When a patient’s existing tooth has decay, is broken, or is painful, the options for treatment are not difficult to figure out. Depending on the amount of damage, the tooth might receive a root canal. Whether it does or does not, the options for restoration are a filling, crown or veneer.
The problem for missing teeth is much more complex. Factors to be taken in consideration of replacement include: how many are missing, have the teeth adjacent to the space shifted, has the opposing tooth erupted into the space, location in the mouth where the teeth are missing, how much bone support is there in the space, how long have they been missing, and what is the condition of the remaining teeth.
With so many factors to be considered, the decision on treatment is unique for each individual patient’s condition.
How long teeth have been missing is a huge factor when considering treatment options. When teeth are removed, the bone in the area does not have a tooth to support and it begins to dissolve away slowly over time.
One and one-half years since extraction is a general rule of thumb when considering dental implants. After that time, the option for dental implants becomes much more limited or not possible.
The general condition of the remaining teeth is also a huge factor. If they are compromised due to gum disease, decay or other breakdown, sometimes the best solution is a full arch replacement. This comes in the form of a full removable denture or an implant retained, fixed full arch restoration. The latter has been referred to as “all-on-four” or “teeth in a day.”
Other than dental implants, sometimes a fixed bridge is a better choice. By utilizing the adjacent teeth to the space for support, a multi-unit tooth replacement can be constructed. This is superior to the other option which is a removable partial denture.
The partial denture can be uncomfortable, can sometimes be unsightly., and over time, it can help loosen the very teeth that it relies on with clasp support to survive.
This option is usually considered a precursor to a full removable denture. As more teeth become lost over time, replacements can be added to the partial denture.
Where missing teeth are located is a significant consideration. If the affected area is in the front of the mouth where the teeth show, there is much more difficulty pulling off a natural look. If performed properly, any tooth replacements in the cosmetic region of the mouth can be made to be undetectable as replacement teeth.
A big factor to consider is long term stability and chewing efficiency. A full set of natural teeth will be much more stable than upper and lower full dentures. There can be as much as a 50% decrease in chewing efficiency with dentures compared to natural teeth.
The other options fall somewhere within that range compared to natural teeth. The fixed options are far superior to the removable ones.
James G. Jenkins, D.M.D. is the owner of Bluffton Dental Care in Bluffton.