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Replacing Lost Teeth

There are 2 main decisions that need to be considered when a tooth has been lost.

1. Does the tooth need to be replaced?

If the lost tooth is at the front then 99% of the time patients will want the tooth replaced for cosmetic reasons.

A lost tooth does not always need to be replaced. Wisdom teeth are removed all the time and we very rarely look at replacing these. Teeth are removed all the time for orthodontic purposes to make space to move the teeth. Eventually the gap was was present following the extraction will be closed. Sometimes in an 11yr old child if the 1st molars are very badly decayed and have a poor future it is better to remove these teeth at this stage. In time the teeth behind the 1st molars will drift forward into the gap left by removing the tooth but only if the extraction is carried out at the right time.

Nearer the back of the mouth we enter a grey area about answering this question. There are millions of people walking around with missing teeth with no apparent consequences. There is even a concept called the shortened dental arch which suggests that if we have all our front teeth and premolar teeth this is enough to allow us to function in a stable way. However depending on the orientation and postioning of the teeth, they can tilt and drift. This can alter over time the way one bites together potentially leading to jaw joint problems. The same tilting and drifting can also make teeth more prone to gum disease and tooth decay. In addition if the remaining teeth are put under more pressure because there are less teeth to bite on this can lead to the other teeth breaking or increasing in mobility.

so the answer to this question is Yes, No and Maybe.

The second question is

2. If I do replace the teeth what should I replace my lost teeth with?

The options you will have are dental implants, dental bridges or dentures. Dental implants are usually the preferred option because they do not involve the destructive preparation of the teeth iether side. Bridgework is done less commonly these days especially at the back of the mouth because of the destructive nature of a bridge preparation and because the cost of an implant is quite close to the cost of a bridge anyway. At the front of the mouth a resin bonded bridge ( which involves removal of very little tooth structure) is an option, and they are relatively inexpensive. However because of the way they hold onto the tooth they can debond ( come away) from the supporting teeth and this is a risk with resin bonded bridges. Where more than one tooth is missing denture work becomes more of an option. The cost of dentures replacing multiple teeth are relatively inexpensive compared to a multiple implant case. The compromise is that the finished result will be something that is not fixed in place and one would need to take in and out of the mouth. For many patients dentures are not well retained in their mouths and implants give them that added security. Sometimes placement of implants is combined with a final restoration which is iether a bridge or a denture. What form the final restoration takes on top of an implant- whether it be a crown, bridge or denture will be discussed in detail prior to starting dental implant treatment.

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