Every day we see patients that have missing teeth. Sometimes they have been recently extracted and other times they have been missing for years. The reasons for missing teeth may vary, but the answers about why to replace them are the same.
All your teeth have an important role to play. They help you chew and grind the food, speak properly and they even are the essence of your smile. We start with 20 milk teeth and then they are replaced by 32 permanent teeth.
Teeth are lost due to many reasons such as gum disease, decay, injury and at times due to genetic reasons. It’s important to replace them because they may cause several problems.
Consequences if missing teeth aren’t replaced
Effects on jaw bone - When you lose teeth, there is an imbalance in the interplay between the teeth and jaw bone. The gums and bone are no longer stimulated enough due to lack of the teeth in that area. So as a result your jaw starts shrinking and the gums pull back. This can weaken the neighbouring teeth and they start moving into the gap created by the missing tooth which might finally lead the neighbouring tooth to collapse as well.
Effects on Appearance - Missing teeth and reduced jaw bone height can make the face look older and wrinkly. Cheek becomes hollow and saggy and lose its fullness as they are no longer stabilized by the lips and cheeks from inside.
Jaw joint disorders: The muscles of your face and side of the face help you chew, grind the food, rotate your jaw and speak. The joint, allowing the jaw movements is known as the TMJ joint. A missing tooth can cause the loss of harmony of the muscles and the joint. This can lead to physical pain and discomfort.
Some other consequences of not replacing missing teeth include:
Ideally, the replacement of the missing teeth should compensate for the structure and function of the tooth it is replacing.
Although, no artificial tooth can replace a natural tooth by 100%, with new materials and technology dentists can provide around 80% of the function by an artificial tooth. American Dental Association (ADA) stresses on the importance of choosing a treatment/replacement option that is ideal for the specific situation, after proper evaluation
The options available to replace missing teeth include
options of missing teeth replacement are-
Full Dentures or Complete Denture: used in cases when all the teeth are missing. There are various kinds of them and explaining them is beyond the scope of this article and would be covered in subsequent articles
Removable Partial Denture: Used when there are multiple teeth missing, with improper or insufficient support for a fixed bridge.
A dental bridge can be used to replace 1 -3 missing teeth in continuation.
Bridge is an artificial tooth fused to a frame. The bridge is supported by implants or teeth surrounding the gap, while the middle section replaces the lost tooth. Bridges can also take support from implants, usually when two or more teeth are missing.
If the bridge is to be anchored to adjacent natural teeth, then these teeth have to be reduced in size by grinding them down.
Bridges can be of metal or all ceramic or both metal – ceramic. The material, shape and size of bridge depends on the tooth to be replaced and patient considerations.
Implants, in dentistry have become a popular option to replace damaged or missing teeth. Implants can be used instead of bridges or help in supporting dentures. They are generally more aesthetic, that is they look like natural teeth.
Implants also are better in providing 80% functionality of the natural tooth/teeth they are replacing. Thus, being the preferred option for replacing teeth in modern dentistry.
Implant is composed of a metallic screw, typically titanium fixed to the bone socket of the missing teeth. The jaw bone is then allowed to grow around the implant for 2-3 months, integrating it with the bone and holding it firmly in the jaw.
After the bone and the implant have bonded an abutment is fitted to hold the new tooth. The ceramic/ metal ceramic tooth is then attached to the abutment.
The implant gets support and supports the jaw bone. It does not require surrounding teeth for support. Thus, the other teeth are untouched in case of an implant.
Implants are permanent solution and do not have to be swapped out over time.
Loss of multiple teeth at the back meant for chewing may mean that they need to be replaced by an implant at one end and a cap may be attached at the other end where there is healthy tooth, with a bridge replacing the remaining missing teeth. Creating a bridge from implant post to healthy tooth. This treatment plan should be undertaken only after proper evaluation. It is recommended only in certain specific cases.
What’s better Implant or bridge?
Both implants and bridges have their pros and cons and require detailed evaluation to determine which option would be best suited. Although there are some generic benefits of each
Short, can be completed in 2-3 appointments over a period of 5-7 days
Long, requires multiple appointments and can take around 2-6 months to complete
Effect on surrounding tooth
The supporting teeth need to be cut and covered with a cap to act as supporting pillars for the missing tooth
The screw is integrated to the bone thus, there is no damage to the surrounding tooth. An implant helps in supporting the underlying jaw
High maintenance, requires proper cleaning around the replaced tooth or might lead to infection
Low maintenance, they are maintained by normal brushing and don’t require any special care
Less aesthetic, not very natural looking
Very aesthetic, they look very alike to the natural tooth they replace
Provides 30% - 50% function of that of the natural teeth it replaces
Provides 80% function of that of the natural tooth it replaces
Relatively lesser initially, although may become more expensive in the long run as it requires frequent replacement
Relatively higher initially, might be cheaper in the long run as it lasts longer
Preservation of jaw bone
Generally destroys the underlying bone
Supports the underlying bone
How to decide?
Cost -The cost difference between an implant and bridge can vary dramatically. A dental bridge is generally more affordable than a dental implant.
Procedure Duration - How long are you willing to wait to have your teeth fixed? A bridge can be fixed in 2-3 visits to the dentist. An implant is a long procedure that requires and recovery times over the span of several months.
Lifespan - The long lifespan and little maintenance with dental implants makes patients over the age of 40 good candidates for this procedure. They may need to be replaced for up to 25 years. Bridges are more affordable but have to be replaced every 5-7 years, possibly up to 10 years with proper maintenance.
WHAT WORKS BEST FOR YOU WILL DEPEND IN YOUR UNIQUE SITUATION. EVERYTHING FROM YOUR ACCESS TO AFFORDABLE DENTAL CARE, COMPETENCE OF THE DENTIST, THE STATE OF YOUR ORAL HEALTH, TO BASIC FINANCES WILL ULTIMATELY DETERMINE WHETHER THE TEETH WOULD BE REPLACED BY A BRIDGE OR AN IMPLANT
Need to know more? We are there to help DentOp - This article has been written by Dr. J R Mohanty