All that remains of the tooth is the root: restoration without implantation

When can a tooth be restored?

When the walls have completely crumbled, but the root of the tooth has not been destroyed, traditional dentistry sometimes suggests removing it. Today, using new protocols, it is possible to preserve the root and create a new stable unit - any of the functional ones, except for the “eights” (wisdom teeth). To do this, you need the root to be healthy:

• Not affected by caries, without fractures or cracks. If such defects exist, then only removal followed by implantation is indicated.
• No cyst. If there is one, then a method of treatment is selected. And only then can you begin to restore.

If a similar problem happens to you, do not rush to the surgeon. New technologies make it possible to accomplish the previously impossible - to preserve the root of a tooth. What to do in a particular case is decided at the appointment, after diagnosis. The vast majority of patients manage to save the tooth after treatment procedures and install a crown on the root of the tooth.

What to do if your tooth chipped?

See a dentist.

The doctor will remove the broken wall, take x-rays of the tooth, and evaluate its safety. If the tooth is not broken much, the root is not damaged or almost not damaged, then it can be restored. Then the tooth is prepared (if necessary, dental canals are treated, caries and old filling materials are cleaned), how badly it is damaged is assessed and the best way to restore it is selected (filling, inlay or crown). If the tooth cannot be saved, it is removed and replaced with an implant or other available method.

Examples when only the roots of the teeth in the upper jaw remain

Example 1. Restoration from one root of a front tooth

In this example (presented in full here), the situation was created literally by the patient’s hands. She tried to glue part of the tooth with superglue and, under the influence of dangerous substances contained in the glue, the crown of the tooth became completely unusable.

But the root of the tooth under the crown below remained intact and unharmed.

The length of the healthy part of this tooth root removed all doubts about the question - is it necessary to restore the root? Certainly! - it is possible and necessary. The tooth was restored in 1.5 hours using Cerec technology. And here in the photo is the happy owner of a new restored front tooth:

Example 2. Restoring 3 front teeth, of which only the roots remain

Here is a treatment example where I restored the aesthetics of her smile to a 22-year-old girl. The three front teeth on the upper jaw were completely destroyed. From the upper teeth 1.2, 1.1, 2.1 only
the roots
:

These three teeth were actually an aesthetically unsightly frame made from old fillings. Now we will not analyze the whole case in detail, I would like to draw your attention to the following points:

• the shape of the roots of the teeth and their condition made it possible to restore them
• There was no talk at all about any amputation - removal of the roots of the teeth of the upper jaw and implantation.

Our patient's smile was designed in a computer program:

So, in the photo below you see a general set for restoring our patient’s dentition, and among the modules there are 3 with a crown and a root.

The roots of the upper front teeth were quickly and, most importantly, effectively restored:

and our patient underwent a beautiful transformation and became the owner of a sweet and chic smile:

This is the enormous potential and aesthetic power of healthy tooth roots! Don't rush to delete them)

Example 3. Complete restoration of the smile zone on the front teeth of the upper jaw

This example is actually very popular on the Internet, since the patient is a TV presenter, and as a result of the treatment she found her new smile. Which is extremely important for her profession. I describe the detailed clinical case itself in another article, but here I would like to note the main points related specifically to the restoration of the roots of the front teeth with crowns.

In the picture below we have removed composite restorations and carious lesions. only the roots remain of the two front incisor teeth.

:

Crowns and “crown + root” modules were prepared in the laboratory:

After installation, the smile began to shine with bright colors:

You can see the entire chronology of our patient’s treatment in one large picture, step by step:

Enamel implantation with Innodent

The procedure is new, but has already proven itself as an effective method for restoring tooth enamel .

• Painlessly cures caries in 1 month
• Relieves tooth sensitivity
• Removes white spots after braces
• Strengthens and mineralizes enamel

Description of the procedure:

Innodent is applied to the tooth surface, which in turn is integrated into the enamel structure at the molecular level. This is achieved through active substances whose characteristics coincide with dental tissues.

Main results:

Cracks and damage to the enamel are completely eliminated, the integrity of the tooth enamel is restored and the process of regeneration of the natural structure begins.

When will the results of the procedure be visible?

You will see the first results 3 days after the start of the procedure, but the process of tooth enamel regeneration itself can last 1-1.5 months. A decrease in the sensitivity of enamel to mechanical and temperature stimuli also occurs gradually. In individual cases, it is possible to re-use the drug after 3-4 months.

Indications for the dental enamel implantation procedure

Below we will describe the main indications for which enamel implantation will be the most effective restoration method.

1. High sensitivity of teeth (temperature and mechanical)
2. Damage (chips) and cracks in tooth enamel
3. Wedge-shaped defect (hyperplasia)
4. Tendency of teeth to the spread of caries
5. Pigment spots on the surface of tooth enamel
6. At the initial stage of caries spread

An important feature of the drug is the possibility of use for preventive purposes, as well as in conjunction with teeth whitening procedures. Effectively copes with the treatment of enamel demineralization. It is possible to carry out the procedure after correction with braces in order to eliminate age spots on the surface of the enamel.

Are there any contraindications to the procedure?

The procedure is completely safe and has no contraindications as such. However, in rare cases, the following are possible: an allergic reaction and individual intolerance to one or more components of Innodent. You should not carry out the procedure with major damage to the internal tissues of the tooth.

Pros and cons of dental enamel implantation with Innodent

Main advantages:

1. High degree of safety and natural ingredients
2. Suitable for pregnant women and children (including baby teeth)
3. As a result, you get smooth enamel with a natural shade
4. Stains and damage are completely eliminated within a month
5. Can be used at the initial stage of caries development and thereby avoid drilling and filling teeth
6. Complete painlessness and absence of discomfort for the patient at all stages of the procedure
7. The procedure is quick - about 15-25 minutes for everything
8. The result lasts really long (from 1 to 3 years)

Flaws:

1. Price - the method is not the cheapest, but in terms of price-quality ratio it has no analogues
2. Really good results are possible a month after the procedure
3. Does not solve the problem with large defects (internal tooth decay)

Dental implantation with the help of Innodent has allowed modern dentistry to truly restore enamel, and not replace it with temporary solutions.

A completely new approach to enamel restoration

Why do tooth remains appear in the gums?

There are many reasons for this phenomenon:

• Perhaps the tooth has completely crumbled, but the root remains.
• The crown received a strong blow and a fracture occurred.
• An incomplete tooth extraction was performed. The remaining fragments cause inflammatory processes in the soft tissues, causing pain.
• Units with the neurovascular bundle removed are often destroyed. The so-called “dead teeth”. The nutrition of their walls is disrupted, the shell becomes fragile and, due to incorrect loading or due to increased fragility, the natural walls break off “at the root.”

If the process has already started, then urgent treatment of the tooth root is necessary. Otherwise, the remains of the unit will have to be removed to avoid infection of adjacent teeth and surrounding tissues.

The situation cannot be ignored: tooth fragments may not bother you at first, but then turn into a serious problem. When trouble occurs, immediately contact the dental clinic to promptly select treatment and find ways to restore the tooth.

How to restore the crown of a tooth

The most important is the preparatory stage, it allows you to identify hidden pathologies and determine the appropriate treatment option. During the preliminary examination, the dentist can carefully examine the oral cavity, take x-rays and panoramic photographs of the jaw, and study the structure and location of the roots and blood vessels. It is also necessary to carry out professional oral hygiene; for this, one of the modern techniques can be used, for example, Air Flow or ultrasound.

If there are teeth with increased sensitivity, bleeding and other deviations from the norm, a course of therapy and physiotherapeutic procedures is prescribed. It is also very important to remove all areas affected by caries and neutralize foci of inflammation. Until this is done, it is impossible to make impressions and make prostheses based on them. At the surgical stage, the doctor must ensure that the artificial crown has reliable support. If necessary, protruding hard tissues are removed or, conversely, they are built up; teeth that cannot be restored can be extracted, etc.

At the orthodontic stage, the bite can be corrected, and this is also the time to straighten curved or erupted units in the wrong place. If this is not done immediately, the supports may not withstand heavy loads in the future. The orthopedic stage involves the manufacture of first a temporary and then a permanent crown. If all previous stages have been completed with the proper level of responsibility, the prosthesis will be securely fastened and will not cause any discomfort to its owner.

Examples of canine restoration when only the root remains of the tooth

Example 4. The pin in the root of the lower tooth was removed, and the canine itself was restored

In this clinical case, I was restoring the lower canine, and the task was to save the root of the tooth and restore the coronal part of the canine, which was almost destroyed by caries. The anterior wall of the lower canine was made in the form of a filling, and it fell apart from the cutting edge.

As you can see in the photo, an anchor pin was installed inside the tooth - this is a pin that is screwed into the canal to strengthen the tooth. The tooth under the filling and the root of the lower canine were affected by caries. When the carious tissue was removed, only the root and a small part of the wall

:

You and I remember the main topic of our article, which tells us the following - if the tooth root remains, it can be completely restored. And this is not the first time that the unique Cerec technology has come to our aid. Using it and digital scanning, we restored the missing tooth module, which also included the root part:

Next, we restore the lower front tooth using a CEREC inlay and get an excellent result - the lower canine is completely restored:

Example 5. The root of the tooth under the crown of the upper canine has not rotted, and therefore the tooth is 100% restored

In this case, there was a total restoration of the dentition (veneers and crowns) with the replacement of worn-out crowns on the front teeth. One of the upper canines under the crown was seriously affected by caries, but its root was practically healthy - only a small part of the tooth root was damaged, see the following photo:

The missing “crown + root” module and new crowns were manufactured in a laboratory. In general, everything is in a smile, it looks just great:

And the owner of a new beautiful smile herself cannot hide her admiration:

All the main tasks in this total work were successfully solved, but the main thing you should pay attention to is that we managed to save the tooth root here too.

Light filling on a pin – what are the advantages of the method?

A post filling is considered a reliable replacement material when a dentist is restoring a fractured unit. A titanium or fiberglass pin is inserted into the root canal, after which the coronal part is restored with a composite material. Among the disadvantages of the method is the potential risk of root fracture, since the pin fails under pressure, as well as shrinkage of the filling and the development of secondary caries under it.

Unfortunately, teeth restored in this way do not last forever. After 3–5 years, the dentist will have to change the filling or, due to global destruction of the crown, perform prosthetics/implantation.

How to determine if a root is healthy

How to understand whether caries has affected the root of the tooth, whether the dentin of the tooth root is intact or whether there are defects? In order to have an objective picture of the process, it is necessary to perform an x-ray of the tooth root and a computed tomogram. A CT scan will determine the true condition of the root and show:

• The presence of inflammatory processes.
• It will determine whether there are neoplasms and what size they are (cyst or granuloma).
• The location of the roots in relation to the neighboring ones, the maxillary sinus.

This is the only way to see whether it will be possible to cure the tooth root using a tab.

Example 6. Restoration of teeth 4 and 5, when only one root remains

In the next total work I would like to highlight the 4th and 5th premolars. In general, the girl’s situation was quite complicated initially at the time she contacted me. Both the lower and upper jaws were restored. Let's look at only the top one.

Front 4 teeth

- these are 1.2, 1.1, 2.1 and 2.2 were entirely made of composite material, under which caries developed. And the teeth we were interested in, 1.4, 1.5, 2.4 and 2.5, were covered with metal-ceramic crowns under which there were metal inlays. Today, such structures are rarely used in advanced dentistry, since the same Cerec technology allows you to achieve excellent results with one module “crown + tooth root”, rather than breaking the structure into an inlay and a crown with an additional adhesive layer. In fact, we place a crown at the root of the tooth with the function of the missing root. There will be a separate example on metal tabs a little later.

So, in the photo below, the crowns were removed, the inlays were removed and carious tissue was removed from teeth 4 and 5, leaving healthy roots

:

If only the root remains of a tooth, this does not mean that it cannot be restored. And let this tooth root be pulpless, i.e. dead - such tooth roots feel great in bone tissue and orthopedic structures can be built on them. Using computer technology and 3D scanning, we first restored virtual teeth:

The following photo shows that on one side we place crowns with an inlay function in place of the 4th and 5th teeth, and on the other opposite side we place half-crowns also with an inlay function.

That is, these are single modular designs - veneers with a root part, which are currently the best for the patient

:

Installing veneers with the root part allows you to completely recreate an aesthetically beautiful dentition:

The stage of temporary prosthetics, which allows the patient to see his smile, plays an important role in the very process of its new formation, since the patient understands that the main problems with the restoration of the remaining teeth, and in fact the roots of the teeth, are left “far behind”:

After installing crowns and half-crowns and restoring the front teeth, our patient’s smile was transformed beyond recognition, the so-called. wow effect:

The clinical example described above can be viewed in detail HERE.

Dental prosthetic options

The main factors that determine the choice of dental prosthetics (if we do not take into account the financial factor for now) are the purpose of the procedure (esthetics or chewing function), as well as the number and location of teeth to be restored. To improve the appearance of healthy (usually front) teeth that have external defects (darkening, chips, cracks, misalignment or size), veneers (special ceramic onlays) or crowns are used.

Crowns are also used to preserve weakened or noticeably damaged (for example, broken or worn down) teeth. They are a kind of caps that are put on a ground tooth. They are made of metal (this outdated technology is still used in some clinics) or modern materials: plastic (temporary crowns), metal-ceramics and ceramics (porcelain, zirconium dioxide, etc.). Both veneers and crowns are non-removable prostheses.

In the absence of 1-2 teeth, either a bridge prosthesis is used - a metal structure (bridge) is attached to the adjacent teeth, used as a support, onto which crowns are fixed, completely reproducing the appearance and function of the lost teeth. Or it will be a prosthesis (crown or bridge) supported by implants.

The advantages of prosthetics on implants are the absence of the need to grind down adjacent teeth, the absence of additional load on them, and the transfer of chewing load to the jawbone (through the metal root), which prevents its atrophy.

The disadvantage is the rather high cost and the need to undergo surgery (implantation of an artificial metal root). If several teeth are missing in a row and it is impossible (or unwilling) to perform implantation, a removable denture is made. For example, clasp (design on a durable metal plate).

In case of complete absence of teeth (edentia), a prosthesis made of acrylic plastic is made. A distinctive feature of removable dentures (both clasp and acrylic) is the ability for the patient to remove and install them independently. The structure is fixed in the oral cavity with special clasps or micro-locks (for clasp ones), or by suction to the gum (for acrylic ones).

Fixed bridge

Restoring teeth with the installation of dentures that the patient cannot remove on their own is called permanent dental prosthetics. These include veneers, crowns (metal-ceramic or ceramic), dental inlays and bridges. Prosthetics on implants is also classified as a non-removable type.

But in some cases, prostheses are placed on implants, which are called conditionally removable. This is due to the fact that you cannot remove them yourself, but a dentist can easily dismantle them by unscrewing the fastening screws - for example, for professional cleaning, repair or replacement. The implants themselves will remain in place.

Crowns

Long gone are the days when crowns were made only of steel and gold. Today, many modern materials are used for dental prosthetics, which are not inferior in strength or aesthetics to natural teeth. The choice of a specific crown material is dictated by both the method of procedure and the financial capabilities of the patient.

Let's look at the advantages and disadvantages of the main types of dental crowns for prosthetics:

• metal ceramics – lining a metal frame with a ceramic composition,
• ceramics – made from porcelain, zirconium dioxide or glass ceramics.

Metal crowns can (and are sometimes) used today. They have undoubted advantages: high strength, teeth need to be ground less for them. But it is necessary to choose solid crowns made of high-quality metal and use them only for the farthest chewing teeth, where they will not be visible.

Ceramic crowns made from porcelain are cheaper, but are the least durable; glass ceramics are the most durable and beautiful, but the most expensive. Zirconium dioxide is the golden mean. Ceramic crowns are not used for prosthetics of chewing teeth due to their insufficient strength for this function. Their area of ​​application is the front teeth, where aesthetics are very important and the chewing function is secondary.

Metal ceramics

Metal-ceramic crowns are excellent for restoring chewing teeth. They can also be used for prosthetics of front teeth, but in this case it is necessary to check their compatibility with existing natural teeth.

Metal-ceramic crowns are opaque (otherwise the metal base will show through the coating), so if your front teeth have a high coefficient of transparency, then teeth with crowns will differ from natural ones. If, nevertheless, a decision is made to prosthetize the front teeth with metal-ceramics, then it is better to choose crowns with shoulder mass, since they do not cause cyanosis of the gums, unlike conventional ones.

Complete dental prosthetics

In case of complete absence of teeth, it is necessary to make a removable or fixed denture. The removable option involves making an artificial jaw from polymer materials (acrylic, nylon, etc.). The structure is fixed in the oral cavity by suction to the gums, just like a suction cup is attached to glass.

The production of such a prosthesis is quite fast, their prices are moderate, and installation does not involve any serious interventions. However, they also have serious disadvantages. The prosthesis must fit perfectly. If it does not fit perfectly, or if during use the shape of the soft tissues has changed slightly (and it will change, because the design does not transfer the chewing load to the jaw bone, which is why bone atrophy will continue), then the prosthesis will not hold well and keep falling out.

The removable version is very massive, extends far beyond the dentition, rests on soft tissue and in some patients causes a gag reflex. Getting used to such a design is a very slow matter (up to 1 month), and some people do not manage to get used to it at all. Hard dentures often rub the gums during chewing, while soft dentures distribute the load unevenly, causing discomfort. The service life of removable polymer dentures is 5-7 years in the most favorable case.

An alternative is complete dental prosthetics using fixed (or conditionally removable) structures supported by implants. The most commonly used are 3 methods: basal implantation, prosthetics on 4 implants (All-on-4) or prosthetics on 6 implants (All-on-6). Basal implantation means the placement of 8-12 elongated implants into the dense layers of the jaw bone.

The advantage of this method is the absence of the need to do bone augmentation, the ability to do without cutting the gums and drilling the bone, the initial strong fastening of the implants, which allows you to immediately install a prosthesis on them. On the other hand, placing a large number of implants makes the procedure more complex, and the lack of large-scale studies of the behavior of implants over many years does not allow for firm guarantees, unlike other implantation methods, which provide a lifetime guarantee on the implants.

Prosthetics on 4 implants

More predictable and well-researched is the method of dental prosthetics on 4 implants. It also allows you to receive a ready-made fixed prosthesis within 3 days after surgery. But the peculiarity of this type is that this design will be temporary and will have to be replaced with a permanent one in a few months (from 5 to 24 months, depending on individual characteristics).

The main difference between the different types of temporary structures is the presence of a metal frame. A temporary prosthesis with a frame is optimal - it is strong enough to last 2-3 years before being replaced with a permanent one. But embedding a metal frame with a screw connection with implants into an acrylic base is a very labor-intensive procedure, due to which the cost will be noticeably more expensive.

An acrylic temporary denture without a metal frame will be cheaper, but it has noticeably less strength, which is why its service life does not exceed 5 months, and even during this time, structural failures are common, especially in men with large and well-developed jaws. A temporary (adaptation) prosthesis must be properly maintained - once every six months (and sometimes more often) it requires professional cleaning by a dentist, and once a year - replacement of the fixing screws.

There are many types of permanent structures for all-on-four prosthetics, so the desired option is selected individually in each clinic, according not only to the specific clinical situation (for example, the amount of space for dentures, determined by the degree of atrophy of the jaw bone), but also to the capabilities of the clinic and the patient.

The highest quality are titanium-polymer prostheses from Nobel Biocare, however, they are characterized by high cost and require a large amount of space for prosthetics, i.e. Patients with a slight degree of bone atrophy will not be able to install them.

Another option is bridge-like structures made of zirconium dioxide or metal ceramics. Their frame can be made of titanium or zirconium dioxide, and in some cases of nickel-chromium alloy, but the beam must be milled. The use of cast structures reduces the strength and accuracy of fit, which can lead to problems in the future.

Prosthetics on 6 implants

The previous method is not suitable for all patients. In large men, young men (under 55 years of age), those who prefer solid foods (meat, fresh vegetables), and those with very soft bones, implants located on the side will experience increased stress, which will inevitably lead to their loosening, resorption of bone tissue around the implants and breakage (or loss) of the prosthesis after a few years.

For such patients, dentures with 6 implants are always recommended as a more reliable and suitable option to avoid overloading the lateral implants. The operation can also be performed using surgical guides or the traditional method with incisions. Loading of installed implants with a prosthesis can be performed within 2-3 days after surgery.

To install a prosthesis, it is better to use branded Multi-unit abutments, since to remove the prosthesis in the future (if it is necessary to clean or replace a temporary one with a permanent one), Multi-unit abutments, unlike standard ones, allow you to remove only the prosthesis, and other abutments will have to be removed along with it , injuring the gums, which creates a risk of infection and the development of inflammation of the tissue around the implants, and this, in turn, can lead to rejection.

A temporary (adaptive) prosthesis is usually included in the cost of prosthetics using the “all on 6” system, just like the “all on 4” system. And the permanent one will have to pay extra. Temporary, as already discussed above, it is better to choose one with a metal frame, especially for men, even though it will be more expensive. It is better to choose a permanent one based on milled titanium or zirconium beams, or, in extreme cases, cobalt-chrome beams. Cast beams are significantly less strong and their fit is less precise.

It should be noted that prosthetics using the “all on 4” and “all on 6” systems always imply implantation with immediate loading, i.e. the prosthesis (temporary) is placed immediately - within 3 days after the operation. Some clinics offer installation using a delayed loading protocol - i.e. after 4-6 months, during which you will have to use a conventional removable acrylic denture. But this is not an “all on 6” (or “all on 4”) technique, but a conventional two-stage implantation.

Partial prosthetics

In the absence of part of the dentition, partial dental prosthetics is performed using a bridge or clasp prosthesis. Those. In this case, structures can be removable or non-removable. To install a fixed bridge, healthy abutment teeth must be preserved at the edges of the edentulous area. The bridge is a metal arch on which crowns are located, simulating missing teeth.

Along the edges there is a system of attachment to the supporting teeth. They are ground down and crowns are also put on them. In the absence of supporting ones, it is possible to install a bridge prosthesis on implants. A removable bridge with partial absence of teeth also implies that the structure will be attached to the supporting teeth. These can be dentures made of acrylic or nylon, or clasp ones.

Partial plastic dentures have clasps with which they are attached to the supporting teeth. Because of this, this type of denture is not used in cases where the supporting ones are located in the smile area, because the clasps will be visible. In addition, such dentures can cause discomfort and pain when chewing. It will be more convenient to install clasp frames.

Clasp prosthetics

A characteristic design feature of clasp dentures is a special metal arch (clasp). In the upper jaw structure it passes through the palate, and in the lower jaw it passes behind the front teeth, adjacent to the alveolar ridge of the jaw bone. The metal base is made of titanium, cobalt-chrome alloy, or precious metals.

Its strength makes it possible to reduce the total weight of the structure and the thickness of the plastic base, which has a positive effect on the ease of use of the prosthesis. For clasp dentures, the supporting teeth located on both sides of the jaw must be preserved.

This is one of the most optimal options for a removable bridge, because:

• clasp dentures effectively restore chewing function,
• firmly fixed on the jaw,
• do not impair diction,
• have a long service life.

To fix the clasp structure, various mechanisms are used - clasps (wire loops), micro-locks and telescopic crowns. The best, most reliable and aesthetically impeccable are clasp dentures with micro-locks and especially telescopic crowns.

They have one drawback - they are very difficult to manufacture and require highly qualified orthopedists and dental technicians, and therefore have a higher cost. But they better transfer the chewing load to the supporting teeth and practically do not cause their destruction, which, for example, occurs with the clasp system on clasps.

Prosthetics of lower teeth

The procedure has a number of features. First of all, aesthetic requirements for the lower teeth are less stringent, since the lower teeth are not as visible as the upper teeth. Also, the lower teeth are subject to a much greater chewing load, which places greater demands on the strength of the prosthesis and the reliability of its fixation.

And in addition, the anatomical features of the lower jaw (absence of a hard palate, frenulum of the tongue, etc.) make dentures difficult, making the task of achieving a strong fixation of the prosthesis much more difficult. As a result, prosthetics for the lower teeth turns out to be somewhat more complex, and the dentures may have a slightly different design. However, the same technologies apply to the lower teeth.

To restore healthy teeth with partial external damage, veneers and crowns are used here, and if 1-4 teeth are completely lost, a permanent bridge can be installed, supported by ground adjacent teeth. Or a removable plate made of acrylic or nylon, with clasps made of metal wire or polymer material.

If there are supporting teeth on both sides of the jaw, it is possible to install a clasp prosthesis, the design of which will differ from that used for prosthetics of the upper teeth in the shape and location of the arch. In case of complete edentia (absence of teeth) in the lower jaw, the dentition is restored using a removable full plate bridge, or a conditionally removable one on implants.

The latter option has a secure fit and impeccable functionality. In the lower jaw, implantation is easier, and the higher bone density often makes it possible to avoid lengthy and expensive bone augmentation surgery. Implants completely imitate natural teeth, including transferring the chewing load to the jawbone, which slows down its atrophy and allows you to use the prosthesis without correction or replacement for a longer time.

Prosthetics of anterior teeth

Front teeth always play an important role in a person’s appearance, so their restoration is almost always an urgent and pressing task that is important to solve as quickly as possible. As a result, prosthetics of the front teeth is associated not only with recreating the shape and appearance of the tooth itself, but also with the aesthetics of a smooth and beautiful gingival margin.

You can correct aesthetics (darkening, abrasion and small chips, gaps between teeth) with the help of veneers or lumineers, and you can restore severely damaged teeth by installing crowns on them. When one or more front teeth are lost, the problem of prosthetics is best and most effectively solved by installing implants.

The chewing load on them in this area is minimal, and quick prosthetics after tooth loss eliminates bone resorption and makes bone grafting unnecessary. When implanting with immediate loading, the patient receives a fully functional structure immediately (however, several months later, after the implant has completely engrafted, the prosthesis will have to be replaced with a permanent one).

In the case of a two-stage implantation protocol, while the implant is healing, the hole is closed with a temporary butterfly prosthesis, fixed with polymer clasps to the adjacent teeth. And after a few months, a gum former is placed, and after another 3-4 weeks - a permanent option. If implantation is not possible, one of the best options would be to install a clasp prosthesis.

Urgent prosthetics

If it is necessary to restore the integrity of the dentition as soon as possible, the patient is offered emergency dental prosthetics, which usually involves installation within one day. These can be temporary removable structures made of acrylic or nylon, other types of plastic, or non-removable ones - for example, temporary crowns. This type of dental prosthetics is used during tooth extraction and during the restoration process.

Another option is express implantation. Installation of a special implant with a bioactive surface can be non-surgical, or rather performed without an incision in the gum. A temporary crown or prosthesis can be immediately installed on such implants.

A characteristic feature of urgent prosthetics is that it is always a temporary structure that must be replaced with a permanent one after some time. Such prostheses are not very durable and have a limited service life.

Turnkey prosthetics

When calculating the cost of dental prosthetics, it is important to take into account all the nuances and costs at all stages. Clinics often try to show a lower cost of the procedure, without including in the price list the cost of some materials or procedures, which the patient will nevertheless have to pay.

That is why such an item as turnkey prosthetics arose. This means that by paying the specified amount, the patient will receive a fully functional prosthesis and will not have to pay anything else for this. However, it is necessary to take into account that in some cases the turnkey cost includes only the cost of manufacturing and installing a temporary prosthesis, which will later have to be replaced with a permanent one.

The cost of a permanent structure and its installation is not included in the price of the turnkey procedure, primarily because the permanent structure is installed several months (6 or more), or even 2-3 years after temporary dental prosthetics. And it is simply impossible to calculate in advance the cost of permanent dentures for months and years in advance, without knowing what type of prosthesis will be installed and how prices will change.

Why removing the root is not the solution to the problem

If there is no natural crown, and instead of it an empty space appears, especially when it is the roots of the upper front teeth, many people habitually rush to the surgeon. They want to remove the remains and quickly install a bridge, eliminating the aesthetic defect.

But first, it’s worth considering the situation with your doctor - there are certain risks during removal: damage to the mandibular nerve, excessive trauma to the gums, and others. In addition, tooth restoration based on its own root is always more gentle than any prosthetic method.

Dentists try to preserve every unit, since the absence of natural teeth leads to a decrease in the quality of life. If you simply remove the roots of permanent teeth, then immediate implantation is needed. In the absence of a unit, destructive processes begin in tissues, and bone volume decreases. Therefore, doctors do not recommend neglecting this problem. Even if there is no chewing molar, which is not visible.

Crown extension algorithm

In the process of building a crown using composite materials, it is especially important to accurately replicate the natural anatomical shape of the tooth surface. The chewing surface of molars is particularly complex. It is diamond-shaped and includes four tubercles:

• Paracone.
• Metacone.
• Protoconus.
• Hypocone.

Additional tubercles may also be present, for example, the Karabel tubercle. Between the tubercles there are grooves separating them from each other. The dentist must reproduce all these structures as accurately as possible, using composite materials and special instruments. Due to this, the chewing load will be evenly distributed, which will prevent further tooth decay.

To simplify orientation, a special coordinate system is used, which divides the tooth into four sections:

1. Medial.
2. Vestibular.
3. Distal.
4. Palatine.

This division makes it possible to more accurately calculate the pattern of tubercles and grooves on the functional surface of the crown, which significantly facilitates the formation of a new surface.

The restoration algorithm looks like this:

1. Cleansing teeth from plaque and other contaminants. Then a material of a suitable color is selected and a local anesthetic is administered. In essence, this is a preparatory stage at which everything necessary for further actions is prepared.
2. Tooth preparation. It involves the removal of parts of the crown that are injured or affected by caries. It is performed within the boundaries of healthy tissues that have retained their natural characteristics.
3. Application of materials. To imitate dentin and enamel, the same composition is used, differing in color. A darker shade is selected for dentin, and a lighter shade for enamel, corresponding to the color scheme of the remaining teeth.
4. Formation of a new chewing surface. It involves the artificial recreation of anatomical structures such as tubercles and grooves. This is a difficult stage, since the quality of the specialist’s entire work largely depends on it. To perform it, you will need to use several types of bur (ovoid, needle-shaped, No. 3, No. 4).

Different burs are needed to repeat the shape of the microrelief of the chewing surface, which will fully correspond to the structure of the lost area. After the process is completed, the crown is polished. To do this, use polishing heads made of silicone or circular brushes with polishing paste.

Restoration of the tooth crown

Polishing significantly improves the smoothness of the crown surface. In addition to additional comfort for the patient, polishing serves as a preventive measure for the development of caries and plaque deposits. It will be much more difficult for food debris and bacteria to attach to a smooth surface.

Examples of restoration of fifth teeth on the upper and lower jaws

Example 7. A metal tab and caries left only the root of the 5th tooth

A patient came to me with a 3.5 tooth. It was a pulpless tooth - the lower five, it did not have any periapical changes or inflammation in the area of ​​the root apex. The tooth was missing the upper half of the crown part of the tooth. This tooth 3.5 initially had a filling, a metal stump insert was installed in the tooth, quite deep, and a filling was already installed on top. Here's a “puff sandwich”:

As I said in the previous example No. 6, metal tabs are beginning to be used less and less in practice - they have been replaced by modern computer technologies, for example, Cerec. As a result of the atraumatic removal of the metal insert, the bone was preserved, nothing cracked: neither the root nor the remaining bone structure:

The restoration of the bottom five was carried out using Cerec technology in 1.5 hours

:

The “crown + root” module fell into place perfectly, the patient was very pleased with such a quick and effective solution to his problem:

Example 8. The top five were completely destroyed by caries. But the tooth root survived

With this example, I want to show you how deep caries can literally “eat” your teeth. And, of course, try to prevent it from developing like this. The patient is a fairly young man who has decided to radically improve his image. This is a laudable decision, but here are the teeth he came to me with:

Caries on almost all teeth. After removing the carious layer, the remains of the teeth appeared in this form:

Please note that in place of the upper tooth 5

There was practically only one root left with a small side wall. In this case, the same technology of tooth restoration using the “crown + root” module and crowns/half-crowns with an inlay function was used. The result of the treatment, as they say, is on the face:

The goal of treatment, according to the patient, has been fully achieved - a brutal Man

:

One-step restoration

One-stage restoration is a therapeutic procedure, while multi-stage restoration is the restoration of a tooth using an orthopedic method (inlays and veneers). A tooth in need of restoration is significantly damaged, and often, in order to restore the shape of the tooth therapeutically, it is first necessary to install a pin in the root. Pins are available in metal and fiberglass. The latter have little flexibility, which completely prevents root fracture during installation. And they come in white and transparent, which eliminates the influence of their color on the final color of the filling.

Fiberglass posts are more expensive than metal ones, but they are preferable for anterior teeth where esthetics are important. Next, the filling mass is applied layer by layer to the installed pin, like a frame. And this is where the real art begins.

The doctor is not limited in time, because The filling will not harden until it is exposed to the light beam of a gel lamp. But the amount of each layer of material, the sequence of application of different shades, the actual choice of color, and ultimately the modeling depend solely on the professionalism of the dentist. Next, the filling is ground and polished, giving it a final sparkling shine.

When and how can you restore a tooth with Cerec?

A common problem is the development of caries on the frontal units. The result is their complete destruction. The patient sometimes comes too late. Or the previous intervention does not bring the desired result. When several units in the smile area are damaged, and some of them only have tooth root tissue left, you can combine the installation of crowns, veneers and restoration of the upper visible part using special inlays in the root system. Sometimes large-scale intervention is needed - the smile area is corrected, damaged teeth are recreated. You can do a step-by-step restoration of 10 or even 20 teeth above and below.

Using Cerec technology, if there is a healthy root, it is easy to restore almost every tooth within a few hours.

• It will be necessary to determine the condition of the root and undergo a course of treatment.
• Then, after treating the upper roots, it is possible to install a module with the alignment of the tooth crown and the insert into the cavity in the tooth root.

A smile should always be charming. When restored, the new units are ideal, better than natural ones. In addition, natural teeth darken under the influence of pigments or turn yellow with age. Therefore, next to the restored ones they look unaesthetic.

To avoid such consequences, units can be corrected with veneers or crowns (when they are 50% destroyed and there is no stable support). To create an impeccable beauty zone thanks to Cerec, you only need a few visits to the doctor.

Photopolymer compositions: features and indications for installation

Such fillings for dental treatment are cured under the influence of light waves, in most cases in the ultraviolet spectrum. They are suitable for installation on the front and lateral teeth, have good adhesion to natural tissue, have a long service life, and allow you to choose a shade that is as close as possible to the color of the dentition.

Light-curing fillings are placed for:

• Protection of damaged outer (enamel) and inner (dentin) layers of the tooth.
• Restoration of medium and large cavities.
• Elimination of too wide interdental gaps.
• Correction of tooth shape.

The photopolymer composition is not recommended if the patient has severely inflamed gums, allergies to components or involuntary grinding of teeth.

Features of Cerec technology

Cerec root inserts and crowns are made from metal-free materials - it can be ceramic or zirconium dioxide. They can be installed even for allergy sufferers without fear. This technology has completely changed traditional approaches to dentistry.

Now the restoration process is comfortable and takes a minimum of time. In my clinic, the procedure is carried out in several stages.

I would also like to note that only one anesthesia is required and there are practically no errors when creating new teeth. Stages:

1. An intraoral scanner determines the boundaries of the damage. This is especially important when only the roots of the front teeth or molars remain. The remaining tissues, antagonist teeth, and closed rows are scanned.
2. The information is transferred to a computer, where all the images are combined into an image.
3. The program creates a three-dimensional model of the remaining tooth, all defects are clearly visible. Then models of the inlay and crown are created that perfectly replicate the anatomical features of the tooth. Dimensions and shape are calculated accurately. It is determined what kind of restoration is needed.
4. The design is made from blanks on a milling module. The elements are being tried on. In rare cases, correction is required. Shade discrepancies or other issues that displease the patient can be easily corrected within a few minutes.
5. The completed root inlay fits hermetically to the remaining parts of the tooth, is securely fixed and exactly matches the shape.

Thus, it is possible to quickly restore units if only the roots of the teeth of the lower or upper jaw remain.

Benefits of Cerec Restoration

The innovation has clear advantages compared to traditional prosthetics:

• The process does not take a week or several days, but only 1.5 hours
  per tooth maximum.
• Accuracy
  . The computer minimizes errors and eliminates errors.
• Biocompatibility
  . Fabrics do not reject materials.

An inlay in the tooth root is created quickly, then the crown is modeled. The price is fully justified by the reliability, long service life of the structures and their aesthetics.

There is a striking difference between the smiles of patients when they only had the root of the tooth left, and the photo after treatment with Cerec dentures.

Types of filling materials

Example 9. Restoring the bottom six “from the root”

In this case, I would like to simply dwell on the moment of restoration itself. The patient is older, over 50 years old. And he felt the need to restore the chewing group of teeth. The picture shows the lower 6th tooth, of which practically only one root remains:

The tooth was restored in 1.5 hours

using Cerec technology. The very speed of tooth restoration in one visit to the doctor and the patient’s ability to immediately, as they say, use it in chewing gives a 100% head start on any existing method of tooth restoration. It works really well - you can see for yourself.

Example 10. Restoring the bottom seven

And I end my examples with the classic option of restoring the seventh lower tooth, of which only the root part remains. Removal of the lower 7th root of the tooth was not required; Cerec technology again proved to be excellent:

After modeling in 3D, manufacturing the module itself only took about 20 minutes, after which it was successfully installed on the remaining root:

Rehabilitation after restoration of the crown part of the tooth

Once the coronal portion has been successfully restored, it requires proper care. This will allow you to maintain the result for many years of life without the need for repeated intervention. You need to brush your teeth at least twice a day, as well as after every meal and consumption of sweet and carbonated drinks. The fight against plaque and hard deposits, which are the main threat to the health of periodontal tissues, can be carried out using a regular brush, antibacterial pastes, irrigator, threads and other devices.

To prevent the denture from changing its shade and standing out against the background of your teeth, it is best to avoid strong, black coffee and tea, red wine, berries, beets and other foods containing dyes. This is not as scary for ceramics as, for example, for plastic or composite material. In order not to break the newly installed crown, you need to avoid nuts and crackers. You can eat them, but only very carefully, in small pieces.

Since restoration requires considerable time and financial costs, it is better to avoid repeated breakdowns. At the slightest suspicion of caries, gingivitis, periodontitis or periodontal disease, you should seek help as soon as possible. The same should be done if minor damage was noticed on one or more teeth. While the defect is barely noticeable, it responds better to the most primitive treatment.

Should the tooth root be removed? In what cases is this necessary?

Is it necessary to remove the root of a tooth? The root must be removed if:

• it is mobile, unstable or has a deep pocket;
• there are cracks;
• the root processes are “recessed” into the bone tissue and are located below their level;
• root tissue is softened or severely destroyed;
• There are chips in the tooth root.

Modern surgery is as painless as possible. Doctors perform the procedure while maintaining the integrity of the surrounding tissue. In the absence of inflammatory processes, it is possible to remove the real tooth root with simultaneous implantation of an artificial one.

CONCLUSIONS:

As you can see from the examples provided, I, orthopedic dentist Sergei Samsakov, an expert in the field of digital modeling and restoration of teeth using Cerec, manage to restore a beautiful smile even in almost the most hopeless cases. If you have similar problems, do not hesitate, contact us, and we will always find the optimal and, most importantly, beautiful solution to your situation.

And remember the simple truth: there are no hopeless situations!

Contraindications

Fortunately, there are not many absolute restrictions, but you need to know about them in advance. This usually includes intolerance to the materials and substances used for pain relief, as well as serious diseases of the heart, respiratory system, problems with blood clotting and mental disorders, due to which the patient cannot remain stationary for a long time. However, in the latter case, a solution can still be found, for example, by using general anesthesia instead of local freezing.

There may be more temporary contraindications; first you will have to deal with them, only then can you talk about restoration. This usually includes the presence of caries, thyroid diseases, problems with the immune system, and oncology. Also questionable is the possibility of treatment during pregnancy and breastfeeding, during radiation therapy, when diagnosing alcohol and drug addiction, etc.

Difficulties may also arise when a person takes certain medications, for example, blood thinners, cytostatics and others. You will also have to temporarily refuse intervention if there is severe stress, cachexia, that is, exhaustion of the body against its background, as well as fear of doctors. In the latter case, you can try the introduction of sedatives, which have a relaxing and calming effect.