Dental Reconstruction
By David D. McFadden, DMD, FACP
Dental reconstructions are an extremely complex undertaking. Most dentists promote the final esthetic result because that’s the most important thing to the patient. However, the outcome is the sum of many components that include advanced education, experience, skill, a commitment to excellence and patience.
There are specialists in reconstructive dentistry called prosthodontists. To become a prosthodontist, a dental student must be accepted to an additional three-year residency program at an accredited dental school or hospital after completing the first four years of dental school. It may not be immediately apparent, but, for obvious reasons, dental school students only get to treat patients with simple dental needs. Prosthodontic specialty residencies are three years long, fulltime and have very demanding requirements. This is a major commitment for any dental student.
Prosthodontic residents are usually detail-oriented, highly ambitious people who want formal education to treat patients with complex dental needs. Typically, these dental students are good with their hands and find general dentistry easy.
Unfortunately for the dental consumer, general dentistry goes by many names. Many dentists use terms like cosmetic dentistry, sedation dentistry, sleep dentistry and implant dentistry in an effort to differentiate themselves from competition. None of these terms are recognized by the American Dental Association with specialty designations. These terms are simply marketing terms used by general dentists to promote themselves to the public. None require even a single day of additional education to use these terms. Prosthodontics is the only specialty recognized by the American Dental Association for complex dental care.
There are no shortcuts to good outcomes. Complex dental procedures are expensive and time consuming. In this author’s opinion, anything beyond one single dental crown is considered complex. When done thoroughly crowns, bridges, dental implants and removable prostheses require extreme precision.
Many patients can only afford to do a major treatment once every ten to twenty years. Therefore, it is of paramount importance to become educated in choosing who completes the care. The official website for the American College of Prosthodontists is www.acp.org. There you can find unbiased information about the specialty that deals with the “restoration and replacement of damaged and missing teeth”. Board certification status additionally separates a small subgroup of prosthodontists in the US. Only 375 private practitioner prosthodontists are board certified by the American Board of Prosthodontics.
Some of the things that comprise a thorough examination, diagnosis and treatment plan include:
To properly prepare for a complex treatment, a dentist should perform a detailed examination of the oral cavity, take adequate x-rays, make molds of the teeth and evaluate all the data carefully.
Many times, a diagnostic wax-up is indicated. The wax-up is a three-dimensional proposal for the outcome, in wax, that the dentist and patient can view and discuss.
Additional specific x-rays such as a dental CT scan, another three-dimensional diagnostic tool that shows bone support for existing teeth or future dental implants.
Because teeth shift, tooth and bone loss occurs, facial structures and support change, it is not always possible to restore a patient to their original state. Understanding what is not possible is just as important as what is possible.
Often, many highly expensive treatments are doomed for failure because the diagnostic phase was not adequate. Some examples include those with a compromised dentition who have significant grinding problems that are not addressed. When care is not used to plan for and manage grinding, failure of the dental prosthesis often results. Tooth length, width and color are also significant factors when considering complex dental care. Bone support can be compared to the foundation of a building. Additionally, each tooth’s root system must also be evaluated as it also provides part of the foundation for the dental prosthesis (crown, bridge, etc).
Because most patients are focused on how it looks upon completion they forget that for a dental treatment to really be successful it must also last. Proper and thorough diagnosis and planning cannot be overlooked when making these important dental decisions. All patients should thoroughly educate themselves before spending time and money on complex dental care.
Dr. David McFadden, a graduate from the University of Pittsburg School of Dentistry, earned his certificate in Prosthodontics from Baylor College of Dentistry and was awarded Board Certification from the American Board of Prosthodontics. He was the Founder and Director of the UT Southwest Dental Implant Center. He is now in private practice in Dallas and may be reached at 214-956-9100.