How to Replace a Missing Tooth Without Having to Wear a Denture

Missing a tooth and having a gap, particularly in an aesthetic position where everybody can see, can have quite a negative impact on self esteem. In a world where appearance and presentation, particularly a nice smile, plays a major part in building relationships both personally and professionally, I am regularly asked; how can I replace this missing tooth without wearing a denture?

Replacing a missing tooth can not only improve your appearance but can also;

- Prevents the cheeks from appearing sunken in appearance, and maintains lip posture and fullness of the lips.

- Help to restore and maintain your natural bite so that your speech and chewing function are maintained.

- Keeps opposing teeth in their natural space, because opposing teeth can continue to erupt into the space of the missing tooth. Also teeth adjacent to the gap can tilt, creating food traps and future restorative problems

- Prevent increased, unnecessary and unnatural stresses on the remaining teeth.

What are the options for replacing lost or missing teeth;

The two main options for replacing missing teeth permanently like natural teeth, are a bridge or dental implants. A bridge is literally like a bridge across a river it uses two poles which are the teeth either side of the gap and then a fake tooth hangs in between the two poles, much like a bridge hangs between the two poles either side of a river. The bridge looks and feels the same as natural teeth and functionally is as good as natural teeth. Before the age of implants having a bridge was the only option to fill a gap permanently.

An implant is a titanium pin that is surgically placed into the bone. The body then bonds to the implant, so the implant becomes like a new root. A new tooth is then attached to the implant with a screw. Implants look and feel like natural teeth, they are a little more solid than a bridge, plus the advantage of implants over bridges is that you don't have to touch the teeth either side of the gap.

Implants are a better option than bridges if;

- The gap is more than two teeth, if the gap is any wider than two teeth then there will be too much force put on the support poles if a bridge is used which will cause damage to these support teeth.

- If the gap doesn't have teeth either side to use as poles or support teeth for a bridge.

- If the teeth either side of the gap have not been treated or minimally treated in the past. Teeth are there strongest long term if left untreated.

- Implants also separate out future treatment issues. Remember bridges are a connected unit between three or four teeth, so if something goes wrong with one, everything then needs to be replaced. It is always a lot simpler and cheaper in the future if you are only dealing with one tooth instead of multiple teeth.

The benefits of a bridge are; - Treatment can usually be finalised within 2-3 appointments. - There is no surgery required.

- If the teeth either side of the gap are heavily filled then crowning these teeth can actually improve the long term prognosis of them anyway, so you are solving multiple issues at once.

- If the teeth have been lost for a long period of time, then there will have been some bone loss and tissue loss. Bridges can solve these issues easier than implants. Without the need of bone or tissue grafting procedures.

The underlying story is both methods are very good, highly successful treatment options, when carried out by well trained and experienced dentists. There are positive and negatives for either treatment modality, which should be fully discussed and understood by the patient prior to making a decision. Not all dentists will explore all option with you, they either don't feel comfortable doing implants or bridges, or they are not experienced enough to carry out the treatment. Most dentists will do bridges, but not all dentists will discuss implants with you. Some dentists who place implants will tell you all the negatives about bridges and only really recommend implants. It is important to find a Dentist who gives you all your options explaining them well without any bias, so you can make your decision.

by Dr Adam Alford