Prosthetics

Special branch of dentistry that is quite appealing for both patients and therapists themselves. It provides repair of damaged teeth, replacement of missing teeth (partial or total), for a relatively short amount of time, with fairly acceptable economic costs , certainly in comparison of often complex and lengthy surgical procedures.

What is dental prosthetics?

Certainly, this field of dentistry is quite dynamic in terms of technical, technological and methodological innovations that happen dramatically fast. It is a special challenge for us dentists who practice this dental discipline, that requires constant monitoring of all these world innovations, upgrading our knowledge and methodology of work, as well as constant investment in technological upgrades to improve the quality of the final prosthetic from biological , mechanical, and of course aesthetic aspect. And all of this represents only half of the conditions for obtaining an ideal workmanship. Inseparable partners in the delivery of a individualized dental prosthetic masterpiece , of course, is the dental technique.

Many years of experience and cooperation with the dental laboratories make us the first and objective critics of all dental stages in the development. The lab techniques that our polyclinic corporate with are highly sophisticated laboratories with multimillion-dollar investments in equipment that follows the digital age, which makes the final constructions a real work of art. Interspersed with stages, where the skillful hands of our dental technicians desing and manufacture unique restorations by perfectly mimicking the translucency of the tooth enamel. In the end it will be concluded that it is a subtle and very delicate individualized art, which is inserted in the mouth of the patient for whom it is made, ennobles the facial aesthetics, gives maximum functional comfort , phonetic well-being and of course a complete life transformation.

 

The services we offer as mentioned earlier are in accordance with all world standards and evidence base dentistry (evidence base dentistry), , in all stages of development:

  • Clinical phase – конзервативна, пародонтална, хируршка припрема, препарација (стругање) на забите, одпечатување;
  • Laboratory phase

Улогата на протетските надоместоци е да се воспостави функционална, фонетска и естетска реконструкција на оштетените заби и забите кои недостасуваат како и рехабилитација на комплетното постоечко забало, како и рехабилитација на проблемите со виличниот зглоб.

This is achieved with fixed and mobile prosthetic constructions depending on the anatomical conditions, periodontal health, anatomical and periodontal condition of the remaining teeth, as well as the financial budget ,that often times influences the choice of a particular service.

Соодветната дијагностика, води до изработка на индивидуализиран план на терапија за пациентот. Овој план детално и темелно го презентираме, а потоа согласно сите критериуми кои влијаат во изборот на соодветниот план на терапија, се носи заедничка одлука која е најдобро решение за соодветниот случај и најприфатливо за пациентот.

There is a whole range of prosthetic reconstructions: crowns, bridge constructions, porcelain laminates,, prosthetic superstructures over implants and mobile prosthetic appliances.

Crowns and bridges

Познато е дека забите кои недостасуваат, забите кои се кариозно премногу оштетни или имаат скршена клиничка коронка (фрактура на дел од природниот заб), можат да се реконструираат со правење на единечни коронки или изработка на мостова конструкција, која во целост ќе ја возобнови функцијата и естетиката на забите.

Crowns се протетски конструкции кои целосно го опфаќаат и го заштитуваат препарираното забно ткиво при што се постигнува целосна функционална, фонетска и естетска рехабилитација. Преостанатиот дел од забот, зависно од степенот на негово оштетување, треба претходно соодветно да се подготви, пред да се прејде во техничката фаза на изработка. Тоа е клиничката фаза која често опфаќа конзервативна, пародонтална, или хируршка подготовка на соодветниот заб или корен.

Types of crowns, classified according to the materials of manufacture:

  • Металкерамика – високо квалитетен германски порцелан нанесен на метална основна конструкција
  • Lithium Disilicate
  • Circonia CAD CAM - one of the best Austrian and world brand
    • Full contour
    • Cut back

Image: an example of high quality PFM construction

 

Bridges се протетски изработки (конструкции), кои се користат за Bridges are prosthetic constructions used for replacement of one or more missing teeth. These constructions mimic the look,shape,and function of natural teeth,and also provide proper distribution of chewing forces.

The materials that are used to make these constructions are different depending on the conditions and aesthetic requirements of the patients:

  • метал-керамичка мостова конструкција – се состои од метален скелет врз кој се наслојува керамиката (високо квалитетен германски порцелан) кој се изработува во заботехничка лабораторија
  • non metal ceramics која е целосно керамичка конструкција и се изработува со специјализирани машини за компјутерски водено дизајнирање и изработка. Circonia – CAD CAM-една од најдобрите австриски и светски брендови
    • Full contour
    • Cut back

Dentures

Dentures are dental prosthetic reconstructive solutions. Which type of prosthetic solution will be used depends on the anatomical condition of the jaws and the financial budget that is acceptable for the patient.

These constructions are usually removable so that the patient can maintain proper oral hygiene. Depending on the number of missing teeth and their biological value they can be classified into:

Classic partial mobile dentures - Attached to the natural teeth or pre-placed bridge construction made on the natural remaining teeth with the help of retention elements (usually wire clasps)

Skeletal partial prosthesis is a mobile construction of a prosthesis attached to the natural teeth on which the bridge construction is made with special preparation of retention clasps. They are made of biocompatible metal,that allows reduction of the size of the prosthesis, without disturbing its stability and retention provided by retention elements, such as clasps and connectors. It is called skeletal because the skeleton is metal, and the part where teeth are placed is made of classic acrylic dental material. This type of mobile construction is much easy acceptable for patients, and the adaptation time is quite shortened. They fit aesthetically with the remaining construction and form a functional whole with dentogenic and gingival distribution of the masticatory pressure which protects the remaining teeth and bony structures of the jaws.

Prosthetics over implants

Prosthetic phase - after observing and performing all the previous phases of the surgical protocol, we are in a phase when we have an integrated implant,an appropriate three-dimensional positioning, a sufficient amount of bone around the implant, and the appropriate thickness of the soft tissue ( keratinized gingiva ). From this moment follows a rather creative phase, which requires patience, dexterity, skill and knowledge.

The moment of prosthetic rehabilitation, valorizes and crowns the entire previously made surgical plan, as well as provides a result with high aesthetic and functional parameters, which give long-term stability to all structures around the implant, the implant itself, and also provides high aesthetic and functional rehabilitation. Depending on the aesthetic expectations and the type of connection of the implant with the future prosthetic fabrication, this phase can be very short, during which several measures are taken with special tools in several visits and then the future prosthetic fabrication is made in the dental technique.

 

Implant prosthetic superstructure in a patient with partial edentulousness

These include individual crowns or bridges. They can be made of different materials, but what makes a significant difference is whether the prosthetic structure is cemented or screwed to the connector of the implant (abutment)

The advantage is always on the side of screw constructions of the implant for several reasons:

  • Easy sustainability - whenever we need to intervene on a structure, implant or soft tissue, the structure can be unscrewed and re- screwed when the intervention is complete.
  • Individualizing the connectors ( abutments ) and giving appropriate support to the soft- tissue architecture, which gives a high and ultimate aesthetic effect, compared to the ready-made fabricated connectors ( abutments ) that do not allow the tissue to be shaped.
  • High degree of safety of the anatomical structures around the implant, compared to cementing , where there is always a great danger when cementing , that part of the cement penetrates into the deep anatomical structures around the implant and cause serious problems and even loss of the implant.

Implant prosthetic rehabilitation in patients with total edentulousness

Овие пациенти во зависност од количината на коскената ресорбција на резидуалниот алвеоларен гребен (остаточна коска), имаат можност од протетска рехабилитација која може да се класифицира во следните групи:

  • Циркуларни (штрафечки или цементирачки) bridges of implants
  • Хибридни тотални (акрилатни) протези – штрафечка тотална протеза.
    • All on 4 – имплант ретинирана и стабилизирана штрафечка протеза со метален трансалвеоларен скелет, поставена на 4 импланти (два аксијални и два коси).
    • All on 6 – имплант ретинирана и стабилизирана штрафечка протеза со метален трансалвеоларен скелет, поставена на 6 импланти.
  • Bar overdenture - протеза ретинирана со метална прачка или шипка која е заштрафена за имплантот – два или повеќе импланти.
  • Locator implant attachment – протеза која е директно ретинирана на имплантите со помош на локатор абатменти, за кој се потребни минимум од два импланти.

 

Complete mobile constructions - Total dentures

Прикрепени на анатомските стуктури на вилиците за нивна ретенција и стабилизација. Изработени се најчесто од метил мет акрилат- материјал погоден за такви изработки. Исто така битен фактор во однос на овие конструкции се и претходно спомнатите копчиња за нивно прикрепување. Тие можат да бидат класични или современи системи за ретенција и стабилизација, со што се постигнува максимална функција и естетика.

*Example of a hybrid total prosthesis

*Example of a hybrid total prosthesis

Aesthetic laminates

Laminates are thin,tooth-colored shells,custom shaped,that blend seamlessly with the rest of the teeth. They can be used for functional and cosmetic correction. 

Најдобрите ламинати се оние што ја имитираат природата. Специјализирани сме за насмевки кои секој ќе ги забележи, но нема да знае зошто. Совршен изглед, исто како природна насмевка. Ако имате заби кои изгледаат премногу мали, нерамни или имаат темни дамки, изборот на различните видови на ламинати можат да бидат одличен избор за вас.

  • Veneers are thin porcelain shells that are applied (cemented )on teeth that are minimally prepared.
  • Lumineers are characterized by the fact that they do not require the removal of tooth substance. They are made of non-metallic ceramics (zirconium cut back -CAD / CAM) or non-metallic Li-disilicate ceramics
  • Естетско бондирање – композитни фасети – his aesthetic intervention on the teeth allows direct application of high quality aesthetic composite through the surface of the teeth, usually in the frontal (front) zone. This allows corrections in the form, shape and color of the teeth. Very often this intervention can be combined with correction of the smile linein order to obtain a better aesthetic effect. In economically developed countries, this intervention is performed as a direct mockup, in order to visualize the possible shape, form and color of the future much more expensive and more complex prosthetic works such as the above-mentioned porcelain laminates.
  • Componeers - composite prefabricated laminateswhich like porcelain are cemented to the tooth surface. The appropriate form, shape and color is selected from a set of ready-made composite shells, and then with a specific method of composite cementing they are glued to the teeth where the aesthetic correction should be made.

Laminates are an excellent choice for solving dental anomalies in the aesthetic zone. Depending on the indication and patients needs, the technique of revisualization can be used , by taking impression from the teeth and making studio models on which the design of the future construction is made in wax. These models can also be used to make temporary constructions to visualize the future construction ( laminates ) in the mouth itself. This is called a waxup-mockup technique so that patients can understand what to expect.

Once the laminates are in place , it is necessary to protect them with a solid night guard.

*Example of waxup-mockup technique 

Before and after photos

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