Missing a Tooth?

No one likes an unsightly gap.  But what are your options?

The gold standard to replace a missing tooth is the osseointegrated implant on which is attached an implant crown.  The implant crown looks and feels like a natural tooth.  But because implants require surgery, the implant patient must be in good health and have adequate bone to support the implant. This service is also the most costly.

The second option is the fixed bridge.  Here, teeth on either side of the missing tooth are covered with crowns to which an artificial tooth is connected.  The bridge is then cemented in place.  Disadvantages are that the teeth on either side of the missing tooth have to be reduced to accommodate the crowns and three or more teeth are now connected, making it difficult to clean underneath and a potential food trap.

The third choice is the removable partial denture. As it is removable, the partial denture is less natural than the implant or fixed bridge.   The partial denture takes getting used to, it may feel bulky and you may not be able to chew as you would with natural teeth.  The advantage is the relative simplicity of the procedure and lower cost.

You may not be a candidate for the implant, the fixed bridge or the removable partial denture.  A dentist can best evaluate which options are suitable for a given clinical situation.  It is important to replace missing teeth because other teeth will drift into the gap and the entire dentition may be compromised.  For more information on replacing missing teeth, call our Long Island dental office for a free consult.

The columnist Jane Brody wrote a wonderful piece about implants in Tuesday’s New York Times. I couldn’t have written it better myself, and I only found one error! (She says that implants usually take about eight weeks to integrate to bone – but I would say that 3 to 6 months is more predictable.) She writes about her own tooth problems and about the first molar that she lost when she was in her 20’s and the resulting bridge that had to be replaced several times in the subsequent years. She recently elected to have implants placed in order to replace the two teeth that were now missing due to decay and gum disease. She gives the reasons that implants are superior to the conventional bridge: A bridge is not as permanent as an implant, the bridge is harder to keep clean, implants do not decay, and adjacent teeth do not have to be reduced for supporting crowns.

The implant procedure involves surgical placement by an oral surgeon or periodontist of a titanium screw, or implant, into the jawbone. The implant then has to integrate with the bone for 3 – 6 months, at which time the restorative dentist attaches an abutment, which is a connector to which a crown is then cemented. The restorative dentist needs to do the treatment plan and closely coordinate the treatment with the periodontist.

Almost 500,000 implants are placed in the United States each year! A patient’s health and quality of bone will affect their suitability for implants. A patient who is a diabetic or who smokes has a poorer blood supply and this will lessen the chance of success. 

The other day a patient asked me how long a dental crown (cap) should last. He had come into my Long Island office with two broken crowns that were about 15 years old. Well, the answer is that all crowns and patients are not alike. A crown should last 10-15 years, but I have a patient who had simply gorgeous gold crowns made some 40 years ago in California that still look as beautiful as they did the day they were inserted. And on the other hand, I have a patient who lost two crowns after only two years because they were poorly made by a dentist right here in Suffolk County.

For a crown to serve well, the dentist has to prepare the tooth properly so that all decay is removed and the tooth is the proper shape to retain a crown. He/she has to take a very accurate impression, make a well-fitting provisional crown, fit the crown properly when it comes back from the dental laboratory and cement the crown carefully. All of this takes careful attention to detail and cannot be rushed. All too often dentists skip a step or cut corners and this will affect the longevity of the crown – and ultimately the life of the tooth.

The dentist must also use the services of a superior dental laboratory that also pays attention to detail and uses finer materials. All too often, dentists who charge less for a crown, can do so because they send their work to inferior dental laboratories.

Another important factor in the life of a crown is the patient. The crown needs to be taken care of with proper brushing and flossing and regular visits to the dentist. If the patient neglects his/her dental health, this will definitely have an adverse effect on the crown. The patient’s systemic health is also a factor. Diabetes and smoking are associated with gum disease which in turn affects the crown and tooth.

For more information about dental crowns and bridges visit drterryshapiro.com/.