Usually Dentists will recommend replacement of missing teeth especially if it is affecting function or aesthetics. In some cases it is recommended not to replace teeth; example your wisdom teeth, once these are removed these are not often replaced as you are able to function without there replacement. Other times you may not want to replace the tooth/teeth, studies having shown that we can continue to function relatively well as long as we have at least 20 teeth. The picture shows the pairs of teeth that are recommended in order to remain in function. It should be noted that even though you will still be able to function there are complications associated with this and leaving the area without a replacement may affect future replacement options. The complications of missing teeth are discussed in more detail on the the other tab.
There are different types of bridges that are available, these depend on the location of the missing space.
Resin-bonded bridges are a cost-effective and minimally invasive fixed tooth replacement option. Meaning they require less to no tooth removal. They are often used replace anterior teeth that do not have a lot of force on them. A metal framework or the natural tooth may be placed in the missing space and glued/cemented to the adjacent teeth. This requires good oral hygiene. There are situations where this is not ideal as it is patient selective. If the bridge debonds, there is often the option to recement or remake.
This is when one of the adjacent teeth to the missing tooth space is prepped for a crown with an added to tooth attached to it. This is often used for anterior teeth as the force of the posterior teeth are too strong and often breaks these cantilevers. That is why conventional bridges are used posteriorly. However, this is stronger than a resin bonded bridge but the down side is that it is not minimal invasive and not reversible. You must weigh up the the benefits of replacing missing teeth with the amount of tooth preparation required.
Implants have changed the way we treat missing teeth due to there ability to preserve neighbouring tooth structure. In the past we used to cut into two unrestored teeth and use them to hold a fake tooth in the missing spot. The issue with this it that it can weaken two good teeth and if decay affects one of them then you could end up losing more teeth. In saying that conventional bridges still have a role in patients that are unable to undergo implant surgery, and particularly if the adjacent teeth need full coverage restorations anyway.
Single implants are often the ideal case for replacing one tooth. Implants require good bone support and are often preferred to be placed within 6 months of extraction. If left for longer then implant placement may not be feasible or may require more treatment like bone grafting. Implants require sufficient bone and space (M-D and interocclusal). Implants do not involve adjacent teeth like bridges. Implants are about 95% like teeth in terms of function and aesthetics. However, they are not full proof and do require upkeep and maintaince with your treating oral practitioner. It should be noted that not all implants are successful with taking to the body with around about 2-3% complication rate during the healing phase.
Implant supported bridge, is a bridge made of two implants. It has the similar characteristics of the single implant instead there are two of them connected.
This is a denture that is held to your jaw via implants. This has the advantage of being secure and supported. As a result, they do not move like traditional dentures. These are difficult to clean and require good maintenance and regular check-ups to ensure their longevity. A great way to think of fixed screw retained dentures are like a picture frame that has been screwed into the wall. The only way to take down the picture is to unscrew the screws. (Click here to see an illustration)
These are plates that you can take in and out of your mouth. They are supported by adjacent teeth and soft tissues in the mouth. They can be metal or full acrylic. The advantage of metal is that it can be thinner and stronger affecting your speech and bite less. Metal is often better tolerated. Acrylic is thicker, accumulates more plaque but is easier to add teeth too if required in the future. The biting force is reduced compared to fixed options but is still more than no teeth in the missing space. Partial dentures have clasps that attach to the natural teeth that help hold the denture in place. Depending on the missing teeth, these clasps may be on front teeth which may be visible with smiling. They can increase risk of caries and periodontal disease to adjacent teeth, they are removable, and requires good oral hygiene. They require frequent check-ups and as the bone changes over time they often require adjustments or addition of acrylic (Relines).
These can be made from acrylic or metal but are often made out of acrylic due to cost. Upper dentures are often well accepted in most cases and tend to hold well due to good suction with the roof of the mouth and soft tissue. However, lower dentures are well known for being annoying and are not as well liked due to their movement. Often clinicians will recommend keeping other lower teeth to help support lower dentures or look at implant retained or fixed dentures. Dentures have one quarter of the normal biting force of teeth, they can increase risk of caries and periodontal disease to adjacent teeth, they are removable, they are often the least comfortable option and requires good oral hygiene. They require frequent check-ups and as the bone changes over time they often require adjustments or addition of acrylic (Relines).
This is a denture type that is often used on lower dentures. Lower dentures are notorious for moving due to the tongue and other soft tissue. As a result, sometimes implants can be used to help support the denture and reduce movement. This differs from implant fixed dentures, in that the dentures are not screwed to the implants rather they are placed in a ball and socket groove. This allows the support from the implants but also allows you to remove which aids with cleaning. A great way to think of implant retained dentures are like a picture frame that is hung on a nail and string. It is supported and secure to an extent. But can be easily removed if need be.
Once a tooth or teeth are removed, teeth do like to move into the missing positions. As a result they move to close the space. This can change your bite but can also make it difficult to replace the missing tooth in the future if left for too long. This is because the space can close too much, which may require more expensive treatment like orthodontic treatment (braces) to regain the space. Over time the area can also lose bone which can result in more expensive treatment like bone grafts being required.
This predominantly happens when you are missing a lower tooth, the upper teeth can supererupt (move down) which can change your bite as well as expose the second layer of the tooth. This can make the tooth more sensitive to cold drinks and air. Which may require treatment in the future. (To learn more about Dentine Hypersensitivity here).
Your teeth support your facial appearance. The amount differs for different people depending on there bite. But as you loose more teeth this may affect your facial aesthetics. If you loose all of your bottom teeth this can cause atrophy of the jaw bone which can really change your facial aesthetics.
When you loose teeth, this can change the way that you bite and can put more force on adjacent teeth. You can think of it just like if you had a flat tire on a truck, it can continue to function but it puts more force on the other tires.
If you have finished reading all the information on this page, get a certificate for your hard work.
This page provides general information about dental topics. It does not contain all the known facts of this subject and is not intended to replace personal advice from your dentist. If your not sure about anything on this site, contact us or speak to your local oral health practitioner. Make sure you give your local oral health practitioner your complete medical history and dental history.
A selection of the references used:
KÄYSER, A.F. (1981), Shortened dental arches and oral function.
Journal of Oral Rehabilitation, 8: 457-462.
doi:10.1111/j.1365-2842.1981.tb00519.x
Armellini, D. and J. A. von Fraunhofer (2004). "The shortened
dental arch: A review of the literature." The Journal of
Prosthetic Dentistry 92(6): 531-535.
Some Images adapted:
Adler, L., Buhlin, K., & Jansson, L. (2020). Survival and
complications: A 9- to 15-year retrospective follow-up of dental
implant therapy. Journal of oral rehabilitation, 47(1), 67–77.
https://doi.org/10.1111/joor.12866
Pjetursson, BE, Heimisdottir, K. Dental implants – are they better
than natural teeth?. Eur J Oral Sci 2018; 126(Suppl. 1): 81– 87. ©
2018 Eur J Oral Sci
Berglundh, T., Persson, L. and Klinge, B. (2002), A systematic
review of the incidence of biological and technical complications
in implant dentistry reported in prospective longitudinal studies
of at least 5 years. Journal of Clinical Periodontology, 29:
197-212. https://doi.org/10.1034/j.1600-051X.29.s3.12.x
Chappuis, V., Araújo, M. G., & Buser, D. (2017). Clinical
relevance of dimensional bone and soft tissue alterations
post-extraction in esthetic sites. Periodontology 2000, 73(1),
73–83. https://doi.org/10.1111/prd.12167
Yuan, F., Cheng, C.,
Dai, N. et al. Prediction of aesthetic reconstruction effects in
edentulous patients. Sci Rep 7, 18077 (2017).
https://doi.org/10.1038/s41598-017-17065-y
Adapted from free dental picture by authority dental" (CC BY 2.0) by Authority Dental
© 2020 Happy Dentists.
