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Replacing Missing Teeth

Why do you need to replace a missing tooth?

Teeth don’t stop erupting unless they hit up against something else.  If there is no tooth on the opposite arch, a tooth will continue to erupt until it extends past where a healthy bite would be possible. The red arrow in the x-ray below on the top tooth is where a tooth has “super-erupted” past the healthy bite.  The blue line is approximately where the end of the tooth, or biting surface, should be.

It doesn’t stop there, the red arrow on the lower tooth shows the direction that tooth is pushed by the upper tooth that super-erupted. The uneven biting forces push the lower tooth to practically lay down into the empty space making it difficult to clean and for it to be ineffective while chewing. This entire end result of a missing tooth not being replaced is called “bite collapse”.

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We can deal with bite collapse in multiple ways depending on each situation but it can be complicated and expensive.  If it is continued without addressing then, in the example below, the patient may loose both the super erupted tooth and the tooth that has fallen into the space.  Unfortunately losing those two additional teeth means that this patient can no longer chew on that entire side. This is an xray of a new patient of ours who did not have one single missing tooth replaced, nor did they have anything to hold off bite collapse from happening.

We wish we could have helped earlier, before the bite collapse occurred but we are happy to be able to help her now. If you have a missing tooth and aren’t sure if this is happening, give us a call and we will do a consultation, by the time a patient notices a problem on their own it will usually be too far gone.  There are ways to stop this from continuing to get worse until you decide which solution works best for you.

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Implants

This is the most stable and best option for replacing one or more missing teeth. The implant body (the part that is integrated into your bone) is made of titanium.

It doesn’t require you to lose any tooth structure on the adjacent teeth like you would have to when you do a bridge and it will act like your own tooth once it is completed.

There are some specifications so you would need to have a consultation in order to make sure you are a candidate for an implant. Mainly, you have to have enough bone to support the implant and you have to heal well (smoking or diabetes can complicate healing).

A specialist will place the body of the titanium implant into the bone and do any bone grafting needed, it takes approximately 3 months for the bone to integrate into the threads of the implant and then you return to our office for the restoration of the implant. We will make the implant crown for you in our office. We do these often and they are wonderful because they look and act and feel like your natural tooth.

 

Bridges

Bridges are using to replace one or two missing teeth, they are not removable and they can look very natural. If single implants are not possible due to lack of bone support a bridge is chosen as well. It will stop bite collapse from occurring which is very important and allow you to chew.

However, you have to have at least one stable tooth on either side of the missing tooth or teeth in order to do a bridge and if you develop decay on the margin of even one of the retainer crowns then the entire bridge needs to be replaced.

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We place what amounts to a minimum of one crown on each side of the area where the teeth are missing to retain the bridge, which means that even if those teeth used for retaining the bridge don’t need crowns, we have to remove tooth structure to be able to do a bridge. This still remains a good option for patients but not as stable nor as conservative as implants.

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Removable Partial Dentures

This is best described as a removable bridge. It may be the only option other than implants if you do not have a tooth behind the empty space to anchor a fixed bridge. In the case where there is no tooth to anchor a bridge, your options would be a partial or implant.

However, unlike on a bridge, a “partial” is held in with a framework that attaches to other teeth, it sits on top of the bone and, depending on where it is located, the framework may be visible. There are options depending on the situation where we can use different types of attachments to better hide the metal connection onto the tooth. During your consultation, we will go over options for you.

The downside to partials is that it is difficult to keep the teeth that the partial attaches to clean and so without careful attention to home care and consistent cleanings those teeth are more likely to develop decay around the attachment area. There are many limits as to what you can eat with it and, like traditional dentures, it causes the bone to dissolve.

All-on-4s

All-on-4s is a trademark name for a non-removable implant-supported denture. It can be used to replace dysfunctional teeth as shown above or for someone who wants the most natural, most functional and highly attractive option for replacing all their missing teeth, this is the most effective way to restore a patient’s missing teeth to achieve the function and the comfort your own teeth had when they were healthy. No diet restrictions (other than you have for natural teeth) or fear that they will fall out when speaking or eating the way traditional dentures will.

This procedure accomplishes three goals far better than any other option to replace many missing teeth at once: It prevents you from losing facial bone support that occurs with teeth loss and age, it acts like your natural teeth and won’t come out of your mouth unless the dentist takes it out, and it has a fantastic cosmetic result.

As previously stated, this is non-removable and the implants that support this system do not require you to have as much bone support as a single implant placement requires. If you have been told in the past you don’t have enough bone to support a single implant you still will most likely still be able to have this procedure done.

All-on-4s is a trademark name for a non-removable implant-supported denture. It can be used to replace dysfunctional teeth as shown above or for someone who wants the most natural, most functional and highly attractive option for replacing all their missing teeth, this is the most effective way to restore a patient’s missing teeth to achieve the function and the comfort your own teeth had when they were healthy.

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No diet restrictions (other than you have for natural teeth) or fear that they will fall out when speaking or eating the way traditional dentures will.

This procedure accomplishes three goals far better than any other option to replace many missing teeth at once: It prevents you from losing facial bone support that occurs with teeth loss and age, it acts like your natural teeth and won’t come out of your mouth unless the dentist takes it out, and it has a fantastic cosmetic result.

As previously stated, this is non-removable and the implants that support this system do not require you to have as much bone support as a single implant placement requires. If you have been told in the past you don’t have enough bone to support a single implant you still will most likely still be able to have this procedure done.

 

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Traditional Dentures

Traditional dentures are removable and allow you to eat with some limits, smile and talk without showing that you are missing teeth. They can look beautiful as you can see below where a new denture replaced an old one!

The problem is the consistency of the fit. For many years this was the only option for someone who had no teeth. Dentures are held in your mouth on the top arch by the fit and by suction across the roof of your mouth. On the lower teeth, there is no way for suction to help, so it is held in by fit only.

The bad side to traditional dentures is that they rest on top of the ridge of bone that where the roots of your teeth used to be and the dentures put pressure on that bone which causes that bone to dissolve. The bone doesn’t dissolve away evenly and as it dissolves, no matter how good the original fit, the denture will not fit well, often people develop sore spots.

The worst part is that when the fit is no longer perfect when you talk or eat it can fall out of your mouth at unexpected and embarrassing times. Adhesives can be used to help avoid this issue. The biggest, most noticeable issue is that as your bone dissolves away you lose the vertical height in your face, causing you to look much older and as if your face is collapsing in (see diagram for the loss of facial support).  Please see the diagram below. Ongoing expenses are that you will need to have it relined to make it fit again, how often is different for every person.

Before & After Photos

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Vertical Bone Loss

The example below shows a woman with absolutely no signs of aging in the form of more wrinkles or coloring changes from one picture to the next.

The only change is her loss of vertical bone support from one. As you can see this one change is the cause of the dramatic changes in her appearance.

Frankly, this is not at all an extreme view. The facial changes that vertical bone loss cause is much more visible than this example.

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