Replacing missing teeth
Now that everything else has been addressed, your gingiva and supporting bone is healthy, root canals have been done and decay has been addressed, it is time to replace any teeth that have been lost or perhaps were never present (congenitally missing teeth do occur). There are three ways to replace a tooth, each with its own advantages and disadvantages. First there is the removable partial denture, commonly just referred to as a partial. Then there is a fixed partial denture, more commonly called a bridge. Lastly there are implants. Partials are the least natural option. They are removable, you have a piece of hardware to get used to, food can get underneath them, they can rub, and clasps used to retain them on your remaining teeth can sometimes show. There are a wide variety of styles, from all acrylic, to thinner, metal frameworks to flexible ones. The advantage they offer is price. Whether you are replacing 1 tooth or 12, it is the same price (though the different styles do have different prices). For more on partials, click here. Bridges offer the advantage of being fixed in place, just like a crown. In fact, it is a crown on each end that does retain it and depending on the length of the bridge may have one or more somewhere in the middle to support and retain it as well. Because they are custom-made, bridges are barely noticeable and can restore the natural contour of teeth as well as the proper bite relationship between upper and lower teeth. Just like a bridge over a river, you have abutments in place to hold up the missing tooth known as a pontic. In the case of a bridge, you pay per tooth, each abutment crown and each pontic counts as a tooth. In cases where the supporting teeth need to be crowned anyway, it can offer a cost savings over an implant, but at a price. Bridges can be hard to keep clean since you can’t floss between your teeth in a normal fashion. To floss in between the teeth of a bridge you need to use floss threaders or specialized floss such as Superfloss to allow passing the floss under the pontic. Failure to keep a bridge clean can lead to recurrent decay of the supporting teeth under the crowns which can lead to having to replace the entire bridge. For more on bridges, click here. The most natural replacement is generally referred to as an implant. It is really a stabilization screw that is placed directly into the jaw bone where the tooth is missing. Once integrated with the bone, which helps to stabilize it and prevent bone loss, an abutment can be screwed onto it, coming out of the gingiva (gums) and allow for a crown to be placed onto it, just like would be done if you still had a natural tooth there. Like a bridge, you pay by the tooth, but unlike a bridge, it is a stand alone item. It can be flossed just like normal and if the adjacent teeth get a cavity, they are dealt with on their own. An implant costs a little more than a bridge, but in the long run can be less expensive and is especially nice if there is nothing wrong with the adjacent teeth. Who wants to grind a perfectly good tooth down just so a crown can be placed back on it to support a bridge? For more on implants, click here. If all of your teeth are bad or missing, you still have options. You can live the rest of your life with no teeth which some people do indeed do, though I don’t recommend it. You can of course do complete dentures or you can still do implants which can be used to support fixed bridges or full dentures.
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