Introduction

Prosthodontics is a specialised branch of dentistry, also known as the "art and science of dental prostheses", which focuses on designing, creating, and fitting artificial teeth and dental appliances.¹ It helps restore teeth, enhance appearance, and improve overall health by designing teeth dentures, crowns, bridges, and dental implants in patients who have lost teeth due to injury, disease, or other factors.² This specialised field is very interesting as it combines intricate artistry with technology to play a crucial role in both aesthetic and functional restoration. Prosthodontics help patients feel more confident in their smiles and about themselves, enhancing their quality of life.¹

Evolution of prosthodontics

From utilizing shells and bones in prehistoric times to harnessing advanced 3D printing technologies and bioengineered materials today, the field of prosthodontics has undergone remarkable evolution and innovation.

The ongoing research is focused on using artificial intelligence and machine learning in treatment planning and regenerative techniques for future prosthodontic innovations.³

Types of prostheses

Below are the types of prostheses based on the needs of the patient:⁴

Implant prosthesis

Dental implants such as crowns, bridges, or dentures are placed within the jawbone to support prosthetic teeth.

Fixed prosthesis

Restores missing or damaged teeth using crowns, bridges, or veneers that are permanently attached to other natural teeth or fitted implants.

Removable prosthesis

Complete and partial dentures that can be placed in and taken out by the patient are commonly used when several or all teeth are missing.

Maxillofacial prosthesis

It focuses on restoring oral and facial structures affected by birth defects, injury, or surgery. It often involves prosthetic eyes, ears, and jaw segments, along with teeth.

Cosmetic prosthesis

Enhances the appearance of teeth using prosthetics like veneers, inlays, and onlays, designed for aesthetic improvement in conjunction with functional restoration.

Making of a prosthesis

Various modalities employed in making a prosthesis are as following:⁵

Advanced imaging in diagnosis

• Cone Beam Computed Tomography (CBCT): Revolutionises prosthodontics with high-resolution, 3D images of oral and maxillofacial structures 
• Enhanced visualisation: Detailed views of bone structure, tooth positioning, and soft tissue for accurate diagnostics 
• Precision planning: Facilitates the creation of digital models that guide the design and placement of dental prostheses 
• Tailored restorations: Integrates imaging data into treatment planning, ensuring restorations match the individual’s teeth structure 
• Predictable outcomes: Improves accuracy and success rates of prosthodontic treatments

Digital dentistry

Digital dentistry has revolutionised prosthodontics by replacing traditional impression methods with advanced digital technologies, enhancing comfort, accuracy, and efficiency in creating customised dental restorations. There are 4 main ways dentistry is advancing, as mentioned below:⁶

Paradigm shift

Digital dentistry has revolutionised prosthodontics, replacing traditional alginate and silicone impressions with digital impressions.

Enhanced comfort and accuracy

Digital impressions provide greater patient comfort and improved accuracy compared to traditional methods.

Intraoral scanners

It captures detailed images of the dentition and surrounding tissues, creating digital models for prosthetic planning and fabrication.

Efficient data transmission

Digital impressions enable rapid data transfer between dental offices and laboratories, streamlining prosthesis design and fabrication.

CAD and CAM technologies

These technologies facilitate the creation of highly precise, customised dental restorations, including crowns, bridges, dentures, and implants.

Material innovations

There are three types of materials widely used in prosthodontics in various clinical presentations of patients. These include:⁷

Zirconia

Commonly used to make crowns and bridges as it has strength and durability, is natural to wear and gives a natural appearance. The translucency can be changed to match the colour of the teeth, which is why it is an excellent option for anterior/posterior restorations.

Lithium disilicate

Lithium disilicate (a glass-ceramic) is a very strong restorative material used to mimic natural tooth enamel. It is the best material for cosmetic restorations such as veneers, crowns, and inlays.

3D-printed materials

3D-printed resins and polymers are used to create personalised prosthetic devices, enabling rapid prototyping and the production of complex designs that are difficult to achieve with traditional methods. 

The artistry in prosthesis

It is remarkable how science truly combines with technology in this speciality of dentistry. Prosthodontists must have a keen eye for detail along with an understanding of dental anatomy, which makes this a creative career path.

Prosthodontists have the role of selecting the right shade of tooth for dental restorations for which they should have a true understanding of how light interacts with the shades of natural tooth colour.

Moreover, they should be able to design prostheses which match the facial features and dental structures, including the shape, contour, and alignment of prosthetic teeth.

Artistic skills are essential in creating restorations, which will improve the patient’s overall appearance,e making them feel more confident about themselves.⁸

Working in collaboration

Prosthodontists work alongside a variety of multi-disciplinary professional teams (including other prosthodontists and dental laboratory technicians) to create a perfect prosthesis for the patient to live up to their aesthetic expectations.

All professionals work within a team to provide patient-centred care. Digital workflows help with this communication, allowing real-time feedback and adjustments to design and fabricate prostheses.

Moreover, the needs and preferences of patients must be addressed. Using tools such as smile design software and virtual simulations allows patients to visualise the outcomes of their desired results and provide their opinions for improvement, too.⁹

The future of prosthodontics

There is much research going into the field of prosthetic dentistry as advancements in AI allow more digital tools to be created to help patients see outcomes of their desired results through online software and machine learning.

Machine learning is used to understand treatment planning and the development of bioengineered materials and regenerative techniques, leading to the creation of new methods for tissue and bone regeneration, improving implant treatments overall.¹⁰

Summary

Prosthetic dentistry is a perfect blend of artistic creativity and technological innovation. Advances in imaging, digital dentistry, materials, and implant techniques have significantly improved patient outcomes and quality of life. This field emphasises patient-centred care and the collaborative efforts of the multidisciplinary team. In this article, we explored the evolution of dental prostheses, the role of imaging and digital technology, the materials used, implant prosthodontics, and the teamwork involved in delivering the best dental solutions for patients.

FAQs

Q1 - What is a dental bridge?

Answer - A prosthetic device used to replace one or more missing teeth by attaching to multiple adjacent natural teeth or implants.¹¹

Q2 - What are the types of dental bridges?

Answer - There are 4 types of bridges. These names include traditional, cantilever, maryland and implant-supported bridges.¹²

Q3 - What are the materials used to make dentures?

Answer - Acrylic resin, metal and composite materials. Acrylic resin is used to make denture bases for prosthetic teeth, metal is used to make partial dentures for strength and durability and composite material is used to create a more natural look.¹²

Q4 - How are dentures made?

Answer - There are 4 steps to make a denture. These include impression, wax model, fabrication, and fitting. The first step includes taking an impression of the gums and teeth, if present. The second step is making a wax model to test the fit and bit. The third step includes creating the final denture from acrylic or other materials. Finally, once the denture is fitted, proper bite and alignment are checked.¹³

Q5 - How do I care for crowns, bridges, and dentures?

Answer - Maintaining good oral hygiene, brushing twice a day, flossing around the crown or bridges and visiting the dentist regularly are just some ways to keep prosthetic teeth clean.¹⁴

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