Wednesday, January 28, 2015

Missing a Tooth?

The implant restoration above the gumline that appears natural
It wasn't too long ago that when teeth were lost, only less than ideal options were considered. Even today, in many parts of the world, the only dentistry that is performed is the removal of teeth. Even in advanced societies including the United States, less than ideal options are only considered.

For roughly the last 20 years or so, dental implants have been placed at a higher rate each and every year. Fortunately, there are now many more practitioners placing dental implants.

Basically there are several options for a missing tooth. These are listed from worst to best.

1. Do nothing. Just leave the space
2. Restore with a removable partial denture
3. Restore with a bridge
4. Place a dental implant

Teeth drift toward the space
The worst option is to just leave the space. This isn't merely a cosmetic issue, it's a functional issue. Firstly, there are fewer teeth to perform the function of chewing. The remaining teeth must bear more force than they are designed to. This will obviously cause problems with the remaining teeth. This situation is similar to ripping out studs from the framework of a house. The remaining studs must now carry a greater load. Secondly, when teeth are missing, the remaining teeth move. Teeth posterior to the missing tooth tend to tilt forward. This will create forces that are not in alignment. Just as if the studs of a wall are placed at odd angles. Another issue is that the opposing tooth will drift into the missing space and further malign the teeth. This is similar to a situation when gears have teeth that do not line up properly. How many miles would you get out of a car that has gears with teeth not only missing, but out of alignment? Not many I'm sure.

Partial dentures
The second option is obviously much better than the first. A partial denture will distribute the forces and prevent movement of the remaining teeth. The disadvantage with this option is that it must be taken out nightly. It does not remain in the mouth permanently. In addition, the denture tends to loosen the teeth that make contact with it.

The third option is a more permanent option. However, I still don't like this option for two reasons. First, the teeth adjacent to the space must be cut and shaped even if there wasn't a problem with them to begin with. So now we compromise two additional teeth to replace a missing tooth. The second reason I don't like this option is that hygiene is significantly compromised. It is much more difficult cleaning under the bridge. The supporting teeth are now more susceptible to recurrent decay. In fact the average lifespan of a bridge is only eight years.

The implant option is by far the best way to restore a missing tooth. Depending on which studies are cited, the success rate is approximately 95%. They will outlast a person life-span. I don't know if my assurances to my patients are true because we haven't done them for five thousand years, but I often joke and tell them that they will still be in place in 5,000 years. I guess archaeologists will confirm my outrageous assurance to my patients. Even if I'm wrong and they only last 100 years, I'd still consider it a success.

Missing tooth replaced with an implant

Not everyone is a good candidate for dental implants. If you have a missing tooth, your dentist should be able to determine if you are a good candidate. I will discuss implants in more detail in a future blog.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

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