Replacing a Missing Tooth
When we are young, losing a tooth is an exciting thing as we put the tooth under our pillow and the tooth fairy comes in the night to trade it for some money. Unfortunately, when we lose a tooth when we are older, it's not such an exciting experience.
Teeth have to be extracted for a variety of reasons. The most common ones are very large/ deep cavities, severe gum disease, and certain types of tooth fractures.
When a tooth is lost, it can be an emotional process. Fortunately, there are several options available to replace the tooth once it is gone. Here, I will discuss the 4 most common options:
The first option is to do nothing at all. In some cases, the extracted tooth won't be missed much so replacing it isn't much of a concern to the patient. This is common when a wisdom tooth has to be taken out, since very little of our chewing function relies on them. Since no treatment is needed other than the extraction, this is obviously the least expensive option but in many cases not the most desirable.
Another option is to replace the tooth with a bridge. A bridge is done by preparing the adjacent teeth on either side of the missing tooth for crowns. Then a "bridge" is placed on top which is basically a fake tooth (called a pontic) that is held in place by being attached to two neighboring crowns (called retainers). In some cases, this can be done for multiple missing teeth in a row. The downside to this option are that you have to drill into neighboring teeth that may be completely healthy, in order to prepare them to hold the bridge in place. Another drawback is that you cannot floss through the bridge. This means that you have to thread the floss underneath the bridge or use a waterpik. Some patients find this to be a hassle. A bridge can usually be completed in a couple of appointments.
Another option is to have the tooth replaced with a removable prosthesis called a partial denture (or just "partial" for short). This is often a better option than a bridge when multiple teeth need to be replaced. Partials have an underlying metal framework to support the appliance and there are clasps and rests on it where it snaps in to fit on the remaining teeth that are still present in the mouth. A partial takes a few appointments to complete and oftentimes adjustments are needed initially to optimize the fit. A downside to this option is that some people just don't like the idea of having a removable appliance. It can also be hard to get used to having a new object like that in the mouth, especially on the lower arch.
A fourth option is a dental implant. This is the most "ideal" option in most cases and is becoming more and more common. A dental implant is a screw that is surgically placed into the jaw that is attached to a piece called an abutment. The abutment attaches the screw to the fake tooth on top. This is a great option because the tooth is replaced without having to drill into neighboring teeth or having to wear a removable appliance. The greatest shortcomings to this option is that it is the most expensive option and it can take a long time before the tooth is fully replaced. Each situation is a little different, but oftentimes a bone graft may be needed after the tooth is extracted, which then needs time to heal. Then the implant can be surgically placed (the screw part). That needs time to heal and integrate into the jaw bone. Then impressions need to be taken so the fake tooth can be made, followed by a final appointment where the fake tooth (also called an implant crown) is cemented in place. This process can vary in time, but typically takes a few months to a year from start to finish. If a front tooth needs to be extracted, you may be thinking, "I can't go that long without a tooth in front!" But don't worry, a stayplate can be made so that you have a temporary replacement for the tooth until the implant crown is ready to be cemented.
All of the steps mentioned here can be done in our office except for extractions, bone grafts, and implant surgery, which need to be done by an oral surgeon or periodontist. The parts used to replace the teeth are created in a laboratory, so that is why multiple appointments are needed in each scenario.
If you have to lose a tooth, we will discuss with you what the best options are depending on the situation in your mouth and your goals/ concerns for your teeth.
By: Anna Hautzenrader, RDH