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We make every effort to keep each tooth, but due to an unfortunate fracture or other extenuating circumstances, sometimes retaining the tooth is not possible. Fortunately, there are a number of options to restore the area, both cosmetically and functionally. Each option has its advantages and disadvantages, which will be discussed and determined based on your lifestyle. The following treatment descriptions cannot replace a consultation with your dentist but provide an information resource to assist in the decision process.
No treatment after extraction
Leaving an open space after an extraction has little benefit to the patient beyond a short-term economic one. Some of the disadvantages include:
Loss of adequate chewing function on the side with the missing tooth. This can lead to over-use of the opposite, non-missing tooth side resulting in need for further dental work.
Teeth tend to shift into open space. Normally, when a tooth is removed and not restored, the teeth behind will tip and the opposing tooth will grow into the space.
Loss of cosmetics depending on the location of the missing tooth.
Removable Partial Denture (Flipper or Retainer with teeth)
One option for tooth or teeth replacement is a removable partial denture. It can be used either temporarily or long-term and is typically a lower cost option compared to an implant or bridge. Often times, a plastic "flipper" is used while a patient is waiting for an implant to heal or during the transition period after extraction until a permanent method is decided. However, for many people, a removable appliance is an economical way to deal with multiple missing teeth. The obvious disadvantage is rather than being fixed in the mouth like normal teeth, the appliance must be removed and cleaned daily. Sometimes retaining clasps can be visible in the smile and it takes time getting used to the the bulk of the appliance.
Removable partials are made with either a metal or plastic base depending on a variety of factors that your dentist will discuss. Normally, these appliances are made in two appointments: one for an impression and one for delivery. Minor adjustments are made a few weeks after delivery during a follow-up appointment to ensure the appliance is as comfortable as possible.
A traditional bridge is a common way to span the gap of a missing tooth. A bridge securely attaches teeth on either side of the missing tooth together through linked crowns. A bridge is fixed to the adjacent teeth permanently and functions like normal teeth. The cost depends on how many teeth are missing and how many teeth are needed to support the missing tooth or teeth. One of the disadvantages of a bridge is the teeth adjacent to the missing tooth must have tooth structure removed to accomodate the bridge. Also, strict oral hygiene is necessary for long-term success and flossing properly underneath the bridge is difficult. Typically a bridge can be completed in two appointments (similiar to a crown), spending 1-2 weeks with a temporary device.
A dental implant is an excellent way to replace a missing tooth or teeth. A dental implant consists of three parts:
Implant body or screw
Implant supported crown (tooth that appears in your mouth)
The implant body is made of titanium and is placed into the bone by a surgeon using a 3-D X-ray to determine the proper placement. The bone is then given time to integrate with the implant in order for it to be strong enough to withstand chewing forces. When the surgeon has determined that the integration process is complete, you will return to our office for an impression. Then the impression is sent to a laboratory to have a custom titanium abutment made along with a crown. The abutment is the interface between the implant body and the crown
(the chewing surface). When completed, you have a completely independent tooth to eat with and floss.
In order to have enough bone for the implant to be placed, other surgeries may be necessary such as a bone graft at the time of the extraction to maintain the current volume of bone. During your evaluation, additional procdures might also be needed and will be discussed. Eventhough the implant tooth is made from titanium, it should be treated like a real tooth and still requires hygienic care. When the implant is neglected, inflammation occurs where the implant meets the bone and the integration process begins to break down. If allowed to continue, the implant can be ruined and lost. Daily flossing, regular check-ups, and cleanings are important for long-term implant health.
While dental implants have many benefits, one disadvantage is the time it takes for a predictable long-term result. Unless circumstances are nearly perfect, expect the process to take 8-12 months from start to finish. Short cuts are available, but they often compromise the predictability and outcome of the procedure.