A very big thanks to Colleen & Westdene Dental Practice.
There are three main solutions to replacing multiple missing teeth- removable dentures, bridges and dental implants. It also possible to have implant retained dentures (removable teeth which are secured into the mouth by dental implants) and implant retained bridges (2 or more teeth fixed to dental implants). Please see below to find out more about these three different types of treatment:
These may be used to replace one or all teeth although the very back molar teeth are generally left off for comfort. Dentures which replace full row/arches of teeth are called complete dentures and a denture which only replaces a few teeth and sits next to natural teeth is called a partial denture. Complete dentures are held in place by muscular control and suction from the soft tissues of the mouth. Dentures, and especially complete dentures, are often initially very difficult to control and tolerate. However, after training your mouth and receiving guidance from your dentist patients generally learn how to wear dentures.
Partial dentures are usually constructed from acrylic or metal and acrylic. Sometimes they incorporate wires clip onto natural teeth adjacent to the denture to help secure the dentures in place. In certain circumstances, the natural teeth are prepared with small depressions in them (rest seats) to create a more solid base for the more sophisticated metal alloy dentures. Metal alloy dentures are more costly to manufacture but are generally easier to wear. This is because as metal is thinner than acrylic these types of dentures are much less bulky whilst still being very strong. Also as these types of dentures do not require suction to stay in far less gum tissue is covered by the denture which is far healthier for the gums. Metal alloy dentures are generally much easier maintain in terms of hygiene also.
It is most important that dentures and the remaining natural teeth are kept very clean to prevent the damaging effect of dental plaque.
A bridge is a restoration that can be used to replace a missing tooth/missing teeth. There are two main types of bridge: a conventional bridge or an adhesive bridge.
A prosthetic tooth is attached to a tooth or teeth which are adjacent to the gap. The natural tooth/teeth will require crowns to be placed on them to allow the prosthetic tooth to be secured in place. This involves quite extensive drilling of the tooth (or teeth) to which the false tooth will be attached. The crowns are either made of gold, a non-precious metal, or a combination of metal and porcelain. The false tooth is usually made of porcelain or ceramic.
Once the natural teeth have been prepared, a mould (impression) of the affected teeth is made. This impression is then sent to laboratory who will construct the restoration. During this time a temporary bridge is placed on the natural teeth to protect them.
Once it has been manufactured, the bridge will be assessed for fit and aesthetics. It may require some minor adjustments before it is cemented in permanently.
The advantages of a conventional bridge are that it is strong and cannot be removed from the mouth. However its’ main disadvantage is that it involves extensive drilling of the natural teeth and thus is quite a destructive procedure. Also as it is fixed in the mouth it is more difficult to keep clean compared to a denture
A false tooth is attached to a wing of metal and the wing is then glued to the adjacent tooth.
With this type of bridge there is no (or only a small amount of) drilling of the adjacent teeth. An injection is normally not required. Once the teeth have been prepared, a mould is made and sent to a laboratory which makes the bridge. The bridge usually takes two weeks to make. No temporary bridge is required.
When using an adhesive bridge to replace a front tooth, the metal wing is stuck on to the back of the adjacent tooth and so cannot be seen from the front. An adhesive bridge replacing a back tooth will have metal wings on one or both sides of the gap. These may be visible if the mouth is opened wide.
The adhesive bridge is stuck on with a very strong glue. The process requires that the teeth be dry whilst gluing.
The advantages of an adhesive bridge are that it is not removable and requires very little drilling of the adjacent teeth. The disadvantage is that it sometimes falls off (though it is easily stuck back on). An adhesive bridge might not be suitable for those who grind their teeth or who play contact sports.
A bridge is not always possible or suitable, for example if there are too many teeth missing or if the remaining teeth or gums are not healthy.
Dental implants comprise of a titanium screw which is inserted into the bone of the jaw and an artificial tooth which is then secured into the screw. The procedure can nearly always be carried out using local anaesthetic. In cases where the patient is anxious about dental treatment the procedure can be done under sedation. Although there have been successful cases where implants have been used to immediately to support dentures, the standard and tested method is to leave an implant for between three and six months to let bone heal around it (a process called osseo-integration), before it is used to support false teeth or crowns. Implants may be used for a variety of dental restorations. These include dentures (removable teeth), bridges (fixed teeth), and single teeth. The success rate for treatment is high (approx. 90 percent). Age is not an important factor although generally implants are not placed in adolescent patients as they are still growing and the shape of their bone may change. However lifestyle has been shown to have a large impact on the success of dental implants. Smokers have a significantly reduced chance of an implant being successful and it is vital that the patient maintains their oral hygiene as implants are susceptible to gum disease (known as peri-implantitis).
Not everyone is suitable for this form of treatment. Enough bone is necessary to hold the implant in place and excellent standards of oral hygiene are necessary for long-term success.