A Tooth is Lost

What’s Next?

Dentistry as a profession has made monumental strides in assisting our patients to keep their teeth where they belong; in their mouths. And to their credit, the public at large has taken years of solid dental advice. So we are just not losing as many teeth as in years past. But even patients who are diligent about their oral health can suffer tooth loss.

A tooth can only be worked on so many times, before there is not enough tooth to work on. So if someone has decay in a molar at seven, then more decay in his or her teens, by the time a dentist might suggest a dental crown, much of the tooth has already been destroyed. Teeth with large silver/mercury fillings or molars in patients who clench and grind, are apt to fracture.

Fractured teeth are the most difficult teeth for a dentist to restore properly, because many times we cannot visualize the full extent of the fracture. If the tooth breaks off at the gum line, it is generally easy to fix. But if the tooth fractures down onto the root surface, it is often times not restorable.

Decay below the bone line, can, at times make the tooth unfixable. Not all root canal therapy is successful. Sometimes, even in the best hands, some cosmetic dentistry procedures do not work as well as we would like

If complications in any of the above situations occur, the tooth needs to be removed and replaced. When tooth removal is necessary, the patient has three very different options available.

He or she can have a removable partial denture. This is a denture that replaces one or more teeth, is used for function like smiling or eating, and is removed for cleaning. This is sometimes a temporary tooth replacement for future implant locations, when a patient has no “tooth in the back” to anchor to, or, as a long-term appliance. The advantage is that this is the most economical way to replace a tooth. Disadvantages include wear on the teeth holding it in place and it collects a lot of food A partial may affect a patient psychologically since it is a “body part” that comes in and out.

The next option is what is called a fixed or non-removable bridge. This involves shaping the teeth on either side of the missing tooth. A lab creates what looks like three teeth that are linked together and attached to the side, or abutment, teeth. The advantage to this is completion in 2-3 visits and there is no appliance to take in and out.

Disadvantages include involvement of the teeth on either side of the space and inability to floss normally, as the teeth are attached together.

The third option is replacing the tooth with a dental implant. In this procedure, the tooth is removed and grafted. We then wait six months to allow the body to integrate with the graft material. Then a hole is created in the bone and the implant, which is essentially a titanium root, is inserted into the bone. We then wait another six months for the implant to knit to the bone. We then create and place a crown on the implant.

The advantages to this are that the patient will be able to floss and eat normally after the crown is inserted as it is not tied to other teeth and the teeth on either side are not affected. The disadvantages include the fact this is a surgical procedure, and there is often a 12-15 month period during which the tooth is not available for use.