Options for Missing Teeth

OPTIONS FOR REPLACING MISSING TEETH

One or more teeth

Removable partial – Acrylic denture with metal substructure or all acrylic denture that seats on top of the gums of missing tooth or teeth. Ideal for patient that have some missing and some existing natural teeth as anchors to hold the partial from moving around.

Advantage:

1. Most cost-effective option.
2. Natural teeth are not cut down or disturbed.

Disadvantage:

1. May have to be removed after each meal to be cleaned.
2. Bone lose over time because it is seated on the jawbone.
3. Speaking, chewing and taste are compromised because of the extra thickness of the acrylic on the gums and the roof of the mouth.
4. Might need to use denture adhesive for added retention.
5. Acrylic teeth can wear down, break and stain with time.

Fixed Bridge – All porcelain fixed bridge that seats on top of your natural teeth between missing tooth or teeth. Ideal for patients that have one existing natural tooth in the front of and one behind of the missing tooth. For every tooth missing, we need one more natural tooth reshaped or cut down to hold the bridge. i.e. If the patient is missing two teeth, we need to reshape three natural teeth to hold the bridge.

Advantage:

1. It is a fixed option; you do not need to remove it after each meal to clean.
2. More natural then the removable option.
3. Better chewing and speaking function.

Disadvantage:

1. Natural teeth need to be reshaped or cut down to make room for the bridge to seat over the teeth. If there is a problem with one of the natural teeth holding the bridge in the future, the whole bridge needs to be replaced.
2. The undersurface of the bridge, the pontic, needs to be cleaning at least once a day to prevent decay of the natural teeth holding the bridge.
   

Implant – Ideal for patients that want a fixed option but do not want to damage their natural teeth. An implant is an anchor that is placed in the bone to replace one or more missing tooth or teeth. The parts of the conventional implant are the implant (the anchor in the bone), abutment (the connection above the gums that holds the crown to the implant) and crown or cap (covers the implant and serves as the surface to chew on). The crown could be screw retained or cement retained depending on angulation of implant and the aesthetic need of the patient. 

Advantage:

1. It is a fixed option; you do not need to remove it after meals or use any denture adhesive for added retention.
2. Natural teeth are not cut down or disturbed.
3. You are only replacing what has been lost.
4. Better chew habits.
   Patient can return to work after one day.

Disadvantage:

1. More costly than the other options available.
2. It involves a minor surgery in the jaw.
   

Missing all teeth

Full denture – Acrylic removable dentures.

Advantage:

1. More cost-effective option. 

Disadvantage: 

1. May have to be removed after meals to be cleaned.
2. Prone to cause existing bone loss over time because it is seated on the jaw bone.
3. Speaking, chewing and taste are compromised because of the extra thickness of the acrylic on the gums and the roof of the mouth.
4. Not stable. Denture adhesive is sometimes needed to help with stability.
5. Can change color with increased stained foods and smoking.
6. Acrylic teeth may wear down and break overtime.

Denture stabilization with mini implants – Acrylic removable dentures with metal substructure that is held in by mini implants over locators. Usually 4-6 mini implants are needed on the upper arch and 4 mini implants on the lower arch to stabilize the denture from moving around. Mini implants have three parts: Mini Implant (the anchor in the bone is less than 3 mm in thickness), Locator (the connection that seats on top of implant) and Housing (attachment that seats in the denture). The housing holds a nylon attachment that has to be replaced once a year or sooner to increase retention of the denture.

Advantage:

1. More stable than the removable denture.
2. Easy to remove and clean for elderly patients that have dexterity issues.
3. Less force on bone because chewing forces are distributed over implants not bone as in conventional denture.
4. Better speaking and taste sensation because less acrylic is needed.

Disadvantage:

1. Must be removed at least once a day to be cleaned.
2. Can change color with increased stained foods and smoking.
3. Acrylic teeth can wear down and break overtime with use.
4. Cannot be upgraded to a fixed option in the future.

Denture stabilization with conventional implants – Acrylic removable dentures with metal substructure that is held in by conventional implants over locators. Usually need 4-6 conventional implants on the upper arch and 4 conventional implants on the lower arch. Conventional implants have three parts: Implant (the anchor in the bone is more than 3 mm in thickness), Locator (the connection that seats on top of implant) and Housing (attachment that seats in the denture). The housing holds a nylon attachment that has to be replaced once a year or sooner to increase retention of the denture. 

Advantage:

1. More stable than the removable denture.
2. Easy to remove and clean for elderly and patients that have dexterity issues.
3. Less force on bone because chewing forces are distributed over implants not bone as in conventional denture.
4. Better speaking and taste sensation because less acrylic is needed.
5. Can be upgraded to a fixed option in the future. 

Disadvantage:

1. Must be removed at least once a day to be cleaned.
2. Can change color with increased stained foods and smoking.
3. Acrylic teeth can wear down and break overtime with use.

 

Fixed Acrylic Bridge or All-on-Four/Six – Fixed Acrylic bridge that is held in by conventional implants. We usually need 4-6 conventional implants on the upper arch and 4 conventional implants on the lower arch. Conventional implants have three parts: Implant (the anchor in the bone is more than 3 mm in thickness), Abutment (the connection above the gums that holds the implant to the bridge) and the Acrylic bridge (a series of acrylic teeth splinted together to serves as a chewing surface). Ideal for patients that have an opposing arch with an acrylic denture or bridge and patients that are on a soft diet.

Advantage:

1. Fixed option that is more stable than all the removable options.
2. More natural than all the removable options.
3. Better speaking and taste sensation because less acrylic is needed.
4. Less in cost than the zirconia option.

Disadvantage:

1. Can change color with increased stained foods and smoking.
2. Acrylic teeth can wear down and break overtime with use.
3. Acrylic is porous and attracts more plaque under the bridge than the zirconia.

Fixed Porcelain/Zirconia Bridge or All-on- Four/Six – Fixed Porcelain bridge that is held in by conventional implants. We usually need 4-6 conventional implants on the upper arch and 4 conventional implants on the lower arch. Conventional implants have three parts: Implant (the anchor in the bone is more than 3 mm in thickness), Abutment (the connection above the gums that holds the implant to the bridge) and the Porcelain bridge (a series of porcelain teeth splinted together to serves as a chewing surface). Ideal for patients that have all their natural teeth or porcelain crowns on their opposing arch, patients that grind their teeth or have a coarse diet.

Advantage:

1. Fixed option that is more stable than all the removable options.
2. More natural than all the removable options.
3. Better speaking and taste sensation because less material is needed.
4. More fracture and wear resistance than acrylic bridge.
5. More stain resistant than acrylic bridges.

Disadvantage: 

1. More costly than the other fixed options but is the most predictable option and investment for your missing teeth.