Replacing missing teeth

MISSING TEETH

Many people have at least one missing tooth in their mouth. These missing teeth can be replaced via a couple different methods, all of which vary in cost and effectiveness. For simplicity sake, let's start by considering an individual missing a single tooth.  There are 3 main options for replacing the missing tooth.  These include a partial denture, a fixed bridge, or an implant.

PARTIALS

A partial denture is a removable appliance that stays in place via a friction fit. These can look pretty good, are cost effective, but loose out to the other options in the function department. Partial dentures cost anywhere between $300 to $1200 depending on design, and often last between 2-10 years. The more expensive ones are designed to last longer and provide a tighter fit. However, regardless of the style, partials are removable appliances. As a result, they will often move around during eating. Some people can handle this, others find it too annoying and end up opting for one of the other tooth replacement options.

FIXED BRIDGES

A fixed bridge is exactly that, fixed. This appliance involves crowns on the teeth on either side of the missing tooth with a fake tooth in the middle. Visually it looks like 3 crowns fused together with the middle one resting on or near the gum tissue. This is a very solid and functional restoration which costs around $2000 and increases in cost the more teeth being replaced. These usually last between 5-15 years depending on home care and restoration complexity. There are 2 major downsides to this restoration. The first is, like partial dentures, the restoration does nothing for preserving the bone which is essential for long term tooth stability.

The second is the complexity to keep the restoration clean. Cleaning under the bridge can be challenging and often these restorations will decay in difficult to detect and difficult to clean areas. In some cases the decay progresses quick enough that one of the abutment teeth are damaged beyond repair, resulting in the next restoration having to replace an additional tooth. This ultimately increases the cost above and beyond that of an implant.

The design for bridges varies on area and size. The majority of bridges are Porcelain bonded to Metal and extend right to the gums where the missing teeth are. Alternatively, for better hygiene, a gap is sometimes left between the gums and the pontic (portion of bridge replacing a missing tooth).

Case #1: Replacement of a single molar with a 3 unit bridge.  This particular bridge has a space under the pontic to facilitate in cleaning and maintenance of the prosthesis and anchor teeth.

Case #2: This is an example of 5 teeth being replaced with a combination of implants and bridge work.  Due to aesthetic reasons, the pontics for this bridge extend all the way to the gumline.  Note, redness of gums is due to temporization process, as this is a photo just after cementation of final prosthesis.

IMPLANTS

Implants come in various styles and designs. The main ones on the market today are comprised of a titanium screw imbedded into the bone and a crown is placed on top. These can be done as single teeth or multiple teeth. They can also be used as anchorage for complete and partial dentures. In the case of single or multiple tooth replacement, implants act and function almost identically to natural teeth. They are aesthetic, they are fixed in place, and they are fully functional. They are not susceptible to decay and are more resistant to gum disease. Implants cost around $3000 - $4000 each, and have the potential to last for well over 20 years (potentially a life time, but implants are still too new for that claim to be validated by research). With their long life implants end up being cheaper in the long run then fixed bridges.

The implant restoration process involves many stages and can take from 3-9 months to complete. Although this can be a long process, it does help spread out the cost of the treatment. This process involves two main stages. The first is implant placement. This stage is often done by an oral surgeon or a periodontist. After the implant is placed and allowed to solidify into the bone, the restoration process begins. Seeing as a picture says a thousand words, view the following 2 cases for examples of the restoration process.

Case #1: Replacement of a single molar with an implant from Nobel Biocare.

Case #2: Replacement of 3 teeth with implants from Zimmer.

Back to top