Are you, a loved one, or a friend missing one or multiple teeth? If so, you are not alone. According to the American College of Prosthodontists, 120 million Americans are missing at least one tooth. Of those, 36 million are edentulous or missing all teeth. Based on projections, over 200 million Americans will be missing one or more teeth within the next 15 years.
Although most teeth are lost due to dental caries (decay) or periodontal (gum) disease, there are other causes. Trauma to the face can lead to loss of teeth and the surrounding bone, which most commonly affects the upper front teeth. In addition, tumors of the jaws, vertical fractures, and severe wear contribute to partial loss of the dentition. These conditions can occur at any age and are quite common.
The obvious consequences of missing teeth are decreased ability to chew and, potentially, poor esthetics. However, many patients are unaware of the progressive changes that occur when a tooth is lost. Our teeth are housed in a special part of each jaw referred to as the alveolar bone. Like bones elsewhere in the body, lack of use can lead to atrophy or alveolar bone loss. When a tooth is removed or lost, approximately 25% of the surrounding bone is lost in the first year. In the absence of treatment, the alveolar bone loss is progressive until this part of the jaw is gone. Other concerns are shifting of the opposing tooth or adjacent teeth, nutritional deficits, and less confidence in social interactions.
We typically divide replacement of missing teeth into two main categories, removable and fixed prostheses. As the name implies, fixed prostheses are not removable at home, while removable prostheses are taken out of the mouth daily for cleaning. Although every situation is unique, most patients prefer a fixed prosthesis.
When a single tooth is missing, a dental implant is an excellent fixed replacement option. Modern implants are precisely fabricated titanium fixtures that are placed into the alveolar bone at the position of the lost tooth root. During healing, the adjacent bone integrates with the implant to form a permanent “root”. When the implant is ready, a post and crown are placed on the implant. The result is a tooth that cannot decay, yet can be flossed, and functions like your natural tooth.
If multiple teeth have been lost, we are often able to place multiple implants in the alveolar bone. After healing, individual crowns can be placed on implants or a bridge can be utilized. With a bridge, implants are not placed for each individual lost root, but rather at selected sites with adequate bone. Finally, a single “bridge” of crowns spans the space between implants to complete the restoration.
Implant restoration replacing a missing upper first molar
Most edentulous (missing all teeth) patients have removable dentures. Many of us have a friend or family member with existing non-implant dentures that they tolerate but detest. The good news is that modern implant dentistry can dramatically improve the stability, bite force, and comfort of many existing complete or partial dentures. Our clients often describe implant-stabilized dentures as life-changing. They consistently experience increased confidence and are once again able to eat the foods they love without denture adhesives.
For edentulous patients that prefer a fixed prosthesis, multiple implants are placed in the upper and lower jaws. After healing, a hybrid denture is attached to the implants. This type of prosthesis is very stable and well-tolerated.
One of the biggest advantages of implants is the efficient transfer of biting forces to the alveolar bone. This force stimulates the bone, allowing maintenance of the existing bone mass, effectively halting the progressive bone loss mentioned earlier. If the teeth have been missing for an extended period, bone replacement grafting is often an option to replace the lost bone.
If you or a loved-one has missing teeth, schedule a consultation with your dentist. At this appointment, he or she will likely perform X-rays and complete a thorough clinical examination. They will also discuss your treatment goals and any functional or esthetic deficits you have noticed due to the missing teeth. Your dentist can help you sort through the options discussed above and develop a treatment plan that will help you optimize your oral health and smile.