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Replacing Missing Teeth

No one wants to hear that they need to have one or more teeth removed, but if it does happen, what’s next? Does each tooth have to be replaced? If the missing tooth is in the front of your mouth or otherwise seen when you smile, then one obvious benefit of tooth replacement is pure esthetics. But what should you do if the missing tooth is in the back of your mouth? In many cases, if a space is left untreated anywhere in the mouth, the teeth behind the space will begin to shift into that space. But the teeth do not simply shift forward; they tilt forward, causing periodontal problems (lack of bone support for the affected teeth). A missing tooth will also cause the opposing teeth (teeth that meet when the mouth closes) to shift into that space, again causing periodontal issues or esthetic concerns. Finally, teeth support the bone of your upper and lower jaws (which, in turn, support your lips and face). When teeth are removed, this bone begins to resorb, or disappear. As more and more teeth are lost, a “sunken in” or “witch-like” appearance of the face begins to develop as a result of this bone loss. With modern dental technology, there are several options for replace missing teeth and preventing future detriment to your overall oral health.

With recent advances in dental medicine, dental implants have become the treatment of choice when it comes to replacing missing teeth. Implants are artificial roots that are placed under the gums where they are allowed to osseointegrate (become one with the bone). After osseointegration is complete, a digital impression is taken and an all-porcelain crown is inserted on top of the implant that looks and feels just like your original tooth. Implants replace teeth without negatively impacting any of the surrounding teeth. Additionally, they preserve the body’s natural bone in the area. Dental implants most closely replicate a natural tooth and, are therefore, the most ideal solution for missing teeth.

Another treatment option for missing teeth is a fixed bridge. A bridge uses the teeth on either side of the space for support. A bridge is composed of supporting crowns (caps) over top of each tooth on either side of the space with the replacement tooth (or teeth) in the middle. This one-piece unit is then permanently cemented into the patient’s mouth. The downside of a bridge is that it requires the removal of healthy tooth structure. A fixed bridge looks and feels great, and before dental implants, was the treatment of choice to replace teeth. A fixed bridge is still the preferred treatment recommendation if there is not enough available bone in the area to place an implant.

The final option for replacing one or multiple missing teeth is a partial denture. There are different types of partial dentures, ranging from an acrylic-covered metal framework, to a metal-free nylon denture that is flexible and very stable in one’s mouth. These variations of partial dentures have different types of “clasps” that allow the denture to attach to the remaining teeth and stay in place. The design and the size of the partial denture depend on the number and position of the remaining teeth. A major drawback to a partial denture is that it has to be removed before sleeping, and cleaned after eating. Additionally, it applies negative stresses to the teeth that it uses for support. Over time, these excess forces can accelerate tooth loss. As a result, partial dentures are the least favorable method for tooth replacement. It should be noted, however, that a partial denture is superior to no treatment at all as they do prevent teeth shifting and the associated negative consequences.