Fixed Prosthodontics - Fillings, Veneers, Crowns, Bridges
Fixed Prosthodontics is the area of restorative dentistry with involves the placement or a restoration or prosthesis that is placed in the mouth by the dentist, and is not removable by the patient. This includes the following: Silver fillings or tooth colored bonded composite resin restorations, porcelain veneers, crowns, and bridges.

1. Silver Filling and Tooth Colored Bonded Resin Restoration

If a tooth has suffered minimal damage from dental decay, wear related to grinding or acid erosion, or has a slight structural cosmetic defect, a silver or tooth colored restoration can be placed.




Despite any negative information you may have heard related to silver fillings, much scientific research has been focused on the material over the past two decades which provide evidence to its safety, and the American Dental Association continues to endorse it as a safe, strong, and cost effective material. We still recommend and use silver fillings routinely in the back of the mouth when cost is an issue, or in situations where tooth colored fillings are not as predictable.




Tooth colored bonded composite resin fillings are typically the first choice of material in esthetic areas of the mouth.Additionally, they do offer the ability of the dentist often keep the size of the filling much more conservative in certain situations, which is always preferred when possible. These fillings are more technique sensitive to place, and are not as predictable long termin certain situations, and therefore are not always the first choice of material for every situation. 

2. Porcelain Veneers

Porcelain veneers are a laminate, “egg-shell” thin porcelain restoration, that are used to cover the front portion and edge of a tooth, most commonly used on front teeth. Veneers are the restoration of choice to restore front teeth that have worn edges, and or previous fractures of the edge. Tooth colored composite resin restorations can be used in the case of slight wear of the edge of a tooth, however, in situations of more advanced wear and when the front portion of the tooth may be affected, or if an existing tooth colored composite restorations is failing, porcelain veneers offer the most esthetic and long lasting result.


3. Crowns

A crown in a restoration that is used to entirely cover a tooth which is badly broken down, or has a previous large silver or tooth colored filling which is failing. An slightly abbreviated restoration called an “onlay” may also be indicated this situation, if the destruction of the tooth is more minimal. Crown restorations can made of full gold, porcelain, or a combination design. Full gold crowns are still the restoration of choice on the molar teeth where the biting forces are the highest, especially in patients who have a history of tooth grinding. Porcelain crowns are tooth colored on the outside, and are reinforced with a white gold or zirconium substructure for strength. A combination design has a white gold chewing surface, with a porcelain outer surface, to allow for a tooth colored restoration with very high durability. This design is most commonly used on upper back teeth, where the porcelain is visible in the smile and the metal portion is “hidden” by the inside of the mouth.




The photograph above demonstrates the various crown designs available. From right to left represents the strongest to weakest designs.

4. Bridges
   

   A  bridge is a restoration that consists of at least two crowns connecting to one or more fake teeth (called pontics). A bridge is an ideal way to replace a missing tooth/teeth, when the teeth next to the space missing the tooth would benefit from crown restorations anyway. The designs described above for crowns also apply to bridges .

   
   

   Veneers, crowns and bridges are fabricated by dental lab technician outside of the office. For this reason, they all involve two appointments to complete. At the first appointment, to tooth is prepared and an impression is made. This allows a lab technician to fabricate the restoration on a stone cast of the tooth.

   
   

   You may have heard advertisements for “1 –visit crowns/onlays,” where a milling machine in the dental office makes the crown at the same visit. While this technology is very exciting, and will ultimately make the present techniques obsolete, we feel that the accuracy and quality is not quite there yet. Just remember the phrase, “If it sounds too good to be true, it probably is!”

Use with Dental Implants

Of the fixed prosthodontic procedures described above (fillings, veneers, crowns, bridges), dental implants can be utilized to support crowns and bridges.

A crown can be placed atop a dental implant to replace a missing single tooth – in the past this was done using a bridge (as described above). The advantage of this is that a the missing tooth can be replaced without involving the teeth next door – this allows for less long term maintenance of these teeth. A bridge can be connected to two or more implants, however a bridge cannot be connected to an implant and a natural tooth.

More Information
Implant Crown vs. Conventional Bridge
Single Tooth Implant Crown
Implant Bridge