Replacing A Missing
Tooth
Article contributed by:
Parkway Dental Practice
The loss of a tooth is a
significant event for
most people. It
raises a myriad of
concerns ranging from
loss of function or
sense of well being to
embarrassment should the
affected tooth be
located in a visible
position.
Recent advances in
dentistry have made the
replacement of a loss
tooth more predictable,
resulting in a more
satisfying experience
for both patients and
dentists alike.
Patients are also
increasingly more aware
on the importance of
preserving alveolar
bone. The alveolar
bone houses the roots of
natural teeth and
contribute significantly
to lip support and
facial appearance.
Most of us are familiar
with the fact that
muscles undergo atrophy
when it is under used.
This is exactly what
happens to our alveolar
bone when we lose a
tooth. The
remaining alveolar ridge
starts to shrink almost
immediately, becoming
narrower and less dense
with time, ultimately
affecting lip and cheek
support. Your
choice of tooth
replacement has a great
influence on this
phenomenon.
This article will help
you understand your
options and highlight
the pros as well as cons
of each option. We hope
that this will enable
you to make better
decisions within the
larger context of your
expectations and overall
well being. In
essence, an affected
person has 4 options on
what to do with the
space left behind by a
tooth.
Dental Implants
Modern dental implants
in its current form were
first introduced in the
early 1980’s by Dr
Branemark. Today,
it is regarded by
dentists as the gold
standard for tooth
replacement due to its
ability to mimic the
natural architecture of
the tooth. Its use
has been studied by
numerous researchers
around the world, over
the past three decades,
leading to an explosion
of dental implant
systems in the market.
With a dental implant,
the dental specialist
places a post into the
jaw bone at the site of
the missing tooth. The
post can be made of
either titanium or
zirconia and is meant to
simulate the root of a
natural tooth. It
is thereafter left in
place to heal and
integrate with the jaw
bone for a few months.
A crown is subsequently
placed over the post.
Dental implants have the
advantage of being fully
bone supported and its
presence preserves the
alveolar bone. It
has a good success rate
as evident by 5 years
survival rates of
between 93% and 97%.
The down side is that
its placement requires a
minor surgery and cost.
Mini dental implants
were first introduced
for use as temporary
implants to support a
temporary denture or as
part of braces
treatment. Several
manufacturers now
produce mini implants
for permanent
restoration of missing
teeth. While the
cost of mini implants is
relatively inexpensive
(approximately half the
cost of a regular
implant), its widespread
use as a permanent
solution has been
hampered by a relatively
low success rate of
between 60% and 70%
after 5 years.
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Dental Bridge
A dental bridge is also
known as a ‘fixed
denture’ as it is not
removable by the
patient. Two
common designs are the
Conventional and
Maryland bridges.
A conventional bridge
requires crowning of the
teeth adjacent to the
missing tooth as
support. This type
of bridge is sturdy,
retentive and can
withstand normal chewing
forces very well.
It is used to replace
back teeth as well as
front teeth. The
disadvantage with
conventional bridges is
that the fate of the
denture is tied to the
fate of its supporting
teeth. In other
words, you will lose the
whole bridge if one of
the two support teeth
located on either side
of the denture becomes
compromised.
The Maryland bridge
requires minimal
preparation of the
support teeth and has
the advantage of being
very conservative of
healthy teeth structure.
The artificial tooth
literally has wings
which serves as points
of attachment to its
neighbours. One
disadvantage of Maryland
bridges is that it is
more easily dislodged.
Some studies have
demonstrated that
approximately 1 out of
every 5 patients will
experience such an
incident over a 5 year
period. That is
why it is more suited
for front teeth, which
are not exposed to heavy
chewing forces.
Dental bridges have the
advantage of being
completely tooth
supported and
permanently fixed.
It is lifestyle friendly
and comfortable to use.
Challenges are
associated with the need
to clean under the
bridge. Your
dentist may recommend
the use of an oral
irrigator (e.g. waterpik
or airfloss) to enable
you to do a better job.
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Dentures
A removable denture is a
low cost option for
replacing a missing
tooth. It can be
made of rigid plastic,
flexible plastic or a
combination of metal and
plastic. Depending
on the location of the
missing tooth, the shape
of the denture may vary
significantly. As
their names suggest,
they are removable by
the patient which makes
it fairly easy to keep
clean and care for.
Removable dentures can
be supported by the gums
alone or a combination
of gum and teeth.
Dentures that sit
directly on the gums of
the missing tooth often
put pressure on the
underlying bone,
potentially hastening
bone loss associated
with tooth loss.
The downside associated
with removable dentures
are the fact that they
often do not feel as
comfortable and secure,
compared to implants or
bridges. Patients
can overcome this by
being conscious of their
chewing habits and
making the effort to
prevent it from coming
loose during use.
Perhaps the biggest
challenge with removable
dentures is to be able
to find a dentist who is
patient enough in
helping you fit one
well. Removable
dentures are not easy to
fabricate, nor is it
easy for patients to get
used to. This is
especially true if a
patient had never used
one before.
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Doing Nothing...
In certain situations,
doing nothing may be a
viable option. For
example, a third molar
that sits right at the
back of the dental arch
which may be difficult
for anyone to keep
clean. Other
reasons could be when
the space left behind is
too small or when the
tooth is located in a
poor position.
These situations will
indeed benefit more from
space closure using
braces treatment rather
than tooth replacement.
Doing nothing may
however not be a good
idea in some situations.
Teeth act like natural
space maintainers within
the dental arch and a
missing tooth can over
time allow for the
unwanted movements of
adjacent or opposing
teeth, causing the bite
to become deranged.
These changes when
compounded with the loss
of function on the
affected side may change
the way we chew, causing
undue stress to the
joints of the jaw bone.
Another drawback of
doing nothing is that
the alveolar bone at the
location of the missing
tooth will quickly lose
volume and density over
the first few years,
potentially limiting or
complicating your
options when you decide
to exercise them in the
future.
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The Future
There is some hope that
in the future we will be
able to grow new teeth
from advances in stem
cell research. It will
be very exciting indeed
if such a hope becomes a
reality.
Meanwhile, if you are
already using any of the
above solutions, do
everything you can to
maintain healthy gums by
ensuring that you are
exercising good home
care and by regular
visits with a competent
dental professional that
you can trust.
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Article contributed by:
Parkway Dental Practice
Dated: September 2014
|
Parkway
Dental
Practice
is a group
dental
practice
located in
the central
part of
Singapore.
Our
experienced
team of
dentists and
specialists
aim to
provide the
community
with
affordable
multidisciplinary
oral care in
a safe and
comfortable
environment.
Our clinic
is equipped
with the
latest
diagnostic
technology
and
equipment,
enabling us
to practice
at the
forefront of
modern
dentistry. |
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