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.
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.
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.
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.
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.
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.