Timely Replacement of Missing Teeth is Crucial

Posted by: Jason Hui, DDS, on May 7, 2013

Loss of permanent teeth as a consequence of either elective or required extraction leads to many problems in the long run if a replacement prosthesis is not rendered in a timely manner.  Aside from loss of the obvious loss of function and aesthetics, supraeruption of opposing teeth and the tipping of adjacent teeth pose serious problems when it comes time to restore the missing tooth.

When all the teeth are present and in contact in the mouth, they are held in place by each other in a stable manner; however, when a tooth is extracted, the newly created space encourages the tooth behind it to tip over.  As time passes, the space becomes smaller because the adjacent tooth has tipped in and occupied a portion of the space.  As observed in Figure 1, with the loss of space, it is impossible to place a prosthetic tooth in the position of the missing tooth without having to cut and restore the adjacent teeth.

loss of space due to missing teeth from dental emergency extraction

Figure 1. This x-ray image displays a missing tooth on both the left and right sides of the lower jaw. As illustrated, over time, the tooth behind it begins to tip over, encroaching on the space previously occupied by the extracted tooth. As one can imagine, with the loss of space as a consequence of delayed treatment, it is now very difficult to restore the missing tooth.

Similarly, the secondary problem of supraeruption exists if teeth are not replaced in a timely manner.  Supraeruption occurs when the upper and lower teeth are no longer in contact and consequently, the unopposed tooth is free to drift out of arch alignment.  When supraeruption occurs and the unopposed tooth drifts into the opposing arch space, a problem is created whereby there is insufficient height to accommodate the prosthetic tooth when both the upper and lower teeth come into contact.

supraeruption as a result of dental extraction from toothache and teeth pain

Figure 2. This is a model of a patient who exhibits the concept of supraeruption. Because the lower teeth were extracted and no timely treatment was rendered, the upper teeth have gradually erupted into the lower arch space. There is very little room when all teeth are in contact to accommodate a prosthetic tooth of a normal height; to restore this case, extraction of the supraerupted upper teeth may be required as the roots are also now far exposed.

With the issues of tooth tipping and supraeruption in mind, we encourage our patients to contemplate elective tooth extractions when the tooth can otherwise be saved and to consider promptly replacing missing teeth in the event that extractions are necessary.  Please stay tuned for our next blog entry on treatment options for replacing missing teeth!

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