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Dental Specialties - Prosthodontics

A Prosthodontist is concerned with restoring teeth to their former function and appearance or replacing missing teeth and surrounding structures to the function and appearance of the teeth that used to be in place. 

Sometimes they do not restore to a former look or function, but transform the look and function of the teeth to something a patient considers to be more desirable. Many people consider a prosthodontist to be a crown, bridge, implant, and denture specialist.

Typically, a prosthodontist gets involved when a case needs multiple crowns for the purpose of changing the occlusion (bite) to be more useful.  My father and my brother are prosthodontists in Utah, and the cases where their skill is fully utilized are cases of very worn or very broken down teeth that seem to be damaged nearly beyond repair.  As an example, a farmer over the course of a long career of bouncing along on an open tractor and holding his teeth together in the dusty air can grind his teeth down to little nubs.  All the teeth are shortened.  A crown can add to the length of a tooth so it is restored back to its original length.  However, in a case like this, placing a couple of crowns would not work because all the teeth need to have crowns in order to make the teeth look and function like they were before they were worn away.  Additionally, all the crowns have to be cemented at the same appointment.  How far do you open the bite?  This is the essence of the three years of training past dental school that the prosthodontist has completed.  They will rebuild all the teeth in either one arch or both arches.  This is termed a full mouth rehabilitation.  It has to be done precisely or else the TMJ (jaw joint) will not tolerate its new position.

A bridge is when crowns (caps) are placed on teeth on both sides of a spot where there is a tooth missing.  The fake tooth (pontic) is hooked onto the two crowns supporting the ends of the bridge.  A bridge is cemented permanently in place.  A partial denture can also be used to replace teeth on an arch where some of the teeth are missing.  Of course, in both the case of the bridge and the partial denture the teeth that support the appliance have to be well anchored in place to support the added load of the prosthetic (fake) teeth that are attached onto it.

When all of the teeth on an arch are missing, a complete denture can be made.  In this province, we have denturists.  A denturist has completed training in fitting an arch with a denture.  A denturist is not trained in replacing missing teeth with anything but a denture.  A prosthodontist can offer more options for a patient than a denturist.  You might wonder if all the teeth on an arch are missing, what option other than a denture is there?  Again, this is where the training and expertise of a prosthodontist comes in.   On many people, implants can be placed either to allow the denture to “snap” in place or if enough implants are placed, the denture can actually be screwed in place on top of the implants.  The thing that makes this less common than one would hope is the cost.  It is costly, but it truly replaces the teeth that used to be in place with something that works in a very similar way to natural teeth.

My brother tells me that typically, a prosthodontist needs at least 60,000 population to be more or less busy in a town.  It is uncommon for a general dentist to refer to a prosthodontist.  Sometimes prosthodontists have dental technicians (the people who actually make the crowns, bridges, and dentures) in their offices. This greatly enhances the ability to match the porcelain of a crown to a tooth with difficult shading.  This could happen when making a single crown on an anterior tooth (front tooth) when the tooth next to it has several shades on its structure.  Because a certain prosthodontist has in house lab support, a general dentist may refer a patient to him not because of technical complexity of the case, but because of an unusual esthetic (looks) concern.

This completes my brief description of what each of the ten specialties of dentistry is all about.  If you have read all ten of these articles, you now know something of the work a specialist is up to in each of the ten specialties in dentistry in Canada. 

- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)

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