If you are going to replace a missing tooth you have to ask yourself the important questions: Why, What, When and Who ?
It’s important to realise that while we can pretty much replace all teeth, not all missing teeth need replacing. We replace teeth for aesthetic and functional reasons. If the replacement is not going to improve either of these factors then there is no point in doing it.
So you want to replace a missing tooth to improve function and/or aesthetics the next question is: with what ? You have three basic choices dentures, bridge or implant, or possibly a combination of two of these.
Dentures are removable “false” teeth relatively simple to provide when dealing with only one or a few teeth. The more teeth that are missing the more complex they become. A framework or structure is fabricated from metal or acrylic to custom fit your mouth with the teeth on it. This can be a relatively inexpensive way of replacing a number of teeth with little or no involvement of the remaining teeth.
Many people wear dentures very successfully and are very happy with them but some people would choose not to have them if possible. So we look at other options.
Bridgework involves the preparation of the teeth either side of a missing tooth for a crown. Two crowns are then fabricated with a prosthetic tooth (known as a pontic), linking the two crowns to create a three tooth structure which is cemented onto the two prepared teeth. This is cemented permanently and is designed not to come out or be removed. Whether or not this is a suitable treatment option depends on a number of factors… do the teeth either side of the gap require crowns? And are they sufficiently strong to withstand the extra load of the pontic what is the likely lifespan of the bridge. It has to be able to survive the rigors of the function of environment and function of the mouth. Again like crowns bridges can be made of a variety of materials; small three unit bridges can be and all ceramic construction, but as the bridges get bigger so we tend to advise porcelain bonded to a metal sub structure which provides greater strength and good aesthetics.
The final option for the replacement of missing teeth is an implant.
This is a titanium screw type structure which is placed into the jaw to replace the root of the tooth. The screw then undergoes a process called osteointegration where the bone and the implant integrate with one another to form a firm join. Once this has occurred a crown can be fabricated to go onto the implant to replace the missing tooth. Placement of implants is a surgical procedure which can be done under local anaesthesia, but it does require careful planning and assessment to make sure that the implant can go in a position where there is adequate bone to support it, and no other anatomical structures will be damaged by its placement, and it’s going to be in the right position for function.
When conditions are favourable for an implant they are a very successful way to replace a missing tooth as the adjacent teeth are not compromised in any way.
For teeth in the smile line, with considerable aesthetic considerations, we try to replace as soon as possible. Some form of temporary, or if possible, a permanent option if planning has permitted this. In emergency situations, this is not possible but generally within a few days some form of replacement can be arranged; either a temporary bridge or partial denture. Once the initial healing has taken place we can look at future long term replacement options.
If the tooth is not of aesthetic importance then we generally recommend allowing healing to take place after it has been lost prior to constructing a long term replacement. However planning can be done during this period and if an implant is being considered then extraction techniques and bone preservation methods should be considered.
Who should replace your missing teeth?
At CJ Carter dental we can carry out all of these services. However not all situations are the same, and there are varying degrees of complexity to be considered. Sometimes a referral to a specialist practitioner may be necessary, but an initial assessment is always advised as some aspects of the ultimate treatment plan may not be carried out by the specialist.
We have a fantastic service provided by our specialists here on the Sunshine Coast and rarely have the need to refer to Brisbane.