Missing Teeth

Why Replace Missing Teeth?

       There are several reasons that you want to replace a missing tooth or teeth. A tooth has many functions some being to chew, to speak, to keep the facial muscles and tissue in a proper position, to smile, and to keep the other teeth from shifting. Once a tooth is lost this whole balance is disrupted and it leads to many various problems.

       Once a tooth is lost the teeth start to shift, this make take some time to notice but it happens fairly rapidly. After a few years the size of the opening has closed dramatically. What used to be a fantastic smile is a gapped hole smirk. Some just prefer not to smile big anymore because they are self-conscious of their looks. The cheeks or the lips can appear sunken in. You may speak differently and sound differently.

What once was a stable bite is now changing. What once was a self cleansing tooth arrangement is now a plaque trapping nightmare. Chewing can be more difficult and tooth decay becomes more prevalent. These are just some of the effects of losing a tooth. This situation can cause TMJ problems and can cause headaches and other discomfort. To minimize the possibility of problems the missing tooth should be replaced promptly. There are a many ways to replace that missing tooth or teeth. The most popular are listed below.

Conventional Fixed Bridge

       The conventional fixed bridge is a tooth replacement that is attached with cement to the adjacent natural teeth. If you have one or two missing teeth on a single side this can be the best method of replacement. If the two teeth adjacent to the space are healthy and the supporting structure (bone and gum tissue) are adequate a fixed bridge can be placed. The only drawback is that the teeth have to be prepared for a conventional bridge to be placed. The preparation requires 1.5 to 2 mm of tooth structure to be taken off the outside of the tooth. If the teeth have no restorations in them it is hard to decide whether to prepare perfectly good teeth. If this is the case perhaps an implant is better suited in that area.

       The procedure takes usually two to three visits and is outlined below.
       The first visit is just like that of a crown, at the first appointment your dentist will numb the area and prepare the teeth by removing 1-2 millimeters of the natural crown away until the weakened portion of the tooth is removed (if any) and solid tooth structure remains making sure there is sufficient space for a porcelain or gold bridge to fit over the tooth and that the two teeth draw together. This procedure requires a great deal of skill and precision to ensure a successful result. The bridge must fit perfectly to prevent further decay and gum disease. This bridge will also restore the patients bite, prevent shifting of the teeth and must look good. After the preparation is completed, an impression of the area is taken to be sent to the laboratory. At the laboratory the lab technician will fabricate a bridge to the dentist’s specifications. The dentist will then place a ‘temporary bridge’ on the teeth to protect the preparations, allow you to function on the teeth, keep the adjacent and opposing teeth from moving and allow you to smile while your bridge is being fabricated.

       At the second appointment, the bridge is bonded or cemented to your natural tooth. Your new bridge should look natural and feel comfortable in your mouth. It is vital that you take care of the bridge and associated teeth. The margins are areas that are susceptible to decay and must be kept clean. You must use bridge threaders and clean under the bridged area. If you take care of your bridge it can last 5 to 15 years or even longer.

       The cost of a bridge is usually equivilent to the cost of the number of teeth being replaced times a cost of a single crown. This could range from $1500 to $6000 depending on the number of teeth involved and the cost of a single crown. This procedure should
only be used in replacing one or two teeth on a single side. If a larger span ridge is desired the procedure is different and can cost more. Please contact your dentist for the specifics.

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Implants

       Implants are used to replace a single tooth, many teeth on one side, or used to support an entire fixed or removable bridge replacing all the upper or lower teeth. The most common implant used today is the osseointegrated implant. This implant is placed in a hole which is drilled into the patient’s lower or upper jaw. Depending on the number of teeth being replaced, one or more implants are placed in the bone. If neccessary a substrucure is fabricated and then a crown, bridge or denture is securely fastened to the substructure or implant.

       Implants are useful for patients that have tried but can’t wear conventional dentures. Patients that lost a tooth, have two teeth with no or small fillings adjacent to the hole and don’t want to cut the teeth down to make a bridge, would also make good candidates. In either case the patient has to commit to good oral hygiene. Implants are usually placed in outpatient settings and have a healing phase of 3 to 9 months.

       There is a significant investment involved to place the implants as well as restore them. They can be placed by periodontists, oral surgeons, or trained general dentists. The cost could be $1000 to $3000 per implant placed and $1500 or more per tooth replaced. So make sure to keep the implanted areas healthy, by brushing and flossing daily.

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Removable Partial or Full Denture

       A partial or full removable denture is a set of artificial teeth that are not fixed permanently to one own natural teeth. This set consitsts of usually plastic teeth set in an artifical plastic or plasic and metal framework that rests on the gum tissue. A partial denture is used for people who have multiple spaces on one or both sides or whose teeth are not strong enough to support a fixed bridge. If the back
tooth is lost on a fixed bridge the only way to replace that tooth would be to place a partial denture or an implant supported denture or bridge. A partial denture usually has clasps or arms that fit around the existing natural teeth and use them for retention. The plastic base just sits on top of the gum tissue.

       A complete denture is just that, it replaces all the teeth on either the top or bottom jaw. The full denture can be the most difficult restoration to get accustomed to. The lower jaw offers little resistence to displacement. Therefore the lower denture tends to move around quite a bit. This movement only causes further atrophy of the jawbone itself, making the denture less and less retentive.

       The upper denture can create a seal using the soft palate (roof) of your mouth. This seal can be adequate to keep this denture in place. You can and do get resorption of the bone but it is significantly less that the lower.

       To fabricate a denture it usually takes approximate 5-7 visits over a period of at least a month. Preliminary and final impressions are taken, teeth are selected, the denture is tried in, and then after proper teeth placement is established the denture is processed. After the denture is delivered there probably will be a few to many adjustments needed to make minor improvements to the fit.

       Partial and full dentures can last many years. They periodically need to be relined to compensate for lost bone. They range from $900 – $4000 per denture (upper or lower).

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