Prosthetic dentistry

Prosthetic dentistry is undergoing major changes, due to recent appearance of new restorative materials, which enable a production of ideally esthetic dental restorations.

• all-ceramic (porcelain) veneers – for frontal teeth;
• crowns (also known as dental crowns) – for any tooth;
• porcelain onlays – for molars;
• bridges – when tooth(s) is/are missing (a cheaper and lesser alternative to dental implants);
• removable prostheses (dentures, removable partial dentures) – in case of serious dental arch defects.

“Pilėnė” is a cosmetic dental clinic in Vilnius, so we do not recommend metal ceramics to our patients, but we can make it at customer’s request. Strength and resistance of modern ceramic restorations is not any lower than metal’s, moreover it displays far superior esthetics and biocompatibility.

Depending on what kind of materials is used, all-ceramic composition is further divided into leucite ceramics (glass infiltration, “cast” ceramics) and monocrystalline ceramics (true porcelain). Our clinic specializes in monocrystalline ceramics as well as metal-free zirconium oxide and aluminum oxide-based ceramics, processed by CEREC 3D system.

CEREC is the most advanced technology (CAD/CAM) in cosmetic dentistry. It consists of a computerized dental scanning and modeling system and highly accurate microprocessor-controlled milling device. This system enables dentist to produce very durable, precise and esthetic in-office restorations (inlays, onlays, crowns, porcelain veneers) in addition to laboratory-made restorations (crowns and bridges) of zirconium oxide and aluminum oxide ceramics.

• Excellent quality, perfect esthetics
• Restorations in single visit
• Dental prosthetics with CEREC maximally saves natural tooth tissues
• Biocompatible materials
• Excellent looks, high precision
• Strong and durable metal-free dental restorations

CEREC restorations are produced from porcelain – a natural substance that has properties very similar to tooth enamel (the hardest substance in the human body). Excellent surface smoothness prevents plaque accumulation, primary luster and color of the restoration is maintained.

Using CEREC system maximally saves remaining tooth tissue – often there is no need to produce a dental crown which fully covers the tooth. CEREC is a time-tested system, developed in Zurich University, Switzerland, about 20 years ago. Since then, the system was greatly improved by German company Siemens Dental Equipment Division (now – Sirona). There are over 10 thousand CEREC 3D systems in the world. Over 10 million CEREC restorations have already been produced. Their precision and longevity has gained worldwide recognition and is scientifically proven.

Dental prosthetics with CEREC:

Often, 1-4 teeth can be restored only in one visit. Porcelain crowns, inlays, onlays, veneers are made immediately in the clinic – they do not need to be sent to the dental laboratory.

The result is up to one visit reduced treatment time, only one injection of anesthetic, no temporary crowns and highly precise restorations guaranteed by computer. Cosmetic prosthetic dentistry – amazing opportunities both to the patient and the dentist!

Some patients do not appreciate the function of their teeth and see them as an aesthetic asset. However, this is a very misleading attitude, which is detrimental to health and the overall condition of the body. Clean teeth are not only an attribute of a beautiful smile, but also a very important part of the human digestive tract. The teeth are used to bite and chew food, which then travels to the stomach. The ability to chew food properly has a direct impact on the proper functioning of the stomach and intestines, and at the same time it gives a sense of confidence and well-being that is not thought about until you have all your teeth. Teeth also have a very important phonetic function in speech. The loss of the front teeth is not only an aesthetic problem, but also causes difficulties in pronouncing certain sounds and in scrubbing. Dentures help to restore the lost teeth easily and quickly, as well as the loss of self-confidence and comfort in life. The cost of dentures depends on the type of denture you choose. Implant-supported, non-removable dentures are the most comfortable and do not need to be removed at night. Such dentures are aesthetic, reliable and durable.

Lost your teeth? Modern dentistry won’t leave you in the lurch! Dentures for seniors are reliable and predictable. Once the situation has been assessed and the right treatment methods have been chosen, lost teeth can be easily restored with dental implants and removable implant-supported dentures. Implant-supported prostheses allow the restoration of full chewing function, with a chewing efficiency of up to 100% of that of the patient’s own teeth. With such dentures, it is possible to eat all food. In comparison, removable trays have a chewing efficiency of only 25% and some food cannot be chewed. Restoring lost teeth with plates means giving up some food and decreasing quality of life, so removable plates are definitely not the first choice of treatment.

Implant-supported prosthetics bring back the comfort of life you’ve lost. These dentures are fully fixed only on the implants and do not cover the palatal part of the jaw, avoiding the nausea often associated with removable dentures. Implant-supported dentures also do not need to be removed at night, and cleaning and maintenance are not much different from with your own teeth. For completely edentulous patients, the lost teeth can be restored using the all-on-4 or all-on-6 technique, in which the entire jaw is restored by placing prostheses on 4 or 6 implants.

The many types of dentures available allow you to choose the least invasive treatment options for your individual patient. Teeth can be restored with overlays, crowns or veneers. Veneers and veneers are exclusively used for the restoration of own teeth, while crowns can be made for both own teeth and implants.

The covers are made of glass ceramic or zirconium oxide. These materials are very strong, withstand the stress of chewing well and, if properly prepared, can be bonded very firmly to the surface of the tooth (the bonding strength is close to the bond between the enamel and the dentin). Overdentures are minimally invasive, usually just removing the old fillings (restorations) and minimally preparing the surface of the original tooth. Overlays are the first choice of treatment for the restoration of severely damaged vital and non-vital endodontically treated teeth.

The crowns are made of glass ceramic, zirconia or zirconia coated with finishing ceramic. Crown prostheses are the treatment of last resort when a tooth is very badly damaged and cannot be restored with other types of prostheses. Crown prostheses involve grinding the tooth from all sides, so this type of preparation is not suitable for teeth that are slightly damaged. The only exception is a particularly dark-coloured tooth or tooth root, where the desired aesthetic appearance may not be achieved with the use of a crown or veneer prosthesis.

Crowns are also used for implant-supported prosthetics. Zirconium oxide or zirconium oxide with finishing ceramics (zirconium ceramic prosthetics) is the most common choice for prosthetics in the aesthetic area. Zirconia is chosen for its strength and extremely good biocompatibility, which allows for a more natural-looking restoration and easier maintenance, which has a direct impact on the lifetime of the prosthesis and the implant itself.

Dental bridges are not recommended because the teeth are not biologically adapted to function under constant increased stress. Crowns are only incorporated into bridges when prostheses are placed on dental implants, as their anatomy and anchorage in the bone is different from that of the patient’s own tooth.

Darkened teeth, teeth that don’t look good, or a smile that just doesn’t look aesthetically pleasing are the most common aesthetic complaints that patients cite. If you have these complaints, cosmetic dentistry can help.

Aesthetic dental prosthetics is done with veneers, crowns or a combination of both. After a properly performed prosthetic restoration, it is not possible to distinguish which teeth have been treated with crowns and which with veneers when looking at the smile. The dentist will choose the right type of denture after assessing the individual situation: the original colour of the tooth and the amount of remaining tooth tissue.

Dental veneers are the first choice of denture because with veneers, the tooth surface is minimally prepared, or sometimes even not polished at all. Glass-ceramic veneers are extremely thin ceramic plates that cover the front surface of the tooth, which is visible to all, giving the desired colour and shape. Dentures made with veneers preserve a lot of healthy tooth tissue.

Unlike aesthetic restorations, veneers restore the original strength of the tooth, as the veneer more closely replicates the enamel properties of the tooth. Also, veneers require less grinding than aesthetic restorations, and sometimes, in the right situation, the prosthesis can be placed without grinding at all, as veneers only cover the front surface of the tooth. Laminates are more durable, do not discolour and do not need periodic polishing.

Dentures with veneers can also improve the aesthetics of the entire smile. It is possible to achieve extremely natural looking results, where it is difficult to distinguish the dentures from your own teeth, even to the professional eye. With veneers, it is also possible to have the so-called Hollywood smile, with extremely white teeth.

A change in your smile can be seductive, but it can also be frightening. Uncertainty, wondering if you will regret it, or if your smile will meet your expectations, can seem off-putting. If you are unhappy with your smile, it’s really not worth it, because getting a new smile is no longer like buying a cat in a bag.

When drawing up a treatment plan, a dental check-up is carried out before each major change. A dental check-up helps the patient and the doctor to find a common language, as it is often difficult for the patient to express his/her thoughts and wishes, and the doctor may misunderstand the patient in turn. Tooth picking can be likened to construction drawings. Before a house is built, plans and visualisations are drawn up to give an idea of what the future building will look like. In the same way, when you have your teeth waxed, your future smile is modelled: the shape of your teeth, the position of your teeth.

We can transfer the smile modelled in the dental technicians’ laboratory onto your teeth using a special plastic camouflage. You can then see live what your future new smile will look like. You can assess the shape, the length of the teeth, the whole smile. The dentist, in turn, also assesses the smile, the individual teeth, their shape, length, phonetics and function, so that the new smile is not only beautiful, but also functions comfortably, doesn’t interfere with speaking, eating and is long-lasting. A photograph is taken, if necessary, a scan of the teeth is taken and the situation is communicated to the dental technicians. Once the patient confirms that the smile is satisfactory, the preparation work starts at the next visit.

• The dentist first chooses the type of denture after assessing the individual situation. The main types of dentures are overlays, crowns and veneers.
• After the type of denture is selected, the denture material is chosen. The choice of material is guided by the dentist after assessing the individual situation. The main denture materials are glass ceramic and zirconia, or zirconia ceramic (zirconia with a finishing ceramic).
• Tooth colour selection, dental photography. Photography is an integral part of modern dentistry. During dental photography, the colour of the tooth is transmitted to the dental technician’s laboratory. The overall image of the smile can also be transmitted if the treatment is required. With the photographs taken using a special protocol, the technicians can produce dentures more accurately, reducing the likelihood of denture repair.
• Tooth preparation: the tooth surface is prepared for the future ceramic prosthesis.
• Silicone impressions or dental scans are taken. The individual situation in the mouth is then transmitted to the dental technicians’ laboratory, where fully individualised dentures are made.
• A temporary wreath is made during the same visit. A temporary crown is essential for proper healing of the gums, maintaining the space between the teeth and aesthetics. The temporary crown is worn while the denture is being fabricated (usually this takes about 2 weeks). It is particularly important to maintain good individual oral hygiene while the temporary crown is being worn, as plaque is more easily formed on the acrylic surface.
• In the laboratory of the dental technicians, the prosthesis is measured in the mouth. The colour, shape, marginal accuracy, interdental elasticity and bite of the denture are assessed. If all the criteria are satisfactory, the denture is glued or screwed in place (in the case of implant-supported dentures). If the denture needs correction, it is returned to the dental technicians for correction. While the correction is being carried out, a temporary crown is worn.
• For the long-term success of your denture, it is very important to follow the specified care instructions and to perform professional oral hygiene at the specified intervals, as well as to attend preventive visits with your prosthetist.

Zirconium oxide is the most biocompatible material available. Its biocompatibility is as high or even higher than that of titanium, which is used in medical prosthetic joints. The gums attach to zirconium oxide by forming a pseudo-osmosomal bond, which acts as a natural protection against the formation of gingival pockets around the tooth or (especially relevant!) the implant. Such prostheses integrate perfectly in the mouth, giving a natural appearance and a long service life.

Glass ceramics are mainly of two types: lithium disilicate ceramics and feldspar ceramics. Feldspathic ceramics are decorative ceramics, also known as porcelains. It has excellent aesthetic properties and is used for the production of extremely aesthetic and thin dental veneers and as a finishing ceramic for zirconia. This ceramic is not generally used for the prosthetic treatment of posterior teeth, as it is not a particularly strong material. Lithium disilicate ceramics are more versatile. It has both good aesthetics and strength. Its biocompatibility is also very good (it is far superior to metal ceramics, but inferior to zirconia). This material is usually chosen by the dentist when a natural-looking but also strong molar or premolar tooth is required.

A beautiful and long-lasting result is not only determined by the dentist, but also by the dental technician who makes the dentures, so the choice of dental technician laboratory has a major impact on the quality of the dentures. High-quality dentures may cost more and require longer visits to the dentist, but usually fewer visits are needed and the prosthetic teeth last much longer. With proper planning and execution of all stages of treatment, you can expect long-lasting and extremely natural-looking results. Choosing high-quality dental services saves both time and money in the long run.