Dentures and Prosthetic Dentistry

A prosthesis is an artificial replacement for a missing tooth, or for a tooth so badly broken down that it can no longer hold itself together. Say “dentures” and most people picture false teeth left in a glass overnight, but those are only one member of the family. Crowns and bridges that stay in the mouth permanently are prostheses too, and so are teeth fixed to implants.

This page is the map: which types of prosthesis exist, what fundamentally separates them and how the decision is made. Each type has its own page with the detail.

Fixed or removable: what is the difference?

The first distinction is who can take it out. A fixed prosthesis can only be removed by a dentist; a removable one you put in, take out and clean yourself.

A third route sits between the two: the implant-supported prosthesis. Here a removable denture can be anchored to implants so that it no longer moves, or the whole arch can be turned into a fixed bridge.

What types of prosthesis are there?

• Crown (cap): Covers a single tooth whose root is sound but whose upper part has lost a lot of structure. For the choice of material, see zirconia crowns.
• Bridge: A one-piece fixed restoration anchored to the teeth on either side of a gap, carrying the missing tooth between them.
• Partial denture: A removable denture, held on by clasps, that fills the gaps while you still have some of your own teeth. The detail is on the partial dentures page.
• Full denture: Rests on the gums and palate when no teeth are left in the jaw; see full dentures.
• Implant-supported prosthesis: A single crown, a bridge or a full-arch prosthesis attached to implants. We compare the connection types on the implant-supported prosthetics page.

When does a bridge make sense, and when not?

Bridges do not have a page of their own, because the decision is usually made side by side with an implant. For a bridge, the teeth on either side of the gap are reduced all the way round and the structure carrying the missing tooth is cemented onto them. If those teeth already have large fillings or crowns, reducing them is no great loss, and a bridge is a quick and sturdy solution. If the neighbours are healthy, untouched teeth, the picture changes: rather than cutting down two sound teeth to replace one, a dental implant is generally the more conservative option.

The limit of a bridge is its length. The bigger the gap, the more load falls on the supporting teeth; bridges that carry many missing teeth on only a few supports run into trouble sooner. For a single missing front tooth, a resin-bonded (“winged”) bridge glued to the back surfaces of the neighbouring teeth can be an in-between solution that needs much less drilling.

What decides the choice?

At the examination we are not hunting for one “right prosthesis”; the answers to the questions below narrow the options down on their own:

• How many teeth are missing, and where? If the back teeth are missing, there is no tooth behind the gap to carry a bridge; the options are an implant or a removable denture.
• What state are the remaining teeth in? Resting a bridge or a clasp on teeth loosened by gum disease means putting the load on a weak foundation.
• Is there enough bone? If implants are being considered, a CBCT scan shows this; if the bone is insufficient, a graft or a different plan is discussed.
• General health and dexterity. If something makes daily cleaning difficult, a design that is easy to clean may be the better choice.
• Expectations and timing. For some patients the priority is never having to take their teeth out; for others it is a shorter timeline or less surgery.

Does a missing tooth always have to be replaced?

Usually, but not always. Over time the neighbouring teeth tip into an empty gap, the opposing tooth in the other jaw drifts down (or up) into the space, and the bite is disturbed. The bone where a tooth was extracted also slowly thins, so waiting a long time can narrow your options later.

On the other hand, if the missing tooth is the last molar at the back and has no opposing tooth, replacing it does not benefit every patient. In that situation, suggesting that we simply keep an eye on the gap is an honest option too; we make the decision together.

How does the process usually go?

1. Examination and X-rays. A panoramic X-ray and, if needed, a 3D CBCT scan. We go through the options together with their timelines and limitations.
2. Treatment beforehand. Decay, root canal treatment, gum treatment and any necessary extractions are completed before the prosthesis is made. A prosthesis built on a problem tooth is lost together with that tooth.
3. Impressions and try-ins. Between one and four try-ins depending on the type; shade, shape and bite are adjusted at this stage.
4. Fitting and adjustment. Short follow-up appointments in the first days deal with small pressure spots and fine-tune the bite.

After an extraction, the gum and bone change shape over several months. This is why a transition period is often planned before the permanent prosthesis, with a temporary solution so that you are not left without teeth in the meantime.

What does the cost depend on?

The cost depends on the type of prosthesis and its material (zirconia, porcelain fused to metal, a metal framework or acrylic), how many teeth or units are involved, whether implants are needed and what treatment has to be done before the prosthesis. After the examination at our clinic in İzmir you receive a written, itemised quote based on your own plan. Insurance cover varies, so check with your own insurer what, if anything, it pays towards.