Missing Teeth and
Tooth Replacement
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Overview
Teeth can be lost when they
are irreversibly damaged due
to dental decay or trauma.
Gum disease can also affect
the supporting bone and gum,
leading to the loosening of teeth
and eventual loss.
When teeth are lost, there are
several methods that can be
used to replace them. These
include dental implants, bridges
and dentures. When the infected
tooth cannot be saved and has to
be removed, prosthesis replaces
the missing tooth to restore
speech, function and aesthetics.
TYPES OF TOOTH REPLACEMENTS
Dental Implants
Dental implants are a substitute
for a missing tooth root. Due to its
durability and strength, they are ideal
as tooth substitutes.
Implants can be used to replace a
single tooth, multiple missing teeth or
to replace teeth in cases with complete
tooth loss. Therefore, in almost any situation, a missing tooth can
potentially be treated with this method.
Almost all dental implants used today
are made from titanium alloy. It is
commonly cylinder- or screw-shaped.
Each implant is carefully and precisely
drilled into the location of the
intended tooth and provides a firm
and stable foundation for long-term
support of the replacement teeth.
These materials have been shown to
be well-tolerated by the body and are
used as supports in the fabrication
of prosthesis to restore function and
aesthetics.
PROCEDURE
The treatment is carried out by a team
of restorative specialists and surgeons
working in close collaboration.
Your dental surgeon will assess your
suitability for treatment with these
implants, taking into account various
considerations such as your bone
volume and quality, tooth and jaw
relationship, oral habits and general
medical health. This may include a
detailed analysis using different X-rays
and scans.
Normally it takes about four months
to a year to complete the entire
treatment. This would depend on
case complexity as well as the need
for additional procedures like bone
grafting.
Phase 1: Treatment Planning
A thorough assessment of your
medical health, oral health, the way
your teeth fit together and bone
volume will be done to produce an
individualised treatment plan.
Phase 2: Surgical Treatment
A minor surgical procedure is carried
out to place titanium fixtures into the
bone. If bone and/or soft tissue are
insufficient, there may also be a need
for additional grafting procedures
before the implants can be placed.
Phase 3: Restorative Treatment
After the integration of the implant
fixtures to the bone, ‘new permanent
teeth’ will be designed and fabricated.
Bridges
A bridge is a fixed prosthesis that
replaces missing teeth by using
neighbouring teeth as support.
Healthy neighbouring teeth are
trimmed and the bridge unit is
fixed on them. A small number of
missing teeth can also be replaced
if the neighbouring teeth are
sufficiently strong.
A bridge can be made of ceramic or
a combination of metal alloys and
ceramics to maximise strength and
simulate a natural appearance.
TYPES OF BRIDGES
This consists of two crowns joined to an artificial tooth that is meant to
replace the missing tooth. The healthy neighbouring teeth are trimmed
and the bridge unit is fixed onto them.
This requires minimal trimming of neighbouring teeth on their back
surfaces. Cement is used to bond the bridge structure to the back of
these teeth. Although this method conserves more of the neighbouring
teeth’s structure, not all patients are suited for it. Your prosthodontist
will advise you on the technique most suited for your condition.
PROCEDURE
Your dentist will need to assess
important factors such as the number
of missing teeth, the condition of the
neighbouring teeth and as well as
those of the supporting gums and
bone prior to advising you on making
a bridge. Your dentist will also be
able to advise on alternative ways of
replacing missing teeth after a clinical
examination.
The procedure itself requires at least
two visits on an outpatient basis to
complete.
The first visit usually involves
trimming the teeth under local
anaesthetic, making an accurate
mould for the dental laboratory
to fabricate your prosthesis and
placement of a temporary bridge for
you to function in the interim period.
At the second appointment, your
dentist will remove the temporary
bridge and check for the fit, bite
and look of the final bridge before
cementing it in place.
Maintenance care for bridges is similar
to that for crowns. The focus is on
regular flossing, brushing as well as
regular check-ups.
Dentures
 A denture is a removable prosthesis
used to replace missing teeth.
Commonly referred to as ‘false
teeth’, it is usually made of acrylic
or a combination of acrylic and
metal. A partial denture is fitted to
replace some missing teeth whilst
a complete denture is indicated
when all natural teeth are missing.
A good set of dentures helps you
to eat, speak, function and often
makes the person look better.
PROCEDURE
Depending on the complexity
of each case, the duration of the
treatment will take about two to
six visits. After the initial visit for
examination and diagnosis, the
subsequent visits will include
making impressions of the mouth
(getting the shape of your gums
and soft tissues), bite registration
(checking how your upper and lower
jaw relate to each other), try-in of
the denture (to check for how the
final denture will look like), issue and
review.
In certain cases, especially when
all natural teeth are absent, dental
implants may be used to aid in
anchoring the dentures so that
they do not move during function.
Your dentist will advise you if you
are suitable for the use of dental
implants to retain your dentures.
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