Although we as dentists are oriented toward preserving the natural teeth, many times this can not be done and a tooth or teeth will require extraction. Sometimes a tooth will just not develop congenitally or is absent from birth. Some are lost from traumatic injury.
Occasionally a very back tooth may not need to be replaced. Most teeth, when missing however, should be replaced, usually due to at least one of the three following reasons.
- The first indication to replace a missing tooth is to restore the appearance especially in front teeth. This can affect one's confidence and even self worth when smiling or talking in public. In some cases, a whole career may be affected when it hinges on the appearance of an individual.
- Second, is to restore chewing efficiency or function back to normal. Certain foods may be avoided when teeth are missing. This can adversely affect both quality of eating enjoyment and maybe even effect the nutritional value of the foods eaten. Also speech and oral sounds may be altered negatively.
- Finally, when teeth, especially back teeth, are missing for prolonged periods, other teeth may begin to drift into the space created by the missing tooth. This may alter the bite and ultimately affect things such as excessive tooth wear or mobility. It also may even affect the muscles of chewing and the joints of the jaws (TMJ) causing discomfort or joint noises or even jaw locking.
This can be prevented or improved by the replacement of the missing teeth especially if the replacement is done prior to drifting of teeth or other symptoms. There are 3 basic ways a teeth can be replaced.
- First is by an appliance that is removable, such as a denture (for a complete arch), or a removable partial denture (RPD), (for a partially toothless arch). The partial depends on clasping to and resting on at least a few remaining strong healthy teeth.
- Second, is a fixed partial denture (FPD) also known as a fixed bridge. Here each end of the bridge is cemented just like a crown over a natural tooth (abutment) which has been trimmed down so a crown can fit over it. The middle of the bridge consists of the false tooth or teeth (pontic) and this part is solidly joined to the ends (abutments) so that the bridge is several units in length.
- Third, is an implant. Implant consist of 2-3 basic parts. A titanium cylindrical root-like part that is anchored into the supporting bone, (the actual implant). Onto the implant is screwed a metallic abutment which is like a trimmed natural tooth, prepared to receive a cemented crown. And finally, a crown is cemented onto the abutment.
