If you are missing a significant number of posterior teeth, eating can be difficult. What can be done about it?

Although each individual varies to a certain degree, there are many commonly shared scenarios.

One option is to continue struggling and do nothing to correct the condition.

A second option is to have a removable partial denture made. Many strides have been made in this area, with different materials such as thermoplastic nylon.

In the past the only option was either an all-plastic flimsy variety or a metal substructure with clasps that are unattractive in a smile. The newer “flexible” partial dentures are at least more esthetic and lighter, and appear to be more comfortable.

Most partial denture wearers, however, find them uncomfortable. Unless anterior teeth are also replaced on the partial, it usually ends up in a dresser drawer.

Assuming there are not enough teeth to employ a fixed bridge, implants become the best solution. (A fixed bridge is when teeth adjacent to the space are prepared for crowns and the missing teeth are connected to them, touching the gum, giving an appearance and function of natural teeth).

If enough bone is present, a traditional root form implant can be used. If there is a deficiency of bone, mini-, small-diameter implants can be used.

The most challenging area of the mouth for tooth replacement is the upper posterior teeth.

If teeth have been missing quite a while, there is usually shrinkage of the bone near the sinus, making implant placement impossible without “sinus lift” bone grafts.

These grafts are accomplished by making an opening through the bone, teasing the balloon-like sinus membrane up, and packing the area with some bone graft material.

When this situation presents itself, close examination of the remaining anterior teeth is warranted. Unless they are very healthy, a full arch replacement might be the best solution.

This procedure is called by various names such as “all on four” or “teeth in a day.”

A prosthesis is made ahead of treatment and is fixed by screws the same day following the extraction of the remaining teeth and placement of four implants in the good bone surrounding those teeth.

The advantages of this concept are many.

  • It is fixed and gives the patient the same chewing efficiency of natural teeth.
  • It is esthetic, which most patients in this category have never had.
  • It eliminates the unpredictability of future anterior teeth failure and having to re-visit the problem over again.
  • Best of all, it is removable by the dentist. This comes in handy for future hygiene maintenance and any possible repair if needed.

The good news is that there are all of these options. The challenge becomes finding the one that fits you best.

James G. Jenkins, D.M.D. is the owner of Bluffton Dental Care in Bluffton.