CAD-CAM technology: how the best dental crowns are made

• types of dental crowns,
• crowns on teeth – which ones are better, reviews,
• how much does it cost to put a crown on a tooth - for 2022.

An artificial crown (Fig. 1) is a tooth prosthesis that restores its anatomical shape, aesthetics and chewing function. Single artificial crowns are used in dentistry to strengthen severely damaged teeth. For example, according to the rules, if the crown part of a tooth is destroyed by 1/2 or more, its restoration should no longer be done with a filling, but with a crown. The second purpose of dental crowns is to restore missing teeth.

In this case, dental crowns are made in the form of a bridge-like prosthesis, in which the intermediate part restores the missing tooth, and the side crowns are fixed on the ground abutment teeth (located at the edges of the dentition defect). However, for this option of bridge prosthetics there is a limitation - the patient should be missing no more than 2 teeth in a row. But crowns and bridges can be fixed not only on ground teeth, but also on dental implants, which will allow you to keep neighboring teeth alive and healthy.

Crown on a tooth: before and after photos

Before dental prosthetics with crowns, teeth require special preparation. For example, the crown part of a tooth destroyed by caries must first be restored with filling material. Root canal filling may also be necessary. After all this, the teeth are ground down for crowns and impressions are taken, based on which the crowns for the teeth will be made.

Indications for prosthetic crowns –

• if the crown of the tooth is destroyed by 1/2 or more,
• prosthetics for missing teeth,
• severe tooth wear,
• the need to change the color and shape of the tooth,
• the need to change the position of one or more teeth - as an alternative to correcting the bite with braces.

Important: in dentistry there is a rule (which does not prevent many dentists from violating it) - that a tooth should be taken under an artificial crown if its destruction reaches 1/2 or more of the volume of the coronal part of the tooth. However, very often dental therapists do not want to give their earnings to their colleagues - orthopedic dentists (prosthetists), trying to restore such teeth themselves using pins and filling material.

In such cases, the remaining walls of the tooth very often cannot withstand the chewing load, which leads to breakage of the walls (and if the lower part of the moving fragment goes under the gum, then to tooth extraction). Such problems arise especially often in pulpless teeth, i.e. from which the nerve was removed and root canals were filled. This is also due to the fact that after removing the neurovascular bundle from the tooth, hard tissues become much more fragile.

Contraindications for crowns –

• tooth mobility,
• when the clinical height of the tooth crown is low (in this case, the artificial crown made for the tooth will constantly fall off),
• poorly filled root canals,
• periodontitis (focus of inflammation at the apex of the root),
• for bridges supported by teeth ground for crowns, the contraindication is the patient’s absence of more than 2 teeth in a row (for bridges supported by implants, there is no such contraindication).

Dental crowns in our clinic

At OWN PEOPLE dentistry, crowns are selected individually for each patient. Our doctors will take into account all the client’s wishes, including the appearance of the prosthesis. One of the main principles of the clinic is the availability of care. Therefore, when selecting a crown, dentists also focus on the patient’s budget and the cost acceptable to him.

All stages of manufacturing and installation of crowns are controlled by the attending physician. This ensures high quality and long-lasting wear of the prostheses. And after installation, the dentist conducts a detailed consultation on wearing and caring for the crown.

Free consultation!

Our clinic provides free consultations, during which the dentist will determine whether the patient needs a crown and outline a rough treatment plan. You can discuss with him the materials and methods of making prostheses in order to choose the most convenient one. The doctor will also tell you what procedures will have to be completed before installing a crown and what costs the patient should expect.

What crowns are best for chewing teeth?

Single dentures for molars and premolars must first of all solve the problem of functionality and prevent further destruction of hard dental tissues. Aesthetics in this case are secondary. If you need prosthetics, the question immediately arises - which crown is best to put on a chewing tooth? Orthopedic dentistry offers single dentures from different materials:

• metal alloys, including precious ones;
• metal-plastics;
• metal ceramics;
• ceramic composites and their combinations;
• ceramics;
• zirconium dioxide;
• aluminum oxide.

The variety of materials can easily be confusing. When prosthetics of the masticatory region, high demands are placed on crowns in terms of strength and durability. To create a prosthetic structure, biocompatible materials that are resistant to high mechanical load are used.

Indications for installation

Artificial crowns are installed in place of the destroyed part of the tooth. The procedure is carried out according to indications:

• more than 70% of the natural tooth crown is destroyed;
• inability to use other correction methods;
• there are large cracks and chips on the enamel;
• a fracture of the natural crown was established;
• high abrasion of enamel in the patient.

Temporary crowns are installed while the tooth is being treated. They allow you to maintain an aesthetic appearance and a beautiful smile.

Metal composite crowns

Another attempt to combine metals and non-metals in dental crowns is metal composite crowns. Their peculiarity lies in the manufacturing method - a light-curing composite is applied to a metal base. A new tooth is formed, similar to a real one. Such dental crowns are very attractive from an aesthetic point of view; they look very good both in place of the front teeth and in the place of chewing teeth.

But there are more disadvantages than advantages.

Contraindications

Not all patients can have crowns. Contraindications to the procedure:

• the last stage of periodontitis - the prosthesis may fall out due to weakened jaw tissue;
• enamel fragility - due to the risk of tooth decay;
• Bruxism - increased tone of the jaw muscles during stress or sleep;
• small height of the teeth and their incorrect position - the crown will not hold;
• pathological bite with incisal overlap - artificial crowns will wear out and destroy healthy teeth.

For some crown materials there are age restrictions for use. Therefore, only a doctor can choose the right prosthesis during a personal consultation.

Our advantages

At the OUR PEOPLE clinic, they value the health of their patients, so doctors install crowns only when indicated. If this method of prosthetics is not suitable, the dentist will select another correction method. An individual approach and attention to each patient is the key to high quality medical care at the SVOI PEOPLE clinic. Thanks to this, our clients wear dental crowns for many years.

Ceramic crown

Ceramics is the most suitable substance for making teeth, since in its composition and structure it is very close to tooth enamel. Ceramic crowns are an ideal option for prosthetic restoration of anterior teeth, as they provide the most effective aesthetic replacement.

So the advantages:

• excellent aesthetic effect;
• excellent prosthetics for both frontal and chewing teeth;
• resistant to dyes.

E-max glass-ceramic crown prostheses are becoming increasingly popular.

What are they: materials

Crowns can be made from a wide range of materials. Some of them contain a metal base, others are completely synthetic. The choice of material depends on the purpose of the crown, wearing time, wishes for appearance and financial capabilities of the patient.

Metal ceramics

Crown with a metal frame and ceramic coating. The material is reliable and aesthetically pleasing. But there are several contraindications to metal-ceramic dental crowns:

• gum recession - the denture becomes visible;
• age under 18 years - thin enamel in children, which is why there is a risk of injury to the pulp when grinding the tooth.

For the adult population, metal-ceramic crowns are considered an excellent option for correcting dentition.

Metal composite

The product has a frame made of an alloy of cobalt and chromium, and a photopolymer composite is used for cladding. The crown is formed in a soft state and then hardens under the light of an ultraviolet lamp.

The result is a thin and durable coating. But the photopolymer composite is colored by bright pigments in food and drinks, so the patient will have to limit himself in consuming such products.

Golden

The material, tested by time and many patients, is gold. It is a precious metal, so it is hypoallergenic. Such products are perfect for people with high sensitivity to foreign materials.

Gold is a soft metal, which is why crowns quickly wear out under the pressure of antagonists. But they do not spoil the enamel of healthy teeth.

Zirconium dioxide

The most modern material for making crowns is zirconium dioxide.

In terms of the ratio of advantages and disadvantages, this material is the most optimal of all possible. But the high price is not for everyone.

Metal-free

Modern techniques for making crowns make it possible to avoid metals in the composition of the product. This is especially important for those who are allergic to them, and you don’t want to lose aesthetics by installing a gold model.

Ceramic

Ceramic crowns are the most similar to natural teeth. They have a sufficient degree of transparency, and can also be matched in color to match natural enamel.

But such crowns are fragile and fragile. Therefore, they are used for the front teeth, and for the back teeth you will have to choose a different material.

Porcelain

Porcelain crowns are not as popular, but they have many advantages.

In terms of the ratio of pros and cons, porcelain products win in many respects. But people with thin enamel are not recommended to have them installed due to the risk of damaging healthy teeth.

Combined

Models made from combined materials are suitable for long-term wear. They can be used for teeth with any location: they are aesthetically pleasing for the front ones and can withstand the load of the back ones.

Such products are not without drawbacks. They quickly wear out and wear out, and can become deformed. But this is a fairly budget option for prosthetics.

Plastic

The products are only suitable as a temporary tooth replacement. They are light and comfortable, their production takes little time and does not require a large budget. While the permanent structure is being prepared, you can use plastic crowns, but you won’t be able to wear them for a long time - they simply won’t withstand the load.

Metal-ceramic crowns –

Such crowns have a metal frame 0.3-0.5 mm thick inside, which is lined with layers of ceramic mass (porcelain) on the outside. In the budget version, the metal frame is made by casting from CHS (cobalt-chromium alloy), but it is also possible to manufacture the frame from alloys of precious metals - such as gold and platinum. Although in this option the cost of 1 Unit of metal ceramics will already be equal to the cost of metal-free ceramics, and at the same time it will still be inferior to it in aesthetics.

The advantages of metal-ceramic prosthetics include high strength, fairly good aesthetics, and, in a budget version, also an acceptable cost. The disadvantages are: 1) the need to grind off a large amount of tooth tissue, 2) the need to depulp teeth, 3) the appearance of cyanosis of the gums around the crown, 4) over time, gum recession may occur, and as a result, the edge of the metal frame may begin to peek out from under the gums. The last two points are especially critical when it comes to crowns on the front teeth - especially in patients with a “gummy type of smile.”

Metal-ceramic crowns: photo

A sharp blueness of the gums and the edge of the metal frame peeking out from under the gums can make the aesthetics unsatisfactory, although this may not be important when it comes to prosthetics of the chewing group of teeth. These problems arise due to the fact that the metal frame of metal ceramics in the standard version is lined with porcelain on all sides (but with the exception of the lower edge, which will be in contact with the gum). And therefore, the thinner the patient’s gum thickness, the more the metal will shine through it, giving it a bluish color.

This can be avoided by using “metal-ceramics with shoulder mass”. For such crowns, the lower edge of the metal frame will also be lined with porcelain, but due to the complexity of manufacturing, this option will cost + 5,000 rubles to the price of 1 Unit in the standard version. But if you decide to opt for metal-ceramics, then you need to pay great attention to what ceramic mass will be used to make your crowns.

The cost of a metal-ceramic crown is

One crown, made from good budget ceramics “Duceram” (Germany) and high-quality cobalt-chromium alloy, will cost an average of 12,000 rubles per 1 Unit. At the same time, if ceramic masses of a higher level are used (allowing one to achieve really good aesthetics), the price in clinics of the middle price category will already be from 15,000 to 18,000 rubles. Examples of manufacturers of high-quality ceramic masses are (Liechtenstein), Vita (Germany), Noritake (Japan).

And usually this is always indicated in clinic price lists (for example, “Ivoclar metal-ceramic crown”). Because each of these manufacturers produces ceramic masses of different levels, we will indicate their more detailed names, and the best ones are “Ivoclar - IPS InLine”, “Noritake EX-3”, “Vita VMK Master”, as well as “Creation” and "Initial". But remember that a good ceramic mass is only half the success (the ability to achieve good aesthetics). The second half is a good, talented dental technician, of whom not everyone is capable of making metal-ceramics similar in color and transparency to the adjacent real teeth.

What other extra charges might there be? –

If you want metal ceramics with shoulder mass, then you will have to pay about 5,000 rubles in addition to the cost of 1 Unit. Metal ceramics based on gold-palladium or gold-platinum alloy will cost approximately 25,000 rubles + the cost of gold (+ 5,000 rubles per gram). Together with the cost of gold, 1 crown will cost approximately 32,000 rubles. Remember that all prices above do not include preparation of teeth for prosthetics, production of temporary crowns made of plastic.

Another option is that the metal frame can be made from CHS, but not by solid casting, but by milling on a computer-controlled machine (CAD/CAM technology). This is a much more precise option for making frameworks, but it is only really important when it comes to metal-ceramic bridges over long distances. Because Since this article is only a review, we have briefly outlined the most important criteria when choosing metal-ceramics, and you can read more about this type of crown at the link above.

Types and methods of making a crown

Products differ not only in service life and materials of manufacture, but also in appearance. The doctor selects the appropriate option during a personal consultation, since an in-person examination of the patient is required.

Bridges

The design is relevant for patients who are missing more than one tooth. In this case, a complex prosthesis is made, the parts of which are connected by a bridge. It is attached to healthy teeth, thus holding crowns. This method is not used for single prosthetics.

Implant supported crowns

If the patient has already installed implants, they can be used as a support for the crown. This will avoid unnecessary stress on healthy teeth and prevent their wear. But if the patient does not have implants, this technique cannot be used.

Crown for one tooth

Most often, patients come with a request to install a crown on one tooth. This is relevant for single destruction from caries or injury. The method of installing a crown is selected based on the condition of the gums, periodontium and bone plates. In some cases, additional operations are required before installing the structure.

Fixation with a pin

A method that is used less frequently than others is placing the crown on a pin. This is a traumatic operation that can cause serious complications. Therefore, they try to abandon this method if alternative methods are available to the patient. If not, the operation is carried out in several stages with constant medical supervision at each of them.

Cast crowns

The most reliable and durable designs are cast crowns. They are made from a single piece of material. The product is highly durable and lasts longer. But this manufacturing technique is not suitable for all materials.

Stamped

To stamp crowns, a dental anvil is used, the processes of which follow the shape of the teeth. To get a stamp, use rubber rings. To make metal crowns, hammers of various sizes and shapes are used. The final form of the prosthesis takes place after processing with special forceps.

Such dentures are cheaper to produce than cast ones. But they are easier to deform and wear out faster. The service life of such prostheses is much shorter.

Crowns made of metal-free ceramics –

Unlike metal-ceramic crowns, these crowns are made entirely of ceramics and do not have a metal frame inside, which can significantly improve their aesthetics. For the manufacture of ceramic crowns in dental clinics, 2 types of ceramics are most often used - either zirconium dioxide or Emax ceramics. However, these materials are not equal in their aesthetic properties, and in addition, they have different manufacturing options that will differ in aesthetics - even from each other.

For example, there are two fundamentally different types of zirconia crowns. In general, we want to say that the choice is not as obvious (as it may seem), and therefore in different clinical situations we will recommend either zirconium dioxide crowns or Emax crowns.

Zirconium dioxide ceramic crowns –

In the manufacture of zirconium crowns, CAD/CAM technology is used, which involves the production of crowns/bridges from pressed blocks of zirconium dioxide - by milling them on a computer-controlled machine. Zirconium dioxide is a variant of ceramics, which in the sintered state has a strength comparable to metal (more than 900 MPa). The price for 2022 for 1 crown in Moscow will average from 30,000 to 40,000 rubles, although in the regions the price may be slightly lower, starting from 25,000 rubles.

Prosthetics with zirconium dioxide: before and after photos

There are 2 types of zirconium crowns. The first option is made from cheap zirconium dioxide blocks, which have a bright white color + are completely opaque, which absolutely does not correspond to the color and transparency of natural tooth tissues. To achieve more or less decent aesthetics, only the internal frame is milled from zirconium dioxide, onto which, after sintering, layers of ceramic mass (porcelain) are applied. It is precisely due to the layers of porcelain that such crowns can be given a more or less natural look.

But such crowns not only have modest aesthetics, but also have another big disadvantage - it consists in chipping the ceramics. The fact is that only the internal zirconium frame will have a strength of 900 MPa, while the strength of the surface layers of porcelain will be no more than 80-120 MPa. As a result, according to statistics, at least 10% of patients experience ceramic chips after a few 5 years (when using this type of zirconium crowns).

The second type is monolithic zirconium crowns “Multi-layer”. Multi-layer technology means that in this case pre-colored zirconium dioxide blocks will be used (i.e. having a gradient of color and transparency). Real living teeth also have such a gradient, starting from the neck of the tooth and towards the incisal edge/cusps of the chewing teeth. Therefore, crowns made from “Multi-layer” zirconium dioxide will be as similar in color and transparency as possible to real teeth.

Zirconium multi-layer crowns –

In the photo above, you can see the aesthetics of single crowns and bridges made of zirconium dioxide, made using the “Multi-layer” technology (they have just been manufactured and are still being fixed on a plaster model of the patient’s teeth). The bridge prosthesis in the projection of 14-15-16 teeth is made with pink artificial gum, and the remaining units are made in the form of single zirconium crowns. Pay attention to the natural color and transparency, which change in direction - from the necks of the crowns to the cutting edge.

A huge plus of multi-layer zirconium dioxide crowns is that they are monolithic. Those. these crowns will be made entirely of zirconium dioxide only (i.e. they will not have a porcelain surface layer, the presence of which can lead to chipping of the ceramic). Monolithic multi-layer zirconia crowns are the best option for many clinical situations. Let's look at what clinical situations such crowns would be optimal for:

• always when it comes to prosthetics of chewing teeth (crowns or bridges),
• always when it comes to implant-supported prosthetics,
• when replacing anterior teeth - depending on the situation*.

*Features of using zirconium on the front teeth –
Good aesthetics when using zirconium crowns in the area of ​​the front teeth cannot always be achieved. The aesthetics will be wonderful if you are going to prosthetize all the front teeth of one jaw at once, or 4 front incisors at once, or all the incisors along with the canines (see photo of the work above). But if you need to make only 1-2 crowns, then it is not a fact that the dental technician will be able to make them 100% similar to the adjacent natural teeth.

The fact is that when working with zirconium dioxide, the dental technician has a limited range of color solutions, which often does not allow such crowns to be completely invisible against the background of neighboring real teeth. When working with other types of ceramics (for example, Emax ceramics), the dental technician has more color options. And therefore, if you only need to make 1-2-3 crowns, then it is better to abandon zirconium dioxide crowns - in favor of “Emax” crowns made of pressed ceramics.

Important: but there is a small exception, which we will talk about in the section on Emax ceramics. Well, the last important point is that “Multi-layer” zirconium dioxide blocks can be of very different quality. Everything here is the same as with the quality of porcelain mass for the manufacture of metal-ceramics - you need to know the manufacturer. In the article at the link below, you can also familiarize yourself with the best options for “multi-layer” zirconium dioxide blocks, which will make the most aesthetic options for zirconium crowns.

→ Cost and features of zirconium crowns

Ceramic crowns made of glass ceramics E-max –

Glass ceramics E.max is the best type of metal-free ceramics for prosthetics of anterior teeth. With crowns and bridges made from Emax, you can achieve truly ideal aesthetics, and all this is thanks to the characteristics of the material, which is not for nothing called glass-ceramics. The basis of this material is lithium disilicate, the crystals of which, in color and transparency, almost completely match the color and transparency of natural tooth enamel.

It is this circumstance, as well as a wide range of color options, that allows the dental technician to make artificial crowns that will not differ from the patient’s real teeth. The price for 1 crown for 2022 will be on average from 25,000 rubles (in the regions it may be slightly lower). But in some Moscow clinics the price can be higher - up to 40,000 rubles per 1 Unit.

E.max glass-ceramic crowns – before and after photos

However, E.max cannot be done in all clinical situations in the oral cavity. Only single crowns can be made from this material, as well as bridges no more than 3 units long - with fixation primarily on the front teeth (the far support of the bridge should not be more than 5 teeth inclusive). Such limitations are associated with the strength characteristics of the material (400 MPa). But with single E.max crowns you can restore both front and chewing teeth.

Crowns/bridges made of E.max (as well as crowns/bridges made of zirconium dioxide) can be either monolithic or made in the form of a pressed frame, onto which layers of ceramic mass will subsequently be applied. There are 2 main E.max materials - “E.max PRESS” and “E.max CAD”. Crowns from the first material are made by pressing under conditions of high pressure and temperature, and from the second - using CAD/CAM technology (read more about E.max in the link below).

→ Cost and features of E.max crowns

How a tooth crown is made

Before you start making a crown, you need to decide on its shape and size. To do this, do:

• visual inspection;
• overview and targeted x-ray;
• 3D – computer visualization of a model of the jaw and tooth.

Making a crown for a tooth depends on its type, the material used and the production method. An impression of the patient's jaw is taken as a sample. They are sent to the laboratory to create a plaster model. After drying, the master cuts out the desired element and makes a prototype of it from wax.

Then the resulting model is fixed on the base and filled with a specialized mixture. In this state it remains in the oven for 4-5 hours. Then the mold is taken out and, while it is still hot, filled with alloy. Until the moment of hardening, the future artificial tooth remains in such a position so that its deformation does not occur.

Implant supported crowns –

The cost of implant crowns depends on the choice of crown and abutment options. As a rule, the choice here is quite simple - 1) it is a metal-ceramic with a titanium abutment, 2) a zirconium crown, but it can be combined with both a zirconium dioxide abutment and a titanium abutment. The prices below are based on the use of a titanium abutment.

• Metal ceramics for an implant – from RUB 26,000.
• Zirconium dioxide crown – from RUB 35,000.
  (the price is indicated together with the cost of the abutment and the use of the cement method of fixation, however, when using a screw type of fixation, the price will be higher in each case by approximately another 3,000 rubles). Prosthetics of 5-6-7 teeth on implants - before and after photos → Cost of installing different implants → Calculation of the cost of prosthetics on implants

Installation process

The procedure for installing a crown is multi-stage. Often the patient has to visit the doctor more than two or three times. It all depends on the initial condition of the teeth and their sensitivity to the therapy, if necessary.

At the initial stage, the doctor conducts a diagnosis, determines the plan and scope of work, and calculates the approximate cost. Often at this time it is still unclear how long the treatment will take, because each body reacts to therapy in its own way.

Laboratory stage

Most of the steps involved in installing a crown take place in the laboratory. At this stage:

• obtain dismountable models of jaws from plaster;
• make a stamped crown;
• grind and polish the product to an ideal shape.

The laboratory accompanies the patient at all stages of installation. The crown can be returned for revision even at the very last moment, since it is important that the patient feels comfortable wearing it.

Grinding the tooth before installation

The most difficult stage, which most patients fear, is teeth grinding. It is necessary to ensure that the crown fits perfectly to the gums. If this is not observed, a pathological pocket will form. Food will get stuck in it, which will cause inflammation and can lead to tooth extraction.

Grinding is carried out under anesthesia, so the patient will not feel anything. Only the top layer of enamel is ground. The tooth itself is not damaged; only 1-2 mm are removed. The depth of work depends on the selected crown material: a smaller volume is sufficient for ceramics, while metal-ceramics require more space.

The purpose of grinding is to equalize the width of the tooth at the neck and at the equator. This is necessary for strong fixation of the crown. It is covered by the gums, which prevents loosening. After processing, there should be no convex parts left - they are sanded off with a special apparatus. At the same time, the chewing teeth must maintain their relief in order to fully perform their functions.

In some cases, during turning, depulpation is additionally performed. This is done according to strict indications, about which the patient is warned in advance.

In case of extensive tooth decay, a stump inlay can be installed. It protects healthy soft tissues from the pressure of the crown on them. Previously, in this case, installation was carried out using pins. Now this technique is not so relevant, since the operation is associated with certain risks. And if it is possible to avoid them using a stump tab, it is better to do so.

Installing a crown on a tooth

A permanent crown is not installed immediately. First, a fitting is carried out, during which the patient evaluates several parameters:

• shape;
• wearing comfort;
• color.

If one of the parameters does not fit, it is better to redo the crown. After all, you need to remember that it will take a long time to wear it, and the cost of manufacturing and installation is usually expensive.

And the appropriate crown is securely fixed with cement. The strength of the installation is checked by a doctor to ensure that the prosthesis does not accidentally fall out.

Monitoring the situation after installation

Once the crown is in place, you need to check whether the installation was completed correctly. To do this, a panoramic or targeted photograph of the oral cavity is performed, depending on the number of installed dentures. Only after this the doctor allows the patient to go home.

If a patient has questions about discomfort or inconvenience when wearing a crown, he can call the doctor at the OWN PEOPLE clinic and ask all his questions. Our dentists care about their clients and are always responsible for the results of the procedure.

Types of removable dentures

This category includes designs that can be removed, cleaned, and put on independently, without the help of a specialist. They are indicated for complete or partial absence of teeth; they can be permanent or temporary. The following types of removable dentures are distinguished:

• lamellar;
• clasp;
• immediate dentures;
• quadrotti;
• sandwich dentures.

Removable prosthetic structures perform an aesthetic function and promote better chewing of food. The advantages of this method of prosthetics include speed of installation and relatively low cost. Permanent structures have significantly more disadvantages.

First, the gum tissue atrophies, making it necessary to replace the artificial jaw every 2 or 3 years. Secondly, plate dentures are not securely fixed in the oral cavity and can distort diction. Thirdly, the materials used wear out quickly and are not very durable. Below are detailed characteristics of each type of removable dentures.

Suction cup or plate prosthesis

An inexpensive and simplest method of prosthetics for complete or significant absence of teeth. The prosthesis consists of a base made from an individual impression and crowns. To make the base, hard hypoallergenic materials (acrylic, plastic) or soft nylon are used.

If several dental units have been preserved, the artificial jaw is attached to them using clasp hooks. In the case of complete edentia, fixation is carried out by suction of the base bed to the gum tissue. For more reliable fastening, dentists recommend using special adhesive compounds (creams, glues).

Complete removable dentures for the upper jaw have a design feature. They completely cover the palate, which increases their surface area and, accordingly, the reliability of fixation in the oral cavity. Prosthetics of the lower jaw in a similar way is undesirable, because the product, without a palatal part, is less well retained in the mouth.

Dentists do not recommend this type of prosthetics for several reasons:

• due to the high load on the gums, hard and soft tissues quickly atrophy, which leads to the need for frequent replacement of dentures;
• design features often contribute to impaired diction and can provoke an inflammatory process;
• patients complain of a long process of getting used to it, discomfort while wearing it, and gagging;
• the prosthesis is not sufficiently securely fixed in the oral cavity, restoring chewing function by no more than 65%;
• the materials used in manufacturing are not very durable; plastic can cause an allergic reaction.

Removable prosthetic structures are still in high demand because they are inexpensive, quickly manufactured, and easy to maintain.

Immediate prosthesis

Also known as a “butterfly” or “bug”, it is a temporary type of prosthetics for 1-3 dental units. It is usually installed before implantation for the period necessary for the engraftment of titanium pins. At this time, a removable denture is necessary to maintain chewing function, maintain aesthetics, and also to prevent tooth discrepancy.

The design received its name due to the similarity of its supporting part to the open wings of an insect. The base is usually made of soft materials, colored to match the gum, and the crowns are made of white acrylic plastic. The denture is attached to healthy teeth using clasps, which are almost invisible when smiling or talking. Immediate dentures are inexpensive, are manufactured in 2-3 days, and look aesthetically pleasing.

Immediate prosthesis

Clasp prosthesis

One of the highest quality modern types of prosthetics for partially edentulous patients. The design is comfortable to wear, aesthetically pleasing, and durable. In addition, the chewing load is evenly distributed between the supporting dental units, which significantly slows down bone tissue atrophy. To install this type of structure, you must have your own healthy teeth on both sides of the jaw.

The clasp prosthesis consists of three main parts:

• metal frame made of titanium, precious metals or cobalt-chromium alloy (CHC);
• a base made of nylon or acrylic, with plastic teeth;
• fixation systems (locks, clasps, telescopic crowns).

The basis of the metal frame is an arc, which serves as a load distribution and ensures the strength of the entire structure. On the upper jaw, it can be in three positions - in front, in the middle or behind - or have a closed ring-shaped shape. when replacing the lower jaw, this element has an exclusively anterior position.

The arc does not come into contact with the mucous membrane and has a small thickness. A nylon or acrylic base with crowns is welded onto it. The thickness and volume of the base are reduced due to the presence of a durable metal frame. This increases the comfort of wearing clasp structures and makes them one of the best dentures for teeth. The reliability of fixation in the oral cavity depends on the type of attachment to the supporting dental units.

On clasps

This is the name for hooks that are placed on healthy crowns, transferring pressure to them and keeping the prosthesis from moving. They are usually made of metal, but if they fall into the smile zone, they can be made of nylon (it is almost invisible). Clamp fastening has the following advantages:

• reliable fixation;
• comfort, quick adaptation;
• no need to grind your own crowns;
• affordable price (compared to other options).

The disadvantages include low aesthetic characteristics, but this only applies to metal clasps. In addition, such fastenings negatively affect the condition of supporting teeth, accelerating their destruction. The reason is the slight elasticity of the hook required to remove or put it on. As a result, it becomes mobile, gradually wearing away the enamel. But this problem can be solved by installing metal-ceramic crowns.

On locks

Fixation of the prosthesis is ensured by metal micro-locks or attachments consisting of two parts. One of them is located on the prosthesis itself, and the second is on the metal-ceramic crown of the abutment tooth. The design of this fastening is reliable and also redistributes about half of the chewing load onto healthy teeth.

The advantages of clasp dentures with attachments include:

• high aesthetics - the locks are located on the inner surface of the teeth, therefore they are completely invisible;
• reliable fixation;
• long service life - about 7 years;
• high rates of restoration of chewing function;
• no pain, discomfort, quick adaptation.

Among the disadvantages, one can highlight the rather high cost of production, which is due to its complexity. In addition, for prosthetics, it is necessary to grind down your own teeth in order to install metal-ceramics.

On telescopic crowns

The most technically complex, but the most effective way to fix the prosthesis in the mouth. The fastening element consists of two parts - a metal cap and a metal-ceramic crown. The first of them is placed on a ground healthy tooth, and the second is attached to the frame of the prosthesis. During installation, the crown is placed on the cap, ensuring the most reliable fixation. Therefore, to the question of which clasp dentures are the best, we can confidently answer that these are the ones.

The advantages of products with telescopic crowns include:

• reliability;
• durability;
• aesthetics.

The main disadvantage of this type of construction is its high cost, since it is necessary to install crowns on at least 4 abutment teeth.

Quadrotti

The name of the design comes from the Italian QuattroTi - the latest development by European scientists in the field of prosthetics. The principle of manufacturing and fixation of the prosthesis is similar to the clasp one, but differs in the material of manufacture. Instead of metal, it uses acetal - a monomer-free plastic, which is characterized by increased strength, 100% hypoallergenicity, and lightness.

Quadrotti prosthesis

This material made it possible to improve the performance qualities of the artificial jaw without compromising other significant properties. The weight of the structure has decreased, the strength is not inferior to its metal counterpart, and there is no risk of allergic reactions. In addition, Quadrotti clasps, made of acetal, are completely invisible on the teeth.

QuattroTi clasp dentures are superior to their clasp-based counterparts in the following indicators:

• aesthetics – the material for making fasteners is available in ten shades of white;
• comfort – the design is light and non-bulky, so adaptation occurs quickly and diction is not impaired;
• long service life - at least 7 years;
• hypoallergenic - unlike metal, acrylic or plastic, it is not able to provoke an allergic reaction.

Quadrotti prostheses are not inferior to their metal counterparts in strength, but have one significant drawback. Their clasps do not perform a supporting function, but only hold them, so there is no redistribution of the chewing load on the supporting teeth. All the pressure is placed on the gum tissue, which can cause pain when chewing. In addition, the price of QuattroTi is higher.

Sandwich

This is the name of a new generation of removable prosthetic structures for the upper jaw without a palate. It is a domestically developed product, made from acrylic plastics. It is recommended for patients who have retained at least two of their own teeth that will serve as supporting teeth. This type of dentures is also suitable if there are no teeth, but 2 implants are installed.

The base is fixed on the gum due to two fasteners that repeat the anatomical shape of the existing dental units. Due to the absence of the palatal part, the product is superior to the standard removable analogue in the following respects:

• does not cause a gag reflex;
• does not provoke inflammation;
• does not impede diction;
• no need to remove at night;
• no need to use adhesives;
• more durable and lighter.

The only disadvantages of the sandwich can be considered a higher cost or the need to install two implants if your own teeth are completely missing.

Pros and cons of crowns

It is impossible to call the installation of crowns a uniquely positive procedure. It has a number of contraindications and disadvantages. But there are much more advantages from it, so it has not lost its relevance for decades.

Advantages

There are significantly more positive aspects of crown prosthetics than negative ones. The advantages of the procedure include:

• maintaining the health of the tooth when it is partially destroyed;
• restoration of chewing function of the jaws;
• protection against tooth decay with removed pulp;
• restoration of intelligible and clear speech;
• possibility of crown replacement;
• restoration of the aesthetic appearance of the smile.

A large number of advantages outweigh some of the disadvantages of the procedure. But they are still worth considering before deciding to install.

Flaws

Like any medical procedure, crown placement is not without its drawbacks. Its disadvantages:

• significant grinding of healthy tooth tissue;
• the procedure is not performed if the root is damaged;
• limited crown service life;
• the need for regular monitoring by a doctor.

Despite the number of shortcomings, dental crowns remain popular and in demand. This is an effective way to restore the integrity of your smile and jaw function without significant financial investment.

Metal-ceramic crown

In search of a compromise between the unaesthetic appearance of metal and the insufficient strength of ceramics, dentists developed metal-ceramic dental crowns. During their manufacture, a ceramic coating is applied to a metal base, masking the metal, while the metal base provides sufficient strength and rigidity. The advantages of such structures include:

• reasonable cost;
• natural appearance;
• strength comparable to conventional metal prostheses.

Disadvantage: when the gum recedes, the metal part of the crown appears from under it, which reduces its aesthetic value.

If it hurts under the dental crown

Installing a dental crown is a complex operation. Therefore, after it, pain may be observed for 2-3 days. This is a normal reaction of the body to intervention. Therefore, doctors recommend taking painkillers during this period.

If your tooth hurts for a week or more, you should consult a doctor for a second examination. It is possible that a pocket has formed between the gum and the crown where food has entered. This can cause inflammation. In this case, you need to start treatment as early as possible so as not to lose the tooth.

Metal crown

Dentures began to be made from metal almost 100 years ago. Initially, preference was given to gold - crowns were made from it quite simply, but were too soft. Gradually, a special gold-based alloy began to be used for crowns - the addition of other metals makes it possible to achieve high strength of the product.

Nowadays, dentists use not only precious metals (gold and silver) to make crowns, but also “base” metals: titanium and steel. All metal crowns have a rather low aesthetic quality - the presence of gold teeth in the mouth currently does not make a person beautiful. In addition, the cost of such products is actually not considered one of the lowest.

Contraindications for staging

1. The patient has allergic reactions to the material from which the crown is planned to be made. In this case, based on the results of allergy tests, a material to which there is no allergy is selected.
2. Severe periodontitis in supporting teeth.
3. Certain malocclusions, for example, excessively deep incisal overlap. In such cases, preliminary preparation is carried out before prosthetics.
4. Bruxism (nighttime teeth grinding) may be a contraindication for certain types of crowns.

What dentures are the best and most comfortable?

Each prosthetic structure has specific characteristics that determine its scope of application.

For upper teeth

The incisors and canines experience less stress compared to the chewing teeth, and they are also within sight. For their prosthetics, the optimal types of fixed prostheses are crowns, adhesive bridges made of zirconium dioxide, glass-ceramics, and metal-ceramics. Molars and premolars are practically invisible, so it is advisable to install durable, inexpensive metal or combined dentures instead. For minor defects, veneers and lumineers are placed in front, and inlays are placed in the back.

Crowns on front teeth

For the bottom

The lower front teeth, like the upper ones, are also located in the smile zone, so fixed structures for them should be as aesthetic as possible. You can save a little on unobtrusive chewing dental units, so the recommendations are the same as in the previous paragraph.

With partial absence of teeth

In such cases, single defects are corrected with cantilever or adhesive bridges. You can also install immediate dentures during a two-stage implantation process. Severe edentia requires the installation of high-quality clasp dentures; you can also try a removable sandwich.

With complete edentia

Most often, inexpensive plate structures are used, but they deform the gums, do not hold well, and cause discomfort. The optimal solution in this case is complete dental implantation.

For temporary prosthetics

In such cases, immediate prostheses are usually used. Cantilever structures can also be used as non-permanent ones.

For children

Which dental prosthetics will be best for a child depends on the specific situation. Typically, children need butterfly dentures during the period of changing teeth to correct the dentition.

Indications for dental prosthetics with veneers

Veneers are thin plates that cover the front surface of the tooth and change its aesthetic characteristics. The fundamental difference is the minimal preparation of hard tissues. After installation, they are not noticeable in the mouth when talking and smiling and are the most aesthetic option for an orthopedic design.

Dental prosthetics with veneers

Veneers may be an option for:

• Change in color of pulpless teeth;
• Injuries (chips and cracks);
• Cosmetic defects of the vestibular surfaces of the anterior teeth;
• Fillings that do not satisfy aesthetic requirements and have pronounced discolorations;
• Large enamel defects, diastema and trema;
• Correction of teeth position.

How to prepare a tooth for prosthetics

There are two reasons why crowns are placed - to protect your own tooth from further decay and to recreate the missing unit. In the second case, we are usually talking about a bridge prosthesis, and then preparatory work requires the supporting teeth (adjacent to the defect), to which the permanent structure will be attached.

If a tooth is severely damaged and its restoration with filling materials is no longer effective, orthopedic treatment with reconstruction of shape, size, color and function using an artificial crown is recommended.

The doctor who will care for the patient is an orthopedic dentist and a dental therapist or endodontist.

Before a crown is placed on a damaged tooth, the canals are filled with gutta-percha, and the coronal part is recreated not with filling materials, but with a metal (sometimes ceramic) core inlay, which has the shape of a tooth prepared for prosthetics. Only after this they begin to take impressions of the jaws and make an artificial crown.

Also, it is worth mentioning how crowns are removed from teeth. At the end of their service life or for other reasons, a situation may arise in which old crowns need to be replaced with new ones. In this case, the doctor cuts the structure in such a way as not to damage the teeth covered with a crown, because after proper processing and polishing, they will again serve as supports.

Care

• Brush your teeth twice daily, as directed by your dentist.
• Use dental floss, a brush or a irrigator to care for the interdental spaces and pontics.
• Even the strongest crowns can be damaged by excessively hard food, so you should not bite nuts, candies, etc. with your teeth.
• Do not eat food at sharply contrasting temperatures, as this can cause microcracks in the ceramics and enamel of the teeth.
• When brushing your teeth, do not forget to pay attention to your gums and make light massage movements.
• Visit your dentist every 6 months and have professional oral hygiene done. In this case, crowns and teeth will serve you for a very long time.

Article material approved by doctor: Evgeniy Aleksandrovich Nikitin Dentist-therapist, orthopedist, pediatric dentist

10 years

Indications for dental prosthetics with bridge structures

Bridges are a non-removable orthopedic structure that is fixed to supports that limit the defect on both sides.

Bridges may be indicated if:

• Included dental defect, no more than 3 units in length;
• Lack of other options for restoring the integrity of the bite using another design or implantation;
• Replacement of a previously installed bridge.

Design Features

Crown on a tooth

is a simple, fast and effective method to restore lost functions. The product, like a cap, covers a specially prepared enamel surface and accurately restores the anatomy of the tooth. Depending on the dental defect, the design of the crowns is full (classic), equatorial (covering half of the tooth), half-crown (fixed on 2-3 sides of the tooth) and three-quarter (covering ¾ of the premolars). The most common and familiar to everyone are full crowns. The type of product should always be selected by a specialist, of course with the wishes of the patient.

A high-quality crown must meet the following requirements:

• Completely and correctly restore anatomy;
• Adhere tightly to dental tissues, especially in the cervical area;
• Have a suitable shade, do not stand out in the dentition;
• Have close contact with adjacent teeth and antagonists;
• Do not overestimate the interalveolar height (do not be high);
• Enter the periodontal sulcus 0.2-0.3 mm;
• Have the most natural appearance possible;
• Do not disturb the movement of the jaws or block the bite;
• Not harmful to health, not toxic.

The following product functions can be distinguished:

1. Restorative
   – consists of restoring the anatomical shape, chewing function, aesthetics, color and position of the tooth.
2. Support
   – creating support for a prosthesis or orthodontic structure;
3. Splinting
   – strengthening and immobilization of mobile teeth in case of periodontal tissue diseases;
4. Preventive
   – prevention of further destruction of dental tissues and their protection.