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Replacing Missing Teeth

Full or Partial Dentures

According to the National Institute of Dental and Craniofacial Research (NIDCR), 3.75% of adults 20 to 64 in the United States are completely edentulous. For the overall population in this age group, the average number of remaining teeth is 24.92 out of a total of 32 permanent teeth.

One of the ways to replace missing teeth to restore oral function and appearance is with dentures.  Depending upon the needs of a case, dentures can be used to replace either a few teeth that have been lost or all of the teeth in the upper or lower jaws. In addition to reestablishing the look of a complete and natural smile, dentures also restore support to the natural contours of the face to eliminate the “sunken” appearance that results from losing multiple teeth. Whether teeth have been lost for reasons of tooth decay, gum disease, a medical condition, congenital anomaly, or trauma, dentures are an effective method of care.

Dentures are removable appliances that are designed to precisely and comfortably rest on top of the gums that cover the jawbones. They can be taken out of the mouth for brief periods of time to fulfill the oral hygiene requirements of maintaining the underlying tissues, cleaning the dentures, and sleeping.

Types of Dentures

The two main types of dentures are: full dentures and partial dentures. Both types are custom fabricated based on the exact specifications obtained from dental impressions and detailed functional as well as esthetic information provided by the dentist.

Full Dentures

Full dentures, which can also be referred to as, “complete Dentures,” are designed to replace all of the upper or lower teeth.  A complete maxillary denture, more commonly known as a, full upper denture, typically consists of a base that covers the roof of the mouth with a full complement of artificial teeth set around the section covering the dental arch.  On the other hand, a complete mandibular denture, or full lower denture, is designed to accommodate the tongue and is horseshoe shaped with teeth set along the portion that covers the underlying dental arch.

  • Conventional Full Denture– A conventional full denture is fabricated and placed after all of the remaining teeth have been removed and the tissue is healed. It takes several weeks for extraction sites to heal and for all of the surrounding bone and gum tissues to fill in and remodel. By allowing this process to reach completion before taking the final impressions for a new denture, the most precise and comfortable fitting prosthesis can be fabricated.
  • Immediate Denture– An immediate denture is one that is inserted on the day the remaining teeth are removed. With this method of care, a patient does not have to be without teeth while waiting for complete healing of the extraction sites. Immediate dentures offer the distinct cosmetic advantage of not having to be without teeth. However, since the healing of the extraction sites is occurring while wearing the denture, a reline or new denture may be required later for improved comfort and fit.
  • Overdenture– An overdenture is a type of complete denture that receives added stability and support from special attachments that are secured to the remaining underlying teeth or strategically placed dental implants.

 

Partial Dentures

A partial denture is a type of removable prosthesis that is designed to restore a complete and functional smile in cases where multiple teeth are missing or require extractions, while some healthy teeth remain in the dental arch. Custom fabricated for a precise fit and cosmetically pleasing appearance, partial dentures are typically secured and stabilized with clasps or precision attachments to select teeth adjacent to the edentulous areas. Depending upon the number of teeth being replaced as well as the functional and aesthetic requirements of the case, a partial denture can be fabricated from a combination of cast metal and acrylic materials, acrylic alone, or thermoplastic resins such as ValplastTM, Flexite®, Duroflex® and tcs®.

 

Fixed Bridgework

Fixed dental bridges involve the preparation and crowning of teeth on either side of an area missing teeth to support artificial teeth to span the edentulous area.

A fixed bridge is a non-removable appliance fabricated to replace missing teeth, which closely resembles a patient’s natural dentition. Besides serving to restore the appearance and performance of a complete smile, a fixed bridge also prevents teeth that are adjacent to or opposite the edentulous area from shifting to protect the integrity of the occlusion. Fixed bridges are strong, durable and natural looking restorations, which once they are permanently cemented into place allow all manner of normal oral function.

How are fixed bridges fabricated?

Fixed bridges are typically fabricated over the course of multiple visits and involve the preparation of the adjacent supporting teeth, impression taking, the placement of a temporary bridge as well as the try-in and cementation of the permanent restoration. The teeth located on either side of the edentulous area that are crowned to provide support for the bridge are referred to as the “abutment teeth,” while the artificial tooth (or teeth) spanning across the empty space are known as “pontics.”

With the dental technology available today, bridges can also be completely supported by implants without any preparation or crowning of the adjacent natural teeth required. Depending upon the aesthetic and functional needs of a case, fixed bridges can be fabricated from different dental materials including porcelain, porcelain fused to metal, or engineered ceramic-like products such as zirconia.

 

Dental Implants

Dental implants represent the most recent and advanced method of replacing lost or missing teeth. Invented in 1952 by a Swedish surgeon named Per-Ingevar Branemark, dental implants today offer a highly effective, long-term solution for replacing missing teeth to reestablish a fully functional and attractive smile. Dental implants can be used to replace a single tooth, multiple teeth or all of the upper and/or lower teeth.

A dental implant is a small, biocompatible post that is surgically positioned by means of a minimally invasive procedure into the jawbone beneath the gums.  Once healing takes place and the implant integrates with the bone, it behaves in much the same way as the root of a natural tooth to provide support for an aesthetically appealing dental crown or bridge. A period ranging from 3 to 6 months is required for the jawbone to fuse with the implant via a process known as osseointegration.

What are the benefits of replacing lost or missing teeth with dental implants?

Dental implants offer several advantages over traditional methods of tooth replacement including:

  • Dental implants come the closest to replicating the look, feel, and function of natural teeth.
  • With precise placement, good oral hygiene and routine care, dental implants can last for many years.
  • Dental implants provide continued stimulation to the underlying bone to prevent the bone loss that occurs when teeth are missing to preserve natural facial contours.
  • Since implants behave like natural teeth, there is no chance that they will slip or dislodge like removable dentures when speaking or eating.
  • With dental implants, it is possible to speak with ease as well as eat and taste all types of food with virtually no restrictions.
  • Dental implants do not decay and will not develop cavities.
  • Unlike a fixed bridge, dental implants do not require any preparation or crowning of teeth adjacent to the edentulous area.

Who is a candidate for a dental implant procedure?

According to clinical studies, dental implants have a demonstrated long-term success rate of well over 95%. One key to the success and longevity of a dental implant is that sufficient bone is present to provide stable support for the implanted surgical post. If insufficient bone is present, a bone grafting procedure is often recommended prior to the placement of a dental implant. Additionally, candidates for dental implants should be free of periodontal disease and be aware that a continued, effective oral hygiene routine and care is necessary to maintain a strong and functional implant.

Treatment Planning for Dental Implants

Treatment planning a patient for the precise placement of a dental implant involves advanced scanning technology and software to map out the details of care from both a prosthetic and surgical prospective. In this way a case can be planned and meticulously executed from the beginning with the final restoration in mind. With advances in implant dentistry multiple approaches to care are now being offered. In certain cases an implant can be placed at the same time a dental extraction is performed. This procedure is known as, “immediate dental implant placement.” Additionally, it is also sometimes possible to place “same-day dental implants.” With this procedure a temporary crown or bridge can be attached to the implants at the same time they are placed. In all cases, complete healing and osseointegration is required before the placement of the final prosthesis.

Types of Dental Implants

Most dental implants are made of titanium but are also available “metal-free” zirconia. Both titanium and zirconia are biocompatible materials, which integrate well with the hard and soft tissues in the jaw. Depending upon the requirements of the case, a single dental implant can be restored with a crown to replace one missing tooth, or multiple implants can be used to support a fixed bridge. In cases where all of the upper and/or lower teeth are missing a full-arch, implanted supported bridge can be placed. Special implants can also be placed for added support and stability for removable overdentures or as anchorage devices in orthodontics called “TAD’s” or Transitional Anchorage Devices.