Dental
prosthetics

Dental prosthetics in the Džolev Polyclinic include:

  • Metal-free (nonmetal) ceramic crowns
  • Metal ceramic crowns
  • Veneers (ceramic and composite)
  • Acrylic dentures – classic partial and complete dentures
  • Hybrid dentures – supradental dentures, implant suprastructures for total dentures fixed on implants
  • Repairs of broken dentures
  • Construction of inlays, onlays and overlays (ceramic and composite)
  • Reinforcement of devitalized teeth (glass fiber, cast restorations, zirconium restoration)
  • Inlay bridges
  • Maryland bridges
Nikolina Osmić

Dr. Nikolina Osmić,
dental prosthetics specialist

For the success of everyday practice, it is important to choose the right material for the specific indications, i.e. to be familiar with the advantages and disadvantages of each particular material.

One of the questions I am often asked in my everyday practice is this: “What is the advantage of metal-free crowns over the metal ceramic crowns and bridges?”

1. First of all, biocompatibility, electrochemical neutrality and lack of galvanic corrosion on metal-free crowns.

2. Secondly, better aesthetic properties, due to the better light transmission, similar to that in a natural tooth. 

However, the metal ceramic crowns have better mechanical endurance. With the invention of oxide ceramics, with improved mechanical properties (resilience and resistance to bending), metal-free crowns have started to be used in the lateral regions as well. But, despite all the improvements, this type of restoration requires a precise estimation of the forces (during the chewing process) because porcelain is a brittle matterial.

 

In order to satisfy high biological and aesthetical demands, a machine processed ceramics also appeared on the market in the 1990s.

Its development had two lines:

  • Mechanically copied - fraisage
  • Computer designed and computer guided suprastuctures – CAD-CAM systems

 

Basically, these are the same kind of ceramics, with two ways of ceramic restoration. 

The most popular oxide ceramic is zirconium oxide, or zirconia. There is a special type of zirconia, a metastable tetragonal phase stabilized by the addition of yttrium oxide. This is a very firm material that can sustain great forces, and is used for the construction of large bridges.

For a perfect smile, it is not always necessary to resort to invasive methods. Sometimes whitening and composite fillings are sufficient. If there is more severe damage to the dental tissue, ceramic veneers or ceramic crowns and bridges are required.

In case of ceramic veneers, the patient can see his prospective veneer in advance, using the WAX-up diagnostic modeling tool. It is used for the creation of mock-ups, i.e. prototypes for dental restoration, made of the same material that is used for fillings. Once the desired shape of dental restoration is achieved, the process of the construction of the permanent restoration can begin. 

Metal ceramic crowns

Despite all the advantages of the metal-free ceramics, most of the restorations are still carried out using metal ceramics. In these crowns, metal is used as a base for the ceramics. It lands firmness to the ceramics. An alloy for the construction of the metal base has to meet special requirements in terms of its compatibility with the ceramics, good connection, thin metal suprastructure and electro-chemical stability.

On the global market there is a huge number of various alloys that belong to the following groups:

  • high noble,
  • semiprecious,
  • non precious.

Today, chrome-cobalt-molybdenum alloys (without nickel) are commonly used, because of their good characteristics and affordability. 

Prosthetic restoration on implants (crowns and bridges)

Prosthetic works on implants are as important as the surgical procedure for the installation of implants. Besides the aesthetical requirements, a special emphasis is put on the functional aspects that guarantee durability and reliability. Individually adapted technical procedures, as well as team work (implantologist – prosthetics specialist – dental technician) is what sets us apart from many other clinics. All the persons involved in the process are our employees, without any outsourced personnel. Each and every patient undergoes a detail examination, on the same day, by all the experts involved in the process. All the steps of the restoration (impression, jaw position measurement, suprastructure testing, metal or zirconium core testing, pre-enamel testing, temporary and permanent cementing) are carried out with all the participants in the process being present. 

Construction of metal-free crowns (zirconium)

Metal-free crowns are used for the teeth in the aesthetical zone. With most young people, the aesthetical zone is normally in the area of the front teeth of the upper jaw, from the second permanent premolar to the second permanent premolar on the other side. There are various types and widths of a smile that can extend this zone towards the permanent molars and gums above the upper jaw teeth. With aging, this zone is further extended to the area of the front teeth of the lower jaw. These biological aspects are the first criterion for assessing the necessity of the construction of metal-free crowns. 

Zirconium is an artificial material of exceptional firmness and beauty. Of all the dental ceramic materials, it is best suited for modern dental restoration. Since there is no metal under the ceramics, the tooth has a transparent, natural look. 

Construction of ceramic veneers

Ceramic and composite veneers are used in the same cases in which metal-free zirconium crowns are used. However, this is a less demanding method for achieving the same aesthetic quality with maximum preservation of the natural dental tissues. Because of this, such veneers are more comfortable to install, and are often chosen by patients who are undergoing prosthetic intervention for the first time. 

Construction of ceramic inlays and onlays

Construction of ceramic or composite inlays and onlays is a further step in the evolution of the dental science in terms of aesthetical and functional requirements of the fillings. Individual construction of inlays and onlays in our dental laboratory, after the dental impression has been made by our stomatologist, ensures better modeling and imitation of dental characteristics. 

Construction of metal ceramic crowns and bridges

This is a standard for solving many prosthetic indications in all age groups. Still the most frequently used type of fixed and combined purpose works, construction of metal ceramic bridges is a safe, maximally standardized method. Development and usage of new materials increases their reliability and quality. For example, metals used for this purposes have no ferromagnetic properties. 

Fiberglass restorations

Fiberglass restorations are used for the preparation of the root of the tooth, in order for a metal-free crown to be placed.

Classic partial and complete dentures

Classic partial and complete dentures are used for the prosthetic care of the patients with insufficient number or quality of teeth, for the construction of some of the above mentioned prosthetic solutions. Strict aesthetic and functional standards for these restorations are the same as for those used for other prosthetic works. 

Skeleton dentures with attachments (CK)

Skeleton Visil-Vironit dentures are a type of dentures with special stabilization systems in the patient’s mouth. This way, the feeling of a presence of a foreign body is lessened, and the functional transfer of forces during chewing is more similar to those experienced with fixed dentures or natural teeth.

Construction of dentures for toothless patients with retention implants

This is a very important technique for improving the quality of life of the patients with complete dentures, especially in the lower jaw. 

Construction of supradental partial dentures

 

Valplast dentures (flexible)

Construction of immediate dentures

(installation of dentures right after a tooth has been extracted)

 

Construction of obturator dentures

(for patients with bone jaw defects)

 

 

Examples
1
Primer1-a

Underdeveloped permanent lateral incisors

Primer1-b

Correction using veneers on lateral incisors

2
Primer2-a

Color change in the treated left central incisor, ground for the placement of the veneer

Primer2-b

Completed, cemented veneer

3
Primer3-a

Old complete upper denture (temporary piece during the osseointegration of the implants)
Old metal ceramic crowns in the lower jaw

Primer3-b

Same pacient – unfavourable relation between the upper and the lawer jaw

Primer3-c

Completed metal ceramic circular bridge for the upper jaw

Primer3-d

Installed suprastructures – Straumann implant system

Primer3-e

Completed upper circular bridge on the implants and lower metal ceramic bridge

Primer3-f

Achieved favourable relation between the jaws

Primer3-g

Precise installation of the bridge on the suprastructures

Primer3-h

Permanently cemented bridges

4
Primer4-a

Old metal ceramic bridges in the upper jaw, before the construction of the prosthetic piece

Primer4-b

Construction of metal-free crowns in the complete upper jaw, right after the cementing

5
Primer5-a

Before the construction of metal-free crowns

Primer5-b

After the construction of the metal-free crowns