Replacement of missing teeth can be done in three basic ways: implants, bridges, and dentures. This is where dentistry has made great strides, and now we have methods to replace teeth that feel great, work great, look great, and are also long-lasting. Like everything else, there is a best solution for every situation, and it takes a careful evaluation to find it. What works for one person may not be the best for another.
In general, the longest-lasting tooth replacement is by use of a dental implant. When replacing a single tooth, titanium posts are placed into the actual bone where the missing tooth used to be, and a tooth is then attached to that post. If possible, implants are preferred because they don’t require any damage to other teeth (unlike bridges or most dentures), they prevent the bone around them from resorbing further (which happens when teeth are lost), and they allow easy flossing between teeth (unlike bridges where floss must be passed underneath, or dentures which must be removed).
In situations where multiple teeth are missing, it is not always necessary to place one implant for every missing tooth. In cases of completely missing lower teeth, the standard recommended treatment is now the placement of two implants to support a complete denture. The evidence is now clear that implant-supported lower dentures are far better than standard dentures. Say goodbye to loose-denture problems.
There are situations where implants are not feasible – whether it be due to inadequate space, inadequate bone, inadequate time, or general health, sometimes a bridge is the best treatment. Akin to a bridge on a road where there is a span supported at both ends, a dental bridge involves a prosthetic tooth (or teeth) supported at both ends by natural teeth. Bridges do not come in and out of the mouth, so hygiene around them needs to be strictly maintained.
This is a patient who had a terrible-looking Maryland bridge to replace her upper lateral incisors. The greyness of the backing metal wings ended up making her front teeth look dark as well. One day, one side of the bridge became loose and she jumped at the chance to replace the whole thing. Ultimately, we chose to do two separate bridges out of an all-ceramic material, bonded only to the canines on each side. Read the whole case presentation HERE. (e.max lithium disilicate bridges from Ivoclar Vivadent 13-X and X-23, cemented by first air abrading the teeth, acid etching with Bisco’s Uni-etch 32% H3PO4 (aq) with BAC, and finally bonding in with Calibra Adhesive Resin cement as per recommended protocol.)
In certain situations, dentures make the most sense. These are removable prostheses that can replace one, some, or all of the teeth in an arch. If remaining teeth are used as support for the denture, we ensure that they are in good health before fabricating the denture.