Replacing Missing Teeth

Prosthodontics is the dental speciality that deals with the diagnosis, prevention and treatment of problems caused by tooth loss, with the aim of maintaining a functional dentition for life.

We offer the following Prosthodontic Services:

• Replacement of Missing Teeth
• Implant Dentistry
• Fixed Bridges
• Partial & Complete Dentures
• Crowns
• Porcelain Laminates (Veneers)

Replacement of missing teeth
Replacement of missing teeth can be accomplished by three different treatment modes:

1. Implant Dentistry
2. Fixed Bridges
3. Removable partial or complete dentures
The best treatment depends on the number, location and condition of the remaining teeth. Other important factors are level of patient commitment, time commitment and cost. Your doctor will discuss all of these aspects with you to help you arrive at the replacement option that is best for you. All three of these options can restore function and stabilize the bite in an esthetically pleasing way.

Implant Dentistry:
Dental implants serve as the foundation for many types of tooth replacement. Implants can replace one tooth or several missing teeth with crowns or bridges that are fixed in place. For replacement of many teeth or all of the teeth, implants can support very secure removable dentures or fixed bridges if the conditions in the mouth are favourable.

Fixed Bridges:
Fixed bridges are natural-looking tooth replacements which fill in the gaps caused by missing teeth, reduce stress on the jaws and help maintain lip and cheek support. These bridges are cemented on the existing teeth and are not removable by the patient.

Removable Partial Dentures:
Removable partial dentures replace the missing teeth by utilizing the remaining teeth for support and grip. Removable partial dentures are a functional, esthetic and cost-effective means of tooth replacement. They can be removed for brushing and cleaning.

Complete Dentures:
Complete dentures replace teeth when all upper and/or lower teeth are missing. They restore the function of eating, restore proper facial esthetics and help people talk properly. Dental implants are sometimes used for better stabilization of these removable complete dentures.

Crowns:
Crowns are used to protect root-canal-treated teeth and to restore the shape, size or color of stained, irregular or otherwise abnormal teeth.

Porcelain Laminates (Veneers):
Porcelain veneers, or laminates, are very thin, tooth-colored shells that are custom-made and bonded to the front surfaces of teeth to close gaps, cover stains and discolorations, and correct chipped or irregular teeth to give you a bright, even, attractive smile.

Questions & Answers

Do you ever wonder who a Prosthodontist is, or what kind of dentistry he or she practices?
If so, you're not alone. Even though millions of people have bridges or dentures, or have their teeth capped, they never think it's all called "Prosthodontics". When dentists have undergone two or more years of speciality education in this sort of dental treatment, and thus specialize in this treatment, they are called Prosthodontists.

Who is a Prosthodontist?
A Prosthodontist is a specialist in the restoration and replacement of teeth - everything from crowns and bridges, to the restoration of implants — procedures that are designed to restore the smile to your face.
In addition to a basic dental degree, a prosthodontist has had an additional two to three years of advanced study and clinical training leading to a Master’s degree in prosthodontics.

What are the most common prosthodontic procedures?
• Single Crowns
• Fixed bridges.
• Removable Partial dentures.
• Complete dentures.
• Overdentures.
• Implant-supported Fixed Crown and Bridge or Removable dentures.
• Reconstruction and Maxillofacial Services - rebuilding the teeth, jaw, palate, or other facial structures, to correct complex problems including TMJ dysfunction, and to evaluate the need for implant dentistry. This may require treatment by a team of doctors.

Why should I replace missing teeth?
Your appearance is one reason. Another is that the gap left by a missing tooth can mean greater strain is put on the teeth at either side. A gap can also mean your ‘bite’ is affected, because the teeth next to the space can lean into the gap and alter the way the upper and lower teeth bite together. This can then lead to food getting packed into the gap, which causes both decay and gum disease.

How are missing teeth replaced?
This depends on the number of teeth missing and on where they are in the mouth. The condition of the other teeth also affects the decision. There are two main ways to replace the missing teeth. The first is with a removable false tooth or teeth – a partial denture. The second is with a fixed bridge. A bridge is usually used where there are fewer teeth to replace, or when the missing teeth are only on one side of the mouth.

What is a partial denture?
This is a plate with a number of false teeth on it. It may be all plastic or a mixture of metal and plastic. Both types may have clips (clasps), to help keep the denture in place in the mouth.

What is the difference between a plastic partial denture and one that contains metal?
Plastic partial dentures are less expensive to make. But unless they are designed very carefully they can damage the teeth they fit against. Metal partial dentures are usually from an alloy of cobalt and chromium and are much stronger, lighter to wear and can be supported by the remaining teeth. Although the base is metal, they have gum-coloured plastic and natural-looking teeth fixed to them. They are more expensive than the plastic ones.

Why do I need a full-mouth X-ray?
A full mouth X-ray helps the doctor have a clear idea about the condition of your teeth, supporting bone structure and jaws, so that he/she can develop a treatment plan that is right for you.

Will I ever get Dentures that fit comfortably?
Yes. With today's modern materials (such as thermoplastic cushion liners) and methods, comfort, function, and a beautiful smile is what we are able to achieve on a daily basis. Just ask our patients!

What will dentures feel like?
It may take a few days or weeks to get adjusted to new dentures, especially if it is a first time experience for you. They may seem loose while the muscles of your cheek and tongue learn to keep them in place. It is not unusual to experience minor irritation or soreness, and saliva flow may temporarily increase. As your mouth becomes accustomed to your dentures, these problems should diminish. One or more follow-up appointments are generally needed after a denture is fitted.

Will dentures change the way I look?
Your new dentures will fill out your cheeks and support your lips. They may even improve the look of your smile and add fullness to your facial appearance. With your suggestions, your dentures can be made to closely resemble your natural teeth so that little change in your appearance will be noticeable.

Will I be able to eat with my dentures?
Initially eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly using both sides of your mouth at the same time to prevent the dentures from tipping. As you become accustomed to chewing, add other foods until you feel you can return to your normal diet. Continue to chew food using both sides of the mouth at the same time. Be cautious with hot or hard foods and sharp-edged bones or shells.

Will I sound different with my dentures?
When you first get your new dentures, your speech may sound different. As you use your new dentures and practice speaking, you will sound "normal" to yourself and others. Reading out aloud and practicing difficult sounding words will help you get used to speaking more normally. You may find your dentures occasionally slip when you laugh, cough or smile. Reposition the dentures by gently biting down and swallowing.

I have some sore spots with my new dentures. Is this normal? What should I do?
Your gums were never created to bear dentures!! Thankfully, they are accommodative to a hard, new plastic denture over a period of time. If a new shoe “bites”, why not a new denture?? Sore spots are perfectly normal for a new denture wearer. If they develop, please avoid wearing your dentures until you are able to see us. But be sure to wear the denture for at least 24 hours prior to your adjustment visit. This helps us to make the necessary adjustments better.

How do I clean my dentures?
Like natural teeth, dentures must be cleaned daily to remove food deposits and plaque. Brushing prevents dentures from becoming permanently stained and helps your mouth stay clean and healthy. It is best to use a brush designed for cleaning dentures or a toothbrush with soft bristles. Avoid using hard-bristled brushes as they can damage dentures. Dentures can be cleaned using a hand soap or mild dishwashing liquid. Brush your dentures before soaking them at night. Make sure you clean all surfaces of the dentures, including the surface which comes into contact with your gums. This is especially important if you use any kind of denture fixative. You may also use a certified denture cleaner to help remove stubborn stains and leave your denture feeling fresher – always following the manufacturers’ instructions.

Do my dentures need any other care?
Dentures may lose their shape if they are allowed to dry out. When they are not worn, dentures should be soaked in tap water, in a closed container. Never place dentures in hot water, as they may distort.
Dentures may break if they fall and hit a hard surface. When handling your denture it is a good idea to stand over a folded towel or a basin of water. When you are not wearing them, store your dentures away from children and pets.

Must I do anything special to care for my mouth?
Even with full dentures, you still need to take good care of your mouth. Every morning and evening, brush your gums, tongue and the roof of your mouth with a soft-bristled brush. This removes plaque and helps the circulation in your mouth. If you wear partial dentures, it is even more important that you brush your teeth thoroughly every day. This will help stop tooth decay and gum disease that can lead to you losing more of your teeth.

Will I need denture adhesive?
Dentures are made to fit precisely and usually do not require an adhesive. Sometimes however, due to the excessive loss of bone support or dryness of your mouth, you may need denture adhesives to make your dentures feel more comfortable.

Should I wear my dentures at night?
We prefer that you take your dentures out at night. This gives rest to your gum tissues by relieving them of the constant pressures exerted by the dentures throughout the day. When left out of the mouth, all dentures should be kept in water.

Why have my dentures become loose with time?
Gum tissues are in a constant state of change like the rest of your body but dentures are not. Hence over a period of time, well fitting dentures tend to fit less securely. The extent to which this happens varies for different patients.

How often should I change my dentures?
Ideally you should change your dentures every 5-7 years. Regular semi-annual visits permit us to advise you better on its need. It is important to replace worn or ill-fitting dentures before they cause problems. Over a period of time, existing dentures will need to be resurfaced or replaced with new ones.
With regular professional care, a positive attitude and persistence, you can become one of the millions of people who wear their dentures with a smile.
Can I make minor adjustments or repairs of my dentures?
Never try to adjust or repair your dentures yourself. By doing so, you can seriously damage them and in turn, harm your oral tissues. A dentist can often make the necessary adjustments or repairs on the same day.

What's the difference between immediate dentures, conventional dentures and an over-denture?
Immediate dentures are inserted immediately following the removal of teeth. The advantage is that the wearer can avoid an embarrassing phase without teeth during the healing period. However, changes in the oral tissues during the first six months following the removal of teeth may require resurfacing of the denture to improve its fit.
Conventional dentures are made and inserted after all the teeth are removed and the tissues have healed completely. The healing period though variable, takes about 3 – 4 months.
Healthy teeth can support dentures better. The prepared teeth provide stability and support for the “Over-denture” and their preservation slows down irreversible changes in the oral tissues.
What is the alternative to a partial denture?
The main alternative is a fixed bridge. This is made by putting crowns on the teeth at either side of the space, and then joining these two crowns together by placing a false tooth in the space. This is all made in the laboratory and then the pieces are cemented into place with special adhesives. The bridge can’t be removed.

Can I always have a bridge to replace missing teeth?
Bridges are only possible if you have enough strong teeth with good bone support. We can advise you on what is best for you.

What are bridges made of?
Bridges usually made of porcelain bonded to metal. There are also new bridges made entirely of a special type of strong porcelain.

Are bridges expensive?
Although a bridge may seem expensive at the outset, it will last many years. It will also improve your appearance and bite. A bridge uses the considerable skill of the dentist and technician, and in this way, it is similar to ordering a piece of hand-made jewellery. The materials used are also expensive. So it is fair to say a bridge will not be the cheapest treatment you have ever had.

How do I look after my bridge?
You need to clean your bridge every day, to prevent problems such as bad breath and gum disease. You also have to clean under the false tooth every day. We will show you how to use special floss, as a normal toothbrush cannot reach these areas.

What is a crown?
A crown is an artificial restoration that fits over the remaining part of a prepared tooth, making it strong and giving it the shape of a natural tooth. A crown is sometimes known as a ‘cap’.

What is a post crown?
In root-filled teeth it may be necessary to cement a post into the root canal in order to provide additional support for the crown.

How long does treatment for crowns take?
You will need to make at least two visits: the first for the preparation of the tooth, impression, shade taking and fitting the temporary crown; and the second to fit the permanent crown. The second appointment is scheduled based on the laboratory time required for fabrication of the crowns.

Does it hurt to have a tooth prepared for a crown?
No. A local anaesthetic is used if necessary and the preparation should feel no different from a filling. If the tooth has been root-canal-filled, then a local anaesthetic may not be needed when a crown is being prepared.

How do I care for my crown?
How long your crown lasts depends on how well you look after it. The crown itself cannot decay, but decay can start where the edge of the crown joins the tooth. Therefore, it is important to keep this area just as clean as you would your natural teeth in order to prevent decay affecting the crown.

How long will the crown last?
Properly cared for crowns should last for many years. We schedule periodic dental check-ups at no extra cost, to review and ensure that our patients maintain their crowns well.

What is a veneer?
A veneer is a thin layer of porcelain custom made to fit over the front surface of a tooth, like a false fingernail fits over a nail. Veneers are used to improve the colour, shape and position of your teeth. A precise shade of porcelain veneer can be chosen to give the right colour to a discoloured or stained tooth or to generally lighten all the front teeth (usually the upper ones). A veneer can make a chipped tooth look intact again. Veneers can also be used to close small gaps, when orthodontics (braces) are not suitable. If one tooth is slightly out of position, a veneer can sometimes be fitted to bring it into line with the others.

What are the advantages of veneers?
Veneers make teeth look natural and healthy. Because they are very thin and are held in place by a special strong adhesive, very little preparation of the tooth is needed.

How long will it take?
A veneer takes at least two visits: the first to prepare the tooth and to match the shade, and the second to fit it. Before bonding it in place, you be shown the veneer on your tooth to make sure you are happy with it. Bonding a veneer in place is done with a special adhesive, which holds it firmly on the tooth.

How long will a veneer last?
Veneers should last for many years; but they can chip or break, just as your own teeth can. Small chips can be repaired, or a new veneer made if necessary.

What about alternatives other than veneers?
A natural-coloured filling material can be used for minor repairs to front teeth. This is excellent where the tooth supports the filling, but may not work so well for broken tooth corners. There will always be a joint between the tooth and the filling material. Crowns are used for teeth which need to be strengthened – either because they have broken, have been weakened by a very large filling, or have had root canal treatment.

What about treatment costs?
The total cost will be based on the treatment you need, and will be explained to you. A beautiful, healthy smile is one of the best investments you can make.

How do I schedule an initial appointment?
It's easy - just give us a call at +91- 484 - 220-3636 and our friendly staff will assist you!

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© All images here are taken by Dr Joseph Varghese. All these photos are of our own patients.