What to do in the absence of a front tooth. What to do in the absence of chewing teeth? Price of dentures for front teeth

Continuing to reinforce theory with practice, I propose to analyze one of my recent clinical cases. In it you will see what prosthetics look like anterior tooth when replenished with implant Nobel Replace, as well as related production ceramic veneer and teeth whitening system Opalescence.

Since the photo-documentation of this case, as it happened, did not begin from the very first stages of the whole work, I will tell about them in words.

So, a young girl (20 years old) turned to us. She lost her central incisor due to an injury when she was a child. All this time she wore a removable plate for 1 tooth, which had to be changed as the jaws grew.

During the wearing of the plate, the bone in the area of ​​the missing tooth atrophied quite strongly and became thinner. The placement of the implant was difficult. Therefore, bone grafting was first performed (i.e., an increase in the volume of the bone in the area of ​​the missing tooth). Delivered after 4 months implant Nobel Replace , and immediately I made a temporary plastic crown on it. For another 5 months, the implant fuses with the bone, and the temporary crown simultaneously forms the correct contour of the gums, lost during the wearing of a removable denture. And so, before the final stage of work, this photo was taken.

From that moment, the main work with aesthetics began, since in the case of prosthetics of the front teeth (especially in a young girl), it is not enough just to make a tooth to close a hole in the dentition. It is very important that the artificial crown fits into the overall “picture” as naturally as possible. If you have read my note on the basic laws in aesthetic dentistry, then it will not be difficult for you to catch the shortcomings that we had to solve. I will mark them right on the same photo.

In addition, the patient wanted to see her teeth lighter, so before making restorations, we still needed to whiten our own teeth by 2-3 shades.

To begin with, in order not to waste time, we started to raise the contour of the gums around the crown on the implant in order to make its profile symmetrical to the adjacent tooth. To do this, on the same temporary crown, which had already stood for more than 4 months, the neck contour was changed in order to “push” the gum upward by the missing couple of mm. Immediately after screwing on the modified crown, the gum, having turned a little whiter, acquired the shape we needed.

But after a few minutes, her color was restored. Thus, one of the problems was solved.

The next step was to conduct a course in-office whitening my favorite system Opalescence Xtra Boost. It acts quite gently, practically without causing any discomfort neither during the procedure itself, nor after it, as is almost always the case when using more aggressive systems such as Zoom, LumaCool, etc., where the whitening gel is additionally activated using a special lamp.

True, to achieve a noticeable effect, it is necessary to carry out 2-3 procedures, each lasting about an hour. In this case, with the initial shade of teeth A3 ...

…we were able to get a pretty natural A1.

This is where we decided to stop. For I myself am not a supporter of extremely white teeth, although, as you know, all felt-tip pens are different in taste and color. But in this case, both me and my patient teeth whitening results seemed quite sufficient.

Now, after obtaining the desired color of your teeth, you could proceed to making an implant crown. At the same time, we also had to ceramic veneer on your own symmetrical tooth, because otherwise it would be difficult to level out the noticeable difference in the width of the two central incisors. It should be noted that the symmetry of these two teeth is most important from an aesthetic point of view. They stand closest to the center, side by side to each other, and at the same time they are quite large, and therefore the eyes of our interlocutors “cling” to them when we smile or talk. The difference between the lateral incisors ("twos") or between the canines ("triples") will not be as noticeable as even the smallest differences between the central incisors - "ones". In order to eliminate the difference in the width of our central incisors by 1.5 mm, we had to make a veneer on the adjacent "one". Moreover, she had small chips on the cutting edge.

So, in a few days of wearing the modified temporary crown, the profile we needed was formed gums around the implant.

Since my blog is also read by novice dentists, the next stage is a little more detailed for them.

In order to accurately transfer the formed gum contour to the dental technician, the standard transfer is individualized. First, we take an “impression” from the cervical part of the temporary crown. To do this, it must be screwed to the analogue of the implant and immersed in silicone to get a good impression of the cervical part.

Then the crown is unscrewed from the analog, and a standard one is screwed on instead. closed tray transfer. The entire void around it is filled with any plastic (Pattern Resin, plastic for Luxatemp timers) or a flowable composite. In this case, I used Ultradent's OpalDam ("liquid rubber dam").

Then all this is carefully polished and screwed in the mouth to the implant. The transfer now maintains exactly the gingival profile that we set with our temporary crown. After processing the adjacent tooth under the veneer, you can take a working impression. In my case, this is a two-layer one-stage silicone impression with 3M Express mass.

Well, then it’s a matter of technology ... more precisely, technology ... a dental technician. It depends on his skill how the final result will correspond in all characteristics of color and shape to natural teeth. The materials from which crowns are made are also important. The most natural characteristics metal-free ceramics. In this case abutment on the implant was made from zirconia.

it customized zirconia abutment . Patients often ask me: what is a custom abutment and why is he? How does it differ from standard abutment? Here, in this example, it’s just good and you can see what it is and why it is ... Let's take a short digression into the theory, for those who are not interested, you can safely skip the next paragraph.

What options for the formation of gums around the implant are there in principle? The first option is the standard factory gingival cuff shaper, or FDM (as it is officially called, usually just a "shaper"). The surgeon screws it into the implant at some stage, and as a result, a “hole” is formed in the gum. Absolutely round, equal to the diameter of the shaper.

After such a shaper is used standard abutment, which will exactly repeat the shape of the resulting standard "hole". This solution is suitable in all cases where the aesthetics of the gum around the implant is not very important. This mainly applies to the posterior chewing teeth.

In all cases when an individual gum profile is needed (as in our version), temporary plastic crowns. After them, the gum contour is absolutely non-standard, as you have noticed, and therefore a standard abutment will not work here. To support the individually obtained gum shape, an individually made abutment is used. Let's end our digression into theory.

For the manufacture of crowns and veneers technology was used E.max. Ideally, a dental technician should see the patient with his own eyes, since it is very difficult to convey all the nuances of color, transparency, microrelief of the surface of the teeth, even with the help of high-quality photographs. In our case, it took even 2 dates with the technician, and it still took several preliminary fittings before the result suited everyone.

The total duration of the entire treatment was about 1 year. I did not count the number of visits by the patient to me and all my colleagues, but there were many. When it comes not only to simply close the "hole" in the dentition, when the patient makes high demands on the aesthetic result of prosthetics, it cannot be otherwise. This is a long painstaking work of all participants in the process, incl. and the patient himself. But the result also brings satisfaction to everyone without exception. I hope that you, readers, too.) Until new interesting cases!

I have a big problem: half of the bottom row teeth are missing. I'm still quite young, I'm 45 years old. But my panic fear of dentists led to such a deplorable result. Now she is ready for anything, just not to look like a toothless old woman. But again, fear ... Tell me, is it really possible to put a dental bridge on four teeth? I'm afraid of the operation, when pins are screwed into the bone, then they are sewn up and all that. The sister put the bridge on two teeth, and the neighbor on the porch - on three. They seem to be satisfied. Is it possible to put a bridge on 4 teeth? Isn't that a lot? And will it then fly off or break? Forgive me for such questions, but I really know about prosthetics only from the stories of my more courageous friends and relatives.

TopDent Expert

Chief physician, orthopedic dentist, K.M.N.

Good afternoon, Natalia Sergeevna.
You are right, speaking about the indications for prosthetics with bridges, you should first of all take into account the extent of the defect in the dentition. But the requirements for abutment teeth also play a special role. The choice of this type of prosthetics is available only after a thorough clinical and paraclinical study. It is necessary to pay attention to the size and topography of the defect, the condition of the periodontal and teeth limiting the defect, as well as the type of bite, etc.

1. When planning prosthetics with bridges, there are a number of rules, according to one of which the number of intermediate crowns should not exceed the number of supporting teeth. Exceeding their number to three or four reduces the life of the prosthesis due to overload of the support.
2. Next, you need to address the question of which teeth you have a defect in and which will become a support. There is a special table of periodontal endurance coefficients, according to which the possible length of the prosthesis is calculated in order to avoid functional overload. According to this table, the sum of the endurance coefficients of a healthy periodontium of supporting teeth should not be more than 1.5-2 units. If the supports are in a state of functional overload, this can lead to their loosening and further unusability.
3. And the third thing I want to pay attention to is that the supporting elements of the bridge prosthesis and its intermediate part should be on the same line. The curvilinear shape of the pontic pontic can lead to load changes in rotation, resulting in the prosthesis being balanced and unusable. Among other things, the height of clinical crowns, their intactness and other nuances are taken into account.

Thus, purely theoretically, it is possible to put a bridge on 4 teeth.

But, besides the fact that this design in itself is not very reliable, your particular case may also have contraindications. I recommend to consider combined treatment, which includes both implantation and a bridge (in your case, 2 implants are required).

And finally, I will say, do not be afraid, all dental operations are carried out under local anesthesia and absolutely painless. Successes in treatment!

Dental implants are removable, they are removed from oral cavity for hygienic care, and non-removable, that is, fixed - they are installed for a long period of time. A separate category includes implants implanted into bone tissue. To satisfy the interest in the pricing policy of prosthetics in mid-range clinics, a price analysis is provided below.

How much does it cost to insert a front tooth?

The anterior teeth are visible, so anterior dentures need to be aesthetically pleasing. Modern dentistry can offer two materials: ceramics and cermets.

It is possible to insert a front tooth, the price of which ranges from 4.5 - 6 thousand rubles, from cermet. This is the most popular material for prosthetics of the anterior teeth. This type of implant is often used due to its reasonable price and good aesthetic appearance.

Question - how much does it cost to insert a ceramic tooth? The answer is for one unit from 13 thousand rubles. Excellent aesthetic appearance and reliability of the design turn into a high cost. The cost consists of the need to purchase expensive equipment, the use of the labor of highly qualified dentists. All this is included in the price.

Prosthetics of fixed teeth, price overview

dental Fixed dentures are of various types:

Dental crown implantation, prices

Dental single implants can be made from various materials that differ in strength and aesthetic properties. Materials can serve cermets, ceramics and metal alloys so prices have a wide range. The cost also depends on the category of the dental clinic, as well as the complexity of the process of making crowns.

Prosthetics with bridges, cost

With the help of such a prosthesis, you can insert a tooth that does not have a root. To install it need to grind adjacent teeth. Then, in the dental laboratory, prostheses are made, which will consist of two crowns worn on the abutment teeth and a middle part that will replace the missing tooth. That is why they are called "bridges". This technology is used in the absence of 1-2 teeth in a row.

The cost of inserting a tooth will depend on what material it is made of and the number of crowns in it. To obtain result of the cost of the "bridge", you need to know the cost of one prosthesis and then multiply by their number.

1. A ceramic-metal bridge of three units will cost 18,000 rubles, plus temporary plastic implants of 3,000 rubles.
2. Bridges of three units of zirconium dioxide will cost 48,000 rubles, plus 3,000 for plastic implants.
3. Putting a new tooth made of a cobalt-chromium alloy from three units of a cast bridge will cost 10.8 thousand rubles.

"Bridges" - adhesive prosthetics

This prosthesis is made directly in the patient's oral cavity from light-polymer filling materials. To enhance the strength of the structure, fiberglass is used, it is installed between two adjacent teeth, the prosthesis area. Then a filling material shaped like a tooth is placed on it. Such a design of three units usually takes up to 2 hours. The period of use of such a bridge is lower than that of a crown bridge, moreover, it is a temporary construction and it has all the same disadvantages as traditional fillings. An adhesive prosthesis can cost 6-10 thousand rubles.

Prosthetics with restorative tabs

tab restores color and shape half-destroyed tooth. This is a more expensive and reliable alternative to light-polymer fillings. Ceramic inlays are not only of higher quality, but also look much more aesthetically pleasing than conventional fillings.

1. A micro-prosthesis made of pressed porcelain will cost 11 thousand rubles.
2. From zirconium dioxide - 14-16 thousand rubles.
3. Cobalt-chrome alloy costs from 3.5 thousand rubles.
4. The cost of a gold tab will depend on its mass.

Prosthetics with veneers

To restore the shape or color of the tooth, veneers can be used. This microprosthesis is for veneer of the anterior part of the tooth, which has lost its shape, color, and also has carious destruction. Veneers are placed on ten upper front teeth and eight lower front teeth. Micro prostheses are an expensive and most aesthetic alternative to light polymer fillings.

1. One porcelain veneer prosthesis will cost 14 thousand rubles.
2. From zirconium dioxide - from 17 thousand rubles.
3. Composite veneer will cost 7 thousand rubles. It is made from ordinary light-polymer material.

This is an overview of prices for the prosthetics of fixed implants.

Dental prosthetics has always been a popular service. Now dentists can offer a lot of options for restoring the dentition.

Their main difference is not only in the characteristics of the design, but also in cost. As a rule, the cost consists of the type of prosthesis, the material used and the work of the doctor.

Removable prosthetics

This type of prosthetics is used in the multiple absence of crowns. The main difference between these systems is that they can be periodically removed for purification. Constructions of this type include acrylic, nylon and clasp prostheses.

Acrylic plastic plate

These designs are a classic option that was one of the first to be developed. Lamellar prostheses are indicated for total absence crowns or most of them. Due to the use of inexpensive acrylic, this type of construction is considered the most budgetary.

Price for removable apparatus consists of two factors: manufacturing and installation. As a rule, in large cities the price range is wider and is 10 - 20 thousand for the installation of one jaw.

In small towns, the average cost of this service is about 12 thousand rubles.

At the same time, the price of a full plate prosthesis differs little from the price of a partial one.

Removable clasp

Unlike the previous option, clasp prostheses are more expensive, since their design involves the use of a metal frame and fixing elements. The device is used for both single and multiple included defects in a number of teeth.

The cost of the byugel will be calculated based on the coverage area and the method of attachment. According to the coverage area, one-sided (simple) and two-sided (complex) models are distinguished. Bilateral models are more difficult to manufacture, so the price for them is 5-10 thousand higher than for simple products.

If the patient decides to opt for a design with clasps, then you will have to pay approximately 25 000 rubles. If special locks are installed as fixing elements, the product will cost about 50 thousand rubles.

Removable nylon

Nylon prostheses in their purpose and functionality are analogous to acrylic prostheses. The only difference is the material of manufacture, which makes the design more elastic, and therefore comfortable to wear. This factor also affects the formation of prices.

Due to the high flexibility of the material, the manufacture of the product requires a thorough preparatory period and special equipment. In addition, nylon itself is not a cheap material. Depending on the coverage area, restoration of teeth by this method will have the following price:

• complete prosthesis from 25 000 rubles;
• partial bilateral - from 20 000 rubles;
• unilateral (up to 3 teeth) – from 15 000 rubles.

Fixed prosthetics

Fixed type prosthetics involves the installation of structures with permanent fixation. The cost in this case will depend on the chosen method. The choice of technique is carried out by the dentist, taking into account the characteristics of the patient.

Single artificial crowns

For the manufacture of artificial crowns use the most various materials, different from each other physical characteristics and aesthetic properties. As a rule, it is the aesthetics of the material that affects the price of crowns.

Dental clinics offer the following types of crowns for prosthetics:

1. Metal. This is the simplest and most affordable method of prosthetics. Installation of one crown will cost approximately 5 thousand rubles. For the manufacture of crowns, a cobalt-chromium alloy is used, which is characterized by increased strength.

   But low aesthetic properties make this species restoration of unclaimed teeth. In some cases, such products can be covered with a plastic coating, which gives artificial teeth a natural look.

   The price in this case is 7,000 rubles.

   In addition to the standard alloy, gold alloy is used for the manufacture of crowns, which increases the cost of the product several times. The price of one unit starts from 15 000 rubles.

2. Metal-ceramic. They are distinguished by high strength and good aesthetic qualities due to the combination of a metal frame and a ceramic coating.

   Of all the options that meet aesthetic requirements, metal-ceramic crowns are the most affordable. Their price varies from 6 to 12 thousand rubles. Such a run-up in price is due to the method of manufacture.

   The most durable and expensive crowns are made using CAD\CAM technology. Crowns made according to classical technology will have a minimum price.

   When choosing, it should be borne in mind that crowns made from domestic materials will be much cheaper than their imported counterparts.

   In the event that an alloy of precious metals, then the price of the crown will be 15 - 17 thousand rubles.

3. Ceramic. In terms of their aesthetic characteristics, they are superior to all other options for crowns. Porcelain or zirconium dioxide is used for manufacturing.

   The zirconia product is the most expensive. Its price is 16 000 rubles. It will cost a little less to install a porcelain crown, the cost of which is - 11 000 rubles.

During prosthetics with crowns, it should be borne in mind that the cost of the service will additionally include the installation of temporary crowns made of plastic. The price of one unit is 1 thousand rubles.

Bridges

In the absence of a group of teeth, prosthetics are used with bridge structures, which are divided into three groups:

1. Metal-ceramic. They are a one-piece structure made of cobalt-chromium alloy by casting and coated with ceramic spraying. Cast bridge price - 18 thousand rubles.
2. Ceramic. Made from expensive zirconia. The cost of the design, including 3 crowns, is 50 thousand rubles.
3. Adhesive. Most a budget option bridge prosthetics. The bridge is formed directly in the patient's mouth using a composite material, which is installed on a fiberglass thread.

   Restoring a tooth in this way will cost an average of 8 thousand rubles.

Tabs

In the case when only part of the crown is destroyed, and the root of the tooth remains intact, restoration with tabs is used. Tabs are small partial dentures that perform all the functions of a real tooth. The cost of this service will depend on the material used:

• porcelain - 10 000 rubles;
• zirconia - 15 000 rubles;
• chrome-cobalt alloy - 4 000 rubles;
• alloy based on precious materials - from 30 000 rubles.

Veneers

Those crowns that have only minor damage or deformation, such as chips and cracks, also need to be restored. To make the surface of the teeth perfectly smooth, veneers are used. Patients can be offered two types of veneers:

1. Ceramic. They are thin ready-made overlays that completely imitate the front of the tooth. They veneer the surface, gluing to a special solution.

   They are in no way inferior to real teeth in their color reproduction, shade and strength. The cost of installing one ceramic veneer is 14 - 17 thousand rubles.

   Here the material used plays a major role. Overlays made of zirconium dioxide will have the highest cost, and porcelain plates will cost less.

2. Composite. By appearance are an analogue of ceramic, only the material for their manufacture is a composite. According to their characteristics, they are inferior to ceramic veneers, which also affects the cost. The price of one product - about 6 thousand rubles.

Implantation

At total loss the tooth can be restored by implantation. Implantation is a multi-stage and expensive procedure, which includes long preparatory work, implantation period and prosthetics.

If we consider the procedure in stages, then we can trace the process of pricing this service:

1. Preparation period. To conduct a detailed diagnosis, you will need to use various equipment. In addition, before implantation, it is necessary to put the dentition in order. The costs may be from 3 to 10 thousand rubles.

   At the same stage, bone tissue preparation is carried out with its insufficient volume, which adds to the total cost about 5,000 rubles.

2. Implantation. For implantation, the implant itself and a temporary abutment (plug) are required. The cost of the implant will depend on the manufacturer.

   The highest quality implants are considered products of European manufacturers, which cost an average of 14 thousand rubles. After implantation, the implant cavity must be closed with a plug, the price of which is within 5 thousand rubles.

   After engraftment, the plug is replaced with a gum former costing about 3 thousand rubles.

   Before prosthetics, a permanent abutment is installed, the cost of which varies from 5 to 10 thousand. depending on the design.

3. Prosthetics. Only certain porcelain-fused-to-metal and ceramic crowns are suitable for implants. The cost of crowns is usually included in the total cost of the service and is 10 - 17 thousand rubles for a unit.

AT dental clinics the service of restoring teeth by implantation method will cost on average 40 thousand rubles. Depending on the status of the clinic and the materials used, the price may vary.

Outcome

The average cost of all dental restoration methods, taking into account material and work, is shown in the following table:

If you find an error, please highlight a piece of text and click Ctrl+Enter.

When prosthetics of the anterior teeth, the main emphasis is on aesthetics. The strength of the prostheses is not so important here, since the chewing load is not so high. The main task set by the prosthetist is to recreate the anatomical shape, color and degree of transparency of natural teeth. Special attention is given to "pink aesthetics", that is, to the gingival margin.

Options for prosthetics of the anterior teeth

Crowns

A crown is a cap that covers the entire visible surface of a tooth. Such prostheses are relevant for severe damage, when the enamel is destroyed by more than 50%. Dental crowns are made in a dental laboratory according to individual casts. The best option is constructions made of metal-ceramic and metal-free ceramics (zirconium dioxide or porcelain).

Veneers and Lumineers

Veneers are ceramic plates up to 0.7 mm thick. They are attached to the front teeth and cover all visible defects (small chips, cracks, darkened old fillings, etc.). Before installation, the enamel is turned.

Lumineers are the same veneers, but much thinner (0.3-0.5 mm). Due to their minimal thickness, they do not require enamel preparation. Such structures are fixed with the help of special glue (cement).

Installation of veneers and lumineers is advisable only for minor damage to the teeth.

Temporary prostheses

Prosthetics of the front teeth is possible with the help of temporary structures (immediate prostheses). These are the so-called butterfly prostheses, made of plastic, acrylic or nylon. They are attached by clasps (hooks) that wrap around the supporting crowns.

Immediate prostheses serve no more than 3 months. They perform a cosmetic function and, as a rule, are installed during the manufacture of expensive implants or ceramic prostheses.

Features of prosthetics of the upper and lower teeth

Prostheses for upper teeth

The upper incisors and canines are most visible when smiling. Therefore, their prosthetics require the highest aesthetics. The ideal option is crowns based on metal-free ceramics. Due to the absence of a metal base, such products transmit light like natural enamel.

Prostheses for the lower teeth

Cheaper metal-ceramic crowns are suitable for lower incisors. Prosthetics with removable structures is difficult due to the small area for supporting the base. In this case, it is better to give preference to implantation, this is the most reliable method.

Prosthetics of front teeth without turning

To fix bridges, clasp and other prostheses, turning of the supporting teeth is required. However, the preparation of enamel leads to the rapid destruction of a healthy tooth.

In addition, in order to avoid pain, it is necessary to remove the dental nerve and fill the canals before turning. A tooth without a nerve is a dead tooth, its tissues no longer participate in the metabolic process and become brittle.

Most optimal solution- this is a sparing prosthetics without turning.

Options for prosthetics without enamel turning:

• adhesive bridges (attached to adjacent crowns with glue);
• lumineers;
• removable nylon prosthesis;
• implantation.

Restoration of anterior teeth with veneers

Extension of front teeth

Tooth extension is an artistic restoration, which is performed using filling materials. This procedure is indicated when the coronal part is less than 50% destroyed. It is an affordable alternative to expensive veneers and crowns.

Other indications for enamel extension:

• mechanical damage - chips, cracks, etc.;
• the presence of interdental spaces;
• violation of the anatomical shape of the tooth (erasure of the cutting edge);
• caries.

You can build up a tooth in just 1 visit, the procedure takes 30-40 minutes. The doctor applies a filling mass (composite) in layers to the defect area. Each layer is illuminated with a photopolymer lamp and instantly hardens. At the end of the session, the surface of the filling is ground and polished to achieve perfect smoothness.

When should implants be placed?

A dental implant is a complete replacement for a lost tooth. It consists of an artificial titanium root and a ceramic crown. Therefore, implantation is relevant in the case when not only the crown part, but also the tooth root is destroyed.

The main contraindication to implantation is the loss of jaw bone tissue. After tooth extraction, the jawbone loses its natural mechanical load. If you do not fix the prosthesis or implant in place of the "clearing", bone atrophy occurs.

In such cases, a sinus lift operation is performed (building up bone tissue with synthetic substitutes).

Restoration of anterior teeth in periodontal disease

The acute stage of periodontal disease is a contraindication to dental prosthetics. First, you need to undergo therapy with a periodontist and achieve a stable remission, and only then put a prosthesis.

Prolonged periodontal disease causes atrophy of the gums and mobility of the front teeth. Therefore, it is important not only to replace the lost crowns, but also to recreate the aesthetics of the gingival margin, to strengthen the entire dentition. For this, 2 types of removable structures are used:

• clasp prostheses - they are based on a metal arc, which allows you to fix loose teeth and evenly distribute the chewing load;
• nylon prostheses - their basis consists of translucent pink nylon, which perfectly imitates the oral mucosa. However, nylon prostheses are used only for periodontal disease of 1-2 degrees.

Clasp prosthetics of the anterior teeth

Price of dentures for front teeth

The average cost of prosthetics in the smile zone:

• zirconium dioxide crown - 30,000 rubles;
• metal-ceramic crown - from 10,000 rubles;
• nylon prosthesis - 12,000 rubles;
• veneer - from 15,000 rubles;
• lumineers - from 30,000 rubles;
• implant - about 40,000 rubles;
• enamel extension - about 7000 rubles.