Restoration and replacement of damaged or missing teeth requires a high level of expertise to ensure that it does not impact the facial structure and has pleasant aesthetics. Prosthodontics is the branch of dentistry that includes treatment of dental and facial structure issues with the implantation of biocompatible tooth substitutes for diseased, missing or injured teeth. Patients seeking prosthodontic rehabilitation include individuals who have been in an accident causing oral trauma, have congenital facial structural issues, have temporomandibular joint (TMJ) disorders, have issues with sleep or snoring, for oral cancer reconstruction, or even for cosmetic reasons. 

Dental Restoration Options

The most common artificial appliances used in prosthodontics are dental crowns, bridges, dental implants, and dentures. All of these tooth substitutes are made in dental laboratories by prosthodontists and dental laboratory technicians based on a lifesize replica of the mouth of the patient.

Dental Crowns

Dental crowns come under fixed prosthodontics that form a tooth-shaped covering over an existing decayed, damaged, or worn-down tooth. Dental crowns are also used in order to protect dental implants and teeth that have undergone root canal treatment (RCT). Resin, metal, and porcelain are the materials that are commonly used to fabricate the crowns. 

Dental Bridges

Dental bridges are fixed prosthodontic appliances that ‘bridge the gap’ created by missing tooth/teeth. It consists of crowns that fit over the natural teeth at the ends of the gap and artificial teeth that fill the space created by the missing teeth. The four main types of dental bridges are traditional dental bridges, cantilever bridges, Maryland dental bridges, and implant-supported bridges. 

Dental Implants

Dental implants are artificial devices that are substitutes for the roots of teeth and provide rigid strength and support to the dental bridge, denture or maxillofacial prosthesis. Implants are also a good option when there are no natural roots of teeth available to attach the dentures or dental bridges on. They are usually made of titanium or its alloys and are shaped like a screw or cylinder to mimic the shape of the natural tooth root.

Dentures

Dentures are removable prostheses that are attached to the gums and act as replacements for missing teeth and surrounding oral tissues. There are two types of dentures – complete dentures for replacement when all of the teeth are missing, and partial dentures where only some of the teeth are being replaced. Dentures may be made of acrylic, metal, plastic or a combination of these and they may replace either the upper or lower arch or both of them together. 

Cost Comparison – Bridges, Implants and Dentures

On the basis of price alone, dentures are the most cost-effective, followed by dental bridges, while dental implants are on the costlier end. However, there are a lot of other factors that are considered by the prosthodontist before deciding on a particular restoration option. The number of missing teeth is the primary determinant. Where there are a lot of missing teeth that need to be replaced, dentures are the most effective and cost-efficient option. However, when there are only a couple of teeth missing from different parts of the upper or lower arch, it makes much more sense to fill the gap with a dental implant. Similarly, if there is a gap of 3-4 teeth in one region, and if the remaining teeth and bone structure is strong, dental bridges prove to be most effective. 

Lifespan and Durability – Bridges, Implants and Dentures

The lifespan and durability of dental restoration appliances depend on multiple factors like the surgical skill of the oral surgeon, the kind of aftercare provided, the oral hygiene habits of the patient after the treatment is completed, lifestyle habits like smoking or alcohol consumption, bone density and volume of the jawbone, and the patient’s other health conditions, such as uncontrolled diabetes, autoimmune disorders, or treatment for chronic diseases like cancer. The lifespan of prosthodontic appliances can only be mentioned as a broad guideline. 

Dental bridges generally last between 5-15 years depending on the care and maintenance given to them. Since they are fixed appliances, they need care just like natural teeth with proper brushing, flossing, and regular dental cleaning. It is also important to avoid biting/chewing on hard or chewy foods using the dental bridge. 

Dental implants have exceptionally long lifespans, are very durable and can easily last for more than 20 years and are considered a long-term solution to oral problems. This may be subject to factors like the size of the implant, the position where it has been implanted, and the kind of functional force it has to withstand. 

Dentures are generally robust and durable but the average lifespan of dentures is between 7-10 years, depending on the quality of the material used. The lifespan of dentures may be dependent on an additional factor – age of the patient. As we grow older, the gums and jawbone shrink and this may make the dentures an incorrect fit sooner as they will become loose. Wearing down of dentures due to constant use may also lead to broken denture teeth, which means they will need to be replaced. 

Maintenance and Care Requirements

Whether fixed or removable, all prosthodontic appliances require careful maintenance so that they last for a long time, with some requiring more care than others. Fixed appliances like dental bridges, crowns, and implants should be cleaned regularly just like natural teeth, by brushing twice a day and flossing at night to remove accumulated food debris. Removable appliances like dentures should be taken out and rinsed thoroughly after eating. The mouth should also be cleaned after the dentures are removed. Dentures should also be brushed like regular teeth and then soaked overnight. Before putting on the dentures in the morning, they should be rinsed again. In addition to these measures, all patients who have prosthodontic appliances in their mouths should schedule regular dental checkups to ensure that the appliances are functioning well within the mouth. 

Role of Your Prosthodontist

Prosthodontists undergo extensive training in the latest, advanced techniques and procedures that are needed for complex dental restorations for optimum functionality and aesthetics. They work with dentists to ensure that patients receive optimal treatment to restore appearance as well as treating oral disorders like TMJ (temporomandibular joint) disorder and other irreparable jaw and tooth damage issues. They are also known as oral architects of the dental team due to their skill with prostheses and restorations. 

Aesthetic dentistry has now advanced to a unique specialty named prosthodontics which concentrates on providing restorative solutions to dental aesthetic issues. In addition to crafting beautiful and confident smiles, prosthodontics is involved in improving the functionality of teeth and keeping the oral faculties healthy and happy. From understanding the patient’s aesthetic aspirations to creating oral solutions that are beneficial for the patient is a journey that is undertaken by prosthodontists. 

Branches of Prosthodontics

There are four primary branches of prosthodontics – fixed, removable, implants, and maxillofacial prosthodontics.

• Fixed Prosthodontics – Prosthetic dentistry where the final solution is permanently fixed and cannot be removed. Correction of tooth discolorations, evening out of teeth, fixing of broken teeth or cracks, dental crowns, inlays and onlays, dental fillings, veneers, and bonding are all examples of fixed prosthodontics.
• Removable Prosthodontics – dental prosthetics that can be easily removed by the patient. Complete set of dentures, partial dentures, and gingival veneers for covering tooth discolorations are examples of removable prosthodontics and are mainly used for patients who are ageing or have health issues that do not support fixed prosthodontic solutions. 
• Implant Prosthodontics – Prosthodontic treatments include dentures, dental implants, crowns and bridges to replace missing or damaged teeth that come under implant prosthodontics. These implants are surgically placed in the patient’s jawbone to act as tooth roots or base supports to receive the prosthetics. 
• Maxillofacial Prosthetics – Misshapen hard and soft tissues due to an injury, medical condition, or even from birth that affect how patients speak, eat, or their oral functions in general can be corrected through maxillofacial prosthetics. Some examples of treatment include correction of cleft palate, full oral reconstruction, and treatment of jaw problems. 

Designing Confidence: How Prosthodontics Enhances Aesthetics and Function

Having a defined mouth and smile can add on to a person’s confidence and boost his / her self-esteem. However, that is not the primary aim of prosthodontics. The oral health issues that they set to rectify include compromised oral function due to missing or severely damaged teeth, TMJ (temporomandibular joint) pain or dysfunction, pain of the mouth or face, and obstructive sleep apnoea. Prosthodontics have contributed considerably towards making oral health better in addition to the more obvious aspect of improving the aesthetics of a person’s smile. They can help to improve the patient’s bite and his / her ability to chew or speak properly, correct TMJ issues and improve their oral function and nutritional intake while maintaining the integrity of the surrounding oral structures (like jawbone and adjacent teeth) and reducing risk of oral diseases or other complications. 

Innovations in Prosthodontic Design and Fabrication

The rapid advancements in dental biomedical science, clinical and laboratory techniques and technologies has triggered many innovations in prosthodontics. Digitization has been one of the most important factors that opened up and broadened the scope of prosthodontics, be it in the clinical or laboratory processes. 

• CAD-CAM technology has enabled the creation of superior restorative prosthetics like maxillofacial prosthesis, extraoral radiation devices, personalised breathing masks, and face protection systems. 
• Rapid prototyping is an automation advancement that helps to produce specialized prosthetic components after assessing human factors and ergonomics without human intervention, thereby bringing down product costs and development time 
• Stereolithography has made it possible to make contact-free facial reproductions, duplicate copies of anatomical sections within a short timeframe and at less cost, and can account for patient development and material flaws.
• Digital Impressioning has vastly improved the quality, consistency, and accuracy of imprints for the design and creation of prosthetics

Prosthodontics in Complex Dental Cases

In complex dental cases, it is important to have a detailed examination with digitized technology to correctly assess the problem beyond routine peridontal examination and bite analysis and the treatment plan is formulated after studying the patient’s oral health, general medical health, and medications. Treatment may often involve interdisciplinary intervention with orthodontics and prosthodontics depending on the nature and extent of the problem. 

Oral pathology is the branch of dentistry and pathology which is concerned with identifying the causes, processes and effects of diseases teeth, gums, bones, joints, glands, skin, and muscles around your mouth (at both macroscopic and microscopic levels) and treating them. The oral pathologists use clinical, radiographic, microscopic, biochemical or other examinations to study symptoms and manage treatment of their patients. Oral microbiology is the study of the microbiota or microorganisms (bacteria, fungi and viruses) that cause diseases in the oral cavity. Oral microbiologists study the impact of the microbiota on oral health so as to track disease progression. Together, oral pathology and microbiology provide the research and clinical practice necessary to understand and manage oral health. 

Role of Pathogens in Oral Disorders

Oral health conditions can be broadly classified into – dental caries (tooth decay), periodontal gum disease, edentulism (total tooth loss), oro-dental trauma, noma (severe gangrene of mouth and face), infectious diseases like oral herpes, and oral cancers. Pathogens play an important role in each of these health conditions. Even where the primary cause for the oral disease is poor oral hygiene, heredity, lack of access to proper oral care, or mouth injury trauma, the disease is often accelerated by the presence of pathogens which affect the teeth, gums and bone surrounding or supporting the teeth. Risk behaviours like consumption of tobacco, alcohol, and an unhealthy diet rich in carbohydrates aid the growth of pathogens causing oral disorders. 

Understanding Pathological Transformations

Oral cancers are potentially life-threatening and require immediate treatment. Caused due to  genetic, epigenetic, microbial, habitual, and lifestyle factors, the early signs of the cancer include oral lesions, inherited genetic mutations (dyskeratosis congenital syndrome), and viral infections (HPV). The oral lesions are broadly categorized under oral potentially malignant disorders (OPMDs). Early detection, prevention, and treatment of OPMDs is key to help prevent its malignant transformation into oral cancer. 

Exploring Cutting-Edge Research in Oral Pathology and  Microbiology

Effectively utilizing rapidly advancing molecular techniques for diagnosis of harmful oral microbiota along with the use of traditional detection methods has expanded our understanding of their association  with health and disease. By using saliva as a diagnostic tool, it is now possible to detect oral diseases early and accurately. The biomarkers present in saliva provide a true reflection of specific oral conditions as well as about overall oral health.

Some of the emerging therapies that have gained popularity due to their effectiveness are:

Gene Editing – Recent advancements using clustered regularly interspaced short palindromic repeats (CRISPR) / CRISPR-associated nucleases (CRISPR/Cas) system have made it easy to identify genetic models that harbour oral diseases and developmental defects. 

Phage Therapy – There is an abundance of bacteriophage in the oral cavity that could possibly penetrate biofilms more effectively than antimicrobial treatments for biofilm removals. This will help overcome the problem of antibiotic resistance that is turning out to be a serious threat to human health. Phage therapy is still in the nascent stage and research is ongoing to figure out whether the bacteriophage can be engineered to enhance biofilm breakdown by releasing biofilm-degrading enzymes.

Kerala has earned wide acclaim for its well-established healthcare system, qualified medical professionals, state-of-the-art facilities and advanced treatments in all specialties, including dentistry. From 1959, when the first Government Dental College was set up in Thiruvananthapuram, the state has made great strides and the best BDS colleges in Kerala provide quality dental education to its students so that patients can receive excellent dental care from professionals with strong academic background and practical expertise.

Setting Up of PMS Dental College

PMS College of Dental Science and Research, located in Thiruvananthapuram Kerala, is widely recognized as one of the best BDS colleges in Kerala. Established in 2002, this college affiliated to the Kerala University of Health Sciences (KUHS) is recognized by the Dental Council of India (DCI) and is the first Dental College in Kerala with NAAC Accreditation for Health Education. The college has a range of international and national collaborations, as well as advanced dental care facilities and a commitment to high-quality dental research. 

Faculty Expertise: Nurturing Tomorrow’s Dentists

The faculty at PMS College of Dental Science and Research are highly qualified, experienced and with expertise in their dental specialties. The guidance and expertise of these established faculty members has been instrumental in the setting up of BDS and MDS courses in 8 specialties as well as a centre for Ph. D studies in 6 dental specialties for budding dentists and Para dental Courses viz Diploma in Dental Hygienist, Dental Mechanic, and Dental Operating Room Assistant as a Value Added Education program for upcoming para-dental professionals. 

Clinical Exposure: From Simulation Labs to Real-World Practice

Early Clinical Exposure is a methodology which encourages exposure of dental students to patients (actual human contact) as early as the first year of dental education, in a social or clinical context that adds on to their textbook learning of health, illness or disease. At PMS College of Dental Sciences and Research, we provide our students with a wide clinical exposure from simulation labs and hands-on patient interaction and dental practice. The clinical exposure is designed to enrich the learning and experience of the students and equip them with tools to move on to the next phase of their study or careers.

Research Opportunities: Shaping Innovators in Dentistry

Research is and should be a mandatory part of dentistry. The research undertaken in biosciences and advancements in technology have improved our treatment of chronic oral diseases such as periodontal diseases and dental caries, development of precision diagnostics, and the discovery of new therapeutic biomarkers. PMS College of Dental Sciences and Research has been recognized as a Scientific Industrial Research Organization by the Department of Scientific and Industrial Research, Government of India for our dedication to scientific research. The Kerala Start-Up Mission (KSUM) under Government of Kerala has also approved our Institution as an innovative and entrepreneurship driven development centre for our contributions towards innovation and research in oral health care.

Beyond the Books: Extracurricular Activities and Student Clubs

College is a great time to explore various activities, discover who you are and unlock hidden talents. Extracurricular activities and student clubs make college life richer and help students learn skills that can never be learnt from textbooks. Our students take part in various cultural, arts and sports events in addition to being part of a variety of student clubs, including Nature Club, Media Club and running a College Journal and Magazine. The college is also equipped with a well-stocked library, hostel, gym, yoga centre, swimming pool, and turf to meet the students’ recreational needs.

Dentistry has constantly evolved over the years from a painful procedure that patients dreaded into a necessary and sought after branch of medicine with focus on both preventive care and controlling damage that has already occurred. It is also a misconception that dentistry is only about the teeth, it gives just as much importance to the gums, teeth pulp and general appearance of the teeth and mouth.

Introduction to Conservative Dentistry and Endodontics

Conservative dentistry is a branch of dentistry that consists of minimally invasive procedures and primarily focuses on preservation of teeth and its supporting structures. This conservative approach helps in providing dental care on a wider scale and longer success rates, which in turn helps in improving retention rates of patients. Treatment of caries, malformed, discoloured, unaesthetic, or fractured teeth all fall under the scope of conservative dentistry. 

Common Conservative Dental Treatments

This vast scope of dentistry can be broken down into three broad branches – Operative Dentistry, Cariology, and Endodontics.

Operative Dentistry involves the prevention and treatment of the common dental issues like 

decayed, damaged, or discoloured teeth, wherein the dentist helps to restore the function and appearance of the teeth while minimizing damage to their structures.

Cariology refers to the study of caries or cavities that form in teeth and treatments that are performed to protect teeth from decay and treat teeth surfaces so as to interrupt and prevent damage to the tissues of the teeth.

Endodontics involves treatment aimed at preserving the natural tooth by ridding it of pulpal and periapical diseases and effective dental pain management, thus making the teeth functional and aesthetic again irrespective of the age of the patient.

Benefits of Conservative Dentistry

The aim of conservative dentistry is to preserve the teeth of the patient instead of treatments that are probably easier to perform but will eventually weaken the teeth structure and cause more damage in the long run. The use of minimally invasive procedures for treatment helps to restore the teeth without altering its healthy structure and helps to prevent further decay from setting in. 

• Reduced Dental Costs: The conservative dentistry approaches help to bring down  the overall costs of procedures for patients who need treatments such as root canals, gum contouring, enamel removal, and other restorative treatments, especially when the payments are not covered by their insurance company. 
• Preserving Original Teeth: The minimally invasive procedures help to preserve the tooth and keep its structure intact. This helps the patients to manage their teeth better in the long run through regular checkups and cleanings. 
• More Emphasis on Aesthetics: Dentists now enjoy the option of giving more focus on aesthetic function of the teeth, giving more attention and detail to their treatment and care thanks to conservative dentistry approaches. This helps them to provide their patients aesthetically-pleasing smiles that suit their facial structures. 
• Natural-Looking Smiles: Unlike traditional dentistry, the minimally invasive procedures in conservative dentistry tend to provide more natural-looking results since more natural tooth material is preserved, and at lesser cost.

Endodontics

Derived from the Greek words ‘endo’ (inside) and ‘odons’ (tooth), endodontics studies the diseases that affect the dental pulp (which is the innermost part of the tooth) and provides procedures to treat them. The dental pulp is rich with blood vessels and nerves and any infection in the pulp can cause sensitivity and acute toothache. Using advanced treatment procedures like complicated Root Canal Treatment (RCT), Hemisection, Radisection, Apicectomy Splinting, Conservative Bridges, indirect aesthetic restorations like Porcelain/Composite Inlays and Onlays, Veneers, Endodontic surgery etc, every attempt is made to save the original tooth while remedying the decay. 

Aesthetic Endodontics

While aesthetics are not the primary focus of endodontics, it definitely needs to be one of the considerations while working with a patient. Aesthetic considerations go beyond basic discoloration of teeth and include the appearance and shape of the gums and / or bite as well. By creating smiles that improve the patient’s appearance, the endodontist is able to restore the patient’s self confidence along with providing structural strength and support. It is also important to note that degeneration of the dental pulp and subsequent endodontic access microleakage are the two main reasons for clinical crown discoloration, which can only be corrected by combining endodontics with aesthetic dentistry. 

Microscopic Dentistry in Endodontics

The use of microscopes to enhance vision in conservative dentistry and endodontics have made both diagnosis and endodontic treatment more accurate and less painful. The high-powered microscopes allow the endodontists to easily find hidden and accessory canals, preserve more of the natural tooth structure and accurately identify and treat even the most intricate dental issues with optimal outcomes. In addition to endodontics, microdentistry is also in use in cosmetic dentistry, general dentistry and implant placement and other types of oral surgery.