Smarter way of replacing your missing teeth

Dr Riaz Ahamed

Unfortunately, sooner or later, every one of us will lose one or more teeth for some reason. If you have several missing teeth, you will not be able to eat properly, speak clearly or even smile as you would.

Loss of one tooth may not be considered by many people as a major problem, unless it is one of the front teeth affecting their appearance. But if you do not immediately replace every single missing tooth, you will be at a higher risk of losing more teeth some time later.

It is expected that most people will lose one or more teeth due to a dental disease, tooth decay or gum disease. Even those who take good care of their teeth with daily oral hygiene may eventually lose a tooth due to an accidental mouth injury or due to simple daily wear in older age.

If someone is missing several teeth, it is obvious that beyond the aesthetic problems will also have problems in eating and speaking properly.

Missing teeth can affect …

Appearance: Even if a single front tooth is missing, it can seriously affect the person’s appearance, self-esteem and social life. With today’s standards in developed countries it is not socially expected to show a missing tooth when talking or smiling. Dental implants do not only look but also feel much closer to natural teeth than any other alternative.

Eating: Missing several teeth can reduce the ability to eat certain food groups, resulting in bad nutrition, poor quality of life and heart burns. Dental implants restore the full functionality of your mouth, and you can return to your favourite diet enjoying life just like with natural teeth.

Speaking: The absence of one or more teeth can disturb your speech, cause a lisp and change the way your voice sounds. Dental implants feel like regular teeth without causing the speech problems that are common when teeth are missing or dentures are used, especially removable ones.

Every missing tooth has to be replaced because the following problems may occur:

Adjacent teeth movement: The mouth structure is strong because each tooth supports the ones next to it. If a tooth is lost this lateral support is lost and adjacent teeth may shift towards the empty space and by time they will become loose and fall out.

Jaw bone loss: The pressure of tooth roots into the jaw bone provides a stimulus to bone cells that keeps them from dissolving away, due to what is called piezoelectric effect. If the root is missing the bone cells in the area start to die and the bone is dissolved. If several or all teeth are missing, the process may result in dramatic loss of jaw bone causing conditions described as jaw shrinkage and facial collapse. This is what gives a caved in look at the faces of some people and makes them look much older than they really are.

The major problem of bone loss, beyond the apparent aesthetic ones, is that any remaining teeth will eventually become loose and fall out, and that dentures will be hard to fit because there will be not enough bone to support them.

Several options are available for substituting the function of missing teeth such as dental bridges, partial or full dentures, and lately dental implants.

Dental implants are the most modern method that prosthetic dentistry has to offer for replacing missing teeth. When you want to replace lost teeth, none of the alternative methods (dental bridges or dentures) will feel and look as close to your natural teeth as dental implants.

Dental implants are small dental devices that play the role of artificial tooth roots used for the replacement of missing natural teeth. They are surgically placed in the jaw bone to replace the root part of the missing tooth and provide a solid base to support a dental restoration that will replace the missing tooth’s crown.

A tooth restored with the use of a dental implant consists of three main parts:

Implant post/fixture: An implant post or implant fixture is a titanium made, screw-like or cylindrical component of the implant that is surgically inserted and embedded into the bone of the lower or upper jaw. The implant post is a non-visible part of the implant that holds the ‘artificial’ tooth in place and it can be considered as the equivalent of the root part of the natural tooth. The external surface of implant posts is usually threaded and sometimes coated with a biocompatible bone-regeneration material to help mechanical stability and osseo integration.

Abutment: An abutment is the part that connects the implant post with the restoration and it is attached on the top of the post with a screw protruding over the gum line. The central part of the post is usually hollow and internally threaded where the abutment will be fixed. Different types of abutments can be used (both in shape or material) depending on the type of restoration that will be supported. In some types of implants (such as mini dental implants) the abutment is not a separate part but it is fixed with the implant post.

Restoration: The restoration (that replaces the visible part of the tooth) is a crown, usually made of porcelain fused to a metal alloy, but also could be an all-metal or all-porcelain crown. The crown is attached (screwed or cemented) either to the abutment or directly to the implant. If the crown is screwed to the abutment, the screw hole is covered with restorative material such as tooth-coloured filling material.

A dental implant is essentially a substitute for a natural root which is placed into the empty socket of an extracted tooth or in a socket carefully drilled at the precise location of the jaw. The implant is screwed into position (if it is a screw-threaded one) or otherwise tapped into place.

The main goal during implants placement is to achieve immediate close contact with the surrounding bone. This creates the necessary initial stability, which over time is steadily enhanced by further growth of bone around the implant (osseo integration). Dental implants are made of titanium because titanium has the ability to biologically bond to the bone. After the bone has grown around and secured the implant, implants provide the foundation for long-term support of a crown, bridge or over denture just like roots hold natural teeth in place.

There are two basic uses for dental implants:

As an artificial root for a single tooth replacement.

As anchors for a fixed or removable prosthesis to replace multiple teeth.

Implants are the modern way restorative dentistry has to offer for replacing missing teeth. Almost 70% of adults have lost at least one permanent tooth up to the age of 45. A 25% of the population has lost all permanent teeth before 75 years of age. Most common causes of tooth loss are tooth decay, mouth injuries, gum disease and ageing.

Dental implants are a suitable option for replacing missing teeth, if an adult has good dental and general health, and there is enough strong bone in the jaw, to support the implant.

Certain medical conditions such as immunodeficiency, osteoporosis, diabetes and others contraindicate with the placement of tooth implants increasing the risk of complications or failures. The specialist dentist will examine your dental and overall health condition to determine if you are a suitable candidate for dental implants.