When teeth are lost or missing, whether through failure to develop or removal of teeth due to tooth decay, advanced gum disease, trauma or failed root canal treatment, the individual and the dentist are faced with a conundrum.
Should the teeth be replaced and if so what is the best way to replace it?
Since modern dental science have evolved, there are now more options available to replace the loss of natural teeth. In selecting a treatment option tailored toward an individual, numerous factors need to be considered and evaluated in order to reach the best treatment for the patient and also minimise problems that can arise.
These factors can range from the following: the status and configuration of the remaining dentition; tobacco use; oral hygiene; medications; systemic diseases; the age of the patient; bruxism and clenching tendencies. Hence in order to reach the most appropriate treatment plan that the patient is happy with, the dentist and the patient must evaluate all of the above concerning factors.
A number of therapy options for the treatment of missing teeth include:
Having no treatment is certainly a viable option. However, depending on which teeth are lost, the long-term effect of not having teeth replaced can be quite discomforting to some people. This not only affects eating and speaking, but in the long-term can cause movement in surrounding teeth resulting in unwanted spaces. If enough teeth are missing bone loss can ensue, leading to a partial collapse of the face, sagging lips (as seen in older individuals) and in cases of extreme bone loss, can lead to an individual being more prone to jaw fractures.
Removable partial dentures
Made from either plastic or from a metal frame, partial dentures replace areas of missing teeth and generally contain hooks that are attached to the adjacent natural teeth to help prevent the denture from moving. This type of denture tends to feel bulky in the mouth because of the thicker plastic frame. However extra plastic teeth can be added with ease to this denture if there are further tooth loss. First-time wearers often described the denture as feeling bulky and will require a transition period, (possibly months) to get use to wearing and adapting to the denture. Unfortunately, there are a proportion of people who can never get use to wearing a denture no matter how well the denture is made.
Similar in principle to partial dentures but replaces the entire arch of teeth. Upper full dentures basically work on suction to keep it in place while bottom dentures rest on the gum ridges and have minimal suction properties. Patients generally find full upper dentures more comfortable and find full bottom dentures more troublesome due to the lack of suction.
A bridge uses the teeth on either side of a gap for support. The teeth on either side of the gap is precisely prepared by specific requirements. The bridge must be carefully fabricated to fit the prepared teeth and then cemented into place.
To restore missing teeth, there are various implant-supported teeth options. When a single tooth is missing, a single implant restored with a crown is a good option. But when multiple teeth are missing, a decision needs to be made whether to replace each missing tooth with its own implant supported crown or implant supported bridge unit. When all the teeth are missing then one has the additional option of having full dentures supported by implants. The decisions are based upon many factors such as spacing issues; the quantity and quality of bone available; and the proximity of the surgical site to vital nerves, blood vessels and the maxillary sinus.
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