Restoration with difficult function - it's the expertise that counts!
In addition to functional diagnostic examinations and functional therapeutic treatments, we also offer dental restoration of your teeth using restorative treatment techniques. In dentistry, this refers to works of art that are produced by dental technicians and prepared and fitted by dentists. We specialize in successfully managing such treatments even for patients with functionally difficult situations – and making you look beautiful in the process. Get in touch with us! – or read on:
Restorative treatment materials such as onlays, partial crowns, crowns or bridges should only be used if your masticatory organ is functionally stable and pain-free!
The German Society for Functional Diagnostics and Therapy (DGFDT) and all relevant specialist societies therefore recommend the following treatment sequence:
1) CMD examination: Is there a well-founded suspicion of a functional disorder?
2) If required, cascading functional analysis and structured diagnosis.
3) Depending on the result, individual functional therapy
4) Only if the bite is subsequently unstable or not supported at all without wearing an occlusal splint is an adjustment of the occlusion indicated. This can be done by dental adjustment measures or by orthodontic treatment. The decision varies from case to case, depending on the individual situation. If treatment is carried out by means of dental adjustment measures, this should be preceded by a simulation phase, either by means of treatment that specifically simulates the altered occlusion or by the use of long-term temporaries.
5) Only if this proves successful is a transfer of the adjusted jaw position by means of restorative treatment indicated, i.e. reduction onlays and veneers, partial crowns and crowns.
Adherence to this sensible sequence has been provided for in the relevant guideline (scientific communication) since 2005 and is therefore standard. Safety makes sense.
(Incidentally, Dr. Ahlers was the lead author of the first version of this scientific statement and has been actively involved in the preparation of every new version since then. And even if the procedure described here sounds routine: even in our practice, which specializes in the treatment of CMD, bruxism and tooth wear, only a small minority of our patients require these final steps of treatment – in recent years it has been less than 10% in each case…
Treatment using minimally invasive reduction onlays that correct the occlusion has been perfected at the CMD Center Hamburg-Eppendorf. We now have the largest controlled collection of cases with this treatment technique – and the most experience.
Treatment using repositioning onlays that correct the jaw position and thus the temporomandibular joint function was first introduced in 1988 at the University of Lund (Sweden) as a clinical trial. According to the various published study results, the success was phenomenal: the CMD patients with (!) TMJ problems treated in this way subsequently fared much better than the patients treated with an occlusal splint in centric jaw relation, and much better than the control group. The Swedish colleagues concluded that it would probably make sense to permanently adjust the jaw position of the affected patients in this way.
In Germany, the Hamburg working group led by PD Dr. Ahlers has refined this treatment technique since the mid-1990s and has repeatedly reported on it in the specialist literature. Since 2009, we have expanded the range of treatment materials used to include reduction onlays made of high-strength dental ceramics. These are adhesively bonded to the posterior teeth in need of correction in a single step. The procedure saves an entire treatment stage and therefore costs – despite the high level of effort involved. It is also extremely gentle for the patients concerned, as pain and nerve inflammation caused by the subsequent grinding of the teeth for treatment with crowns are eliminated. However, the procedure is also extremely demanding in terms of dentistry and dental technology. For this reason, the figures from our specialized dental practice are not necessarily transferable to other dental practices.
This is a good thing, because the work involved in such treatments and the demands placed on dentists and dental technicians are also enormous for us – and can only be carried out by well-coordinated teams and with a great deal of time. Even under these conditions, temporary minor setbacks can occur during treatment, which we can usually overcome with immediate, targeted countermeasures and trusting patience.
In the past, front teeth damaged by tooth wear, caries or accidents were crowned. Where possible, we now also treat these teeth minimally invasively using ceramic veneers.
If teeth are damaged by wear and tear, caries or accidents, you need protection yourself. In the past, crowns were the treatment of choice for this. The fragile porcelain jacket crown was replaced in the 1970s by metal crowns with ceramic veneers – another development from Germany that has become established worldwide. Such metal-ceramic crowns are durable – their loss rate is only 1%/year. However, they require an extremely large amount of substance to be removed: a good 70% of the visible area of an anterior tooth has to make way for them. And the metal core prevents natural aesthetics – tooth color is not the same as tooth identity.
New all-ceramic restorations offer an alternative: ceramic veneers. These were originally developed for cosmetic corrections. The ceramics are now much stronger and look even more natural. Together with new preparation forms and preparation instruments, this has enormously expanded the range of indications for ceramic veneers. It is therefore fitting that the world’s leading grinding instruments for the preparation of ceramic veneers were developed by PD Dr. Ahlers and Prof. Dr. Edelhoff. The study on the effect of the instruments on treatment quality was also conducted under the direction of PD Dr. Ahlers. When it comes to restoring anterior teeth, we therefore use appropriately adapted ceramic veneers whenever possible .
Significant tooth wear is hard on teeth. The affected teeth need protection by restoring the lost enamel covering. Today, we can protect such teeth much more gently using new forms of restoration.
In the past, teeth damaged by tooth wear had to be ground down considerably for the actual treatment with crowns. In figures: According to a study by Edelhoff and Scholander, between 63 and 73% of the substance of the clinical dental crown is lost during preparation for a dental crown. This applies to both the posterior and anterior regions: the figures are almost identical. And the result for the affected teeth is also: an additional treatment risk. This increases even more when ceramic is used as a restoration material, because the previously damaged and subsequently ground teeth react more sensitively to the materials when they are bonded.
To prevent this from happening, PD Dr. Ahlers and Prof. Edelhoff have developed a new preparation technique and new preparation instruments to go with it. These halve the loss of substance of the ground teeth to approx. 30% – and thus the risk. And if the teeth have already been worn down by grinding, the loss of substance is even less. As a result, the teeth are restored gently and durably with all-ceramic tooth-colored occlusal onlays instead of crowns.
At the CMD Center Hamburg-Eppendorf, we use this technology routinely – after all, the first tests with the new grinders were carried out here and at the University of Munich. We know our way around… Would you like to know more? Talk to us!
Depending on the individual situation, proven metal or modern ceramic restorative materials are used for technical and esthetic purposes. are used. In addition to the esthetic effects, the possibility of preserving remaining tooth substance also varies.
We will explain the advantages and disadvantages to you using the example of handy models and work with you to find a suitable solution from the various alternatives.
Minimalism is in – this also applies to dentistry. In the past, fillings tended to be larger, but today new restoration techniques allow for barely visible restorations the same size as the actual defect.
The prerequisite for this is modern and regular prophylaxis. Dentists must also be proficient in special techniques that involve working with micro-instruments and magnifying glasses. In this way, minimal loss of substance is turned into maximum success – which is also barely visible.
As one of the leading specialists in this field, PD Dr. Ahlers also developed a new working technique in his habilitation thesis, which enables the gentle repair of tooth-colored fillings in the event of later defects at the edges. Since this technique has been published in a book, other dentists are now also learning how to use it. We use it in our specialized practice as required; all our treatment rooms have the necessary special equipment.
All in all, this has led to the development of a new form of dentistry which, thanks to regular check-ups and professional prophylaxis, makes it possible to restore defects that are detected earlier and therefore much smaller than in the past in a much gentler way.
The result of these treatments is usually invisible to third parties due to smaller volumes and tooth-colored restorative materials. Nevertheless, we can show you – with high-resolution intraoral cameras and flat screens at every