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Prosthodontic Dentistry

Dental 4 You Clinic - Cosmetic Dentistry and Dental Implants
by Chiangmai Dental Professionals in Thailand
Services > Periodontic Dentistry
Dental Crown
Dental Bridges
All ceramic system
Cercon System
Procera System
IPS Empress System
Dentures

Prosthodontic Dentistry or Prosthetic Dentistry treats missing teeth or treats existing teeth that have significant damage. Restorations are used to replace or restore missing teeth or missing parts of the tooth structure.

Benefits of Prosthetics

The benefits of fixing missing teeth include:

  1. Prevents adjacent teeth from drifting into surrounding space of the missing teeth
  2. Teeth out of position can damage tissues in the mouth
  3. The difficulty of thorough cleaning between crooked teeth runs the risk of tooth decay and periodontal (gum) disease that can lead to the loss of another tooth.
  4. Improves  your smile
  5. Helps to chew food properly
  6. May improve speech
  7. Prevent a drooping face by providing support for lips and cheeks

Dental Crown


Before

After

A dental crown or dental cap is a custom made restoration that covers a tooth with sustained significant loss of structure. They are analogical to being a thimble capped over your finger. Dental crowns are used to restore teeth to a certain shape and size. They provide strength and improve the appearance of the tooth.

Benefits of Dental Crowns
  • Protects severely damaged tooth or tooth weakened by decay, fracture, large fillings or root canal therapy from fracturing. Teeth with large fillings tend to "flex more" forcing the tooth apart possibly causing stress fractures
  • Holds together cracked or weaken teeth and seal the tooth from decay
  • Covers discolored and irregularities in teeth in improving cosmetic appearance
  • Helps preserve the natural function and position of the teeth
  • Restores tooth with large decay, cavities or filings
  • Supports the replacement teeth in a bridge
  • Restores and maintains natural bite
  • Covers a dental implant
  • Restore your smile
Ceramic Crown
Ceramic Crown
Porcelain Crown
Porcelain Crown
Types of Dental Crowns
  • Metals used in crowns include gold alloy, other alloys (palladium) or a base-metal alloy (nickel or chromium). Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, they rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.
  • Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown's porcelain portion can also chip or break off.  Porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown's porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.
  • All-resin dental crowns are less expensive than other crown types. However, they wear down over time and are more prone to fractures than porcelain-fused-to-metal crowns.
  • All-ceramic or all-porcelain dental crowns provide the best natural color match than any other crown type and may be more suitable for people with metal allergies. However, they are not as strong as porcelain-fused-to-metal crowns and they wear down opposing teeth a little more than metal or resin crowns. All-ceramic crowns are a good choice for front teeth. The all-ceramic crowns used at Dental4U Aesthetic clinic include the IPS Empress system and the new e-max crowns from Ivoclar Vivadent, Procera Nobel Esthetics from Nobel Biocare, and Cercon Smart Ceramic (Zirconium Crown) from Dentsply.
  • Temporary versus permanent. Temporary crowns can be made in your dentist's office whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by the dental laboratory.
Procedure for Dental Crowns Treatment

The course of treatment described here is one of several options available at our dental clinic. Consult your dentist to find out what the best solution is for you, given your specific condition.

  • First evaluation and crowns tooth preparation
  • A few X-rays may take to check the roots of the tooth receiving the crown and surrounding bone. If the tooth has extensive decay or if there is a risk of infection or injury to the tooth's pulp, a root canal treatment may first be performed.
  • Local anesthesia is administered at the region for crown tooth preparation
  • The natural tooth is reshaped to receive the new dental crown
  • If a large area of the tooth is missing (due to decay or damage), a filling material will be used to "build up" the tooth to support the crown.
  • Records are taken and approved with the patient to determine the color, bite, length and shape of the crown
  • An impressions taken for a replicate model of the teeth
  • This model is sent to HEXA CERAM dental laboratory where the individual personal crown is fabricated (The crown usually return from laboratory in 2 to 3 days).
  • A temporary crown is placed on while the permanent crown is made
  • Fitting of crowns on delivery
  • The temporary crown is removed
  • A quality assurance including check the fit and color of the permanent crown is done for any re-adjustments of the dental crowns
  • If everything is acceptable, a local anesthetic will be used to numb the tooth and the new crown is permanently cemented in place. 
Step 1
Bangkok Dental Crowns Procedure

Step 2
Thailand Dental Crowns Procedure

Step 3
Bangkok Dental Crowns Procedure

Postoperative care Instructions for Dental Crowns

Dental Crown DiagramBoth the preparation and placement of the temporary crown as well as the bonding of the permanent crown may cause some minor tenderness in the area. Some individuals may experience sensitivity in teeth. This sensitivity will disappear gradually over a few days to weeks.

  1. Avoid chewing on or eating hard foods on the restorations for 24 hours from the time they were cemented
  2. To help with discomfort or swelling rinse your mouth 3 times a day with warm salt water. (1tsp. of salt in 8oz of water)
  3. Keep crown area clean to maintain tissue compatibility (the contour of the prosthesis must allow the surrounding tissue to conform to a natural, healthy position)
  4. Some sensitivity in teeth may be experienced by certain patients. This sensitivity will disappear gradually over a few days to weeks. If teeth are sensitive
    • Avoid hot, cold or acidic food and beverages
    • Pain medication be taken as directed as long as there is no medical contradiction based upon your medical history
    • Use fluorides rinse and toothpaste for sensitivity teeth
    • Clean teeth properly
Care for Dental Crowns

Dental crowns require the same regular and consistent home and professional dental care, as your natural teeth to prevent decay at the tooth-dental crown junction. To provide optimum longevity for your restorations, please follow the home care tips below:

  1. Brush after eating and before bedtime around the crown with a soft toothbrush, especially where the crown meets the gum line. At the gum line harmful bacteria can be accumulate to cause decay and gum disease.
  2. Floss at least once to twice a day. Use the proxy brush or dental floss to remove plaque under and around these areas to maintain good oral hygiene. Build up of food debris and plaque on your teeth and gums can become infected.
  3. Rinse with fluoride rinse before bed. Swish the fluoride rinse vigorously in your mouth for at least one minute. Do not swallow any of the rinse and do not eat or drink anything for 30 minutes
  4. Be careful about chewing toffees, gum, grainy rolls and tough food in this area
  5. See your dentist for regular professional check-ups and cleanings

Dental Bridges


Before

After

A dental bridge is one method to fill a gap created by a missing tooth (or teeth). A bridge is made up of two crowns for the teeth on either side of the gap. The false tooth is called pontic and can be made from gold, alloys, porcelain or a combination of these materials. Dental bridges are supported by natural teeth or implants.

Benefits of Dental Bridges

  • Restores your smile
  • Restores your ability to properly chew and speak
  • Maintains the shape of your face
  • Distributes the forces in your bite properly by replacing missing teeth
  • Prevents remaining teeth from drifting out of position
  • Helps preserve the natural function and position of the teeth
  • Restores and maintains natural bite.
Types of Dental Bridges


Before

After

Traditional bridges Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic in between. Traditional bridges are the most common type of bridge.

Cantilever bridges Cantilever bridges are usually used when there are adjacent teeth on only one side of the missing tooth or teeth.

Maryland bridges Maryland bridges also called a resin-bonded bridges or a Maryland bonded bridges. Maryland bridges supported by a metal framework which have metal wings on each side of the bridge are bonded to the back of existing teeth.  

Porcelain Bridge Ceramic Bridge

Types of Dental Bridge Materials

There are three basic types of materials for dental bridges:

  1. Porcelain fused to metal dental bridges
  2. All porcelain dental bridges
  3. All metal dental bridges (Gold)

The all porcelain dental bridges and porcelain fused to metal (PFM) dental bridges are tooth colored bridges. PFM dental bridges are usually used to restore back teeth where the forces of chewing and grinding are strongest. All porcelain dental bridges are the most aesthetic and are used almost exclusively for front teeth where the need for strength is not as critical. Gold dental bridges are the most durable and offer the most precise fit. Gold dental bridges do not chip.
The porcelain bridges used at Dental4U Aesthetic clinic include the IPS Empress e-max from Ivoclar Vivadent, Procera Nobel Esthetics from Nobel Biocare, and Cercon Smart Ceramic (Zirconium Bridge) from Dentsply. 

Procedure for Dental Bridges Treatment

The course of treatment described here is for traditional bridges, one of several options available at our dental clinic. Consult your dentist to find out what the best solution is for you, given your specific condition.

  • First evaluation and bridge tooth preparation
  • Local anesthesia is first administered at the region of bridge tooth preparation
  • The natural teeth adjacent to the missing gap is reshaped to receive the dental bridge
  • Records are taken and approved with the patient to determine the color, bite, length and shape of the bridge
  • An impressions of your teeth are made, which serve as a model for dental technician.
  • This model is sent to HEXA CERAM dental lab where the individualized bridge is fabricated
  • A temporary bridge is placed on to protect the exposed teeth and gums while the permanent bridge is made
  • Fitting of bridge on delivery
  • The temporary bridge is removed
  • The new permanent bridge will be checked and adjusted, as necessary, to achieve a proper fit.
  • A quality assurance check is done for any re-adjustments of the dental bridge. Multiple visits may be required to check the fit of the metal framework and bite. This is dependent on each individual's case.
  • The permanent bridge is fitted and cemented into place on the teeth
Postoperative care Instructions for Dental Bridges

Both the preparation and placement of the temporary bridge as well as the bonding of the permanent bridge may cause some minor tenderness in the area. Some individuals may experience sensitivity in teeth. This sensitivity will disappear gradually over a few days to weeks.
Replacing missing teeth should actually make eating easier but until you become accustomed to the bridge, eat soft foods that have been cut into small pieces.

  • Avoid chewing on or eating hard foods on the restorations for 24 hours from the time they were cemented
  • To help with discomfort or swelling rinse your mouth 3 times a day with warm salt water. (1tsp. of salt in 8oz of water)
  • Keep crown area clean to maintain tissue compatibility (the contour of the prosthesis must allow the surrounding tissue to conform to a natural, healthy position)
  • Some sensitivity in teeth may be experienced by certain patients. This sensitivity will disappear gradually over a few days to weeks. If teeth are sensitive :
  • Avoid hot, cold or acidic food and beverages
  • Pain medication be taken as directed as long as there is no medical contradiction based upon your medical history
  • Use fluoride rinse and toothpaste for sensitivity teeth
  • Clean teeth properly
Care for Dental Bridges

Dental bridges require the same regular and consistent home and professional dental care, as your natural teeth to prevent decay at the tooth-dental crown junction. It is important to keep your remaining teeth healthy and strong to provide optimum longevity for your restorations since the bridge long term success depends on the solid foundation offered by the surrounding teeth. To accomplish that, please follow the home care tips below:

  • Brush after eating and before bedtime around the bridge with a soft toothbrush, especially where the bridge meets the gum line. At the gum line harmful bacteria can be harbored to cause decay and gum disease.
  • Floss at least once to twice a day. Use the proxy brush or super floss to remove plaque under and around these areas to maintain good oral hygiene. Build up of food debris and plaque on your teeth and gums can become infected.
  • Rinse with fluoride rinse before bed. Swish the fluoride rinse vigorously in your mouth for at least one minute. Do not swallow any of the rinse and do not eat or drink anything for 30 minutes
  • Be careful about chewing toffees, gum, grainy rolls and tough food in this area
  • See your dentist for regular professional check-ups and cleanings

All ceramic system

The all-ceramic system used at Dental4U Aesthetic clinic include the IPS Empress system, IPS Empress Esthetic and the new e-max crowns from Ivoclar Vivadent, Procera Nobel Esthetics from Nobel Biocare, and Cercon Smart Ceramic (Zirconium Crown) from Dentsply.

Porcelain fuse to metal crowns do not transmit light through the crown, resulting in a somewhat dull tooth appearance. All ceramic crown, on the other hand, allow for light transmission, so the entire tooth and the surrounding tissue are illuminated and lifelike in appearance.


Light transmit porcelain
fuse to metal crown

Light transmit all porcelain crown

Cercon System


With the Cercon system, a high-tech ceramic, Zirconium Oxide, is now available and has already been proven in many extreme situations such as heat shields in the Space Shuttle, brake disks for sports cars and the spherical heads of artificial hip joints. This high-tech ceramic has the potential to give prosthetic care a whole new image, because Cercon smart ceramics it can now be used in dentistry.

  • Verified by the medical application of zirconium oxide for about 20 years
  • No allergic reactions reported in the published literature
  • No interaction with other dental materials
  • Good insulating behavior of the ceramic against cold/warm influences
  • Smooth ceramic surface that supports good oral hygiene
  • Well integrated to follow the natural contours of mouth. Together with natural teeth

Procera System

The secret behind Procera All Ceram is its unique combination of strength and beauty. Over the last few years, new technology has made dental porcelain more practical. Until now, porcelain coated ceramic copings has been neither strong enough nor durable enough for widespread use

With the strength in the core material, Procera All Ceram can be recommended for prosthetic reconstructions anywhere in the mouth. More and more patients are asking for constructions made of material not containing metal or other alloys. Procera All Ceram is made of bio-compatible material (comparable to Titanium) which minimizes the risk of allergic reactions. No need to worry about your allergies when you use Procera All Ceram. The translucent coping offers remarkable esthetic characteristics. When combined with Procera All Ceram Porcelain the advantages are clearly demonstrated.

Procera All Ceram combines excellent and profound strength with beautiful esthetics. The material consists of 99.5 percent pure aluminum oxide and is biocompatible, thereby ensuring excellent long-term esthetics. Procera All Ceram is translucent giving the tooth a natural appearance. At the same time Procera All Ceram is excellent for concealing underlying surfaces, such as amalgam and root fillings. This ceramic is also customized but still industrially produced, ensuring predictable results. You should try quickly in your mouth with minimal adjustments.

 

IPS Empress System

Ips Empress SystemIPS Empress is an all-ceramic crown system that gives you exceptional esthetics plus strength. A proven ceramic alternative to metallic restorations, IPS Empress offers patient satisfaction with aesthetic, natural looking restorations, by the exclusive use of ceramic materials. The utilization of bonded ceramic restorative materials is intended to reestablish function, shape, contour, color (hue, value and chroma), natural light transmission and strength of natural dentition.

Individually colored tooth restorations can be reproduced in exact shape and shade. The result is an individually fabricated restoration with an excellent fit and all the characteristics of a natural tooth. Even when working in limited space, optimum aesthetic results can be obtained.

The Empress system produces crowns, inlays/onlays and veneers, providing one of the strongest all-ceramic restorations available. The restoration is modeled in wax and invested in a specially formulated investment. The system's furnace then allows the restoration to be pressed in leucite reinforced ceramic porcelain. After removal, the object is finished to the required aesthetic and anatomical specifications, using staining and layering techniques.

As for every all-ceramic system, the presence of a metallic post and core is not advisable, because of the shadow effect or the grayness of the substructure that inevitably results after cementation. This can be overcome by having the post and core fabricated in a ceramic metal, and a ceramic opaque fired to it. This is a two-step procedure with very pleasing results.

In the case of several single crowns or laminates, the same color is strongly recommended for all preparations (i.e., all substrates). To enhance the mechanical properties of this glass ceramic, the prosthetic restoration must be luted with an adhesive technique, using the latest generation dental adhesive. The composite cement must be chosen carefully to maintain the aesthetic properties of the all-ceramic restorations.

Principle: The highly innovative processing technology for all-ceramic offered by IPS Empress is creating new potential for producing natural looking restorations. A. Wohlwend at the University of Zurich further developed the idea of moulding heated ceramic to reproduce accurate ceramic copies of wax models.

Method:In the IPS Empress system, the restoration with all its functional specifications is modeled in wax. Once the wax restoration has been invested and burned out, the heated, softened ceramic is pressed in the mould.

Material: The ceramic is based on glass that contains latent nucleating agents. In a process comprising several stages, controlled crystallization is used to produce leucite crystals, measuring a few microns, in the glass matrix. The semi-finished product of leucite-reinforced ceramic powder is pressed into ingots and sintered. These ingots are the basic components from which we press restorations. The constant high quality of the ceramic ingots ensures the reproduction of the physical values of the restorations.

  • IPS Empress all-ceramics provide impressive aesthetic results because the materials look so natural.
  • IPS Empress all-ceramic are used to provide absolutely matel-free restorations. They are a biocompatible alternative for people suffering from allergies.
  • IPS Empress all-ceramic are used at numerous universities throughout the world.
IPS e.max glass-ceramics

Ips E.MaxReinforced glass-ceramics has been successfully used in all-ceramics in press technology for 15 years. Glass-ceramics can not only be just pressed but also milled by means of a state-of-the-art CAD/CAM technique.
IPS e.max Press are new highly aesthetic lithium disilicate glass-ceramic ingots with optimized homogeneity and high strength. They allow the fabrication of restorations with a high accuracy of fit. The strength of 400 MPa which has been unmatched to date by glass-ceramics enables conventional cementation.
In cases where you have dark color tooth such as from root canal treatment, and tetracycline stain, it is also possible to produce pressed all-ceramic restorations with the help of IPS e.max Press, since the ingots are also available with high opacity.

IPS e.max CAD is based on the same materials technology as IPS e.max Press and ideally unites the CAD/CAM processing technique with a high-performance lithium disilicate ceramic. The IPS e.max CAD blocks are used for fabricating tooth-coloured restorations with high strength in an innovative manufacturing process.

Indications:
  • Anterior and posterior crowns
  • Anterior and premolar bridges (only IPS e.max Press)
  • Implant superstructures

Independent of the processing, both glass-ceramics IPS e.max Press and IPS e.max CAD offer a natural shade effect and promote light transmission into the restoration.
Thanks to the high strength values, IPS e.max Press and CAD restorations can be adhesively, self-adhesively (Multilink Sprint) and conventionally cemented.

The highlights:
  • Highly aesthetic lithium disilicate glass-ceramic
  • Lifelike aesthetics independent of the shade of the prepared tooth
  • Adhesive, self-adhesive and conventional cementation due to the unrivalled strength of 360-400 MPa

IPS Empress Esthetic

News from the IPS Empress Original System

The IPS Empress pressed ceramic system, which has been clinically proven for more than 15 years satisfies discerning users and patients all over the world. Twenty-five million placed restorations are testimony to the long-standing success of IPS Empress.

The Original System is continuously being developed, setting trends in the market with regard to aesthetics and function. The most recent innovation from the field of all-ceramics is called IPS Empress Esthetic. The material opens up a host of unexpected possibilities, particularly for veneers.

The new IPS Empress Esthetic Line offers heightened aesthetics, enhanced properties and cost effectiveness for the Staining Technique and partially layered veneers in your laboratory.

Dentures

A denture replaces missing teeth and adjacent tissues. Unlike dental implants, a denture is removable. 

Benefits of Dentures                                 

  • Prevents existing teeth from drifting into surrounding space of the missing teeth
  • Teeth out of position can damage tissues in the mouth
  • Helps to chew food  

Type of Dentures

Complete Dentures
          
Thailand Dental Complete Dentures

Complete dentures or Full dentures are used when all the teeth are missing . Complete dentures can be either "conventional" or "immediate". The framework of complete dentures may be made of resin, metal or a combination.
Implant supported overdentures are an alternate to conventional dentures whereby a full dentures is placed over the dental implants with metal bar/balls that gives better retention.

Partial Dentures
Thailand Dental Partial DenturesBangkok Dental Partial Dentures

Partial dentures are used when some natural teeth remain. A removable partial denture usually consists of replacement teeth attached to a pink or gum-colored plastic base, which is connected by metal clasps or precision attachments that holds the denture in place in the mouth. Precision attachments are generally more esthetic than metal clasps and they are nearly invisible

Conventional Dentures and Immediate Dentures

Conventional Dentures are made after the teeth have been removed and the gum tissue has begun to heal. Conventional dentures are ready for placement in the mouth about 8 to 12 weeks after the teeth have been removed.

Immediate dentures are made in advance and can be positioned as soon as the teeth are removed. As a result, the wearer does not have to be without teeth during the healing period. However, bones and gums shrink over time; especially during the healing period following tooth removal therefore immediate dentures would usually require more adjustments to fit properly during the healing process and generally should only be considered a temporary solution until conventional dentures can be made. The healing process as it can take months for your bone and tissue to stabilize after tooth extractions.

Procedure for Conventional Dentures Treatment

  • First Evaluation and dentures site preparation
  • if tooth extraction is required, the teeth are extracted and left to heal
  • Making the dentures
  • Once the gums are healed and healthy, an impression of the mouth is taken for a wax-up
  • The wax-up is used to determine the most optimal position of the jaw and teeth dimensions (size, shape, length, width)
  • The wax up is sent to a dental laboratory to construct a "try-in" set of denture
  • Trial of "try-in" set of dentures and re-adjustments
  • The "try-in' denture are placed in the mouth to assure comfort, fit, bite position and appearance
  • The "try-in" dentures are re-worked in the labs and trail fitted during next visits until the color, shape and proper fit is obtained for the final set of dentures to be cast
  • Fitting of final dentures

For immediate dentures, impression-taking and the wax-up is first done before tooth extraction. 

Recovery Expectations

Recovery from getting dentures may be a two-step process. If extractions are necessary, patients can expect the recovery of their gums to take up to 4 weeks or longer.

Once healed and the dentures are placed, the patient will need time to adjust to the new teeth. While patients can speak normally within a few hours, they may experience minor discomfort when eating or chewing. This discomfort may last from several days to a few weeks until the muscles of your cheek and tongue learn to keep them in place and you get comfortable inserting and removing them. It is recommended that patients with new dentures eat soft foods until they become comfortable with chewing.

It is not unusual for minor irritation or soreness to occur and for saliva flow to increase when you first start wearing dentures, but these problems will diminish as your mouth adjusts to the new denture. 

Care for Dentures

  • Dentures should be removed at night to give the gums a rest and to reduce the pressure on the underlying bone or as directed by your dentist
  • Regular denture care includes brushing your denture with a denture brush and a denture paste after eating. Dentures can collect plaque and food stains
  • Keep your dentures in water to avoid drying out and distorting.
  • Dentures can and may break if dropped onto a hard surface, thus be careful when handling them.
  • Clean and massage your gums and tongue with a regular soft-bristled toothbrush to help keep them healthy.
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