Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or maxillofacial tissues using biocompatible substitutes.

Dentistry is mostly prosthetically driven, i.e., replacement of lost dental hard and soft tissues is the ultimate goal. Hence prosthodontics plays an important role because before any treatment is instituted, prosthodontic consultation and intervention is needed to determine how the existing dentition and soft tissues can be conditioned to receive the new prostheses and that the sequence and timing of the various adjunctive treatments can be laid out.

Currently, dentists have to complete 3 years of full-time intensive post-graduate training to acquire the basic qualification of a prosthodontist. Further advanced training after the basic prosthodontic training is usually required to complete the whole training process. Then the individual may attempt the specialty exit examination. Upon passing such examination, the person is considered qualified.

A prosthodontist is a dentist who specialises in reconstructing your teeth.

Prosthodontists are trained dental specialists in the areas of cosmetic dentistry, crowns and bridges, dental implants, dentures and other restoration and replacement of missing teeth and associated structures.

They act as a "director" of a dental treatment plan as s/he may collaborate with other health care professionals to develop solutions to a patient's individual dental concerns.

Prosthodontists are most suited to plan, direct and finally restore function and aesthetics to patients with complex dental problems.

We use our teeth for eating everyday, so they are bound to undergo wear and tear. However, excessive tooth wear is a concern as it can lead to sensitivity to cold, loss of vitality of the teeth, collapse of the bite, and a whole array of dental problems.

You should consult your dentist/prosthodontist to diagnose your problem. S/he can help you to identify the cause of tooth wear, prevent further loss of tooth structure and restore your dentition to improve your dental health, oral function and aesthetics.

In advanced cases, the loss of tooth structure can lead to collapse in the facial height. The prosthodontist can re-establish a new bite and facial height for the patient after careful planning.

A missing tooth could be replaced immediately after tooth loss.

Sometimes, it is advisable to wait for 2 months after a tooth has been lost before replacing it. This allows time for adequate healing and for the extraction socket to be filled with bone tissue.

If a missing tooth is not replaced, the following may occur:

• tilting and drifting of the neighbouring teeth,
• over-eruption of the opposing tooth, and/or
• tissue resorption at the extracted site, which will get worse as time passes.

When these occur, effective replacement of teeth for optimal function, speech and esthetics may be compromised. This is compounded if more than one tooth is lost. In the front part of your mouth, sufficient height and width of jaw bone is critical to restore the lost front teeth with natural looking restorations. In addition, adequate volume of bone is needed if the missing teeth are to be restored with implant-supported restorations.

Options to replace a missing front tooth include

• removable denture
• fixed bridge, or
• dental implant.

A removable denture may pose issues of speech difficulties initially. This may improve with time as the individual copes with the denture. The presence of a denture in the mouth may also cause discomfort to the individual. Otherwise, the removable denture is the most conservative treatment option to replace the missing tooth.
 
A fixed bridge requires teeth adjacent to the missing teeth to support the bridge. The individual must be compliant with good oral hygiene measures to maintain dental health.
 
Dental implants require a minor surgery to place the implant fixture into the jawbone. Sometimes, there is insufficient bone for the fixture and bone grafting may be needed. The implant fixture will take about three to six months to integrated with the jawbone. Crowns are then attached to the implant. Dental implant therapy has a proven track record.

Please consult your dentist or prosthodontist on the suitability of each treatment option as the situation for everyone is different.

Various factors need to be considered when a dental implant is being planned. Factors such as bone volume and quality, tooth and jaw relationships, oral habits, general medical health and social habits will be evaluated. Medical conditions such as diabetes mellitus and social habits such as smoking may result in reduced implant success rate. An oral surgeon and/or a prosthodontist may assess each individual on the suitablility for treatment with implants.

Dentures are artificial replacements for one or more missing teeth. Partial dentures are those that replace only a few teeth, while complete dentures are those that replace a complete set of missing teeth. Dentures could be supported by dental implants, which feel, look, function like natural dentition.

Missing teeth should be replaced to maintain the stability, health and function of the dentition. In view of the modern technology, a missing tooth can basically be replaced through three methods, a denture, a bridge or an implant.

A denture is a removable prosthesis that replaces the missing teeth and its surrounding tissue to allow one to eat, talk, and smile confidently. A complete/full denture is made when all the teeth are missing. A removable partial denture replaces the missing teeth by support from the remaining natural teeth through hooks, or attachments.

The dentures will require some time to get used to. Pronouncing certain words and eating require practising with the new dentures. Start with taking smaller bites and softer food. During eating, food may get caught around the hooks and underneath the dentures. The dentures should be removed for rinsing to prevent impaction of food against the teeth, which can lead to dental decay. The dentures should be brushed and left in a cup of water before retiring to bed. Dentures should not be worn during sleeping to allow the gums to rest.

The teeth of the dentures can be worn out with time, making chewing inefficient. Dentures should be stable inside the mouth. As the jaw bone shrinks with age, the dentures become ill-fitting and cause discomfort during eating and difficulty in speaking. This is the time that they need to be changed.

Dentures usually last between 5 to 10 years. Just like your natural teeth, denture teeth wear and take in stains from the food that you consume. The shape of your gum and jaw may also change with time. Thus your dentures may need adjustments periodically in order to continue to fit properly.

Keeping your denture clean is extremely important. Like your natural teeth, dentures collect food debris. It is important to brush your dentures at least once a day. Use a separate brush for cleaning your dentures. Do not use regular toothpaste as this can be abrasive on the denture material. Brushing with liquid soap or plain water is adequate. After mealtimes, it is also advisable to rinse the dentures with water to remove any food debris.

It is recommended that you remove your dentures at night before going to sleep. This is to give your denture supporting tissues a rest. The dentures should be stored in a glass filled with plain water.

Off the shelf commercial denture cleaners may be used if desired. Keeping the dentures wet will prevent your dentures from changing in shape. Denture wearers should seek regular dental check-ups every six months to ensure that the remaining dentition and soft tissue are in good health, and that the dentures are functioning properly.

This is dependent on the quality of the restoration placed, biological alterations to the supporting oral structures as well as maintaining the restoration placed. Most crowns and bridges can be expected to last up to 10 years, if not more.

The common reasons for failure are influenced by the type of prosthesis fabricated as each has their own inherent pros and cons. However they can be broadly characterised as follows:

• Biological reasons - Dental caries or tooth decay of the underlying tooth structure
• Gum disease or overloading in bite force leading to loss of bony support, tooth mobility, pocketing, or gingival recession.
• Pulpal or nerve damage of the supporting tooth
• Fracture of the supporting teeth or roots
• Mechanical reasons - wear and tear of the restoration, fracture of the restoration

A full-mouth restoration is the individual restructuring of each and every tooth in a mouth.

Full mouth restoration is indicated when the teeth are worn down, broken down or missing, causing problems in both the function and appearance of the mouth. The most common solutions are a combination of either crowns, veneers, onlays, and bridges. In essence, the old restorations and worn teeth are prepared, impressions are made of the healthy tooth structure. Provisional teeth will be placed at the same time and these provisional teeth are used until the definitive restorations are made.

In many cases, the answer is, "yes." If you have teeth that are worn, shifted, missing, broken, or a combination of these, then ‘full mouth restoration’ may be the answer. It is designed to restore your smile and make eating easier and more comfortable.

The Prosthodontic Society (Singapore) (PSS) welcomes all dental surgeons as Associate members. They have the opportunity to convert into full membership after they have given a professional presentation to the PSS.

One of the main objectives of the Prosthodontic Society (Singapore) (PSS) is to provide continuing education programmes. The PSS organises an annual conference. Experts from various fields of prosthodontics and related specialties are invited to help develop the local expertise. Members pay a preferred rate for such conferences. In addition, the PSS conducts monthly lectures for members, which are free to members. Such educational activities help members to achieve the required Continuing Professional Education points.