The ideal replacement for missing teeth
- Have you heard of implants to replace teeth?
- Did you think it is a luxury?
- It may be more costly than other forms of tooth replacement, but when you consider how:
1. It can save and preserve the remaining teeth, bone and gum,
2. It looks natural
3. It improves enjoyment of food
You will appreciate why nowadays it is the standard treatment and the IDEAL treatment in the replacement of missing tooth / teeth
The overall dental health status has improved with the modern day dental health care and teeth are being preserved rather than removed. Nonetheless, teeth may be congenitally missing (born without a tooth or multiple teeth) or lost due to many reasons, amongst which are the following:
- Very gross caries making it impossible to restore
- Advanced periodontal (gum) disease
- Teeth lost in traumatic injuries
- Teeth removed due to the excision of a tumor Replacement of teeth
While many may still view removal of teeth as a solution to their dental problems, it may turn out to be just the beginning of many more problems!
In the anterior (front) region, loss of even one tooth is severely distracting, besides causing problems in phonation.
Loss of posterior (back) teeth may cause problems in chewing. In cases where most of the posterior teeth are lost, there could be excessive stress on the front teeth resulting in their premature loss. Thus a replacement becomes essential.
Replacement with a removable denture is the most economical. However, it is not necessary retentive or stable. When oral hygiene is less than ideal, the supporting teeth may become
carious or mobile resulting in progressive loss of more teeth. In those totally edentulous (toothless) patients, full dentures, especially the lower ones, are a constant source of discomfort and discontent. The usual complaint is the difficulty in controlling a very mobile denture and the reduced chewing efficiency.
Bridges have the advantage of being fixed. However, it is necessary to prepare adjacent teeth for capping. Tooth decay or tooth fracture may result in failure of the fixed bridge.
Another problem with loss of teeth is the loss of supporting bone or alveolus. This progressive thinning of the bone may cause difficult in replacing the teeth in their original position.
Dental implants represent an important milestone in the advances in Dentistry. The past thirty years sees a tremendous development in this technology. The possibility of individue4 replacement of missing teeth in a predictable manner is the closest one could get to simulating or even replicating the natural state of the dentition. In addition to a fixed replacement of a tooth, it also stabilizes the status of the support bone, maintaining the one volume. The biggest advantage is that the adjacent teeth are not cut down in any way and the maintenance of the tooth is no difference from the natural dentition.
Where multiple teeth are lost, a reduced number of strategically placed implants could be used to support bridges.
In fully edentulous situations, unstable dentures and inadequate chewing efficiency is the main problem. Implants can be used to provide support and retention for a removable denture. It has the advantage of aesthetic appearance, firm and comfortable to chew on, yet easy to maintain. In ideal cases, fixed prosthesis can be constructed.
Types of implants
Present day dental implants are made of titanium. This material is strong, light and noncorrosive. It is very biocompatible and it promotes a direct intimate contact with the bone, which is known as osseointegration.
An implant is shaped like a screw and it is inserted into the prepared site in the jaw bone. This represents the root of a tooth. An abutment is connected to this implant body. This will project through the gum to receive the supra-structure. Most abutments are made of titanium. For absolute aesthetic appearance, zirconium is the material of choice but it is much more costly. A number of combinations of suprastructure can be constructed: be it a single tooth a
bridge or a removable over-denture.
There are many brands of implants, the parts of which are mostly not interchangeable. Essentially, implants may differ in diameter, the shape of the screw threads, the implant surface and the connection of the abutment to the implant body. The dental surgeon who provides implants usually has his her preferred system and is able to advice you accordingly.
Timing of implants
To avoid excessive bone resorption resulting in a reduction of bone volume, implant should ideally be placed soon after removal of the tooth. In some cases, implants could be placed immediately after a tooth is removed. Following insertion of the implant, it is generally allowed to heal undisturbed for a period of about three-six months before proceeding to the construction of a crown or bridge. In favourable conditions, construction of the prosthesis, at the same time as the placement of implants is possible.
In summary, implant is set to be the idea replacement for missing teeth. There are however limitations. Firefly, progressive resorption of the bone results in the hone being too thin to
accommodate an implant. There are mini implants of smaller dimension but in general implants are at least 3mm in diameter. Secondly, resorption may also result in reduced bone height and this is especially problematic in the upper posterior teeth in which the maxillary sinus poses a limitation while in the lower posterior region, the inferior dental nerve may prevent placement of implants. Other limitations relate to the patient& medical and health status and smoking habits.
In many situations, anatomical limitation could be overcome with addition surgical procedures augment the bone or relocate the nerve.
Teeth need cleaning and professional maintenance; so do implants. While implants may not decay, they could become mobile. This is exacerbated by poor oral hygiene and neglect. Smoking has also been identified as a contributing factor to implant failures.
Regular home care supplemented by professional care would go a long way towards ensuring longevity of your natural dentition and those of the implants and the prostheses.