A dentist finishes 4 years of dental school and receives a DDS or DMD degree. A general dentist has good knowledge in most dental disciplines and can provide a wide range of dental services. A prosthodontist is a dentist who specialises in restorative and reconstructive procedures. A prosthodontist is a dentist who returns to university for three years to complete a full-time graduate programme, gaining a certificate in prosthodontics as well as a Masters degree. Prosthodontists have more advanced training than dentists, so even though they can perform all of the services of a general dentist they typically manage more complex cases. Because the rigorous training required to become a prosthodontist is time consuming and tough, there aren’t many of them. Prosthodontists are dentistry’s best kept secret.

Crowns are hollow restorations that slide over the top of a tooth and cover the tooth on all 5 sides (top, front, back and sides). They are used when a tooth is broken, chipped, cracked, heavily filled or has a very large cavity (hole in it). Crowns can be made of metal(gold), porcelain, zirconia or acrylic. Your prosthodontist or dentist will recommend which crown material is best for you. Veneers are basically half a crown and they are glued onto the front of a tooth as a thin facing (like an artificial nail is glued on). Veneers are used to subtly change the shape and colour of teeth. As thinner, more delicate restorations than crowns,  veneers are usually recommended for the front teeth only. They are very kind to the tooth because you don’t have to grind a tooth down to glue a veneer on. Veneers can be made in a dental lab out of porcelain or built-up chair side with filling material by your prosthodontist or dentist.

Tooth bonding is a process in which a prosthodontist (or dentist) repairs a tooth by applying (bonding) a tooth-coloured material called composite resin to the surface of the tooth. It might be a straightforward and cost-effective technique to repair teeth cosmetically in a single visit. The procedure might take anywhere from 30 minutes to more than an hour, depending on how challenging it is. The tooth is primed/cleaned with chemicals (an acid, a primer, an adhesive), and then the composite resin is added in bits and shaped. The substance is then cured/hardened using a specific light. More composite resin filling can be applied, shaped, and cured as necessary. Then, using specific burs (drill bits), the composite is shaped and polished to look like a tooth.

When you have missing teeth, a prosthodontist can fill this gap or “bridge” the gaps in your smile with false teeth. A bridge then, is a false tooth (called a pontic) that fills in the gap in your smile that is attached to the teeth next to the gap by cemented crowns. Another term for this is a fixed partial denture (fixed, because it attaches to the other teeth with a glue/cement). This is an example of a bridge to replace 4 missing front teeth. The end crowns on the left and right get cemented to the 2 teeth next to the gap in the mouth and the 4 pontics (false teeth) fill in the gap between the missing teeth. If the false tooth is attached to the adjacent teeth with some thin metal wire hooks, this is not a bridge. Dentists call this a removable partial denture because you can remove your false teeth by unhooking the wires from your mouth.

A dental implant is a root substitute so it is used when you have missing teeth. It is an artificial root made of titanium that looks like a screw (see photo). It’s inserted into the jawbone, under the gumline, to replace the roots of missing natural teeth. When the implant is healed, it fuses to the jaw bone so that you can use it as an anchor to attach artificial teeth like, dentures, crowns and bridges. The specialists that are involved with implant dentistry are, prosthodontists, oral surgeons and periodontists. The prosthodontists do all the planning for the implant and give you the artificial teeth, the oral surgeons and periodontists place the implant anchor in the jawbone and monitor the healing.

I like to tell patients that basically a periodontist is a specialist that is responsible for all the stuff that goes on below the gums and a prosthodontist is the specialist that’s responsible for everything above the gumline. A periodontist is a dental specialist that treats problems and diseases of the gums, the attachment part to bone and the bone housing the roots of teeth. They will also place titanium implants in the jawbone as part of their specialty. Prosthodontists are dental specialists in restorative and “reconstructive” dentistry, that treat missing teeth with crowns, bridges, implants and dentures. They are also specialists in appearance related dentistry to improve the look of teeth with bonding, veneers and tooth bleaching. Prosthodontists often work with periodontists in a collaborative nature to provide a beautiful smile where healthy gums frame the customized aesthetic tooth restorations.

That is a great question! It depends on a lot of factors. Your prosthodontist would review these factors with you in helping you to decide what type of restoration would be best for you to replace the missing teeth. For an implant we will look at the following information: do you have enough height and thickness of bone to place an implant into? Do the teeth next to the missing teeth need crowns or already have crowns? When you bite down, do you have enough space for an implant restoration and for the components? Do you have manual dexterity to clean around a bridge or around a deep implant? Do you want the gap filled as quickly a possible or are you willing to have temporary false teeth there for 3-6 months while the implant heals?

The answers to these questions will tell you if you should get an implant or a bridge to replace your missing tooth.