Replacing a missing tooth
Tooth loss can occur for a variety of reasons – congenital absence, trauma, dental disease, as well as damage or failure of the tooth support system.
It is not uncommon for a tooth or teeth to be congenitally absent – in most cases the primary (baby) tooth is present but there is no successor (permanent tooth) to replace it.
Where trauma has occurred, it is important to consider the extent of the injury. Often a tooth can appear unharmed but damage may become apparent some time later (even years), especially where a root fracture has resulted. In more severe types of trauma, there may also be damage to the jaw bone requiring reconstructive surgery as well as tooth replacement.
The most common reason for tooth loss is dental decay (caries), but gum (periodontal) disease is also a significant problem. This is an infection in the gums and supporting structures of the teeth that leads to loss of bone. In some cases, this can cause teeth to fall out or become beyond repair and require extraction.
Our teeth are designed to work together and whether visibly noticeable or not, if a missing tooth is not replaced, other teeth can drift out of position. Shifting teeth can lead to misalignment and problems with your bite, as well as promote tooth decay and gum disease. Additionally, when teeth are lost, the bone that supports the teeth shrinks as stimulation ceases. This is called resorption and begins almost as soon as the tooth is lost and increases over time.
Fortunately, missing teeth can, and should be, replaced.
There are several options for addressing missing teeth including the use of implants, bridges or dentures. In adults, implants are becoming a common way to replace missing teeth for a number of reasons. A dental implant is currently the closest replacement option to a natural tooth, acting as an artificial tooth root that is submerged into the jawbone. Made from strong, biocompatible material, it helps to prevent bone loss by preserving and bonding to the existing bone. If sufficient bone is available to accept the implant, it is a highly preferable treatment – especially in adults.
Amongst teenagers and children however, it is considered more practical to substitute natural teeth for the missing tooth where possible. Often children present with two front teeth damaged or missing and this is especially suited to replacement with the natural teeth supported by braces. Reshaping of the substituted teeth and possibly others in the area either before or after braces is carried out to camouflage the teeth which if done well, can be indistinguishable from a perfect natural dentition. Substitution using natural teeth is also available to some adult patients.
A tooth-supported fixed bridge is the most common alternative to dental-implant but has several disadvantages as placement requires grinding away of healthy, adjacent teeth, which will be used to support the bridge. The bone underneath may also deteriorate over time due to lack of stimulation and there is more maintenance required with bridging.
Partial or full dentures are also used in some cases, especially where there are multiple teeth lost or removed. These are rarely as natural looking, stable or comfortable as implants and can impact eating and speech as well as only having a lifespan of a few years.
There are advantages and disadvantages to each type of tooth substitution option and it is important to explore all of these to determine the best solution for you. These highly specialised treatments are carried out by a specialist restorative dentist or prosthodontist in conjunction with Whyte Orthodontics. Ask our staff for more information.