Over the past decade, the Dental profession has made it quicker and less painful for patients to preserve their own natural teeth and smile but, even with the advent of computerized digital technologies, stronger more bio-compatible materials and improved clinical techniques, patients who are diligent about their oral health can still suffer tooth loss.
Unfortunately there are numerous different scenarios which can lead to tooth loss, listed below are some of the more common causes.
Patients with a compromised immune system, smokers, uncontrolled diabetics or the very elderly are still very susceptible to tooth loss due periodontal infections and loss of bone support.
If a patient has a bad bite or “malocclusion” then teeth that are either in cross bite or misaligned can be lost due to traumatic occlusion.
Broken down fillings
You are born with teeth that have only a finite amount of tooth enamel so, every time a filling is placed and replaced the filling gets bigger and supporting enamel shell gets smaller and weaker. Teeth that are heavily filled with large silver/amalgam fillings are much more likely to fracture and breakage.
Clenching and Bruxism
Patients who clench and grind or teeth are also more susceptible to fracture and premature tooth wear both of which can lead to tooth loss.
Failed Root Canal Therapy
Often times fillings are so large and badly decayed underneath that the tooth requires root canal treatment. Since a root canal hollows the tooth out and weakens it Dentists typically recommend restoring root filled teeth with crowns for added strength Sometimes patient forgets to have their root filled teeth crowned – then they bite down into something hard and it fractures. Not all root canal therapy is successful – even in the hands of experienced Dentists root filled teeth can be lost to infection and root fracture.
If the decay starts underneath an existing crown or on the tooth below the gum line or the teeth that have exposed root surfaces, then the decay can quickly spread down or even in between the root(s) making the tooth non-restorable.
are typically very difficult to restore but, it depends a lot on exactly where the fracture is located. If the cusp of a tooth breaks off at or above the gum line, typically a crown can be fabricated. However, if the fracture extends down onto the root surface of the tooth, often times it cannot be saved and has to be extracted.
If complications in any of the above situations occur, the tooth needs to be removed and replaced.
Necessary Tooth Removal
When tooth removal is necessary, the patient typically has three different options available.
Option 1: Partial Denture
The patient can elect to have the Dentist make them a removable partial denture. This is a denture that replaces one or more teeth, is used for function like smiling or eating, and is removed for cleaning. This is sometimes a temporary tooth replacement for future implant locations, when a patient has no “tooth in the back” to anchor to, or, as a long-term appliance. Typically, removable partial dentures are the most economical way to replace one or more. Disadvantages include wear on the anchor teeth; food trap; has to be taken out and cleaned; can break or become loose. There is also the psychological impediment that comes with having to take your teeth in and out.
Option 2: Fixed Bridge
The second option is what is called a fixed bridge. This involves carefully shaving down the teeth on either side of the missing tooth. A dental lab creates a one piece tooth shaped appliance usually made of porcelain and or metal which is anchored to the abutment teeth on either side of the space and joined together via a fake tooth in the middle called a “pontic”. The advantage of a fixed bridge is that the appliance is not removable –it is cemented onto the teeth permanently but the disadvantages include having to shave down the teeth on either side of the space and the inability to floss normally because the bridge is usually constructed as a single piece. As an alternative to a fixed bridge, IF the neighboring teeth have no fillings, and the bite is stable, some cosmetic Dentists like Dr. Willoughby will give the patient the option of fabricating what is called a Maryland bridge. This type of a fixed bridge is bonded onto the tongue side of the neighboring teeth and much more cost effective because it does not require nearly as much removal of tooth structure. The disadvantage is that they do not typically last more than a couple of years and are at best a temporary aesthetic ‘fix’.
Option 3: Dental Implant
The third option is replacing the tooth with a dental implant. In this procedure, the tooth is typically removed and at that same appointment a CT guided surgery is planned to replace the tooth with a dental implant (made of bio-inert titanium alloy shaped like a tooth root) This procedure also requires a bone graft. It then takes 6-9 months for the body to integrate with the graft material and the dental implant. The implant can then be uncovered and impressions are taken so that an implant abutment and a permanent ceramic crown can be seated permanently on the implant fixture.
The advantages to a dental implant is that it is the most permanent form of dentistry available today and if the patient keeps the gum tissue around the implant healthy and clean there is no reason why it cannot last a life time. With dental implant crowns the patient is able to floss and eat normally after the crown is inserted as it is not tied to the neighboring teeth. The disadvantages include the fact this is a minor surgical procedure, and it can take up to a year during which the tooth is not available for use. Often times a Maryland bridge can be fabricated as an interim fixed appliance as a temporary replacement for the missing tooth. The other disadvantage is cost because dental implant surgery is still not covered by most dental insurance plans.