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Missing or loosing natural teeth is one of the most distressing things for patients. But in todays day and age with huge advances in dentistry we have a wide array of options available to not only restore the missing teeth but also complete form and function of the teeth immediately.
One of the most distressing thing for anybody is too lose a natural tooth due to various reasons. It can adversely hamper the quality of life of the patient in many ways. It affects both the aesthetics and function of the patient. A missing tooth or teeth alters the mastication or chewing ability, speech. Also over time if a missing tooth is not replaced it causes bone loss in the jaws and loosening of the overlying soft tissue.
Significant bone loss leads to loss of vertical height in the patient which is the distance between the nose tip and the chin. this can severely affect the oral functionality and the facial aesthetics or appearance. This also makes replacement very difficult over time.
A loss in vertical height put excessive strain on the temper mandibular joint (TMJ) over time. This results in a common complaint of pain and tenderness in patients on mouth opening and chewing. It also causes Trismus or restricted mouth opening due to the discomfort in the joint.
Also over time the gap or space left by a missing tooth can lead to movement or tilting of the adjacent teeth to fill the gap naturally as nature desired. Also the teeth in the opposing jaw which lies opposite the missing tooth holds it in place. Now when this tooth goes missing there is supraeruption of the opposing tooth in which the tooth moves out of the socket above the occlusal plane. This leads to loosening and loss of the opposing tooth.
In addition to the above problems loss of an anterior or front missing tooth severely affects the aesthetics. In such a case the patient is very conscious when smiling or speaking. This also hampers the speech thereby gravely undermining the confidence of the patient. All the above problems can be avoided by timely and accurate replacement of missing teeth.
Since replacement teeth should last for at least several years, it is very important to choose the correct option depending on various factors like: Patient's concern, oral health, time frame available, cost effectiveness.
There are three main options available to replace missing teeth. These include the following:
A. Removable dentures: These can be either complete or partial dentures. As the name suggests these can be removed and cleaned out and placed back into the mouth. This is one of the oldest technologies available.
The advantage of this system is that the centre and the surrounding area can be easily cleaned But over time this system has become outdated as there are several problems associated with This like:
Fitting and adjustment of a removable denture takes a lot time and effort on both the patient and dentist's part. One of the biggest disadvantage is the significant amount of bone loss associated with removable dentures. Also in many cases it causes a lot of discomfort for the patient as the base plate rests directly on the gums. Speech of the patient can also be altered and it takes time to to speak effortlessly while using the denture.
A complete denture in the upper and lower jaws replace the complete set of missing teeth in an edentulous patient. A partial denture replace few or several missing teeth in a partially edentulous patient. This generally consist of a metal framework covered in acrylic with good quality acrylic teeth.
B) Fixed bridges : in this system a bridge or a fixed restoration is used to replace missing tooth or teeth. In this system the adjacent teeth next to the edentulous area are reduced or ground to act as support or abutment for the bridge. These abutments hold the bridge in place.
There are certain advantages of this system like it is fixed to the adjacent teeth and does not need to be removed and placed again and again by the patient. This significantly reduces the patient hassle. Also a fixed bridge is much more comfortable as there is no baseplate resting on the soft tissues so it is much less irritating to the gums. This is also much more aesthetic in which the prosthesis lies on the soft tissue, also if the shade matching is done well it gives a very good result. Ceramic or porcelain bridge can be matched very well to the adjacent teeth. Also the forces of mastication or chewing are not transmitted.
The disadvantage of a fixed bridge is that it is more difficult to maintain the gingival or gum health. It is imperative to keep the soft tissues surrounding the abutment teeth clean and the gums healthy. Also it compromises the adjacent or abutment teeth by grinding them it can cause sensitivity and pain over time. In some cases over time these teeth need pulp therapy or root canal treatment. This is the main disadvantage as compared to an implant supported crown.