I Lost a Tooth, How do I Replace It?

So you’ve lost a tooth and you want to replace it. With a tooth missing, you’ve likely realized that the functional quality of teeth is just as important as the esthetic factor. Teeth are necessary tools that are used in many essential parts of our daily lives, including eating and speaking.

The traditional method of helping a patient who has missing teeth is to prescribe a denture. A denture is a removable prosthesis that replaces missing teeth and the surrounding tissue. Dentures are predictable and proven; however, they require a lot of work by the patient to maintain and keep clean. On top of this, patients who wear dentures will likely require adjustments over multiple years due to the degrading nature of the toothless mouth.

In recent years new technological advancements have made another solution more accessible. Dental implants are biocompatible screws that are surgically placed into the bone that holds your teeth. These screws act as new tooth roots, allowing dentists to place man-made teeth on top of them. Implants secure new teeth to bone, mimicking the natural structures to restore strength and function.

How do I know which method is right for me?

What Are Implants?

Implant dentistry is the field of dentistry that focuses on restoring teeth with implants. Modern dental implants are medical-grade, screw-like metal devices that are drilled into the supporting bone of your mouth to act as an anchor to support a replacement tooth or replacement set of teeth. Implant restorations are a permanent solution that can help to restore the lost functionality of your teeth.

Implantology is not currently an American Dental Association defined specialty in the United States, although dentists are able to receive additional training in the subject through various programs. To receive an implant, a patient may have to visit more than one dentist, as there are fewer surgeons who specialize in placing implants than there are general dentists.

What to Expect from Implant Surgery

The implant surgical process can take from one to three appointments, depending on the method of surgery chosen by your dentist. It is more common for dentists and surgeons to have the patient go through multiple appointments, but in some cases the processes can be combined safely into a single appointment.

The goal of implant surgery is to place an implant into the patient’s bone. To achieve this during surgery, first an incision is made in the tissue above the bone. Then a hole is drilled slowly and gently into the bone. Next, an implant is twisted into the hole and the tissue above it is reconnected and stitched closed. Over the next several weeks the bone around the newly placed implant heals, giving the implant strength and stability.

At the next appointment, the dentist cuts open the tissue above the implant and places a connecting device called an abutment on top of the bone-fused implant. The abutment extends through the tissue and into the mouth. The gum tissue is then stitched around the abutment, which allows it to heal esthetically. In general, there are two main categories of abutments: healing abutments and final abutments. Healing abutments are used to shape the tissue during the healing process, and final abutments are used to secure the final prosthesis to the implant screw.

At the final appointment the prosthesis, whether a single tooth restoration or a multi-unit denture, is placed on top of the final abutment and secured in the mouth.

Implant Options

Single-Tooth Implant

Single-tooth implants are implants that replace one missing tooth. The finished implant is made up of a single implant screw, one abutment and one connected restoration. A single-tooth implant can be used if the dentist desires not to remove any existing tooth structure, which would be required to fill a gap utilizing a bridge restoration.

Implant Bridges and Full-Arch Reconstructions

In cases where the patient is missing multiple teeth in a row or has an entire arch without teeth, the dentist may place more than one implant to secure the restoration or prosthesis. Multiple implants help better distribute the forces of the bite through the bones of the jaw, reducing the chance of failure while also giving the patient much more functional strength.

Taking Care of Implants After Surgery

Implants give patients a second chance at having the appearance of natural teeth, so proper maintenance is important. Taking care of implants is similar to taking care of natural teeth, meaning that it is important to brush and floss daily. The removable appliances that often connect to implants have the advantage of being able to be taken out of the mouth, making thorough cleaning a breeze.

Most importantly, the guidelines and information given to you by your own personal dentist should be followed specifically. After surgery, your dentist will likely give you an informed list of do's and don'ts to protect your mouth. Not following these rules could prove disastrous for the future of your implant restoration. It is very likely that you will be told to avoid directly brushing or flossing the implant site immediately after the surgery.

Dentures

Dentures are removable devices that mimic missing teeth and surrounding tissue. They are expertly crafted from acrylic resin and other plastics to match the existing gums and teeth in the mouth. Utilizing a combination of suction, friction and tension, the device fits securely in your mouth and replaces your missing teeth.

Patients often take for granted how much their teeth build their facial appearance. Without teeth, the muscles in your face can start to sag, making the face look much older. Dentures help restore the dimensions of the face, giving patients a natural appearance.

How Dentures Are Prescribed and Fabricated

Prescribing a denture takes multiple appointments. If the patient has remaining teeth, the dentist may elect to pull them out in order to build a better space for the new prosthesis. Once the arches are cleared, the dentist takes impressions of the upper and lower ridges of the gums. From this impression a stone model of the mouth is created. This first model is used to create a custom impression tray, which helps the dentist take more accurate impressions of the patient’s gum tissue. Using the new tray, new gum impressions are taken. These new impressions are used to create a more accurate stone model. Strips of wax are then softened and smoothed together on the stone model to replicate the width of the gum tissue and teeth. This setup is called a wax rim and is used to establish and measure the required dimensions of the future denture, including the positions of the arches and required space for the new teeth. Once this setup is approved, denture teeth are placed in the correct position on the wax rim. This entire arrangement is tested in the mouth, with the doctor checking bite and speech patterns. Then a laboratory uses this wax version to create the final denture out of various plastics.

Dentures and Partials

There are two distinct categories of dentures: full dentures and partial dentures. Full dentures replace every single tooth in an entire arch while a partial denture only fills the gaps in your existing arch. Depending on your exact needs, the category of denture your dentist selects will vary. Partials utilize a series of clasps, hooks and shapes to secure themselves to existing teeth. In some cases, your dentist may choose to remove your remaining teeth in order to more securely fit a full denture rather than prescribing a partial that would not fit securely.