Treatment Options for Replacing Missing Teeth

Posted by: Jason Hui, DDS, on May 21, 2013

Recently updated on March 3rd, 2014 at 02:20 pm

In the previous blog entry, we discussed the paramount importance of replacing missing teeth in a timely manner to avoid issues that compromise tooth restorability such as supraeruption, tooth tipping, and bone loss.  The various treatment options for replacing missing teeth include dental implants, bridges, removable partial dentures, and flippers.  These options offer significant functional, aesthetic, and cost variations and it will be necessary to weigh carefully all advantages and disadvantages with a long term perspective.

Dental implants are today’s gold standard for restoring missing teeth because once the procedure is successful, the long term prognosis is quite good.  Because it is impossible to acquire a cavity on an implant, replacement of the implant is often not necessary, unlike the other replacement options.  Lastly, dental implant is the only replacement option that will allow for the most natural function (i.e., implants feel like natural teeth when chewing, and one can also floss as if it was a natural tooth).  In order for an implant to be a viable option, sufficient bone is required for support (note: if a tooth is extracted and is not restored in a timely manner, the bone that housed the original tooth will resorb over time and this presents a complication for dental implants).  A dental implant resembles a screw constructed from titanium and is surgically placed into the bone to serve as the new root (Figure 1).  Once the implant successfully fuses with the bone, an abutment is placed on top of the implant to serve as the platform that protrudes out of the gums, and the implant crown can then be seated on the abutment permanently.  Overall, an implant should be seen as a wise long term investment.  Although implants may be more costly than the other options to begin with, in the long run, they end up being the more financially sound option because redoing them is usually not necessary.

Figure 1.  This schematic illustrates a titanium dental implant that is placed in the bone to serve as the new root for the missing tooth, and the abutment that is attached on top of the implant that serves as the platform for the implant crown.

Following dental implants, dental bridges are the next best option to restore missing teeth.  Bridges, in their most basic form, involve crowning the teeth adjacent to the missing tooth (these natural teeth that anchor the bridge are called abutments), and linked to these two crowns is a unit that replaces the missing tooth, called the pontic (Figure 2).  This prosthesis functions fairly similarly to natural teeth and serves as a fixed option that cannot be removed.  The downfall to this option, however, is that it is necessary to cut the adjacent natural teeth down in order to allow for the bridge to fit over of them.  Also, the success of the bridge relies on the abutment teeth’s health; if either of the abutments develop a cavity, then the entire bridge must be redone.  Bridges are usually required to be redone on average about every ten years due to failure, so continued expenditure should be expected.  Lastly, cleaning of the bridge is more involved because it is impossible to floss normally since the bridge is fused at the top, so floss threaders are required to clean, which requires a more meticulous effort.

Figure 2.  This schematic illustrates a three unit dental bridge. Note that the natural abutment teeth have been shaved down in order to accommodate the bridge. Also note that the three unit bridge is connected at the top so conventional flossing is impossible.

Next up, removable partial dentures are the least expensive permanent solution to replacing missing teeth.  This prosthesis essentially utilizes plastic teeth as replacement teeth and a metal or acrylic frame to hook onto natural teeth (Figure 3).  Removing the partial denture every night before bed is necessary in order to maintain gum health, and chewing is often compromised since the teeth are made of plastic.  One should also expect replacing this prosthesis about every ten years because it will wear, break, and become ill-fitting.

Figure 3. This image illustrates a removable partial denture that replaces four missing teeth. The metal framework hooks onto natural teeth in order to retain the prosthesis.

The flipper is the last option to restore missing teeth and is in fact the cheapest option possible; however, this prosthesis should be seen as a temporary solution.  The expected longevity of a flipper should only be a few months, though with meticulous care and minimal use with chewing, it could last a bit longer.  Flippers are good temporary prostheses made to replace missing teeth to prevent the previously discussed problems of supraeruption and tooth tipping because they fill in the missing space so other teeth are not allowed to shift.  Also, if finances are a problem, but a permanent solution for replacing the missing teeth is desired, a flipper can preserve the space temporarily and buy some time.  Flippers are similar to removable partial dentures, except they are made from weaker materials to allow for their lower cost (Figure 4).  This option is very inexpensive and should be executed immediately if one is unable to utilize the other permanent options.

Figure 4. This illustration reveals a dental flipper that is designed to replace a missing front tooth. The acrylic framework and clasps of this temporary flipper are much weaker than those of the permanent removable partial denture.

Delay in replacing missing teeth can lead to severely increased expenses in the long run, so Paragon Dentistry invites everyone to contact us for an evaluation to determine the best course of treatment for replacing your missing teeth!