Prosthesis In Dentistry: Types, Importance Of Shade Taking, And Orthodontic Treatment

Protracting and retracting the soft tissues

Describe about prosthesis in dentistry.

Prosthesis in dentistry refers to the process of replacing a single tooth or several teeth as well as missing tissues. If it happens that the teeth are not stable or are missing entirely, they can be restored back by the use of eitherfixed or removable prostheses, a painless solution.In fixed prosthesis, the missing teeth are replaced by the use of bridges or crowns through cementing directly on the teeth. The removable prosthesisfor the teeth are attached to the toothless jaw incase a tooth is totally missing or directly on the teeth or implants, if it is only some teeth which are missing (Li et al., 2013). Under normal circumstances, if one or more teeth are lost this causes the neighboring teeth to move over time. Thus the remaining gaps needs to be filled up early enough while there is still sufficient space to reposition the tooth. If this is not done as early as possible, the body begins to close this gap by moving the nearby teeth and its opposite number on the other jaw. The result of this reposition is occlusion of the mouth, resulting in several consequences for the temporomandibular joints as well as other repercussions on the spine.

However, the oral cavity is a very difficult area to treat in restorative dentistry since the cheeks, tongue and lips provide difficulties in accessing and visualizing as well as manipulating the instruments to be used for the dental procedures. If not properly used, these instruments can result in the bleeding and injury to the soft tissues.The dental dam provides control and proper access to the tooth for proper preparation and restoration.In case the cervical lesions are at or below the free margin of the gingiva tissues, methods that employ gingival retraction needs to be used. In case the crown or on-lay margins are at or below the free margin, then the tissues needs to be displaces by use of methods that are not likely to cause damage or bleeding to the tissues To protect the soft tissues, I would aspirate and hold the cheek back with my aspirator or I could give the dentist some cotton rolls Ito et al., 2013).

In tissue management, therefore, the soft tissues should be placed away from the preparation margins. In the mechanical displacement method, the tissues are physically moved from the tooth aside so that proper visualization as well as treatment can be done. Basically the retraction cord can also be used for this physical displacement. It is preferred by many dentists because it is woven in different sizes and shapes to accommodate the varying thicknesses and diameters of the dental cavity (Zhao et al., 2014). Some other manufacturers have also come up with non-impregnated cords and chemically impregnated cords.Therefore a dentist needs to wear protective latex free gloves when handling these retraction cords. If there is a contamination with latex materials, this can result in an inhibitory effect while setting the vinyl polysiloxane impressions materials leading to gingival tears of the materials used for impression.

Importance of shade taking

In order to reduce the problems that can arise from selecting of shades in dentistry, it is crucial that the dentists comprehend the art as well as science of shading and color selection. The fact that the appearance of a given color and its perception has both objective and subjective implications may make this process to be difficult. Moreover, the human eye fails to perceive color in a clear, consistent and concise manner due to variation from one person to another (Alshiddi and Richards, 2015). As a result of these differences, the clear understanding of color requires that one understands the dimensions of color accompanied by its value, translucency and specific focus.The inconsistency in the results arising from dental shading due to control of colors has been a problem from time immemorial and hence the need to lay emphasis on this issue.

Therefore there needs to be a clear cooperation between the clinician as well as the laboratory technician in the development of better materials to be used for restoration and development of dental adhesives. In addition, these materials should enable the clinician to increase the rate at which translucency and vitality of the teeth becomes after dental restorations. The ceramic restorations should be done while at the same time maintaining optimal color and shading. This is because in the modern world, an attractive smile is an essential part of life as compared to initial perceptions of it being a luxury. This therefore calls for an attractive visual appearance of the person who has undergone dental restoration to be attractive. Therefore determining the color and shading for a dental restoration depends on the environment, illumination and the eyes of the receiver.

Prosthesis can be prescribed by technicians for instance if the patient lack all teeth and hence this procedure can restore the functions of the mastication using a device which the patient can easily remove and reinsert any time they want. This is because this device replaces all the teeth by use of an acrylic resin support and ceramic teeth. In fact, the more natural the appearance of the dental system is, the closer it resembles that of the face of the respective patient. On the other hand, a partial prosthesis is normally attached to the remaining teeth by the use of hooks. If the dentist uses metallic support structureas anchorage materials, this is referred to as skeletal prosthesis.

Orthodontic records are needed for carrying out orthodontic treatment plan although the monitoring of the facial growth as well as its development is also of dental clinic importance. Some of the traditionally used charts and records include the intra oral photographs, extra oral photo graphs, dental casts, clinical measurements and radiographic images (Hämmerle et al., 2015).Recently, there has been technological advancement in the digital world as far as dental models are concerned through the application of digital dental set-ups which mimic the actual outcome of the expected orthodontic treatment. Additionally, the application of the three-dimensional imaging on the face has led to development of alternative methods to conduct the documentation of the patient. In order to come up with the final charts or records to be used for a certain patient, it is imperative that the dentist analyzes each record separately for its specific contributions.

Importance of laboratory prescription for prosthesis

In removable treatment, the removable materials are used to fix the remaining teeth or fill up the spaces left. They consist of a customized plastic base plate with wires and screws attached. They are basically used for simple tooth movement but can also be used for initial stage s of complex treatments (Meyer-Marcotty et al., 2012). The fixed treatment consists of individual brackets which are stuck on the teeth. As a result of this fixing, the tooth movement occurs due to the thin flexible wires as well as elastic bands. The teeth are then slowly moved into their normal positions through little pressure as the wires get adjusted.

These instruments, which include interproximal saws, interproximal stripping systems, band seaters, bur kits as well as cutters and pliers, help, ensure practitioners provide patients with exceptional, precise orthodontic care. Several orthodontic instruments are available and differ in functions as well as options. Some are designed for general use, while others are specialized for certain tasks. For instance, the orthodontic cutters can be customized for specific task although they can be also combined with orthodontic pliers. On their own, the orthodontic pliers are to perform arch wire functions such as loop forming, arch wire contouring and torqueing. Other appliances include the bur kits, cutters, band seaters, cassettes and interproximal saws.

Fixed orthodontic appliances- They consist of band cemented to teeth and thin metal wires positions the teeth in the right position. The metal wire is tied to the bands with steel ligature and the bands are made of either metal, ceramic or plastic (Teh et al. 2014). The different stages in fixed orthodontic treatment are as follows:

• Fitting- In this stage the dentist requires patient’s records to assess the teeth where fitting is required and metallic spacers to create space for bands and separate back teeth. During the first stage, the X-rays of teeth are taken based on which orthodontist plans treatment for patients. After this fitting is done either by removal of crowded permanent teeth and fitting of braces. Metal or elastic separators are first used to create space for banding teeth and then bands and brackets are bonded to the teeth. Fitting helps in aligning irregular teeth and improving height differentials. For fitting, the dentist requires equipments like adhesive to cement the bond and brackets or archwires are needed to fix bands (Costa et al., 2015).
• Monitoring- During the monitoring stage, extraction are done after fitting the braces. Working with fixed braces after fitting helps in resolving overbites and closure of space after extractions. Equipments needed by dentist in this stage include rubber bands and brackets with hooks for adjustment.
• Adjusting- The final stage is the adjustment stage in which adjustment to the braces are done by equipments like changing wires or adding springs or elastics. Finally retainers are used to hold the teeth in new position during debanding appointment (Papageorgiou et al., 2016).

Removable braces- This appliance is used when baby teeth are left or when jaw growth needs to be normalized and treatment of lateral incisor cross bite. The removable appliances are retained by dentist by use of equipments like the Adam’s clasp, Labial arch and the Acrylic Resin framework. Bow is used in removable appliances to retract and retain teeth (Pahkala 2013). The different stages in bonding of removable orthodontic appliances includes the following-

• Fitting- Fitted resin is used to precisely fix the brackets on cast of teeth. After fixing the brackets on ideal position, a transfer tray is formed on the cast.
• Monitoring- They are soaked in warm water and trimmed to get the ideal fit for patients.
• Adjusting- In the final stage, the teeth are isolated and resin is painted in enamel and brackets. The trays (removable devices) are finally removed and brackets get bonded to the teeth (Levrini et al. 2013). The main equipment required in this process is the resin and removable tray that can be used by the dentist.

Retainer- Retainers are made of wires or plastic to realign teeth after surgery or fixing braces. Use of retainers in new position helps the periondontal fibers to adapt to changes in bone and reduce any changes in final tooth position. Retainers may be of two types- fixed retainers made of thin wires bonded in the lower or upper front of the teeth and the removable retainers held in place by hook or clasps (Vig 2013). The stages in fixing retainers are-

• Fitting- An impression of the new teeth is taken on a mold and retainer is fabricated out of wire.
• Monitoring- After fixing retainers, it is necessary to regular monitor the patients to check for any cavities and cleaning the teeth. Dentist ensures that the retainer is fixed in place.
• Adjusting- After the new teeth is accurately fixed and aligned, the removable retainer are removed. In case of fixed retainers, they are used to ensure that braces do not shift back to the previous position. These are worn by the patient as specified by the orthodontist. The key equipments needed by dentist in this process include molds, wire, fixing agents to ensure that brace do shift back from its original position (Pahkala 2013).

The charts and records for orthodontic treatment

An orthodontic nurse is involved in the setting up of the surgery each day and ensures that everything such as patient notes are ready and any work which is required for that that day has been brought from the laboratory (Durkan et al., 2016). They also prepare the required instruments for a particular dental protocol as well as mixing any substances such as composite, bonds, and alginate and glass isonomer. Dental nurses also tidy up the surgery room by disinfection of surfaces and the sterilizationof the dental instruments that have already been used (Dye, 2013). They also make sure that the patients are comfortable before and during dental treatment.

Reference list

Alshiddi, I.F. and Richards, L.C., 2015.A comparison of conventional visual and spectrophotometric shade taking by trained and untrained dental students.Australian dental journal, 60(2), pp.176-181.

Costa, A.A., Serra-Negra, J.M., Bendo, C.B., Pordeus, I.A. and Paiva, S.M., 2015. Impact of wearing fixed orthodontic appliances on quality of life among adolescents: Case-control study. The Angle Orthodontist, 86(1), pp.121-126.

Durkan, C., Belsi, A. and Griffiths, R., 2016. The knowledge of dental nurses at one institution of the scope of practice of the dental team members.BDJ Team, 3, p.16010.

Dye, S., 2013. Orthodontic solutions and the dental nurse's role.Dental Nursing, 9(9), pp.500-502.

Hämmerle, C.H., Cordaro, L., Assche, N., Benic, G.I., Bornstein, M., Gamper, F., Gotfredsen, K., Harris, D., Hürzeler, M., Jacobs, R. and Kapos, T., 2015. Digital technologies to support planning, treatment, and fabrication processes and outcome assessments in implant dentistry. Summary and consensus statements.The 4th EAO consensus conference 2015.Clinical oral implants research, 26(S11), pp.97-101.

Ito, M., Wee, A.G., Miyamoto, T. and Kawai, Y., 2013. The combination of a nylon and traditional partial removable dental prosthesis for improved esthetics: a clinical report. The Journal of prosthetic dentistry, 109(1), pp.5-8.

Levrini, L., Abbate, G.M., Migliori, F., Orru, G., Sauro, S. and Caprioglio, A., 2013. Assessment of the periodontal health status in patients undergoing orthodontic treatment with fixed or removable appliances. A microbiological and preliminary clinical study. Cumhuriyet Dental Journal, 16(4), pp.296-307.

Li, Y.J., Chang, C.K., Lin, G.M. and Lu, C.C., 2013. Radio Frequency Identification (RFID) Inserted Fixed Prosthesis and its Applications in Clinical Dentistry. International Journal of Automation and Smart Technology, 3(2), pp.101-105.

Meyer-Marcotty, P.D.P., Boehm, H., Linz, C., Kunz, F., Keil, N., Stellzig-Eisenhauer, A. and Schweitzer, T., 2012. Head orthesis therapy in infants with unilateral positional plagiocephaly: an interdisciplinary approach to broadening the range of orthodontic treatment. Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopädie, 73(2), pp.151-165.

Pahkala, R., 2013. Orthodontic Retainers and Removable Appliances: Principles of Design and Use (2013). The European Journal of Orthodontics, p.cjt040.

Papageorgiou, S.N., Gölz, L., Jäger, A., Eliades, T. and Bourauel, C., 2016. Lingual vs. labial fixed orthodontic appliances: systematic review and metaâ€Âanalysis of treatment effects. European journal of oral sciences.

Teh, L.H., Kerr, W.J.S. and McColl, J.H., 2014. Orthodontic treatment with fixed appliances in the General Dental Service in Scotland. Journal of Orthodontics.

Vig, P., 2013. Orthodontic retainers and removable appliances: principles of design and use. British dental journal, 215(10), pp.537-537.

Zhao, B., van der Mei, H.C., Subbiahdoss, G., de Vries, J., Rustema-Abbing, M., Kuijer, R., Busscher, H.J. and Ren, Y., 2014. Soft tissue integration versus early biofilm formation on different dental implant materials.Dental materials, 30(7), pp.716-727.