Tooth replacement

Don't worry about lost teeth – they can be replaced!

There are various methods to create tooth replacements which resemble your natural teeth.

There are two groups of replacements:

Fixed replacements

• Temporary replacements (they can be fabricated on the spot!)
• • Replacement without filing teeth
• • Aesthetic crowns
• • Metal-ceramic crown
• • Full-ceramic (metal-free) crown (applied in case of metal allergy)
• • Zirconium-dioxide crown
• • Ceramic veneer
• • Gold-ceramic crown
• • Galvanised gold-ceramic crown
• • Richmond crown (anchored into the root canal)
• • Implant-supported replacements

Removable replacements

• • Full removable denture
• • Partial removable denture

Temporary replacements

What materials can be used to prepare temporary replacements?

Since these replacements are temporary, we use pliable tooth-coloured acryl, which hardens when exposed to external light and takes the shape of the tooth. Unlike permanent crowns, this kind of artificial replacement does not resemble natural teeth, nor does it take their function. It is only used to replace permanent crowns during the treatment.

Temporary replacement fabricated in the surgery

If your treatment is short and does not exceed 1-2 weeks, your replacement is prepared by your dentist on the spot, so that you won't be left without a tooth during your treatment. This replacement will not only give you an aesthetic appearance, but will also protect the surface of filed teeth and prevent them from becoming sensitive.

Temporary replacement fabricated in a dental lab

If your treatment is longer, e.g. after a tooth extraction when wound healing takes 5-6 weeks, your replacement is prepared in the lab by a dental technician. The technician prepares the temporary bridge in advance, and your dentist inserts it right after the extraction.

Such replacements can only be worn for a couple of weeks or months without the risk of tooth decay, since they do not seal the teeth properly. They are fixed in a way, which enables your dentist to remove and replace the bridge to perform the various steps of treatment. Since the attachment is weak, the bridge may become loose. In this case we put it back as soon as possible.

Replacement without filing teeth

Conventional replacement of a single tooth involves insertion of a bridge, which is preceded by filing neighbouring teeth. This solution is only acceptable if these teeth are also damaged. Thus the bridge does not only replaces the missing tooth, but it also protects the neighbouring teeth and gives them an aesthetic appearance.

However, it is not recommended if the neighbouring teeth are intact or only slightly damaged. By filing these teeth we would lose a lot of healthy tooth material.

Fortunately, it is possible to replace a missing tooth without filing natural teeth. We create special compartments on the surface of the neighbouring teeth (if you have minor superficial decay or fillings, we can convert these) and adhere the permanent bridge, the actual replacement, into these compartments which in this way are aesthetically filled and covered.

There are various possibilities to replace a tooth with this method, depending on the type of the defect and the aesthetic requirements.

Aesthetic crowns

With crowns used earlier (they contained metal or metal alloy) greyish discoloration of the gums could appear with time. Aesthetic metal-free crowns do not cause such problems, so many patients come to our surgery to have their old crowns replaced with ones which will leave them with healthy gums without later discoloration.

Aesthetic crowns include:

Full-ceramic crowns

These types of crowns, as their names indicate, are metal-free.

Zirconium-dioxide crowns

These high-precision zirconium-dioxide crowns are designed with computer scanning. Zirconium-dioxide can replace metals because it is not only aesthetic, but it is virtually unbreakable.

Galvanised gold-ceramic crowns

It is often the best solution for replacing front teeth (such as upper incisors). This solution meets the highest aesthetic requirements as well.

Dentists at Fehérdent are always up-to-date with the advances in dentistry, so they can offer you state-of-the-art solutions.

Implant-supported replacements

• • Implant = exogenous tissue (material) inserted into a living organism, e.g. artificial root
• • Implantation = inserting exogenous tissue (material), e.g. artificial root, into a living organism

Here we only describe procedures which involve implantation. Implantation is discussed in details in a separate section (Implantation).

Replacing a single tooth supported by an implant

Implants used in the replacement of a single tooth consist of the following main parts:

• • base inserted into the jaw bone (with internal thread)
• • abutment (screwed into the base)
• • crown (screwed into or cemented on the abutment)

Implants are the best solutions to replace a single missing tooth which has healthy neighbouring teeth.

Replacing several teeth supported by implants

If several teeth are missing in one dental arch, it is not necessary to insert implants for each missing tooth. If 3-4 teeth are missing, it is enough to insert 2 implants and fabricate a bridge which consists of as many parts as the number of missing teeth. In this way we can replace all missing teeth.

We can prepare fixed replacements with implants and bridges even if all teeth are missing, provided you have enough bones in your jaw. A so called full-arch bridge requires at least six implants in the upper jaw, and four in the lower jaw. Therefore in this case it is a better solution to prepare removable dentures which we support with implants.

Removable denture supported by implants

Conventional dentures cannot be supported with implants and they cannot be converted, therefore new dentures must be fabricated. 2-4 implants are required to replace canines and second premolars. The dentures snap into these implants like press-buttons on clothes.

Removable dentures supported by miniature implants

If there isn't a sufficient amount of bone, regular implants cannot be inserted. If all teeth are missing, and this condition has been present for a long time, the width of the jaw bone is so small that complete removable dentures can only be fixed with miniature implants.

Removable dentures

Full upper denture on an acrylic base

A full upper denture is comprised of artificial teeth cemented onto a plastic base, which because of its special design is held in place due to vacuum effect. With this denture we can restore the chewing function, the contour of the upper lip and the speech. It takes approximately two weeks to prepare and requires several visits to the dentist. It is usually recommended for elderly people who are not suitable candidates for implantation.

Full lower denture on an acrylic base

We prepare it to be worn on the lower jaw bone. For details the same as described for upper dentures applies.

Full lower denture with a metal weight

We can incorporate a metal weight into the lower denture to increase its weight and thus increase adherence, so that the denture is held in place more securely. This weight is embedded in the acrylic base and is not in contact with anything within the oral cavity. Therefore it can be used safely in patients with metal allergy. Increased adherence ensures better chewing function and speech. We do not use weights in the upper denture, because it would decrease adherence by pulling the denture downward.

Partial upper denture on a metal base with clasps

The denture is made up of replacement teeth cemented onto a thin metal base. The fixtures needed to hold the denture in place (metal clasps) are cast together with the base, therefore they can withstand a bigger load. The device does not break easily and it is easy to clean, so you can avoid the unpleasant odour in your mouth since less bacteria are accumulating on the surface of the denture. Aesthetically, however, these dentures are not perfect, especially if they are used at the front. We place a fixed bridge on the remaining teeth which are filed to provide proper attachment for the clasps.

Partial lower denture on a metal base with clasps

For partial lower dentures we recommend metal bases, because they can withstand the pressure caused by chewing more effectively. The advantages are similar to those described above, and aesthetically they are more acceptable here, because lower teeth are rarely visible when you speak or smile.

Partial upper denture on a metal base with precision attachment fittings

Compared to attachment with clasps, precision attachment fittings are better solutions, especially for upper teeth. They are not visible and they provide stronger attachment. However, they can only be applied if you have a sufficient number of abutment teeth on both sides, or else they could dislodge the teeth. With the precision attachment fittings the removable denture attaches precisely to the fixed bridge. These devices are only viable on a metal base (there is a separate charge for the fittings). The teeth used as abutment for the fixed bridge (at least two teeth on each side of the middle axis) should be healthy, non-mobile teeth.

Partial lower denture on a metal base with precision attachment fittings

The minimal number of teeth needed is two teeth both to the left and right of the mid-line. On each side these teeth are connected with a bridge into which we incorporate the fitting, the patrix. The precision attachment part of the denture, the matrix, attaches precisely to the patrix.

Solutions to prevent ill-fitting dentures

Milling technique

In order to ensure proper attachment of the bridge and the removable denture, we create small indentations on the inner surface of the bridge (fixed part) in the metal-ceramic part using a special milling technique. The extensions on the metal base of the denture attach to these indentations, which will prevent the rotation of the denture around its axis and provides continuity between the bridge and the removable part.

Precision attachment fittings

Precision attachment fittings may slide or behave like a press-button or a telescope. In case of sliding fittings precise attachment is achieved with a little peg on the bridge and a small socket in the denture. The peg cast together with the bridge slides into the socket in the denture. Both the peg and the socket have a plastic cover (cap or lining) to prevent wear. The plastic cover can be replaced. Press-button fittings are best described as a ball extension on the bridge and a socket in the denture, with the ball snapping into the socket. Proper attachment is achieved by a strong rubbing force. If one or two neighbouring teeth are missing, we can fabricate a special fitting device. We insert a cast metal bar between the remaining teeth and the denture fits on this bar like a saddle. In order to achieve better retention and prevent shifting of the denture sideways, we can apply an interlock, which is an extension of the metal plate. It fits next to or in between the milled indentations, thus creating better attachment. When we fabricate partial dentures, it is recommended to use as many attachment solutions as possible to hold the device in place.

Primary and secondary telescope crowns

Telescope crowns are also precision attachment fittings. They can be applied if instead of two teeth on each side there are only 1-3 teeth left, which is not enough to apply dentures with other types of precision fittings. Telescope crowns consist of a smaller (primary) and a bigger (secondary) crown. The smaller primary crown is glued onto the shaped tooth. The bigger secondary crown incorporated into the denture snaps over the small crown. Precise attachment is ensured by the rubbing force, which prevents the denture from shifting while you are chewing. The crowns can be made of gold, but dental metals are also suitable and do not require welding. Golden crowns are welded onto the metal plate with a special welding technique, which together with the price of the gold increases the costs.

Telescope crowns are used to attach the following devices:

Upper denture on a metal base with telescope attachment

This type of denture is a partial removable denture which can only be fabricated on a metal base. It is because separation of the primary and the secondary crown requires a very big force which plastic plates cannot resist. The base itself can be made of golden mesh, especially if the crowns are also made of gold, since they can be welded together with simple welding. However, gold is not recommended for upper dentures because it is heavy and it will pull the dentures downward

Lower denture on a metal base with telescope attachment

From a practical point of view, lower dentures can have a heavy base, because it will press the denture to its place. Instead of dental metal, the plate can be made of golden mesh, although it will not make the denture significantly better. However, if the telescope crowns are made of gold, it is easier to weld the secondary crown to the golden mesh.