Removable Prosthesis

Bleaching Trays

Bleaching trays, or teeth whitening trays as they’re more commonly known, are plastic retainers that hold whitening (bleach) gel and are made using models of the patient’s teeth. Each tray is custom-made to fit over the patient’s maxillary and mandibular teeth like a ‘glove.’

Teeth whitening trays can be used by anybody, but the effectiveness differs as per every individual. Teeth with multiple colorations, bands, splotches or stains due to tetracycline use or fluorosis do not whiten as well, whereas artificial teeth, caps, crowns, veneers, and existing dental fillings do not whiten at all. Use of bleaching trays in patients with these characteristics/modifications will affect esthetics of the patient, especially if they are present in the ‘smile line’ (visible teeth) of the patient.

Constituents:

If the bleaching trays in question are over-the-counter ones, then these are usually made of a flexible material that molds to the patient’s teeth. The material fits around the teeth gently, and allows for whitening to occur on the surface and in the interdental spaces. If the trays are custom-made by the dentists, then these will have molds that have been created specifically for the patient and therefore fit in perfectly over the teeth.

Some teeth whitening trays are pre-filled with a peroxide-based whitening agent, while others come with syringes of whitening gel that can be dispensed as needed by the patient. Each of the teeth bleaching trays is pre-filled with the appropriate amount of a peroxide-based whitening gel that is similar to what is used in popular whitening strips and other over-the-counter whitening products. Most whitening systems include a full set of disposable trays; two trays per day, one for the mandibular teeth and the other for the maxillary teeth. Either way, teeth whitening trays usually require a longer daily application time than many other whitening options. Some need to be applied for hours at a time, while others recommend overnight application.

Vacuum Forming

Vacuum forming, also known as thermoforming, is a process by which a sheet of plastic is heated to a forming temperature, stretched onto a single-surface mould, and forced against the mould by a vacuum. This process is usually used in the fabrication of all kinds of bleaching trays, helping achieve the desired thickness and flexibility.

There are several uninformed reservations revolving around tooth bleaching and its methods. However, many dentists consider bleaching to be the safest cosmetic dental procedure out there.

Dentures

In simple terms, dentures serve as removable artificial replacements for natural teeth and gums. They differ from other forms of replacements or repairs in that they are not permanently affixed to the natural teeth or jawbones.

Dentures are available in two main types:

1. Full or Complete Dentures – Replacing all the teeth in the maxilla and/or mandible
2. Partial Dentures – Replacing a select few missing teeth

Given that the only way to replace a lost tooth involves some form of anchor, usually the natural teeth, dentures become the only viable solution when multiple teeth on the same row are missing. They are typically custom-designed to fit the patient’s mouth, visually matching the existing teeth and surrounding tissue. Complete dentures are often worn throughout most of the day as a substitute for natural teeth and removed for cleaning at night. Partial dentures function similarly but are clipped onto the remaining natural teeth as an added feature.

How long do dentures last?

As dentures are constructed from artificial materials and are not usually built on top of existing enamel, they generally do not deteriorate with time. The primary reason dentures may need replacement is due to changes in the patient’s tissue and bone structure over time. This natural and unavoidable aspect of aging necessitates occasional adjustments to keep dentures comfortable and secure in the patient’s mouth.

Advantages:

1. A viable option for individuals who have lost several or all of their natural teeth.
2. Help prevent facial tissues from sagging or caving in when multiple teeth are missing in one row, contributing to a more normal appearance and improved self-esteem.
3. Completely pain-free.
4. Sturdy, flexible, and easy to maintain.
5. Economically cost-effective.

Disadvantages:

1. Require replacement every few years due to anatomic changes in tissue and bone structure.
2. Involve multiple sessions for fabrication.
3. Need frequent cleaning.
4. In cases of partial dentures, may contribute to abutment tooth loss.
5. Can lead to bone loss.

Nightguards

A nightguard is a protective appliance worn over the teeth, usually to prevent damage from heavy occlusal forces that occur during teeth clenching or grinding. There are many different types of nightguards, made from various materials with different shapes, sizes, and purposes. The most common and most beneficial type of nightguard is a hard acrylic, custom-fitted mouthpiece covering either all of the upper or all of the lower teeth. As nightguards are appliances that deal with tooth size, arch shape and other intraoral features, it is imperative to have them custom-made after receiving expert advice from a dental professional, rather than using pre-manufactured over-the-counter nightguards.

Indications:

1. Bruxism
Bruxism, which is the technical term for grinding of the teeth, is a lot more common than one might think. Many people manifest the stress of the day during the night in the form of clenching and/or grinding their jaw, which in turn causes severe damage to the enamel of the teeth, while also weakening the supporting muscle and bone structures.

2. TMJ Dysfunction
The temporomandibular joints (TMJ) are the small connective tissues on either side of the face that attach the jaw to the skull, allowing for smooth movement when we speak, chew, and smile. When these small, triangular joints are damaged or overworked, it often results in painful or impeded jaw movement, which makes laughing and/or yawning significantly painful. Nightguards can be crafted to hold the jaw in its ideal resting position while sleeping, consequently preventing excess strain and relieving the pressure on the TMJ. Over a few weeks of wear, most people see significant improvement in their symptoms. However, in order to maintain results, one might need to wear the appliance even after the symptoms subside.

3. Implant Treatment for Monolithic Zirconia and other Full-arch Restorations
The goal of occlusal nightguards is to minimise any possible parafunctional habits occurring tooth-to-tooth and direct them to tooth-to-guard instead. Patients who are supporting implant prostheses sometimes find it hard to accurately judge the level of occlusal force they are generating. In these cases, it becomes necessary for the patient to wear occlusal guards in order to protect the prosthesis.

4. Snoring
Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. It can be caused by various conditions, such as obesity, nasal congestion, nasal deformities, overuse of alcohol, obstructive sleep apnea (OSA) etc. As snoring is a result of the obstruction of the airway, nightguards help in keeping the airway open in order to mitigate or eliminate snoring.

Advantages:

1. Reduced pain and tension – nightguards are lightweight, practical and comfortable.
2. Reduced headaches – people who have disorders related to the jaw often tend to have headaches. Nightguards help prevent them.
3. Prevent tooth damage.
4. Better sleep – nightguards reduce any symptoms related to the jaw, which lead to a more relaxed sleep.

Orthodontic Appliances

Orthodontic appliances are corrective and supportive appliances that are designed and prescribed by an orthodontist to treat malocclusions, including crooked, crowded, and/or protruding teeth that do not fit well in the maxillary or mandibular arches.

They are generally classified into three groups:
1.  Fixed Appliances – these are cemented and/or bonded to teeth. These can only be removed by dental professionals.
2.  Removable Appliances – can be removed by the patient.
3.  Extraoral Appliances

We’re going to elaborate a little on Removable Appliances.

Removable Orthodontic Appliances, sometimes referred to as ‘plates’, usually consist of a plastic or acrylic framework that supports a variety of wires. These wires can either be active in order to move teeth into certain positions, or passive, in order to hold the appliance in place. The ‘plates’ sometimes even support auxiliaries such as expansion screws to widen the dental arch, or springs, which are placed to move specific teeth. Removable appliances are no substitutes for braces, but can be used for simple tooth movements, sometimes as a preliminary measure prior to a more comprehensive treatment, once all permanent teeth have erupted. Sometimes, these appliances are also worn as retainers to maintain the result of an orthodontic treatment.

Types of Removable Appliances:

1.  Hawley’s Appliances (Labio-lingual appliance) – used for repositioning individual teeth in the arch.
2.  Screw Appliances – used to expand the arch perimeter.
3.  Functional Appliances – to move the teeth and skeletal structures with the use of functional forces.

Advantages:

1.  Patient can put them on and take them off as needed.
2.  Are less conspicuous.
3.  Can be fabricated by a general practitioner. Orthodontic expertise isn’t necessarily needed.
4.  Reduces chairside time for patients, as it’s manufactured in a lab.
5.  Is budget friendly, compared to fixed appliances.

Disadvantages:

1.  Offers the correction of only simple malocclusions.
2.  Multiple rotations cannot be corrected.
3.  Heavily dependent on patient compliance.
4.  Allows movement of fewer teeth.
5.  Retention is poor specifically in the mandible.
6.  Are more prone to breakage and loss.