General Restorative Dentistry

What are crown and bridges?

A crown or bridge is a fixed prosthesis that can be used to fill a gap in your mouth, restore the natural shape or appearance of a tooth.

A crown is used to restore the shape and appearance of a normal looking tooth in your mouth. It can be placed onto a ground down tooth or post retained root .

A bridge can be used to replace a gap from missing teeth. The adjacent teeth from one side or both sides of the gap can be used to support the bridge.

What To Expect At This Appointment

Dependent on the need and severity of your treatment it can be provided on the NHS by a specialist Restorative Consultant . Following a detailed discussion of which type of replacement is needed an appointment will then be made for preparation of the tooth/teeth.

Your appointment can take 1-2 hours and be done in the dental chair using a local anesthetic. At this appointment the tooth / teeth will be filed and prepared for impressions to be done from which a prosthetic laboratory can then use to make the crown or bridge.  The following appointment will be made 2-3 weeks later to fit the  crown or bridge this can take up to 1 hour.

Further appointments will be needed with our dental hygiene therapist for the long term care and maintenance.

Frequently Asked Questions

Can all my teeth be replaced with crowns and bridges?

In some cases crowns and bridges can be used to replace all or some
missing or badly broken down teeth.

What if my crown or bridge becomes loose?

In the long term once your treatment has been provided at the hospital you will be discharged back to the care of your own dentist who will
take over the care of your treatment. If they think you need to be
reviewed by us again a new referral can be sent.

How do I look after my crowns / bridges?

An appointment with our dental hygiene/therapist will be made after
fitting of the prosthesis to go through cleaning and maintenance. But life long care will be needed to maintain the health of your mouth.

Please speak to a member of staff if you need this leaflet in large print, braille, audio or another language.

What are dental implants?

Dental implants are one of the options of restoring missing teeth. They are made from titanium posts which are surgically inserted into the jaw bones to replace missing teeth. They can support removable dentures, fixed crowns and bridges.

Their use is dependent on several factors such as :

• General medical health
• Quality and quantity of bone
• The gum condition
• The health of the remaining teeth
• Proximity to important nerves, blood vessels and sinuses

Benefits

• To improve appearance
• To improve function—eating, speech
• To preserve the remaining jaw bone
• Quality of life

What dental implants can be used for

• Patients with congenitally missing teeth
• Patients with extreme retching difficulties that have difficulty with dentures
• Loose dentures that cannot be improved conventionally
• Patients with surgical defects
• Cleft palate patients

Types of implant supported teeth

Implants can support an acrylic removable denture, a fixed bridge or a single crown depending on the clinical situation. Teeth can crack or break off the bridge or denture, especially if you grind and clench your teeth.

Attachment clips within the denture can become loose or break after long term use necessitating the need for repair. Appearance can be- compromised if you have advanced bone and gum recession leading to longer looking teeth and dark triangles between adjacent teeth.

It is important that you care for your implants as you would with natural teeth by maintaining good levels of oral hygiene. Smoking is recognised as a risk factor which can result in delayed healing and potential implant failure. Therefore we Advise you to stop smoking before and following completion of treatment.

As with conventional dentures, crown and bridge work repairs, maintenance will be necessary from time to time. This leaflet serves as a general guide . More detailed information can be provided by your clinician.

Planning your treatment

Your clinician will ask questions about your concerns, general health and carry out a thorough examination of your mouth. This process could involve several hospital visits and joint consultations with other specialists.
You should expect to have X- rays taken and impressions to make a mould of your jaws to allow further examination.

Decision making

The outcome of the planning stages will indicate whether implants are suitable and what alternative treatment is available. As implants are more complex they are generally more expensive. You may be told that you have insufficient bone, which may require additional surgery such as a bone graft. The graft could be taken from your chin, the wisdom tooth area in your mouth or if larger quantities are needed, from your hip.

Alternatively grafts from other sources may be used. This additional bone graft procedure could prolong the overall treatment by 4-6 months.

Time scale

The treatment, from the time of placement to completion, could take any time between 6 months to over a year depending on the bone quality, how healing progresses, and if bone grafts were placed.

Alternatives treatments to implants

• No treatment is always an option
• Removable denture / ‘plate’
• Fixed bridge

All options will be discussed with you on your consultation.

Implant insertion

This procedure can be carried out using local anaesthesia in the dental chair or if necessary can be done under a general anaesthetic in theatre. Special instruments are used to create a surgical hole or flap through your gum and bone, the implant is then inserted into the bone and the gum replaced and held together with some dissolvable stitches, these can take up to 5 weeks to disappear. A follow up appointment will be made with the consultant a few weeks later to check the healing and if necessary to take xrays.

The implants will usually be left for at least three months before they
are used. If you usually wear a removable prosthesis for example a denture or retainer, you may be asked to leave this out for the first week to aid healing.

Implant exposure:

A second minor surgical procedure usually under local anaesthesia is undertaken following healing, to expose the top of the implant and to place a healing cap on to the implant. This allows the gum to re-contour around the implant in preparation for the restorative phase.

Restorative phase

This would involve obtaining follow-up X-rays and impressions, to assess healing and also to order the appropriate implant accessory parts. The number of appointments at this stage varies depending on whether the space is to be restored with a denture or a bridge. Review appointments are made to monitor the implant restoration and underlying bone.

Potential complications

Following surgery some degree of discomfort swelling and bruising should be expected. This is not uncommon however prolonged and severe pain should be reported to your clinician as these signs may be an early indication of complications.

Implants can be rejected resulting in pain loosening, infections and complete loss of the implant.

Please speak to a member of staff if you need this leaflet in large print, braille, audio or another language.