Is replacement always necessary?
When all is said and done, decay is about losing teeth, and sometimes the process is so far along that even the most advanced dentistry can’t help. In that case, a tooth is extracted, and you’re left with a space in your gums. I realize the anguish that comes with even one missing tooth. It may be in the back of your mouth, out of sight, but you’re still aware of the empty space because your tongue never stops probing it. And you’re concerned about food getting wedged in the space.
Your dentist has even deeper concerns. He knows your teeth were designed to work together to help you eat, speak, and smile. Losing a single tooth can affect all three functions and have an impact on your self-esteem as well. That’s because, over time, your teeth will shift to fill the empty space, and when they do, your face may look older and your bite may become unbalanced.
Traditional options—still relevant!
For years, the standard answer was to replace missing teeth with a fixed bridge, a removable partial, or (if all or most teeth were missing) a traditional complete denture.
Before going further, let’s define those terms because they can be confusing.
A bridge is cemented in place and cannot be removed. A bridge can also be called a fixed partial denture—fixed because it can’t be moved and partial because
it replaces some, but not all, teeth. It is typically made of metal and porcelain.
It fills a space that is left when teeth are removed and is cemented on both ends to permanent teeth. It literally bridges a gap.
Bridge is the more common term for a fixed-partial denture because, like a structural bridge, a dental bridge is firmly and permanently secured at both ends.
A removable partial denture, more commonly called a partial, looks like a bridge and has the same purpose—to fill the gap where a tooth used to be—but it’s not cemented in place. It’s held in place with metal clips and can be removed by you or your dentist.
A partial is usually less expensive than a bridge because it’s easier to fabricate and is made of a less costly metal with teeth and gums of plastic rather than porcelain.
Full dentures are just that—replacement appliances used when all teeth have been extracted, usually because of decay, gum disease, or trauma. A complete set of dentures consists of two plastic plates with built-in artificial teeth and gums. One can be fitted in the upper jaw, the other in the lower. They are held in place by a snug fit with the gums and underlying bone.
While dentures are no longer the standard of care, they are readily available and remain a common, affordable option with little to no risk of failure.
Implants are the new kids on the block for the replacement of one or more teeth. They are so different from dentures that I’ve devoted a special section to them later in this chapter.
Pluses and minuses of traditional options
Because a bridge, or fixed partial denture, is cemented in place, it offers the advantage of stability. It feels like real teeth and, as the name indicates, is not removable. It costs more than a removable partial denture because of the time and materials involved in making it. It also requires more work to clean under and around the artificial tooth or teeth that are part of the bridge, whereas a partial, which is typically bulkier, can be lifted out of the mouth for cleaning.
Here’s another consideration: To provide anchors for a bridge, the teeth to which it will be attached must be drilled down to one-to-two millimeters in all directions. In a very real sense, you sacrifice good teeth to have the bridge.
If the anchor teeth have large fillings or recurring decay, they may require treatment to stabilize them before the bridge is fabricated. In that case, there really is no “sacrifice” since the teeth are suitable candidates to be covered anyway.
However, you may want to think twice if the anchor teeth are what we dentists call virgin teeth—meaning they have no decay, no fillings, and no structural issues. In such cases, an implant to fill the empty space may be a better solution. Why? Because the work needed to prepare a good tooth for anchoring may lead to decay, a root canal, and even loss of the tooth. An implant, though expensive, bypasses that issue as you’ll see in the next section. Be sure to discuss the options with your dentist, including the costs involved, before making a decision.
The removable partial denture, or partial, is an economical choice, the least expensive of the alternatives for replacing a lost tooth or teeth. There are downsides. If not seated and retained properly, partials tend to be unstable and can make eating and speaking difficult. They also need to be removed for cleaning
and sleeping, which could be embarrassing in some circumstances. They may require more frequent adjustment and replacement than other solutions.
If undecided about having a removable partial, talk with your dentist about being fitted with a less expensive temporary partial, called a flipper or flexi-partial. This will allow you to try the partial concept. If it’s not right for you, you will not have invested a great deal of money, and the decision to go with another solution (or not) will be easier.
While dentures alone are no longer the standard of care, they are readily available and remain a common, affordable option with little to no risk of failure.
Schedule a consultation with Dr. Stonisch to find the best solution for your missing teeth. Call the Faircourt Dental Smile Studio at 313-486-0084 or reach out to us on the contact form on our website.