Even with great advances in dentistry in the last 50 years, people still face the unfortunate event of tooth loss. I am frequently asked about the need and approach for tooth replacement. Fortunately, with the advancements in dentistry we can replace teeth in a life-like, aesthetic restoration with natural function and beauty.
There are several options for replacing a missing tooth or teeth. The possibilities depend on: where in the mouth, how many teeth are missing, the age and overall health of the individual, and the health of the adjacent teeth and surrounding gum and bone.
The options for replacing missing teeth are:
- Do nothing
- Removable partial denture or complete denture
- Non-removable bridge
- Implants with removable teeth
- Implants with non-removable teeth
Doing nothing, this is usually not a good option. A missing tooth is a functional and may also be a cosmetic issue. Missing teeth will affect how well you chew, lead to teeth shifting and a bad bite, diminish your smile and cause food traps. A bad bite will affect how well you chew and can contribute to joint and muscle pain (TMJ). Besides the annoyance, food trap areas lead to decay and periodontal disease, and neighboring teeth tend to shift into the gap changing the bite. Usually, the only time I recommend a do nothing approach is in the case of an acute medically compromised individual.
Removable partial or complete dentures, these were the treatments of choice years ago when options for more stable outcomes were not available. There are many disadvantages to dentures. Dentures tend to move around causing difficulty in eating, talking and smiling. They need to be removed for cleaning and soaked at night to keep the mouth and denture from becoming infected. Dentures rest on the gums and bone and cause sore spots and bone loss, eventually leading to dentures that don’t fit. Partial dentures also anchor on teeth and the pressure put on these anchor teeth weakens otherwise healthy teeth often leading to more tooth loss. Dentures need to be relined every one to two years and replaced every 5 to 7 years due to bone changes and when the denture teeth wear out. Dentures are usually the least expensive option and for some patients medical health may not allow for alternative treatment.
Non-removable bridges, this option has been the standard for replacing single or multiple teeth for decades. Bridges are attached to other teeth. If you are missing one or more teeth but still have several healthy natural teeth a bridge may be fitted to the existing teeth. As long as the adjacent teeth and gums are healthy this is a very successful long term solution. The cost is higher than dentures but the benefits outweigh the cost differential. Bridges are stable for chewing, they do not move, longevity is very good, cleansing ability is fair, and they can be made to match your natural teeth. On average, well-made bridges tend to be replaced every 12-17 years. The biggest drawbacks to bridges are homecare is difficult and when the bridge needs to be replaced it involves several teeth.
Implants with removable teeth, this is an option for replacing multiple teeth in adults. Implants are titanium posts placed in the jaw bone to replace the roots of missing teeth. Implants can be placed singularly or in multiples. The health of the patient is extremely important. Patients taking bisphosphonates for osteoporosis will need to consult with their dentist and physician about this procedure. Like removable dentures, they need to be removed for cleaning and are left out at night. They can cause sore spots and bone loss in the areas that they rest on the gums. The big advantage to having implants is increased stability of the teeth and bone preservation in the areas of the implants. These teeth are more comfortable than non- implant supported removable dentures because they have less movement. They do need to be relined when there are gum and bone contact because the gum and bone will recede. This option can be more costly than removable dentures but is much more stable, more comfortable and longer lasting.
Implants with non-removable teeth are usually the most stable and longest lasting way to replace missing teeth. Children, teens and some young adults may not be good candidates since their jaw bones are still growing. Implant(s) are placed in the jaw bone and non-removable teeth are made to fit to the implants. With this option maximum stability is attained and the implants help prevent bone loss. Patients can resume normal chewing with no restrictions. These implant restorations can be made to mimic natural tooth and gum tissue. Single teeth can be replaced with an implant and crown. Multiple teeth can be replaced with implants and bridges or implants and teeth — all non-removable. Implant replacement of teeth may be more expensive than bridges or removable dentures but implants have better longevity, are more comfortable, feel like teeth and are easier to maintain.
Deciding which approach to take should be achieved with a patient and dentist discussion about the advantages and disadvantages of each, but replacing missing teeth is usually the best option.
Dr. Robert A. Gallegos is a Fellow in the Academy of General Dentistry, he is on the faculty of Spear Education, a member the American Academy of Cosmetic Dentistry, the American Academy of Dental Sleep Medicine and the American Dental Association. Dr. Gallegos practices dentistry in Middleburg, VA. www.MiddleburgSmiles.com.