Tooth Replacement Guide


Plastic Model of Dental Implant screw and Crown. Dentist in Sun City AZA common concern that people have is the possibility of losing their teeth. Tooth loss can be caused by a variety of factors including gum disease, tooth decay, and injury. Luckily, there are many solutions available for tooth replacement!

Let's take a look at some of the options that people have when considering tooth replacement procedures:

What happens if you don't replace teeth?


If you do not get missing teeth replaced, you will lose bone (which supports facial tissue) in your jaw, and look older. Up to 50% of the bone is lost in the first 6 months after a tooth is removed. Teeth surrounding the gap shift position, allowing gum and bone to disease occur more easily, affecting your bite and becoming more prone to tooth decay. Lastly, jaw joint problems can occur or flare up when teeth are removed.

When is tooth replacement not needed?


Wisdom teeth do not need to be replaced. Some people have little change in their mouth when their second molars (12-year molars) are removed. Otherwise, tooth replacement is strongly recommended.

When should you undergo tooth replacement?


You should get a replacement as soon as possible after a tooth is removed. Often the replacement is started when the tooth is removed. Get an opinion on what type of replacement tooth is appropriate before the tooth is removed.

What are the options for tooth replacement?


Typically, the options available for tooth replacement are implants, bridges, dentures or partial dentures.

Dental Implants


Implants are widely used and most often the preferred option for tooth replacement.

How much pain is there with implant surgery?


Implants are placed into your jaw bone under local anesthesia or IV sedation, so there's little discomfort involved in the surgery itself. Typically people are surprised that having an implant is less painful than having a tooth removed. Like any other surgical procedure, there's some mild pain and soreness in the area around the implant for a few weeks, but this can be alleviated with pain medication. We prescribe mild and moderate strength pain relievers for all procedures, to be sure that you have medication to help you after the procedure.

How do they feel?


The teeth built on dental implants feel more like natural teeth than the other tooth replacement options, and chew better. Patients find they chew as well as natural teeth, have no discomfort and often need no further work.

How well can I chew with an implant?


Once the bone grows to the implant and the post and tooth are attached, you will be able to comfortably bite and chew any food. In fact, one of the main reasons that people opt for dental implants is their ability to mimic natural teeth and correct issues with difficulty chewing food well!

Longevity of implanted teeth


Once your implants are integrated with the bone in your jaw, research shows that they can be extremely long-lived, depending on the individual's health and anatomy. I expect that 95% of all the implants I place will be there indefinitely. Other factors like consumption of tobacco or alcohol, diabetes as well as oral hygiene, and the number of teeth being replaced can affect the longevity as well.

How long does the treatment take: during treatment, number of treatments and total length of time?


The first treatment typically takes less than an hour. At 2 weeks the sutures are removed, and the bone integrates around the implant over the next 3–6 months.

Then the implant is tested for its stability, the Implant Stability Quotient (ISQ) is used as an objective measurement of implant-bone integration (see the Technolgy section and read about ISQ). At that point, a post and crown are made within 2 weeks to fit the space, bite, and implant. In other situations, a patient may get immediate teeth the same day as the implants are placed (see Procedures section and read about Immediate Loading) and with other procedures, bone and or gum tissue may need to be regenerated. All treatment methods affect the length of total treatment time and the number of visits. As you may sense, there are typically a number of ways to take care of dental problems.

What are the advantages of dental implants?


The most important benefit of implant supported teeth over other tooth replacement procedures is that implanted teeth feel like your natural teeth, and leave you more self confident when you eat, talk, laugh and smile. Our patients tell me their implant supported teeth chew 75-95% as well as natural teeth. There is no movement in the teeth over dental implants, no discomfort with chewing, no future decay problems and no future root canal treatments. They are often a low maintenance solution to replacing missing teeth that stimulate the bone, so no further bone loss is expected. They are made without damaging or modifying any teeth adjacent to the one being replaced.

Why not have implants? Risks, common problems, etc.?


Certain medical conditions like uncontrolled diabetes, as well as alcoholism and psychiatric disorders may make you unsuitable for implant surgery. You will need to have the area(s) assessed for the amount of bone loss and the availability of space for implants. Your dental implant surgeon and restoring dentist together will determine what choices or treatment options work best for you. The most common problem that patients report is more food gets caught around the implanted teeth than natural teeth. This is similar to, or less than, other tooth replacement methods.

What are the disadvantages?


While the chances of long-term success are over 98% for lower jaw implants, they drop some as you go further back in the mouth, and with upper implants. In situations were the patient is a heavy smoker or drinker, or has other medical conditions, failure rates increase minimally as well. Implanted teeth still need to be cleaned, both at home and professionally. The fear of surgery is a disadvantage for many people, yet patient’s consistently do incredibly well with the amount of discomfort. Implanted teeth collect food, and patients comment about that routinely. I consistently hear that the treatment and postoperative recovery was easier than expected. Like most things of high value, implant dentistry requires a significant investment financially and the return on that investment exceeds the cost.

Aesthetics of implant treatment


Implanted teeth look and feel like your natural teeth, and can improve your appearance, reducing lines in the lower face, where missing teeth are affecting your facial structure.

What happens to the bone around an implant?


The patients bone attaches to the implant. This is called osseointegration. Unlike other tooth replacement methods, implants do this without affecting any of the teeth around the missing tooth site. This is unique to dental implants in that all other tooth replacements either allow bone loss to continue, or accelerate the bone loss (as with partials and dentures) where a tooth is missing and cause the remaining teeth to loosen up over time. I have treated hundreds of patients that were told years ago that they didn't have enough bone for implants. Not all dentists understand what is possible when it comes to implant dentistry because they have so many areas of dentistry to keep up on.

What are they made of?


Implants are made of an alloyed form of titanium. This has been proven to be very safe. Research shows some microscopic particles of titanium in the bone surrounding a dental implant and there are no issues for anyone (even the most sensitive patients) with biocompatibility or chemical reaction with dental implants. "Rejection" of an implant does occur and is caused by other factors.

How much do they cost?


Since the materials used for them are costly and the procedure requires precision instruments and components, dental implant fees are thousands of dollars. Most people are surprised at what the fees are for dental implants and the teeth over them, however multiple research studies show patient satisfaction above 89-97% and that the patients would have the treatment again given the choice. The dentists training and credentials to place or restore dental implants also enter into the cost and are essential to get predictability. Ask your surgeon how long he/she has placed dental implants and how many they have placed. Also ask how long the surgeon and dentist will stand behind their work. This also affects their fee. Lastly there are many implants on the market today and a number of them being made overseas. Most have little to no research to back-up claims of predictability. Dr. Kammeyer uses Nobel Biocare implants, which have been the industry leader worldwide for decades.

How much research is there on implants?


Since the discovery of the osteophilic or "bone-loving" properties of implants by a Swedish orthopedic surgeon at Nobel Biocare, in 1952 and their subsequent availability for widespread clinical use in the 1980s, there has been extensive research into new materials and procedure modifications to achieve extremely high levels of predictability.

Bridges


Bridges are traditionally a popular choice for tooth replacement, given to their cost and are used less now that we have a more predictable option. Here's what you need to know about them:

How do they feel?


Bridges feel and look somewhat like natural teeth or implanted teeth. A crowned tooth covers the "abutment" teeth and fake teeth or "pontics" that rest on your gums and the adjacent teeth, they span a longer space than dental implants. Ceramic or porcelain bridges can be made to match the color of your natural teeth, and can come close to looking and feeling natural. Bigger bridges will feel weaker and a patient that has both implants and bridges will predictably chew on the implanted teeth rather than the bridged teeth as they are stronger.

How well can I chew with a bridge?


Once you become accustomed to a bridge, chewing and biting can become easier than with a missing tooth. A tooth replacement will also help you speak more clearly, since missing teeth can affect the way you speak.

How long does making a bridge take?


Bridges can normally be completed in two weeks to several months, with at least two visits to the dentist and often more. Each visit can take between 45 minutes to several hours, depending on the health of adjacent teeth and how extensively they have to be ground down to accept the bridge.

How long does a bridge last?


The condition of the teeth that a bridge fits on is the biggest factor in bridge longevity. The better the bridge fits and the better you maintain your oral hygiene through brushing, flossing and dental checkups the longer it will last. Research studies show a wide variability with bridges lasting between 5 and 15 years or even longer. The more teeth that are replaced, or the worse condition they are in, and the more a patient clenches or grinds their teeth, the faster a bridge will fail.

What are the advantages?


The biggest advantage that bridges have over other treatments is that there is often no surgery involved for their placement, and the procedure takes less time with fewer visits. Bridges can also help to restore natural tooth function, though not as well as implants, yet a bridge is an improvement over a missing tooth nonetheless.

What are the disadvantages?


Since a bridge is typically installed by cutting away the hardest part of a tooth, the enamel on the teeth, they weaken the tooth and cause much pressure on the remains of the teeth. This often leads to a tooth dying, which requires root canal treatment. If decay or periodontal (gum and bone) disease occurs the bridge will need replacement or worse yet, the tooth may need extraction. Every week we treat a patient that has failed bridgework with a hopeless tooth. Either of the results wipes out the initial cost-effectiveness of a bridge. Lastly it can be difficult to clean under a bridge since they're connected to one or more teeth so food collects where teeth are lost. Since each person's mouth is unique, ask your dentist which method of tooth replacement is best given your situation.

How are bridges made?


Bridges are made by attaching a fake tooth to one or more teeth adjacent to the space of the missing one, after the outer layer of tooth structure has been removed.

What happens to the teeth that bridges hang onto?


The adjacent teeth are ground down so they will support the replacement tooth, so the extra pressure from the missing tooth is supported by the trimmed down teeth. Note the disadvantages mentioned above.

How aesthetic is a bridge?


Bridges can range from looking almost completely natural to obviously fake, depending on the material used as well as the position of the teeth in a person's smile. Given implants replace fewer teeth they are often but not always, more aesthetic.

What happens to the bone under a bridge?


The bone will resorb over time under the false tooth of a bridge, sometimes a little, sometimes a lot. Whenever a tooth is extracted the bone melts a great deal during the first 6 months, so planning before tooth removal is especially important.

What are bridges made of?


There are many materials used for bridges, with ceramic and porcelain on metal being the most popular choices since they can be made to match natural tooth color. With longer spans bridges use base metals, which often include nickel, under the porcelain. Costume jewelry is typically made with nickel, so you should tell your dentist that you are sensitive to nickel if you are planning any crown or bridgework.

How much do they cost?


In the short term, bridges are often but not always cheaper than implants, since they take less time and the materials cost less. Over the longer term (greater than 5 years) studies show bridges cost more. This initial cost difference can be a few hundred dollars to over a thousand dollars.

Partial Dentures


Partials are a common tooth replacement option for people who have lost a number of teeth. Here's what you need to know about them:

How do they feel?


Partials feel awkward or bulky when you first start wearing them, just like full dentures. Studies show that most people don't continue to wear their partial denture as they never get used to it. Some partials move around when eating, talking or laughing and patients tell me that they feel uncomfortable.

How well can I chew with a partial denture?


This varies with how many and which teeth are being replaced. When there are more teeth replaced by the partial denture, then fewer teeth support the partial denture during use. This results in a decreased ability to chew. Much like dentures, our gum tissue was never designed to withstand the forces of chewing. When food gets under a partial denture, it is "pinched" between the partial and the gum tissue and that hurts. This causes social insecurity, especially when eating out with family or friends.

How long do partial dentures take to be made?


Partial dentures can be made in 2–5 visits.

Do patients wear partial dentures long term?


When a partial is adjusted to fit in your mouth, you may be asked to wear it all the time. This will allow quicker adjustment as well as identification of any problem areas. In my experience and according to several research studies, most people (4 out of 5) abandon their partial dentures long term. Most often people object to the bulk of the appliance. Looking at a partial denture, it is easy to see that there is a lot of metal and plastic to replace the missing teeth.

How long do they last?


The partial itself is very durable. The bone under a partial denture resorbs, melting away permanently and the teeth can shift, decay or break over time. With proper care, you can expect them to last anywhere from 5 years and then the partial will need to be relined or a new one made.

What are the advantages?


The main advantage of a partial denture is that it is easy to make (compared to other tooth replacements) and they cost much less than bridges or implants. In addition, the procedure is relatively painless.

What are the disadvantages?


The main problems with partial dentures are that they can be uncomfortable to wear, do not last as long as more permanent replacements, and need continued modification or replacement as the bone under them melts away and the plastic teeth wear down.

How are partials made?


Partials are made with base metals including nickel and chrome with plastic/acrylic gum and teeth replacements called methyl methacrylate. They are basically fake teeth that are attached to a replacement pink or gum-colored plastic base, which usually is attached to a metal framework.

What happens with the teeth that they grab onto?


Like bridges, there will be extra pressure and erosion or decay on the adjacent teeth where a partial grabs on for support. This results in loosening, decay or fracture of the abutment tooth that the partial attaches to.

How aesthetic are partial dentures?


Most partials can be made with materials that look similar to your natural teeth, but they do not look as natural as implants or bridges. Partial dentures can also shift or move when you speak or eat, and be noticed as false teeth. They often also have wire clips that are visible in one's smile.

What happens to the bone and gum tissue under a partial denture?


Similar to the way bridges can cause bone under them to diminish and deteriorate over time, partials may also have the same effect. If you don't keep them clean, this can also cause food to accumulate under them, leading to gum disease or damage. I have removed diseased tissue under partial dentures, caused by the irritation of the partial denture on the soft tissue.

How much do they cost?


Partial dentures are much cheaper than implants and bridges initially, primarily because they require less time, use simple techniques and do not last as long. Cost will vary depending on the number of teeth that need to be replaced, and can range from a few hundred dollars for a temporary partial to well over several thousand dollars.

Complete Dentures


Dentures are a traditional way to replace a full arch of missing teeth. They have been used for decades and are typically custom-made for your mouth. They can take a few weeks to a few months to be completed and rely on the "snow shoe" principle, resting on lots of soft tissue when you bite down. This makes the denture much bigger than the teeth being replaced.

How do they feel?


Dentures initially feel very awkward or bulky. Whenever this many teeth are changed, with any method, a persons speech is affected. Some people adapt to them over time and in my experience, the older a person is the harder it is for them to adapt. Dentures move around when eating, talking, or laughing, and lower dentures move the most. Dentures put pressure on the gum tissue and often cause sore spots when new, as the bone changes, or when a person eats medium to harder foods.

How well can I chew with a complete denture?


Studies show that denture wearers can chew 10% as well as people with teeth. Denture wearer's diets tend to be softer and sweeter than for people that have teeth, at a time in one's life when "roughage" becomes more important. When food gets under a denture, it is "pinched" between the denture and the gum tissue and that hurts. This causes discomfort, embarrassment, social insecurity, and studies show many people that wear dentures socialize less. This is all reversed when patients shift to dental implant supported teeth.

How long do dentures take to be made?


Dentures can be made in 2–5 visits, when a patient has no teeth. If they are having teeth removed or the tissue isn't healthy, more visits are required to fit a denture.

Do patients wear dentures long term?


Many people abandon their lower denture long term. I have seen this countless times and often replace a new denture with implanted teeth because the patient can't tolerate the denture. Given the gum tissue is thinner, there is no palate to cover with the denture and the tongue is a very strong muscle, it is no surprise that keeping a lower denture in place is a challenge. Even though the upper dentures have more stability than lowers, patients increasingly want to replace their upper dentures as often as we replace lower dentures.

How long do dentures last?


The bone under a denture resorbs rapidly because the denture pounds on the gum tissue causing the bone to melt away permanently. This bone loss continues as long as a person wears a denture and is worse than if they don't have a denture at all! With proper care and average bone loss per year you can expect them to last anywhere from 2–5 years and then it will need to be relined or new dentures made.

What are the advantages?


The main advantage of a denture is that it takes less time and they are cheaper to make, costing less in the first few years. How easy it is to make can be deceiving, because it is an art that requires experience to do well, especially with a patient who has worn a denture a long time. Many dentures will never meet the patient’s expectations no matter how well they are made. The procedure is relatively comfortable.

What are the disadvantages?


Denture wearers suffer many problems: Difficulty chewing, speaking, keeping the denture in place, especially when laughing, sore gums, and social insecurity are just a few of the problems that countless denture wearers have mentioned to me. Dentures require regular modification or replacement to maintain the fit of the denture on the tissue, as the bone under the tissue keeps changing its shape. Many denture wearers just live with their denture long-term and wear the bone away unevenly. For these folks it is much like a car, deferred maintenance does catch up to the owner.

How are dentures made?


Dentures and partials are made with with a plastic/acrylic called methyl methacrylate. They are basically fake teeth that are attached to a pink or gum-colored plastic base. This takes 2–5 visits minimum.

How aesthetic are full dentures?


Most dentures are made with materials that look similar to your natural teeth yet there is that "denture look" that many people don't like.

What happens to the bone and gum tissue under a denture?


When teeth are removed, 25% of the bone is lost in the first 3 months and 50–60% is lost in the first 6 months. Over the long term this bone loss continues. A long time denture wearer consistently has less bone than they had years ago. Much like the bone, the gum tissue wears down and becomes thinner in some areas and becomes loose and flabby in others, causing the patient to have sore spots or problems with getting a denture to fit.

How much do they cost?


Full dentures are much cheaper than implanted teeth, because they require less skill and training, less time to make, use simple techniques and do not last as long. Cost will vary depending on the number of teeth that need to be replaced, and can range from over a thousand dollars for one denture to several thousand dollars per arch of denture teeth.

How will a denture affect your diet?


With full dentures, you will most likely be able to eat soft and medium hardness foods. Most people who wear dentures cut their food into smaller bites, they avoid food that is extremely sticky, hard or has sharp edges and countless denture wearers that I have treated can't eat steak.
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