North Lake Tahoe Bonanza By Jason R. Doucette December 29, 2011
The Removable Partial Denture
The quickest and least expensive solution to replace a missing tooth is with the use of a removable partial denture (RPD). This is a removable appliance that can be used to replace one or more missing teeth in the entire upper or lower part of the mouth. The advantage of a RPD is that for one fee, a patient can have all or most of his or her missing teeth replaced with a single appliance. Additionally, if a patient has lost lots of bone and/or teeth in the smile region of the mouth and cannot afford the surgical procedures needed to correct the defects, a RPD is a great option.
However, when only replacing one or even two teeth, a RPD is rarely the option of choice. This is usually due to the drastic changes a patient must make in his or her lifestyle in order to accommodate this new prosthetic that is only replacing one or two teeth. RPD’s tend to be a little bulky and uncomfortable to a patient who once had nothing in the roof or floor of his or her mouth before the teeth were lost. In addition, the prosthetic is not only bulky and uncomfortable, it is also removable and sometimes less efficient when chewing food than something that is permanent and non-removable such as a fixed bridge (discussed later) or dental implant. Furthermore, the teeth that support the partial usually become highly sensitive to hot, cold, and even chewing due to the constant torque on them during chewing and removing the appliance.
The consequence that concerns me the most with this option is that even though the spaces have been treated, the issue of bone loss has not. Therefore, as time goes on, the bone in each space will continue to atrophy. Hence, a patient must cautiously consider this option because if implants are to be placed in the future, the bone that was once there in the past, may not be in the future.
— Jason R. Doucette is a Doctor of Dental Medicine with Incline Dental Care.
The Fixed Bridge
Prior to the arrival of dental implants, the true gold standard for replacing a missing tooth for decades was with the use of a fixed or cemented porcelain/ gold bridge. Today these bridges are used routinely for numerous reasons such as when there is not enough room for an implant, the teeth on both sides of the space need crowns, or maybe because a fixed bridge is more affordable concerning insurance when compared to an implant. All are valid reasons for choosing a fixed bridge, but there are consequences that follow this option that are sometimes unavoidable. The first is that when either of the teeth are prepared for crowns in order to retain the bridge, they may become irritated and require root canals. This may happen during the phase of treatment or years down the road, it is an unknown. Another consequence of this option is the likelihood that a patient will need this bridge replaced seven to 10 years later due to recurrent decay under one or both crowns supporting the bridge. Due to the design of a bridge, it is more difficult for most patients to adequately clean them when compared to natural teeth.
Finally, the most damaging consequence still exists, which is again the continual loss of bone where the fake tooth in the bridge hovers over the space. Therefore, the issue of placing an implant in the future may not be as easy or as inexpensive as it would have been when the tooth was initially lost. More importantly, as the bone shrinks away under the fake tooth in the bridge, the patient may experience problems such as food impaction or unsightly gaps if the bridge is in the smile region of the mouth. In either case, the bridge would have to be re-done or another option like a dental implant with a bone graft may need to be considered.
The Dental Implant
The invention and implementation of dental implants into the world of dentistry has revolutionized the way dentists are able to treat patients with missing teeth. Due to this phenomenal technological advancement, we are now able to replace a missing tooth without a trace of evidence that it was ever lost. Additionally, because the implant is placed directly into the bone, replacing the root of the missing tooth, the supporting bone around the implant is again stimulated and maintained. Thus, meaning that the supporting bone will remain intact and never shrink away as long as the implant is present. Even more exciting, the adjacent teeth are not required to treat the space.
Additionally, if a dental implant is going to replace an extracted tooth, in most cases, a bone graft should be done at the time of extraction if the implant is not placed at the same time the tooth is extracted. This will prevent the bone from atrophying. Otherwise, there may not be an adequate amount of bone for an implant at the time of placement six months later when the extraction site has healed. This could result in more costly surgeries to prepare the site. Most of the time, these voids can be grafted with a pre-packaged syringe of bone grafting material. These syringes usually consist of either a synthetic bone or a highly processed (de-mineralized and freeze-dried) cow or human bone. So immediately after a tooth is extracted, the grafting material can be injected into the void and then secured with one or more sutures. Rarely is it necessary to harvest the graft from a patient’s hip or jaw to fill the void from one extracted tooth.
A dental implant is a small titanium cylinder that replaces the root of a missing tooth. It is usually placed at the time a tooth is extracted if it is in the smile region, or it is placed four to six months later if the extraction site was too large for initial placement.
If a front tooth is lost and the healing of the surrounding bone is not properly controlled or stopped with a dental implant and/or bone graft (both discussed later), numerous issues can arise that will compromise the final outcome of the patient’s smile. The most common of these esthetic complications is either a reseeded gum-line at the neck of the new tooth or an absence of gum tissue in between the new tooth and adjacent teeth. Both of these outcomes will result in what most refer to as “black holes” or “gaps.” These gaps are not only unaesthetic, but are also at risk for periodontal disease (dental bone disease). This is because the gaps allow food to be trapped at or below the gum-line of the adjacent teeth. If these food particles (plaques) are not completely removed, an infectious process (periodontal disease) will ignite and lead to a progressive amount of bone loss in that area. This in fact, may lead to the loss of more teeth if left untreated.
When the implant has completely attached itself to the surrounding bone (after four to six months of healing), a connector is attached to the dental implant bringing the assembly above the gum line. Then to complete the process, a crown is cemented in place.
When fully integrated (attached) to the bone, a dental implant is stronger than the original tooth. Chewing with a dental implant assembly feels like the original tooth was never lost. As for cleaning the implant and its crown, it is no different than cleaning the original tooth. More importantly, the implant is made of pure titanium, so it can never acquire a cavity. This however, does not mean that cleaning the implant is not required because the implant is still surrounded by living gum tissue and bone. Therefore, it is highly recommended that the implant assembly be cleaned routinely as any other tooth in the mouth. If properly cared for by the patient and the dentist (meaning cleanings and check-ups are never missed), there is no reason why a patient should have to replace an implant in his or her lifetime.
An implant is among the few prosthetics in dentistry that I believe will withstand the test of a lifetime in full function without damage or distortion. Over time, there is no doubt that a dental implant is far more cost effective than any other treatment option available today concerning a missing tooth. Due to its superior qualities in the replacement of a missing tooth, if applicable, a dental implant, in my opinion and clinical judgment, is the optimal solution to the problem.