Fixed prosthodontics is a specialized field of dentistry focused on restoring and replacing missing or damaged oral structures with permanently attached devices. This treatment provides patients with a stable, long-term solution for improving both the function and appearance of their teeth. Unlike removable options, fixed prosthodontics cannot be taken out by the patient and are secured either by cement or screws to existing teeth or dental implants. The goal of this restorative work is to re-establish a healthy bite, enhance a smile’s aesthetics, and improve overall oral health.
Defining the Scope of Fixed Prosthodontics
Prosthodontics is the area of dentistry dedicated to the design, manufacture, and fitting of artificial replacements for teeth and other parts of the mouth. The discipline is formally recognized as one of the twelve dental specialties by the American Dental Association (ADA). Fixed prosthodontics involves restorations that the patient cannot remove on their own, offering a high degree of stability and permanence.
The permanence of these devices is achieved by bonding them to the prepared surface of natural teeth or by securing them to integrated dental implants. This mechanical stability allows the restorations to withstand the strong forces of chewing and speaking, effectively restoring the natural function of the mouth. Treatment is aimed at correcting issues like severely damaged teeth, replacing missing teeth, and improving the alignment and color of the dentition for a harmonious smile. Porcelain and zirconia are often the materials of choice for these restorations due to their strength and ability to mimic the translucency of natural enamel.
Common Fixed Restoration Solutions
A variety of fixed devices are available, each designed to address a specific restorative need. Dental crowns are the most common fixed restoration, functioning as a custom-made cap that covers the entire visible surface of a compromised tooth. Crowns are typically used to protect teeth that are severely decayed, fractured, or have undergone root canal therapy, providing structural support and restoring the tooth’s original shape.
Dental bridges are a solution for replacing one or more missing teeth by physically spanning the gap. A traditional bridge consists of an artificial tooth, called a pontic, which is fused between two crowns that are cemented onto the healthy adjacent teeth, known as abutments. This arrangement restores the chewing surface and prevents the surrounding teeth from shifting into the empty space.
For teeth that require restoration but still have a significant amount of healthy structure remaining, inlays and onlays offer a more conservative approach. An inlay is a custom-fabricated filling that fits within the cusps of the tooth, whereas an onlay covers one or more of the cusps and is sometimes referred to as a partial crown. Both are used for moderate-sized cavities or damage that is too extensive for a standard dental filling but not severe enough to require a full crown.
Veneers are thin, custom-made shells of tooth-colored material, usually porcelain, that are bonded to the front surface of teeth. While they can provide minor functional correction, veneers are primarily aesthetic restorations used to correct issues such as chips, gaps, discoloration, or minor misalignment. Minimal tooth preparation is required for veneers, preserving more of the natural tooth structure compared to a full crown preparation.
The Step-by-Step Treatment Process
The process of receiving a fixed prosthesis begins with an initial consultation and comprehensive treatment planning. The dentist performs a thorough clinical examination, often including X-rays or digital scans, to assess the health of the supporting bone and surrounding teeth. This planning phase is crucial for determining the appropriate type of restoration and ensuring a predictable outcome.
Once the treatment plan is confirmed, the preparation phase begins, which involves reshaping the tooth or teeth that will support the restoration. This preparation, which may require local anesthesia, involves removing a specific amount of enamel and dentin to create space for the fixed device to fit without interfering with the patient’s bite. The precise reduction of tooth structure is necessary to ensure the final crown or bridge has adequate thickness for strength and a natural appearance.
Following preparation, the dentist takes impressions of the prepared area and the opposing jaw. This impression serves as the blueprint for the dental laboratory technician to fabricate the custom restoration. A temporary restoration is then placed over the prepared teeth to protect them from sensitivity and maintain the space while the permanent device is being created, which typically takes several weeks.
During the laboratory phase, the technician uses the impression and the dentist’s instructions to meticulously craft the final restoration from materials like porcelain or zirconia. At the final appointment, the temporary is removed, and the permanent restoration is fitted and checked for precise fit and aesthetic qualities. The fixed prosthesis is then permanently secured using a strong dental cement or, in the case of some implant-supported devices, a screw mechanism.
Maintenance and Expected Lifespan
Fixed prosthodontics are designed for longevity, with the typical lifespan of crowns and bridges ranging from ten to fifteen years or more, depending on the material and patient care. The durability is highly dependent on effective oral hygiene and regular professional maintenance. While the prosthetic material itself is often resistant to decay, the underlying natural tooth structure and the surrounding gum tissue are still vulnerable.
Patients must maintain meticulous daily cleaning, which includes brushing twice a day and flossing around the restoration, paying particular attention to the margin where the crown meets the gum line. Special cleaning aids, such as floss threaders or interdental brushes, are often required to clean beneath a bridge where the artificial tooth meets the gum tissue. Regular dental check-ups and professional cleanings allow the dentist to monitor the restoration’s integrity and the health of the supporting tissues. Factors such as unchecked tooth grinding, trauma, or the development of decay or gum disease can significantly shorten the lifespan of the fixed prosthesis.