Prosthodontics

Prosthodontics is a branch of dentistry that specializes in the repair and replacement of teeth that are missing or damaged to the point at which function is impaired. These treatments often include the use of dental prosthetics, or artificial teeth, in the form of crowns, bridges, full and partial dentures, and other similar items, and may be removable or permanently fixed. The practice of prosthodontics focuses not only on restoring the cosmetic appearance of teeth and the mouth, but also on restoring proper function for biting, chewing, and speaking.

Background

The earliest practice of dentistry was concerned mostly with the extraction, or pulling, of teeth that were damaged or diseased. The ancient Egyptians used bands of gold to help attach teeth that were growing loose to stable teeth in an effort to save them in the earliest recorded attempt at prosthodontics. People were replacing these missing teeth with dentures as early as 700 B.C.E. The Etruscans living in what is now Italy began attaching gold bands to animal teeth or teeth from a deceased person and using the bands to connect the replacement teeth to teeth still in the person's mouth. The Phoenicians developed a similar practice about 300 C.E.

For many years, substitute teeth were carved from the teeth of walruses and hippopotami, or from the ivory in elephant tusks. These dentures were not very comfortable and gave off an odor after a time. People continually sought better options and new ways to use teeth from one person to replace another. About 600 C.E., the Mayans successfully inserted shells into the jaw as substitute implanted teeth. Other cultures also attempted implants with various substances, including stone. Over the years, attempts were made to implant teeth from one human to another with various amounts of success. During the early twentieth century, a new procedure was developed using metal screws—made first of gold and later of a chromium-cobalt alloy called Vitallium—to anchor replacement teeth into the jaw. Researchers have continued to develop improvements and innovations.

While experiments with implants went on various cultures around the world, most eventually began to make dentures containing human teeth. Many of the teeth used were taken from men killed in battles. The discovery of a process for making vulcanized rubber helped to improve dentures in the 1850s, when molded rubber replaced gold bands for holding dentures in place. This also made them more comfortable and more affordable. The development of plastics throughout the nineteenth and twentieth centuries allowed for better and less expensive dentures, further improving prosthodontics.

Along the way, dental professionals also experimented with filling materials and substances that could be used to coat or fill in damaged areas of teeth. New techniques were also developed to help implants meld to bone, making the teeth stronger and more solid. Prosthodontists now have ways to replace or repair teeth to match existing natural teeth in shape, size, and color.

Overview

Prosthodontics is one of nine divisions of dental care recognized by the American Dental Association. It is among the oldest of dental practices, after oral surgery, and applies to a full range of dental problems from a chipped tooth to a full set of implanted teeth to reconstructing the mouth of someone hurt in an accident. In many cases, the prosthodontist will work with a team of dental specialists and possibly medical doctors to resolve a patient's problems.

All prosthodontic devices, such as bridges, crowns, partial or full dentures, and implants, can be completed by a general practice dentist. However, some dentists choose to specialize in prosthodontics. This requires an additional two to four years of schooling beyond the four years completed by general dentists. During this additional training, prosthodontists learn the techniques for fitting, making, and inserting various types of replacement teeth.

The practice of prosthodontics applies to other areas of oral health and appearance as well. Prosthodontists are trained in understanding how the teeth and jaw are affected by injury and diseases such as cancer, as well as the impact of some types of birth abnormalities. They can repair tooth and jaw problems such as pain and difficulty chewing related to these conditions. Prosthodontists can also help with problems such as temporomandibular joint dysfunction (TMD) and similar jaw issues, as well as snoring and sleep disorders related to the shape and construction of the mouth.

In addition to learning the physical procedures for extracting or reshaping damaged teeth, fitting replacements, and other techniques for correcting tooth and jaw problems, prosthodontists learn skills that are as much art as they are science. The teeth that they create as replacements need to match the remaining teeth in color, size, and shape. Even when a full set of dentures is being made and there is no need to match existing teeth, the prosthodontist works to make the dentures look like the teeth they are replacing, or to make the teeth look as if they fit the person's age, gender, size, and overall appearance.

Twenty-first century prosthodontists can take advantage of new digital technology that assists with the design and fitting of replacement teeth. This technology allows the practitioner to repair or craft replacement teeth faster and easier than before, so that a person can get a chipped tooth fixed in less than one full day. New materials make dental replacements more comfortable and durable than in the past.

According to the American College of Prosthodontists (ACP), an estimated four thousand prosthodontists were practicing in the United States in 2016. The cost of prosthodontic work varies considerably, depending on the condition of remaining teeth (where applicable), the health of the bone (for implants), and the number of teeth replaced. A full set of dentures can cost $2,500 or more, while implants can cost upwards of $3,000 per tooth. While dentures may be less expensive, they can be uncomfortable and cause unpleasant tastes. They are also more prone to breakage and can be lost. Implants have a less than 5 percent failure rate (Alderman).

Bibliography

Abraham, Celeste M. "A Brief Historical Perspective on Dental Implants, Their Surface Coatings, and Treatments." The Open Dentistry Journal, 16 May 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4040928/. Accessed 10 Dec. 2016.

Alderman, Lesley. "For Most, Implants Beat Dentures, But at a Price." The New York Times, 30 July 2010. PERLINK "http://www.nytimes.com/2010/07/31/health/31patient.html" www.nytimes.com/2010/07/31/health/31patient.html. Accessed 10 Dec. 2016.

"Dental Treatments Provided by the Prosthodontist." Association of Prosthodontists of Canada, ttp://www.prosthodontics.ca/procedures.html" www.prosthodontics.ca/procedures.html. Accessed 10 Dec. 2016.

Hobkirk, John A. "Prosthodontics: A Past with a Future?" Journal of the Canadian Dental Association, May 2005, Vol 71 No. 5, PERLINK "http://www.cda-adc.ca/jcda/vol-71/issue-5/326.pdf" www.cda-adc.ca/jcda/vol-71/issue-5/326.pdf. Accessed 10 Dec. 2016.

"What is a Prosthodontist?" University of Michigan, PERLINK "http://www.dent.umich.edu/about-school/department/bms/prosthodontics/what-prosthodontist" www.dent.umich.edu/about-school/department/bms/prosthodontics/what-prosthodontist. Accessed 10 Dec. 2016.

"What is a Prosthodontist and the Dental Specialty of Prosthodontics?" American College of Prosthodontists, YPERLINK "http://www.prosthodontics.org/assets/1/7/1.What‗is‗a‗Prosthodontist‗and‗the‗Dental‗Specialty‗of‗Prosthodontics‗‗-‗approved1.pdf" www.prosthodontics.org/assets/1/7/1.What‗is‗a‗Prosthodontist‗and‗the‗Dental‗Specialty‗of‗Prosthodontics‗‗-‗approved1.pdf. Accessed 10 Dec. 2016.

"What is Prosthodontics?" Pacific Coast Society for Prosthodontics, YPERLINK "http://www.pcsp.org/whatisprostho.html" www.pcsp.org/whatisprostho.html. Accessed 10 Dec. 2016.

"Where to Go When You Chip a Tooth? A Prosthodontist." American College of Prosthodontists, 14 April 2016, HYPERLINK "https://globenewswire.com/news-release/2016/04/14/829085/10161851/en/Where-to-Go-When-You-Chip-a-Tooth-A-Prosthodontist.html" globenewswire.com/news-release/2016/04/14/829085/10161851/en/Where-to-Go-When-You-Chip-a-Tooth-A-Prosthodontist.html. Accessed 10 Dec. 2016.