Major prosthetic restorations are necessary in patients with problems of tooth loss or, simply, very worn out teeth, with great problems due to the disintegration of the mastication system.
At what point is a major prosthetic rehabilitation considered necessary?
At the moment in which the teeth lose the centric relation position, that is to say, a buccal closure with a good position of the articulations (TMJ). Many patients with tooth loss and wear end up looking for a pathological closing position, as they try to achieve maximum chewing efficiency. This erroneous centric position is what ends up causing a problem for the rest of the structures of the oral cavity.
When will such a rehabilitation be recommended to the patient?
At the time when the lost structures or pieces must be recovered. These are patients who need a global and complete approach for the prosthesis to work properly.
What type of prosthesis (removable or fixed) will be chosen, depending on the patient’s case?
The type of prosthesis is perhaps not the most important thing. What is important is that whatever it is, it is well designed by the dentist, with a global approach. The type of prosthesis is what will give more or less comfort to patients, but the same problem can be solved successfully in different ways.
What will determine the choice of one dental prosthesis or another in large prosthetic restorations?
There are many factors that will determine the choice of one prosthesis or another. Among them, the following should be highlighted:
- The complexity of the treatment. It will not be the same a prosthesis on implants in which bone grafting is needed, or that can be solved without grafting.
- Anatomical factors. The fact that there is no dental piece in the most posterior sector of the mouth makes it impossible to provide a prosthetic solution with fixed teeth with the traditional system of bridges, making it necessary to use implants.
- Health factors. There are pathologies that make some type of treatment inadvisable, such as allergies, psychiatric disorders, treatment with bisphosphonates, etc. In many cases it will be necessary to evaluate the risk-benefit of a treatment in a specific patient.
- Economic factors. Unfortunately, this is also important, since in cases of great complexity it may be that the treatment is very expensive and it is not possible to carry it out. It is in these cases where more economical but well-executed solutions can give good results.
What are the benefits of prostheses for patients?
In general, fixed teeth provide more comfort to patients but, as mentioned above, for various reasons this may not always be possible, which does not mean that removable solutions (to be taken out and put in) cannot provide a good quality of life.
And what are the disadvantages of dental prostheses?
Although most fixed prostheses are more comfortable, this is not always the case. There are cases of major resorption and bone loss in which, with a removable prosthesis, greater facial esthetics is achieved, implant hygiene is facilitated and perimplantitis problems are avoided.
Are there any contraindications to dental prostheses?
Yes, for the same reasons described for the choice of a type of prosthesis. Above all, due to health issues, such as psychiatric disorders, physical disorders that make good hygiene of the prosthesis impossible, systemic diseases that prevent surgery, etc.
What are the limitations of prostheses and what care should the patient take?
It must be understood that prostheses made by dentists, no matter how well made and finished they are, will never be like natural teeth. Prostheses, like most medical treatments, have limitations from the functional, esthetic, hygienic, etc. point of view.
The care that patients should take consists of maintaining excellent oral hygiene, controlling overpressure (discharge plaque) and regular check-ups.