partially edentulous. (3)

Candidates

There are several reasons why an individual may need to visit a prosthodontist. These reasons may include dental trauma, congenital abnormalities affecting the mouth, or purely cosmetic concerns. Prosthodontic treatments are suitable for individuals who  

• need denture implant fit and placement
• have jaw, sleep, or snoring issues 
• have traumatic injury 
• need oral cancer reconstruction (4)

Risks and Side Effects

After a dental procedure, there may be various complications that require immediate attention. Such complications may include swelling and pain, dry socket, osteomyelitis, bleeding, and osteonecrosis of the jaw. These urgent dental problems necessitate prompt and specialized attention.

• Swelling and pain
• Dry socket (alveolitis)
• Osteomyelitis
• Osteonecrosis of the jaw
• Bleeding (5)

Post-Procedure and Follow-up

Following dental surgery, it is important to avoid using a straw, spitting, or using mouthwash for three days. Instead, warm salt water should be used for gentle soaking and excess should be allowed to fall out of the mouth. This is because using straws and spitting can create pressure in the mouth and lead to dry sockets.

During the first three days after surgery, it is recommended to drink plenty of fluids (at least 8 ounces per hour on average) and consumes soft foods such as yogurt, scrambled eggs, and mashed sweet potatoes. This is essential for proper healing and recovery and can reduce post-surgery nausea, vomiting, and dizziness. It is important to eat and drink as much as possible for optimal recovery.

Additionally, smoking, chewing tobacco, and consuming alcoholic beverages should be avoided for five days as smoking can increase the risk of dry sockets. (6)

Recovery

During the healing process, it is necessary to limit all activities to 3-5 days accordingly. It is important to keep blood pressure low to aid initial recovery. Good oral hygiene should be maintained. It is recommended to gently wipe the surgical site(s) with a toothbrush after 3 or 4 days. (7)

Results

In order to see and improve the final result after the treatment is completed, it is necessary to follow a soft diet for 6 weeks and avoid applying excessive force to the implant site(s) for 3 months. (8)