Tooth Replacement Options
If you are missing one or more teeth, you may be all too aware of their importance to your looks and dental health.
Your teeth are designed to work together to help you chew, speak and smile. When teeth are missing, it is difficult to do these things. Even the loss of a back tooth may cause your mouth to shift and your face look older. Fortunately missing teeth can be replaced.
If a tooth is not replaced, other teeth can drift out of position and change the bite. Shifting teeth can possibly lead to tooth decay and gum disease
Missing teeth can lead to loss of jaw bone and support for the facial tissues leading to a change in appearance
The following are three options your dentist may suggest, depending on your needs. Replacement teeth should last for years at a time, so it is important to choose a treatment that’s right for you.
What is an implant?
Natural tooth compared with a dental implant crown
A dental implant can be thought of as an artificial tooth root that is submerged into the jawbone. When dental work such as a crown, fixed bridge or a full set of dentures is added to the implant fixture, one or more missing teeth can be replaced.
A dental implant is fabricated from a very strong, biocompatible material placed in a simple procedure that, generally, is as convenient as a tooth extraction.
After an initial healing period, during which the implant is buried in bone and left undisturbed under gum tissue, it is uncovered and connected to a small metal post that secures and supports the artificial tooth.
The implant material is extremely biocompatible. The bone grows to the implant and bonds to it. This makes the implant very strong. The process is called 'osseointegration'.
How long does it take?
It depends on the type of bone, and where the implant is placed into your jaw. It can range from a few months to over 9 months.
Generally, implants in the front lower jaw need around 4 months; the back upper jaw needs around 9 months and elsewhere in the mouth around 6 months. These times may need to be lengthened if bone needs to be grown or grafting has taken place.
Is everyone suitable?
Some people may not be suitable for this procedure. Conditions such as alcoholism, some psychiatric disorders and uncontrolled diabetes can cause problems. Your dentist will also need to check to see how much bone you have and whether there is enough space for an implant. The adjacent teeth roots will also need to be away from the implant. If you don't have enough bone, it is possible to grow bone or even graft bone from elsewhere in the mouth or places like your hip.
What are the advantages of implants?
The adjacent teeth are not damaged or cut in any way. It helps to prevent bone loss. Implants are also used to stabilise loose dentures or even replace them with fixed bridges.
What happens if an implant fails?
This means the implant has not attached or integrated to the bone. It usually fails at the second stage surgery. The failed implant is unscrewed, the bone left to heal for a while and a new implant placed. Other options such dentures or bridges are also available.
What is the procedure for an implant?
The gum is folded back and the bone drilled to receive the implant. You may have this done in the chair with local anaesthetic or go into the hospital for a general anaesthetic. The implant is generally covered over and left to heal until the implant is osseointegrated. Your dentist or surgeon may also leave the implant uncovered by the gum at this first stage. A second operation may then be needed to uncover the top of the implant.
Before/After implant placement and after crown cementation
What is the success rate?
The success rate depends on where in the jaw the implants are placed. The lower jaw has a very good chance of success (98%). The further back in the mouth you go, the lesser the prognosis, but this is generally over 90%. If you smoke, the chances of success drop by at least 10%.
Why is implant treatment expensive?
Because it is a complex process requiring expensive precision components and instruments.
Why choose dental implants?
A dental implant is the closest thing to a natural tooth your dentist can give you. They feel much more natural and secure than traditional removable dentures, especially if these are loose fitting because of extensive bone loss. If several adjacent teeth are missing, a fixed bridge may be attached to dental implants as an alternative to a removable partial denture plate. Dental implants allow for the replacement of a missing tooth without modifying adjacent teeth. Your dentist will be happy to discuss alternatives for restoring your dental function with you.
Are implants complicated?
The simple answer is no, if sufficient bone is available to accept the implant. The procedures can all be done in the dental surgery, using only local anaesthesia. In the first stage of surgery, the implant root component is inserted into the bone site.
This surgery generally takes about sixty minutes to complete. After six to ten days, the stitches are removed and the buried implant is allowed to heal for about three to six months. During this time, bone grows into the implant surface to secure it.
The second stage of surgery is very simple and lasts only about thirty minutes. During this stage, the buried, secure implant is uncovered using a small incision in the gum tissue. A post is attached to the implant until the final prosthesis is complete, which can take as little as two weeks. There is minimal discomfort associated with either of these surgical steps, certainly no more than having a tooth extracted, and usually less. Dentist prescribed medication can alleviate any uneasiness. Improved aesthetics, function and quality of life follows in a few weeks with your new prosthesis fitted.
A front tooth is replaced with an implant and crown. The x-ray shows the implant which has become integrated into the bone
How long will an implant last?
This is impossible to predict. Though research has demonstrated a long life once the implants have been integrated with bone, each patient is different, and longevity may be affected by overall health, nutrition, oral hygiene and tobacco usage. Individual anatomy, the design and construction of the prosthesis and oral habits may also have an influence.
Are there any limitations?
Discuss this with your dentist, as there are a few medical reasons preventing the use of implants. Sufficient bone to accept the implant is the major limiting factor. This can be assessed radiographically (x-rays), and bone can even be augmented where it is deficient.
In this case dental implants have been used to enable full restoration of the patient’s teeth and bite.
What is a bridge?
A bridge is a dental restoration that fills the space where one or more teeth are missing. The bridge restores your bite and helps keep the natural shape of your face.
Bridges are commonly used to replace one or more missing teeth. They span the space where the teeth are missing and restore your bite helping to keep the natural shape of your face. Bridges are cemented to the natural teeth or implants surrounding the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments. As with crowns, you have a choice of materials for bridges. Your dentist can help you decide which to use, based on the location of the missing tooth (or teeth), its function, aesthetic considerations and cost. Porcelain or ceramic bridges can be matched to the colour of your natural teeth.
Two missing front teeth are replaced with bridges
It is essential that you discuss your options to replace missing teeth with your dentist. Bridges, implants, dentures or implant-supported bridges or dentures can be considered, and each have their own advantages and disadvantages.
What Types of Dental Bridges Are Available?
There are three main types of dental bridges:
Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic (false tooth) in between. Traditional bridges are the most common type of bridge and are made of either porcelain fused to metal or ceramics.
Cantilever bridges are used when there are adjacent teeth on only one side of the missing tooth or teeth.
Maryland bonded bridges (also called a resin-bonded bridge or a Maryland bridge) are made of plastic or porcelain teeth and gums supported by a metal framework. Metal wings on each side of the bridge are bonded to your existing teeth.
How is a bridge placed?
A single missing tooth is replaced with a three-unit fixed bridge
Before a conventional bridge can be made, the teeth must be reduced in size so that the bridge will fit over them properly. After reducing the teeth, your dentist will take an impression to provide an exact mould for the bridge to be constructed on. If porcelain is to be used, your dentist will determine the correct shade for the bridge to match the colour of your existing teeth.
Using this impression, a dental technician then makes your bridge, in the material your dentist specifies. A temporary bridge will be put in place to cover the prepared tooth while the permanent bridge is being made. When the permanent bridge is ready, the temporary bridge is removed, and the new bridge is cemented over your prepared tooth or teeth.
How Long Do Dental Bridges Last?
Dental bridges can last five to 15 years and even longer. With good oral hygiene and regular check-ups, it is not unusual for the life span of a fixed bridge to be over 10 years.
Will It Be Difficult to Eat With a Dental Bridge?
Replacing missing teeth with a dental bridge should actually make eating easier. Until you become accustomed to the bridge, eat soft foods that have been cut into small pieces.
Will the Dental Bridge Change How I Speak?
It can be difficult to speak clearly when teeth are missing. Wearing a dental bridge with the anterior teeth in their proper relationship will help you speak properly.
How Do I Care for a Bridge?
It is important to keep remaining teeth healthy and strong as the success of the bridge (depending on the type selected) depends on the solid foundation offered by the surrounding teeth. Brushing twice a day and flossing daily helps prevent tooth decay and gum disease that can lead to tooth loss. Your dentist or dental hygienist will demonstrate how to properly brush and floss teeth as it is important to clean between your teeth and under the bridge. Keeping a regular cleaning schedule will help us diagnose any potential problems at an early stage when treatment has a better prognosis. Selecting a balanced diet for proper nutrition is also important.
Are implants better than a bridge?
More people are now choosing implants over bridges. As far as being more economical, the main reason is that dental implants have a higher success rate and rarely need to be replaced. According to certain studies, bridgework may only last an average of 8-10 years.
A dental bridge has a fake tooth or "pontic" that rests on the gums. This is a very difficult situation to create a realistic looking tooth. Dental implants are placed below the gum surface and the crown erupts through the tissue just like a natural tooth. In addition, as the name states, a bridge splints the adjacent teeth together making hygiene difficult. Implants do not decay but the teeth supporting a bridge can decay if hygiene is not well maintained. This can lead to the bridge failing and requiring replacement.
One major reason that people may choose an option is whether or not they wish to undergo a specific procedure. Although relatively non-invasive, a Dental Implant placement is a surgical procedure. On the other hand, a bridge requires that the teeth on either side of the toothless space be trimmed down to support the fake tooth. A bridge is still a very good restoration, however a Dental Implant is the state of the art way to replace a tooth and in many cases is the preferred "standard of care".
The most important benefit of Dental Implants is often unrecognised. When a tooth is lost the bone is no longer in function. Because of this the bone slowly begins to disappear in this area. Denture patients often have little bony ridge remaining, and often the loss of a single tooth, with associated bone loss, leads to an aesthetic nightmare. Implants act just like a natural tooth in terms of stimulating the bone. By placing an implant you are not only replacing a missing tooth, but you are maintaining bone.
Discuss your options with your dentist.
3. Removable Dentures
What are dentures?
A denture is an appliance that replaces teeth. You remove it to clean it and it may be replacing all the teeth (full denture) or some of them (partial denture).
How do they differ to crowns and bridges?
Removable dentures are those dentures (plates) the wearer can remove and replace at will. These types of dentures can replace one tooth, all your natural teeth, or any number of missing teeth in between. A crown or a bridge is fixed or cemented in place and cannot be removed.
What are the steps to getting a denture?
Before any denture treatment is undertaken, it is recommended that you have a thorough dental check-up. If you are having full dentures, it will involve an examination of the mouth and an assessment of the health of the gums.
If you are having a partial denture, this check-up will include a full examination of your teeth, gums and other soft tissues of your mouth. At this check-up radiographs may be taken to ensure the teeth are healthy, and strong enough to help support a denture. Remember, the only oral practitioner who has the training and is legally able to undertake such a thorough check-up is your dentist.
You then have impressions, bite records, trial wax insertions and then the final insertion and instructions.
How are dentures made?
Many removable dentures rely on some of your remaining natural teeth to help keep them in. Your natural teeth were never designed to help support a denture. In most cases, some minor modification of your natural teeth would be desirable to improve the wearability and life of your denture. Your dentist has the required training to be able to modify your teeth to ensure the highest quality removable denture is constructed around your natural teeth.
Examples of full dentures (top and bottom left), upper partial chrome denture (top right) and lower acrylic partial denture with clasps (lower right)
How long will I have to go without any teeth?
Some removable dentures are made to be inserted immediately after the removal of a tooth or some teeth. These types of removable dentures are commonly termed 'immediate dentures'. They can be constructed to replace only one tooth or many teeth. Your local dentist can undertake all the required stages involved in immediate dentures. This will mean that one person will oversee the whole treatment, assuring you of the highest possible standards.
How often should I have my denture checked?
If you currently wear removable dentures of any kind, it is advisable that you have these checked regularly. It is recommended if you have any remaining natural teeth you should have these and your dentures reviewed every six months or as directed by your dentist. If you have no natural teeth and wear removable full dentures, your dentures should be reviewed at least every two years.
Why may my denture need to be relined?
The rapid shrinkage of bone following extractions means the denture will soon need to have the fitting surface relined once that shrinkage has slowed down enough. After a reline, patients report a much better fit. This relining maybe done between three and six months after an immediate denture has been fitted. Your dentist will advise you when an immediate denture is ready to be relined.
Relining involves an additional fee, but this is going to be cheaper than a new set of dentures and it is often very much appreciated.
All dentures lose their fit through natural changes in your mouth. Chewing gum, biting your nails or grinding your teeth can accelerate this.
You should see your dentist yearly for a denture check, when refitting or relining may be necessary. For example, many patients report that their full dentures are loose after a period of rapid weight loss.
Considering your options for tooth replacement
There are advantages and disadvantages of each type of tooth replacement and it is important to explore all your options, with the help of your dentist.
Preserves gum and bone. No damage to adjacent teeth
The most cost-effective long term solution
A very long term solution and high average life expectancy
An implant is most similar to a natural tooth
Fixed prosthetic device
Look, feel and function like natural teeth
Don't require removal for cleaning
Usually less expensive than fixed bridges or implants
Initial investment is higher
Longer treatment period may be required
Some surgery is required
The average life expectancy of high quality bridgework is approximately 5-15 years
Adjacent teeth have to be reshaped to fit a bridge
Risk of permanent tooth nerve damage and development of abscesses
Gums and bone often continue to shrink
If a tooth is extracted, a temporary bridge needs to be fitted for a few months to allow the bone to heal before a permanent bridge can be fitted
Frequently move about when eating, talking, laughing and smiling
Can damage the gums
Average life expectancy of high quality dentures is approximately 5-8 years
Gums and bone often continue to shrink
They can break or be lost
They can be uncomfortable
Some people are embarrassed to take them out for cleaning or at night