Replacing a missing tooth IS important. One might think they look alright and can chew and speak “just fine” without the tooth, but they may not realize how profoundly their smile and ability to function can be affected. For example, teeth adjacent to the missing tooth, as well as opposing teeth, tend to “drift” into the open space causing misalignment that can cause increased likelihood of gum disease, chewing difficulty, and if the missing tooth is a front tooth, well you know that is not going to improve your smile.
Dental Implants: In many cases, the best way to replace a missing tooth is a dental implant. The most ideal situation for an implant is when the teeth either side of the missing teeth are “virgin,” meaning that they are healthy and have never been filled or treated in any way. Nothing is better than a healthy natural tooth! With the advent of implant placement there is no need to touch those healthy neighboring teeth. In fact an implant is placed in the space between the adjacent teeth without any preparation of those teeth at all. An implant looks and feels just like a natural tooth, and requires no special care once completed, other than good home care. The steps for implants are as follows:
- First, under local anesthesia, a screw-like titanium implant is placed in the jaw, which can often be done at the same time the tooth is removed.
- Several months later, the implant will have “integrated” (meaning that it is essentially fused with the jaw bone).
- At that time, with both bone and tissue healed, a metal post/buildup is placed in the implant which will ultimately support a crown. The post/buildup is prepared and a digital impression taken for making an implant crown.
- In an office (such as RTDental) that has the ability to make a “same day crown” the patient can sit back and relax as the porcelain crown is milled. The implant crown can then be placed same day once the milling is complete. If a manual impression is made the impression is sent to a dental lab and the patient returns at a later date to have the implant crown place.
The new implant supported porcelain tooth is virtually indistinguishable from your other natural teeth, and can last for many years with minimal maintenance.
Bridges: An alternative way to replace a missing tooth is with a bridge. As the name implies, the teeth on either side of the missing tooth space must be used to support the prosthesis. Therefore, supporting teeth must be healthy enough to handle the stresses associated with function, and careful assessment of the supporting teeth must be undertaken to be sure that they are sound. The usual steps for a bridge are as follows:
- Old broken down fillings and or cavities on the supporting teeth need to be addressed. Under local anesthesia, the teeth are strengthened by removing decay and old fillings and building the teeth up with strong bonding material that will support the bridge adequately.
- Usually the same day the built up teeth are prepared in a fashion very similar to a typical “cap” or “crown.” A digital or manual impression is taken and is subsequently used to fabricate a metal or porcelain bridge. With the advent of stronger porcelains more and more porcelain bridges are now placed in situations that were not feasible years ago, and had to be fabricated with metal frameworks.
- Most often there is a waiting period for the bridge to be fabricated by a dental lab, and the patient will have to return for the bridge placement, usually with local anesthesia necessary to keep the patient comfortable.
Bridges are generally very suitable when the supporting teeth are already restored in some way, with old broken down fillings or crowns. Bridges do not generally have as long a life span as implants possibly needing replacement in 10 to 15 years.
When comparing cost a dental implant prosthesis is a bit higher. However, once placed and restored, an implant will rarely require any further treatment in the future. A bridge, on the other hand, often needs to be replaced in 10-15 years. Thus, although the initial cost of an implant is higher, the long-term value is often greater.
In summary, there are many indications where an implant is the best choice for restoring a missing tooth, and similarly, there are many indications where the best choice is a dental implant. A great dentist in Durham will be a good coach for helping you to choose which service is best for you.