What is Prosthodontics

Prosthodontics is one of nine dental specialties recognized by the American Dental Association (ADA). Dentists in the field of prosthodontics (prosthodontists) offer the most advanced form of sequencing treatment, restorative treatment and maintenance. They also perform an esthetically higher level of implantology and full mouth reconstruction. A dental school graduate seeking a career as a prosthodontist must attend an additional three to four years of schooling in an ADA-approved program. Prosthodontists provide multi-disciplinary levels of care, including repairing failed treatments that negatively affect the mouth and smile, treatment of maxillofacial (jaw and face) abnormalities, treatment of cases stemming from congenital disorders as well as cases stemming from oral/maxillofacial trauma or neglect and advanced dental care for complex anatomical features of the teeth, gums and supporting bone structure.

Prosthodontists work closely with their patients to develop a comprehensive treatment plan and to help patients understand what improvements are possible. Using state-of-the-art procedures, the prosthodontist is often viewed as the architect of a restorative dental treatment plan. Particularly for partially or completely edentulous (toothless) patients, a prosthodontist is typically the key treatment planner. Although prosthodontic treatment can be expensive, prosthodontists boast proven results and provide the highest esthetic and functional level of reconstructive dentistry.

Prosthodontic Procedures

Prosthodontic treatments are designed to produce a balance between functionality, longevity and esthetics. Prosthodontic treatments include the following:

Esthetic Reconstructive Dentistry

is the most advanced approach to providing fully or partially edentulous (missing one or more sections of teeth) patients with the highest level of implantology treatment. Esthetic reconstructive dentistry maximizes the structural and functional connection between the dental implant and the living bone. Dental implants are a significant investment, costing up to thousands of dollars pertooth (including crown), but people are seldom disappointed with the results.

Dental Veneers and Other Bonded Restorations

fall into the category of cosmetic dentistry and are used to create bright, white smiles with beautifully shaped teeth. Regardless of what causes unattractive teeth, these types of restorations may solve most or all of the issues, including severe tooth discoloration, chips, cracks and the wear and tear that causes uneven teeth.

Ceramic and Metal Ceramic Dental Crowns

are prosthetic teeth designed to repair damaged teeth. Crowns are typically forged from metal, porcelain or a combination of metal and porcelain materials. Crowns are expensive, ranging from $600 to $1,200 per tooth in the U.S. and can last for up to 10 years or longer if cared for appropriately. Since today’s crowns can be manicured to resemble the natural appearance of the other teeth in your mouth, they are esthetically pleasing. Despite the cost, people are typically happy with the results.

Dental Bridges

are prosthodontic restorations designed to serve as a treatment for missing teeth. A dental bridge can be either be tooth-supported (most common) or implant-supported. A dental bridge is often used as a replacement for a removable partial denture.

Removable Complete Dentures

are full-mouth teeth replacements designed for edentulous people. Complete dentures help people who have lost all their teeth due to trauma or poor oral hygiene, giving them better chewing abilities in addition to a more appealing appearance.

It is important to note that it may take time to adapt to removable complete dentures. Mouth sores, for example, may result from rubbing and pressing of the dentures on the mucous membranes. It may be necessary to visit your prosthodontist for the adjustment of dentures from time to time. These adjustments should resolve any problems.

Although dentures have their disadvantages, most people prefer dentures over the problems associated with an edentulous lifestyle.

Removable Partial Dentures

are designed for partially-edentulous people. People typically prefer fixed partial dentures (dental bridges) over removable partial dentures, though some partially-edentulous people do not qualify for fixed partial dentures because they lack the supporting tissues to which fixed dentures attach.

Fixed Partial Dentures

like removable partial dentures, are designed for partially-edentulous people. Fixed partial dentures are commonly called dental bridges and are more costly than removable partial dentures; however, they provide the most natural results for the treatment of partially-edentulous people.

In addition to the aforementioned treatment plans commonly employed in prosthodontics, the prosthodontist is also adept at providing treatments for jaw problems caused by temporomandibular joint disorder (TMD), snoring disorders, sleep apnea problems, and some degree of reconstruction following treatments/surgery for oral cancer. Prosthodontists work closely with periodontists, endodontists, oral surgeons and orthodontists to elicit the finest restorative results.

Inlays and Onlays

Inlays and onlays are an old fashioned, traditional method of restoring teeth that are not commonly used by dentists these days. They are known as indirect fillings. When the biting surface of the tooth is damaged and regular fillings are not adequate, inlays and onlays are used to fill crevices or repair extensive damage.

The difference between dental fillings and inlays and onlays is that dental fillings are directly done on the spot: they are placed in the tooth during your visit to the dentist, on the other hand, inlays and onlays have to be made in a dental laboratory; these are then subsequently fitted and chemically bonded to the damaged tooth by the dentist. Hence the name: Indirect fillings. Sometimes, inlays and onlays are used in place of full dental coverage crowns. As compared to full dental coverage crowns, they are better fitting, last longer, and look better.

When the material is bonded within the center of the tooth, it is called an inlay. If the damage is more widespread and the new structure covers the whole chewing surface including one or more tooth cusps, the procedure is called an onlay.

Frequently Asked Questions

Q:What is a Prosthodontist?

A: A prosthodontist is a dentist who specializes in the restoration and replacement of teeth. Most prosthodontists receive two to three years of additional training after dental school in a program accredited by the American Dental Association based either at a hospital or a university. The training includes reviews of the literature, lectures, treatment of patients and laboratory experience in fabricating restorations.

Q:What dental procedures does a prosthodontist perform?

A: Prosthodontists are the experts in dental rehabilitation and have mastered many procedures including: crowns, caps, bridges, veneers, removable partial dentures, dentures and dental implants. In addition to restoring dental implants with restorations, many prosthodontists are surgically placing implants as well.

Q: Is a prosthodontist different from a cosmetic dentist?

A: The American Dental Association recognizes nine dental specialties, and the ADA does not include cosmetic dentistry as a specialty. Prosthodontists receive extensive training and experience in dental esthetics and cosmetics during their graduate programs which currently last three years. Many cosmetic dentists receive training during seminars or a series of courses, but this training is usually limited to weekend or possibly weeklong courses.

Q: Will the prosthodontist complete all of my required treatment?

A: The prosthodontist is best viewed as the “architect” of your dental project. S/he has the vision of your final outcome, both the esthetics of your smile and the improved function of your bite. Often other dental specialists may participate in your treatment to help establish a solid foundation for your restorations. Every prosthodontist develops a treatment plan customized for each individual patient, and s/he will determine if adjunctive procedures by another doctor are necessary.

Q: What does a Prosthodontis do?

A: A prosthodontis specializes in restoring your natural teeth and replacing missing teeth or tissue (in and around the mouth and face) with artificial, lifelike substitutes.

Q: How does a Prosthodontist perform their procedures?

By non-removable replacements such as crowns or bridges.

By removable replacements such as dentures.

By restoring mouth, facial, or ear structures that were made defective by disease, injury, surgery, or by birth defects such as cleft palates.

Q: What are the most common prosthodontic procedures?

  • Single Crowns – creating non-removable jackets or caps of metal, porcelain or plastic, covering teeth to protect them and restore normal function and appearance.
  • Fixed bridges – creating non-removable restorations to replace missing teeth.
  • Partial dentures – creating removable replacements for partial tooth loss.
  • Complete dentures – creating full, removable replacements for total tooth loss.
  • Overdenture service – creating removable replacements utilizing the roots of some teeth or a dental implant for support.
  • Implant-supported Fixed Crown and Bridge or Removable Dentures – creating non-removable restorations and/or removable dentures supported by permanent dental implants.
  • Reconstruction and Maxillofacial Services – rebuilding the teeth, jaw, palate, or other facial structures, to correct complex problems including TMJ dysfunction, and to evaluate the need for implant dentistry. This may require the services of several doctors.

Q: What is a Board Certified Prosthodontist?

A: A Board Certified Prosthodontist has successfully completed extensive examinations by the American Board of Prosthodontics. These examinations involve written and oral examinations in prosthodontic theory and literature, the presentation of three different patient treatments, documented from the beginning to the end of the treatment and examinations over the rationale of this treatment. As a Diplomate of the American Board of Prosthodontics, the prosthodontist must successfully complete a re-certification examination every eight years.

Q: What’s so different about a Prosthodontist compared to a “regular” dentist?

A: All dentists have the same basic goal: to help you take care of your teeth, mouth, and other aspects of your oral health. So most general dentists do a lot of prosthodontic service: they cap teeth, make bridges, and do some reconstructive work. There is a difference in emphasis, however. Because the Prosthodontist concentrates on one area of dentistry, he or she can usually handle more complex problems more easily or more efficiently than the general dentist. It’s the same with other specialty areas of dentistry. Oral surgeons, orthodontists, endodontists, periodontists, and Prosthodontists … all make up the skilled specialty complex of dentistry.

Q: What is the procedure used for Inlays and Onlays?

A: Generally speaking an inlay or onlay procedure usually requires two or three dental visits to complete it. In the first visit, the dentist makes a mold of your teeth as they exist in your mouth. This gives the dentist a basic structure to work from. A temporary sealant is placed on your damaged tooth. The mold is then sent to the laboratory where the technician will proceed to make an inlay or outlay as advised by the dentist, depending upon the extent of damage. The material to be used for the inlay or onlay is also selected in this visit.

The material selected to make the inlay or onlay depends on many factors such as the location and visibility of the tooth- if the tooth is situated at the back of the mouth and will not be visible when you smile or speak, then gold may be recommended as the material to be used, as this is long lasting, offers better protection and is smooth causing less abrasion to the opposing tooth. Whereas if you require an inlay or onlay for your front teeth, or teeth that will be exposed when you smile or speak then porcelain will be recommended as the best material as this can be made and colored to match your existing healthy teeth and will thus blend in better. If are a person who habitually grinds your teeth or have a very strong bite or chew heavily, or if you have malocclusion where your jaw is misaligned, then resin could be the best material for you. The dentist will help you make your best choice.

In the second visit, sometimes a temporary inlay or onlay could be fitted, if the final inlay or onlay is not yet ready. The final fitting would require a third visit. If the final inlay or onlay is ready, this will be fitted in the second visit. The temporary sealant will first be removed. When fitting the inlay or onlay the dentist will ensure that the restoration fits perfectly with all adjacent teeth, that there are no problems with malocclusion that might affect the fit of the inlay or onlay. When the inlay or onlay is fitted, it will be bonded to the tooth and then polished.

Q: What are the benefits of using inlays and onlays?

A: Inlays and onlays are methods of repairing comparatively wide-ranging tooth decay or damage without really needing to replace the entire outer portion of the tooth as one would need to do with a crown. The amount of tooth material required to be removed is less, so inlays and onlays tend to be more conservative and esthetic as compared crowns.

The inlay and onlay procedures strengthen a tooths structure as compared to fillings where the structure may be weakened due to removing too much tooth material. Inlays and onlays are also likely to last longer than a regular filling, because the inlay or onlay material is custom made and bonded or fused to the tooth.

They offer a superior fit as compared to crowns, as the procedure tends to preserve as much of the healthy tooth as possible. This also safeguards the structure of the basic tooth and does not weaken it further and this in turn offers strength and stability to the teeth. An onlay can actually protect the weak areas of the tooth as the procedure does not require the complete reshaping of the tooth.

Esthetically, tooth color is retained offering better visual appeal, because inlays or onlays will not discolor as resin fillings usually do. Due to the fact that inlays and onlays are custom made and they fit better and do not shrink or change size during the curing process, this makes it a lot easier for you to clean or brush your teeth. Inlays seal the tooth better as compared to regular fillings and thus they keep out bacteria ensuring that there is no further decay taking place inside the tooth, under the filling.

Q: What lies in store for Inlays and Onlays?

A: Inlays and onlays as a restorative procedure are here to stay. They offer a fantastic amalgamation of excellent functional longevity and esthetic naturalness in addition to the fact that the materials used for making inlays and onlays continue to evolve, improve and become better, the procedure is not likely be replaced by another.

Q: Factors to consider when selecting a Dentist for an Inlay or Onlay:

A: Not many dentists use the inlay and onlay procedure as there is no formal training for this procedure that any dental school offers. Dentists can get trained in the inlay and onlay procedure while working in close collaboration with the laboratory technicians. Sometimes the laboratory technician can be a part of your consultation or visit to the dentist offering his advice if the doctor has the technology of a video conference where the image of your teeth can be seen in real time by the dentist and the technician. Often the technician may be part of the fitting procedure, assisting the dentist, using the same conferencing technology.

Q: What does the Inlays and Onlay procedure cost?

A: The expenses of the inlay and onlay procedure vary and depend upon many factors such as:

  • The fees of the dentist you have chosen. Renowned and experienced dentists may be more expensive as compared to a dentist who is just starting out and setting up his / her practice.
  • The location of the teeth that require the inlay or outlay in your mouth: For example, teeth in the front of the mouth are easier to prepare and work on as compared to molars or teeth located at the back of the mouth.
  • The size of the inlay or onlay required- smaller inlays or outlays are cheaper as compared to bigger ones.
  • The material that you select for the inlay or outlay- it goes without saying that a gold inlay or onlay will be more expensive as compared to porcelain. Conversely, porcelain inlays or onlays might require more craftsmanship and this might cost more in terms of labor than material.
  • Another factor influencing the price of inlays or onlays is your geographic location. If you live in a place where this technology is not available, you may need to travel to a place where it is. Or there may not be a local technician to fabricate the inlay or onlay, in which case it will need to be sent to a place where it can be fabricated and this will add to the cost.

Q: Does Dental Insurance cover Inlays and Onlays?

A: The insurance policies and procedures differ from company to company. Inlays and onlays could be classified under basic or major service by the insurance company.

In the basic category the usual procedures such as dental cleanings, dental fillings, and routine services may be covered. Some insurance companies might have a pre-set limit for these services. You will have to verify from the company what these are. In case the dental insurance company that you have selected classifies the inlays and onlays procedure in the major category as they do for full coverage crowns, then it is possible that you will be compensated at the 50 percent coverage rate.

Again as this is variable, it is best that you verify with the insurance company that you have selected. In event you wish to be really sure how much compensation you will receive, you could ask your dentist for an estimate of the cost, and submitting this to the company, you can ask at what rate you will be compensated. That way you will have a clear idea of the cost and reimbursement that you will have to prepare for.