Options: Bridges, Partials, Dentures, and Implants
There are some obvious consequences of missing teeth such as the aesthetic of large gaps and difficulty with chewing or speech, however there are a host of other consequences which not everyone may be familiar with. 70% of the population in the United States is missing a tooth; typically a molar in the back of the mouth. Missing teeth will impact the shape and size of the alveolar bone (responsible for surrounding and holding the tooth sockets in place) as well as the actual jaw bone. In fact, the alveolar bone experiences a decrease of 25% in width within the first four years of tooth loss. The constant stimulation of chewing with your teeth causes continual reformation in the bones. 1 Without this process the bone actually melts away, a process referred to as resorbing. Over years, this can cause drastic changes in appearance of the face, structure of the mouth, and arrangement of remaining teeth. Appearance-wise cheeks become hollow, the jaw shrinks and shifts forward, lips can sag, and the lower portion of the face actually shrinks making people look prematurely old. Inside the mouth teeth will shift which may cause more issues with speaking and chewing. The tongue can also expand to fill the space that teeth once occupied. Of course the number of missing teeth as well as individual variables will affect the path of these changes.
For many years the best option for restoration of missing teeth was bridges, partials, or dentures. During a bridge procedure the two teeth surrounding the missing tooth are prepared in order to cement permanent crowns on top. Between and affixed to the crowns is a pontic, which is a porcelain or ceramic tooth that fills the void from the missing tooth. Sometimes bridges are also call fixed partials. A partial denture is removable and made to replace several teeth, but not a whole mouth. The replacement teeth are attached to a pink base made to resemble the natural gum and usually clipped into place. Dentures are similar to partials, however they are for the replacement of a full set of teeth on the top or bottom. Both partials and dentures do take some time to get used to and require special care. Although all of these procedures are still widely performed and aid in chewing, speech, appearance, and maintaining tooth placement they won’t prevent the bone loss that occurs from missing teeth. In addition they will require adjustment over time as bone loss occurs and the inside structure of your mouth changes.
Implants are a relatively recent advance in dentistry and have the advantage of preventing the bone loss that would occur from missing teeth. Implants insert titanium into the jaw bone which actually fuses to the bone and provides the stimulation to the bone similar to that of a normal tooth. An artificial tooth is affixed to the titanium similar to how a crown is placed over a normal tooth. If a patient is missing multiple teeth Implants can also be used to fashion a bridge with the implants supporting either side of the center pontic. Implants can also be cared for similar to natural teeth and don’t have the special maintenance needs of partials and dentures. One drawback to an implant is price. They are much more expensive than the restoration options covered, however they are typically the longest lasting option. Implants also involve multiple steps and the whole process takes longer than the other options. Although it is rare, it is possible that the implant can be rejected by the body.
A video of one of our patients running over his no longer needed partial with his truck!