Partial removable dentures with telescopic fixation Secondary telescopes are made by casting “in one piece” simultaneously with the frame of the clasp denture

Prosthetic technologies are improving, modern orthodontic implants are natural and comfortable to use. High aesthetic results of bridges and implants are achieved through the use of the latest technologies for the production of orthopedic material. Telescopic crowns are used to preserve intact teeth and to restore lost ones. Let's consider their types, the material used and the design of prostheses on telescopic crowns.

When are telescopic crowns used?

The main reason for prescribing telescopic (combined) crowns is the absence of a large number of natural molars in the jaw. Due to edentia, it is impossible to install a clasp prosthesis, so an alternative to this device is telescopic crowns.

Telescopic crowns are also installed when there is a risk of losing remaining teeth due to their unreliability and instability. Such systems look very natural and are highly reliable and comfortable.

Advantages

• Strength;
• long period of use;
• installed on an implant or ground tooth;
• there is no load on the root of the tongue;
• aesthetics, beautiful smile;
• it is possible to improve the system if necessary;
• do not interfere with diction and speech functions;
• are quickly installed and do not require lengthy adaptation;
• support optimal chewing load.

A bridge is much cheaper than installing individual implants on several teeth.

An important advantage of the telescopic device is the free space under the tongue and palate: the taste of food is felt without distortion. The upper part of the structure can only be removed with a strictly vertical upward movement.

Bone tissue is protected from loss, since the telescopic system ensures uniform chewing load on it. Tissue atrophy does not threaten with constant use of the prosthesis.

Flaws

• The device is visible under the gums;
• the need to grind healthy molars for supports;
• the need for several fittings during the manufacture of the system;
• high price of material and installation.

A double crown requires more interdental space for placement. Also, the service life is limited: after 4-5 years, the fastening of the device will weaken. However, dentures for crowns will last 10 years or more.

The disadvantage is the forced depulpation of healthy molars under support. As a result of nerve removal, molars become fragile and vulnerable. The removal of a large volume of hard tissue for grinding also has a negative impact on the health of the incisors.

Contraindications

• Absence of all teeth in a row;
• low coronal part of the incisors;
• severe periodontal diseases;
• abnormal location of support units;
• pathological wear of incisors;
• pregnancy;
• mental illnesses.

Telescopic crowns cannot be installed if the bone tissue is destroyed or there are no supporting units. It is also not possible to install a prosthesis if the jaw structure is abnormal (low palate, too deep or incorrect bite). Obstacles to the installation of implants are: oral infections, acute somatic diseases, insulin dependence.

Installation may require grinding of healthy molars. This should be taken into account when choosing the type of prosthetics.

A combined telescopic prosthesis is indicated for unsteady molars: they are firmly fixed in the gum.

Advantages

• The bridge or clasp part is simply removed, which facilitates oral hygiene.
• Dentures can be adjusted if the number of lost teeth increases over time; it is enough to make changes to the bridge or clasp.
• Sturdy mount. Since the base of the crown is fixed with dental cement, the design is very reliable.
• A bridge or clasp made of modern materials is almost invisible. Visually, artificial teeth do not differ from natural ones.
• The telescopic prosthesis provides a uniform occlusal load on the patient’s supporting teeth. All areas of the jaw are subject to equal pressure during chewing, and the risk of injury to the gums is minimal.
• When worn, the denture is very comfortable, does not cause discomfort, and does not distort speech.

Device

Telescopic prostheses got their name because of the features of the device: similarity to the structure of a telescope. The upper part (prosthesis) is placed on the lower part - the crown. The shape of the crown resembles a cap that is put on a previously prepared (ground) molar. If teeth are missing, metal implants can serve as support. The upper part of the mechanism imitates a natural molar.

The uniqueness of the proposed system lies in the ability to supplement implants as needed. As an example: if you unexpectedly lose another molar, you can quickly supplement the system with a new implant.

Computer-aided design allows you to recreate the anatomically accurate shape of molars. Electronic computers model orthodontic systems, then their forms are produced automatically. Cladding with ceramic or other material is carried out manually.

Consists of two parts

• Removable;
• non-removable.

The removable part is a metal-ceramic prosthesis and resembles a small cap. It is installed on a prepared tooth (turned) or an artificial metal implant. The fixed part can be a bridge familiar to everyone, or a modern clasp device.

The non-removable part is located below; it is fixed to the supporting unit with orthopedic cement to keep it tightly. The removable part is put on the stationary part and secured. If necessary, you can remove the top and then put it on again. The non-removable (stationary) part of the device is installed by the dentist. Removable parts can be installed or removed by yourself.

The absence of moving parts in the device ensures reliable fixation and long service life without breakdowns. However, the upper part of the system may unexpectedly fall out while chewing hard or sticky foods.

Types of crowns

• Conical;
• cylindrical.

Cylindrical ones are used in telescopic devices for intact periodontium. They have several advantages:

• control over fixation strength;
• ease of manufacture;
• device strength.

However, cylindrical units do not hold traction well; they are used when necessary.

Conical ones are more stable and reliable: they are not subject to breakage and cannot be deformed. Based on patient reviews, it is clear that these devices do not jam. However, you should forget about toffees and other viscous foods: the bridge may fall off along with the toffee. To ensure reliable adhesion, a friction pin is installed.

The telescopic system does not interfere with salivation, so drying out of the oral mucosa is completely eliminated. The absence of clasps (clasps) ensures stable fixation of the mechanism in the oral cavity.

Prosthesis design

The design of the telescopic prosthesis resembles the device of a telescope; parts of the crown are put on top of each other. This structure ensures reliable fastening of the denture to the supporting teeth, while at the same time allowing it to be quickly removed.

The design includes:

• Non-movable permanent base. It is made of a metal alloy and fixed to an abutment tooth or implant using dental cement. The main task is to create a rigidly fixed support for the prosthesis.
• Movable removable part. This is a bridge or clasp prosthesis into which a metal-ceramic crown is soldered. When installing a prosthesis, it is placed on a support. Thanks to this, the removable half can be easily removed by the patient himself.

In telescopic dentures, two types of crowns are used - cylindrical and cone-shaped. In modern dentistry, cone-shaped dentures are more often used, since they can provide a tight fit and at the same time they are easy to put on and remove. The dentist calculates the cone angle and other characteristics individually for each patient. When calculating, the doctor takes into account two main factors - the structure of the jaws and the number of lost teeth.

In some cases, when there is periodontal disease, cone-shaped crowns are not installed. In this case, cylindrical ones are used. They are rarely used, since they are difficult to manufacture and are not always suitable for fixing the structure.

Material

Modern orthopedics has innovative materials for creating high-quality prostheses. They are all absolutely safe for health and biocompatible with mucosal tissues. The material does not oxidize and does not release hazardous substances when interacting with human tissue.

Modern medical alloys also do not cause allergic reactions. This is a decisive factor when choosing prosthetic options.

Material for making crowns:

• gold;
• zirconium;
• silver.

The non-removable base of the system is made of hypoallergenic alloys of precious metals. This is necessary to prevent oxidation and rejection of implants by body tissues.

Material for the manufacture of removable elements:

• metal ceramics;
• metal-plastic;
• plastic;
• porcelain;
• gold;
• zirconium dioxide.

Gold

In the recent past, the safest material for making orthodontic units was gold alloy. However, the strength of such orthodontic systems does not solve the issue of aesthetics: gold teeth look old-fashioned. In modern orthodontics, zirconium-based alloys are used, which are coated with gold or ceramics. As a result, devices made from expensive metals are much cheaper.

The disadvantage of gold material is its softness and rapid abrasion during chewing of food. Therefore, in modern orthodontics, alloys of gold with palladium or platinum are used. Thanks to alloys, implants gain the necessary strength. To get rid of the glare of the precious metal, the base is covered with ceramic mass. The result is gold-ceramics - a durable and high-quality material.

Ceramics

Ceramic implants are the most popular due to their aesthetics and comfort. Ceramic teeth look like natural teeth. These systems are placed on the smile line, but sometimes ceramics are placed on the posterior (lateral) molars. The disadvantage of ceramic implants is fragility and instability under mechanical influence.

Ceramic structures do not darken over time and are not stained by food.

Metal-ceramic crowns consist of a metal base with a ceramic coating. Ceramic-based prosthetic structures are popular in our country due to their low price and durability. The wear resistance of cermets is much higher than that of ceramic products. The disadvantages include the appearance of a metal rim due to atrophy of the gum tissue.

Metal-plastic

Metal-plastic dentures consist of a metal base with a plastic coating. These devices can be installed as a temporary replacement for permanent ones: the plastic quickly turns food-colored. Plastic also negatively affects the condition of dental tissue: it breaks down faster.

Plastic systems are the most short-lived and unreliable. They cannot be installed on chewing units, as they cannot withstand mechanical load. In modern orthodontics, plastic implants are used extremely rarely.

Zirconium

Zirconium dentures are highly durable and resistant to active mechanical (chewing) loads. They are recommended to be installed on the chewing group. However, zirconium dioxide imitates tooth enamel so naturally that dentures are often placed on the smile line.

Porcelain

Porcelain dentures look very aesthetically pleasing and attractive, but they cannot be installed on chewing units due to their fragility. Porcelain is installed on the smile line. Implants must be treated very carefully, as they crack and chip at the slightest mechanical impact. Repairing and restoring implants takes a long time, so it is cheaper to be careful.

Indications and contraindications

A telescopic (primary and secondary) metal crown is indicated in the following cases:

• restoration of aesthetics and functionality;
• partial, complete edentia, the presence of units with a large affected area that need to be restored.

Contraindications are:

• pathological abrasion of enamel;
• the periodontium is in a neglected state and requires preliminary treatment;
• turning the side supports is impossible for a number of reasons;
• incorrect positioning of teeth and other anomalies of units planned for use as supporting ones.

Some of the contraindications are relative. Once obstacles have been removed, the system can be used for installation.

Installation

The procedure for installing prostheses involves several stages:

• sanitation of the oral cavity;
• removal of unreliable molars;
• removal of nerves, turning of supporting units;
• taking an impression of the jaw to make support caps;
• fitting.

Sanitation of the oral cavity involves the elimination of caries, inflammation, tartar and other pathologies. The dentist also removes any molars that cannot be treated. After this, the doctor processes the supporting molars: removes the nerves and grinds them. Next, the doctor makes an impression of the gum to create a mock-up of the orthodontic device.

As soon as the model is ready, the patient comes for a fitting. After this, primary crown caps are made, then they are tried on and adjusted to the jaw. When the primary crowns pass testing, a secondary mock-up is created based on them. Next, the telepathic device goes through the modeling stage, and then fitting - the internal part is connected to the external part.

You should be prepared for frequent visits to the orthopedic dentist for fittings. You will have to visit the office twice in a week. The entire period of creating an orthodontic system can take 3-4 weeks.

The main indications for the installation of such prostheses

Today, dentists use telescopic crowns if there are the following indications:

• loss of a large number of teeth: the prosthesis can replace several adjacent elements,
• the poor condition of the remaining units: that is, it is obvious that they will soon have to part with. After their loss, the design can be adjusted.

However, installation of such systems is not possible in all cases. Among the contraindications are the inclined position of the teeth, their abrasion of degrees 2 and 3, and individual intolerance to the materials of the product.

Operating rules

In order for orthodontic systems to last as long as possible, you need to properly care for them. Orthodontic appliances do not need to be removed at night like regular dentures. This is much more comfortable and enjoyable than holding dentures in a mug with solution. However, for hygiene procedures, the structures can be easily removed.

Orthopedists recommend cleaning the orthodontic device after eating, using special brushes with long bristles. Cleansing products should be recommended by an orthopedic dentist. There are special tablets for hygiene, but the right product should be selected in accordance with the material of the devices.

With care and proper care, a telescopic combined prosthesis can last 9-10 years.

Since the device may be made of fragile material, it is recommended to remove it over a soft surface. An accidental fall of the structure will not damage its integrity. When rinsing, it is recommended to place a material or a soft towel in the sink: to protect against breakage if accidentally dropped.

In order for the system to fit tightly in the oral cavity, it is necessary to periodically visit the orthodontist: he will adjust the design. It is important to promptly eliminate minor defects and strengthen the system.

Alternative prosthetic options

Based on the diagnosis, the orthopedic dentist, who will coordinate the entire treatment process, proposed several options for resolving the situation:

• dental implantation - installation of several implants on which a removable denture is fixed, but the patient, due to her age, did not want to install implants, and the price is quite expensive.
• removable telescopic dentures of increased comfort - such dentures provide excellent aesthetics and are very comfortable for patients. The prosthesis is attached to special telescopic crowns installed on the remaining teeth, and these can literally be 1-2 teeth. Many clinics refuse to manufacture this type of removable dentures, since technically the manufacture of telescopic dentures is quite difficult, requiring highly qualified dental technicians, the use of complex equipment and special materials. At Dial-Dent, orthopedic dentist S.V. Zukor has been successfully installing telescopic dentures for many years. The clinic has its own laboratory and excellent dental technicians. Many Dial-Dent patients have used this option for dental prosthetics and were satisfied.
• conventional removable dentures are the cheapest option, but such dentures are very unreliably fixed in the mouth; the patient rejected this option.

Toothache under a crown

If pain appears under the crown, this may indicate the presence of a pathological formation:

• Cyst or granuloma under the root;
• bruxism;
• molar overload;
• root fracture;
• root destruction by caries;
• progressive periodontitis.

To determine the cause of the pain, you need to see a dentist and take an x-ray. If a cyst or granuloma is detected, treatment must be carried out. If the root is fractured, the tooth must be removed because it is no longer able to bear the chewing and supporting load. A dental implant is inserted in place of the removed molar.

Life time

The service life of a prosthesis varies from person to person, and telescopic structures are no exception. On average, the prosthesis lasts for about 3 years without creating any problems. If the condition of the teeth does not deteriorate or the telescopic denture is installed on implants, it will last up to 10 years.

The service life is affected not only by the condition of the teeth and oral cavity. The structure gradually wears out and the fastening of the crowns becomes loose. This can be caused both by errors made during manufacturing and installation, and by violations of the operation of the prosthesis. In order for it to serve for a long time, you need to regularly visit the dentist for examination and correction.

Bottom line

A combined prosthesis on telescopic crowns is a reliable prosthetic system. The system is great for older patients, as it provides reconstruction in case of unexpected loss of new teeth.

Also, telescopic crowns allow you to replace broken parts and are easy to correct. Prosthetics are carried out when there is a significant absence of teeth in the oral cavity and when the remaining units are unreliably fixed. Installation of such crowns allows you to achieve reliable attachment of dentures in the oral cavity and an attractive smile. The prosthesis allows you to freely communicate with people, smile beautifully and take part in a joint celebration. The cost of the systems is high, but the result justifies the cost.

Sources used:

• Borovsky E. V., Antonov M. E. Single-stage replacement of a single missing tooth
• Ministry of Health of the Russian Federation
• Bartsch F. Manufacturing of inlay bridges using Targis-Vectris technology // “NS” for dental technicians. - 2000.

Clasp telescopic dentures: before and after photos

Both natural teeth (including movable ones) and implants can be used as support. But in order for the fastening to be reliable, and the orthopedic product itself to last as long as possible, you need to install at least six such crowns.

Tooth extraction, bone grafting and gum grafting

While under sedation, the patient had six teeth removed and the gums around some teeth were corrected. The operation lasted two hours.

Sedation is a type of anesthesia in which the patient breathes on his own, and can even follow the doctor’s instructions, but at the same time his state is like in a dream, there is no pain, no unnecessary worries, the patient is relaxed and calm. The anesthesiologist monitors the patient's condition throughout the operation. The clinic has a separate room where you can rest after surgery.

View after tooth extraction: