Prosthodontist: Complex Cases & Considerations

Dr Advocate Avatar IconUpdated: September 1, 2022
By: Dr. Advocate

Classic car hobbyists have a fantastic talent for restoration and repair. However, there’s a specialty with an even greater skill set to restore dentistry’s most complex oral overhauls. Prosthodontists treat complex cases by replacing and repairing teeth using different restoration materials. Their scope of practice overlaps with much of a general dentist’s; however, they also assist with oral cancer facial reconstruction, traumatic injury repair, and advanced temporomandibular jaw (TMJ) dysfunction.

This specialty is less known to the public than an oral surgeon or orthodontist because many general dentists are completing advanced training to manage complex cases in their practice. However, there’s still a great need for prosthodontists, particularly for full mouth reconstruction and other complex issues. Let's take a look at these procedures in more detail.

Recommended Reading: Five Qualities of a Great Dentist


Full mouth reconstruction

One of the most challenging cases to treat and manage is a full mouth reconstruction or rehabilitation patient. This procedure is necessary if the patient has worn their teeth down so severely that their bite has collapsed, leading to TMJ pain and discomfort. Their teeth may also require removal if prompt treatment is delayed. Full mouth reconstruction involves crowning or replacing every tooth to protect the remaining tooth structure and find a proper jaw position when chewing.

This procedure requires exceptional communication between the clinician and the lab technician. Areas of detail include restorative material, varying shades, accurate fit, midline verification, smile design, and bite registration. Treatment will take place over many months; however, crown preparations may be completed during a single visit or broken up over a few days.

The patient will be able to evaluate the shape of the teeth before delivery when wearing the temporary crowns, as the lab fabricates a mold for the patient to try out. After the crowns are completed and ready for delivery, the temporary crowns will be removed, and the new crowns will be cemented or bonded into place. First, let’s take a closer look at the differences between cementing and bonding crowns.


Cementing

  • Ideal if isolation is compromised
  • Single step application
  • Ideal for metal crowns
  • Takes minutes to hours for final set
  • Weaker strength compared to bonding
  • May wash out under crown over time
  • Some cements prevent cavities from forming
  • Decades of research and development
Bonding

  • Exceptionally strong bond strength
  • Requires multiple steps for application
  • Ideal for ceramic restorations
  • Requires perfect isolation
  • Sets in seconds using UV light
  • Newer product/less research
  • Ideal for anterior crowns

The clinician will evaluate when and where the teeth contact during biting. It’s essential to verify that all teeth hit simultaneously and with equal force. If one hits before the others, adjustments will be needed, the tooth becomes tender, and the crown may fracture. It’s recommended to wear a nightguard after case completion.


Complex cases

Dental Specialist - Prosthodontist dental implants illustration | My Dental Advocate

Prosthodontists require 2-3 years of advanced training and education for accreditation. They’re experts in restoring teeth, including complex cases, a term for issues that a general dentist wouldn’t feel comfortable taking on in their practice. A typical example is a patient who’s had facial trauma, requires reconstruction of their teeth, and has temporomandibular joint (TMJ) complications. Because the teeth and the jaw are closely related when chewing, it’s essential to restore their teeth in harmony with an ideal comfort zone of the TMJ.

The dentist will develop a treatment plan between the patient, clinician, and lab technician. The dentist may need multiple delivery attempts to affirm the ideal fit before final delivery. Prosthodontics needs to be exceptional at formulating a dental treatment plan, providing clear explanations to the patient, communicating effectively with the lab technician, and executing a complex procedure. An oral appliance will also be necessary to minimize TMJ discomfort and encourage healing.


Considerations

Prosthodontists are equipped to handle many types of complex cases. Cosmetic dentistry is another aspect of their practice that many patients desire. With so many opportunities for continuing education and training for general dentists, it’s no surprise that only 3% of the population knows what a prosthodontist does. However, general dentists are increasingly competent and comfortable handling more complex cases. If your general dentist refers you to a prosthodontist, understand that you’ll be receiving expert care and attention to detail with your case.


Related: Best MDA Recommended Products


Final thoughts


Prosthodontists play a vital role in the dental community, and general dentists look to them for guidance and understanding of complex cases. For example, have you recently been referred to a prosthodontist? Do you understand your proposed treatment plan? My Dental Advocate’s team of board-certified dentists can provide a second opinion on your planned treatment. We look forward to bringing you peace of mind by verifying your treatment plan, suggesting an alternative, or answering your questions.


Dr Advocate Avatar IconAbout the Author

Dr. Advocate is an actual board-certified dentist with clinical practice experience and a mission to provide accurate dental patient education. He believes everyone should access easy-to-read dental resources presented in layman’s terms with relevant, up-to-date dental research and insight to improve their oral health.




Dental Specialist - Prosthodontist showing jaws model to patient | My Dental Advocate

Prosthodontist:
Complex Cases & Considerations

Dr Advocate Avatar IconUpdated: September 1, 2022
By: Dr. Advocate

Classic car hobbyists have a fantastic talent for restoration and repair. However, there’s a specialty with an even greater skill set to restore dentistry’s most complex oral overhauls. Prosthodontists treat complex cases by replacing and repairing teeth using different restoration materials. Their scope of practice overlaps with much of a general dentist’s; however, they also assist with oral cancer facial reconstruction, traumatic injury repair, and advanced temporomandibular jaw (TMJ) dysfunction.

This specialty is less known to the public than an oral surgeon or orthodontist because many general dentists are completing advanced training to manage complex cases in their practice. However, there’s still a great need for prosthodontists, particularly for full mouth reconstruction and other complex issues. Let's take a look at these procedures in more detail.

Recommended Reading:
Five Qualities of a Great Dentist


Full mouth reconstruction

One of the most challenging cases to treat and manage is a full mouth reconstruction or rehabilitation patient. This procedure is necessary if the patient has worn their teeth down so severely that their bite has collapsed, leading to TMJ pain and discomfort. Their teeth may also require removal if prompt treatment is delayed. Full mouth reconstruction involves crowning or replacing every tooth to protect the remaining tooth structure and find a proper jaw position when chewing.

This procedure requires exceptional communication between the clinician and the lab technician. Areas of detail include restorative material, varying shades, accurate fit, midline verification, smile design, and bite registration. Treatment will take place over many months; however, crown preparations may be completed during a single visit or broken up over a few days.

The patient will be able to evaluate the shape of the teeth before delivery when wearing the temporary crowns, as the lab fabricates a mold for the patient to try out. After the crowns are completed and ready for delivery, the temporary crowns will be removed, and the new crowns will be cemented or bonded into place. First, let’s take a closer look at the differences between cementing and bonding crowns.


Cementing

  • Ideal if isolation is compromised
  • Single step application
  • Ideal for metal crowns
  • Takes minutes to hours for final set
  • Weaker strength compared to bonding
  • May wash out under crown over time
  • Some cements prevent cavities from forming
  • Decades of research and development
Bonding

  • Exceptionally strong bond strength
  • Requires multiple steps for application
  • Ideal for ceramic restorations
  • Requires perfect isolation
  • Sets in seconds using UV light
  • Newer product/less research
  • Ideal for anterior crowns

The clinician will evaluate when and where the teeth contact during biting. It’s essential to verify that all teeth hit simultaneously and with equal force. If one hits before the others, adjustments will be needed, the tooth becomes tender, and the crown may fracture. It’s recommended to wear a nightguard after case completion.


Complex cases


Dental Specialist - Prosthodontist dental implants illustration | My Dental Advocate

Prosthodontists require 2-3 years of advanced training and education for accreditation. They’re experts in restoring teeth, including complex cases, a term for issues that a general dentist wouldn’t feel comfortable taking on in their practice. A typical example is a patient who’s had facial trauma, requires reconstruction of their teeth, and has temporomandibular joint (TMJ) complications. Because the teeth and the jaw are closely related when chewing, it’s essential to restore their teeth in harmony with an ideal comfort zone of the TMJ.

The dentist will develop a treatment plan between the patient, clinician, and lab technician. The dentist may need multiple delivery attempts to affirm the ideal fit before final delivery. Prosthodontics needs to be exceptional at formulating a dental treatment plan, providing clear explanations to the patient, communicating effectively with the lab technician, and executing a complex procedure. An oral appliance will also be necessary to minimize TMJ discomfort and encourage healing.


Considerations

Prosthodontists are equipped to handle many types of complex cases. Cosmetic dentistry is another aspect of their practice that many patients desire. With so many opportunities for continuing education and training for general dentists, it’s no surprise that only 3% of the population knows what a prosthodontist does. However, general dentists are increasingly competent and comfortable handling more complex cases. If your general dentist refers you to a prosthodontist, understand that you’ll be receiving expert care and attention to detail with your case.


Frequently asked questions (FAQ)


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Yes, there are cases when it’s needed. If your dentist refers to you, it's for a specific reason. If they don’t mention why, be sure to understand your proposed treatment better.

Yes, most prosthodontists can place and restore implants which is convenient in that your treatment can be completed with one clinician rather than traveling around to multiple providers. In addition, important information is documented and saved regarding implant details.

Unfortunately, not all prosthodontists promote their specialty in their practice name or branding. You may have to research their website to learn more about their education and training. Sometimes this can be confusing when a general dentist refers a patient to a prosthodontist, yet it appears it’s another general dentist.

Related: Best MDA Recommended Products


Final thoughts


Prosthodontists play a vital role in the dental community, and general dentists look to them for guidance and understanding of complex cases. For example, have you recently been referred to a prosthodontist? Do you understand your proposed treatment plan? My Dental Advocate’s team of board-certified dentists can provide a second opinion on your planned treatment. We look forward to bringing you peace of mind by verifying your treatment plan, suggesting an alternative, or answering your questions.


Dr Advocate Avatar Icon
About the Author

Dr. Advocate is an actual board-certified dentist with clinical practice experience and a mission to provide accurate dental patient education. He believes everyone should access easy-to-read dental resources presented in layman’s terms with relevant, up-to-date dental research and insight to improve their oral health.



Related Topics


Endodontist

Orthodontist

Oral Surgeon

Pedodontist

Periodontist


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