Replacing Teeth Part 1: Today’s Techniques

by Dr. Don Rose,Writer, Life Alert

Introduction

Face it. As we get older, or “long in the tooth,” our teeth can cause an increasing number of problems for us. For one thing, teeth actually do become longer for many people over time (hence the expression), due to recession of the gums. This type of gum disease is particularly common in seniors. If left untreated, such recession can loosen a tooth’s foundation to the point where it may eventually fall out.

While losing a tooth is never a welcome thing, there are many options available for dealing with such a situation. In this article, the first of a two-part series, I discuss various methods being employed today for replacing teeth when they fall out.

Partial Fallout: Restoration of Remaining Tooth

If you suddenly see a tooth in your hand, don’t despair yet. Sometimes only part of a tooth may fall out. In this case, if there is a sufficient amount of tooth remaining in your mouth, today’s dentists can often restore the tooth fragment(s) enough to support a crown, with a final result that approximates the look and feel of your original tooth.

Depending on what parts of the tooth are left after “partial fallout” occurs, there may be multiple steps involved. For example, the dentist might add material to what’s left of the tooth to make it larger and stronger (a buildup), in preparation for holding a final crown. For even more support, a “post and core” procedure may also be needed, during which a thin, screw-like post is put in the root of the tooth, with an exposed “core” that supports a final crown. For teeth with multiple roots, like molars, multiple posts may be used.

The options presented below deal with situations where one or more teeth are totally lost.

False Teeth and Dentures

Ironically, while young George Washington became famous for telling the truth, the father of our country later became well known for his false teeth. The practice of replacing lost teeth with artificial creations that approximate their look and function has been around for centuries. Dentures are what many people think of today when they think of seniors replacing their teeth. This type of dental device is a removable tooth (or teeth) that either gets “glued” onto the gum or attached to one’s good (“anchor”) teeth for support. The downside to dentures: the twin chores of cleaning and reapplying adhesive must be done repeatedly, and dentures can at times get unseated from the gum, causing potential embarrassment. On the plus side, this is probably the least invasive option of those presented here.

Bridge

When there is a gap between two land masses, we can build a bridge across it. It turns out that this idea can also be applied to one’s teeth.

Imagine losing a tooth between two good ones. In many cases a dental bridge can be made, which gets attached on top of these two teeth, thus filling the gap where the lost tooth used to be while the two good teeth serve as “anchors” to support the bridge. This kind of bridge, which looks like a row of three teeth attached end to end, is cemented on top of the two good “anchor teeth” after they are reduced a bit in size, since the two ends of the bridge act like crowns (one atop each anchor tooth). The middle of the bridge, which takes the place of the missing tooth, is called a pontic; ideally, it will look, feel and function just like the tooth that used to reside in the gap. The pontic is held in place because it is attached at its edges to the two “end teeth” of the bridge.

After the two anchor teeth are properly prepared, the bridge is placed atop the anchors and bonded in place. The end result looks like three normal teeth in a row.

The downside of this kind of bridge is that two perfectly good teeth must be reduced and covered over (crowned) in order to accommodate the bridge. Some conservative dentists resist tampering with good teeth in order to deal with the loss of a bad one; not only must they be reduced before the bridge is put in, but down the road the stresses on the two good teeth may be greater than before. In some cases, decay, breakage or structural weakening can occur. Hence, some dentists opt for other dental techniques. One such alternative is called the Maryland bridge.

Maryland Bridge

In contrast to the traditional bridge, the Maryland bridge is another option that is usually cheaper and less invasive, since it doesn’t require reducing the two anchor teeth and it requires no crowning. The same general goal applies (using a pontic to fill the gap between two good teeth), but this time the pontic is attached in a different way: via a wire connected directly to the two adjacent teeth. The wires are attached in the rear, away from the outside world, giving a cosmetically pleasing result. Some claim this kind of bridge may not last as long as the crown-based bridge, but anecdotal accounts show that it can. Only a dental professional can know for sure, after giving a complete examination.

Dental Implant

The dental implant is perhaps the best known “rising star” in the tooth replacement universe. The implant is now a popular and versatile weapon in the fight to maintain, reshape and improve smiles. Its popularity stems from its ability to give, in many cases, a result that best approximates the look, feel and function of a real tooth.

When used for a single missing tooth, there are typically two main steps to getting an implant. First comes the foundation, where a type of hollow metal tube (typically made of titanium) is inserted into the jaw in the space where the tooth used to reside. Think of this as an artificial root. Then, after your mouth heals around this fake root, the artificial tooth – sitting atop a support post -- is screwed into the base. Voila, you now appear to have a totally new tooth, one that stands on its own without any anchoring to neighboring teeth or adhesives to worry about. Many people state that they can't tell the difference between their implant tooth and their other teeth.

To replace multiple missing teeth, the general principle is the same.  Two or more implants act as a base foundation, onto which a set of two or more artificial teeth are placed by inserting the screw posts they have at the bottom (one post per implant base). This sounds similar to the principle behind dentures, but in this case they are fastened permanently, as opposed to having to repeatedly apply adhesive. Of course, implants also cost a heck of a lot more than dentures, but for many patients the cost is well worth it.

Immediate-Load Implant

Just as two main types of dental bridges exist, there are two main kinds of dental implants to consider. Some dental professionals now employ “immediate-load” implants for certain qualified patients, with the once-unimaginable result that a patient can come in missing a tooth and leave with a new replacement in one day. Yes, a single visit and your gap is beautifully filled with a fake tooth attached to what is essentially a small bolt screwed into the bone that used to hold the missing tooth. Not all patients have the right stuff to qualify for this technique (for example, if one’s supporting bone structure is not sufficient for immediate load), but for those who do, the results can save a great deal of time and hassle.

Final Thoughts

As we have seen above, there are many options now available to replace a lost tooth, or lost teeth. I presented a few of the most commonly used methods. Keep in mind that not every method is perfect for every person. Everyone’s mouth is different.

Of all the above methods, traditional implants are often the most expensive as well as the most invasive, since they involve a form of oral surgery. Thus, make sure to get a thorough exam and do due diligence about implants and implant dentists before you jump in.

Finally, you should always check with a dental professional before choosing on any course of action. A second opinion never hurts either, and can even prevent some hurting down the road.

Coming in Part 2: Tomorrow’s Trends

In Part 2 of this two-part series, I will present new ideas for tooth replacement currently being researched that may become popular with dental patients in the near future.

The information provided above is, to the best of our knowledge, reliable and accurate. However, while Life Alert always strives to provide true, precise and consistent information, we cannot guarantee 100 percent accuracy. Readers are encouraged to research any statements made and use any resource links provided to gather more information before drawing conclusions and making decisions.
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