Despite your best efforts, you’ve lost one of your teeth. Maybe it left a gaping hole in your smile and you want to fix it. Maybe you can’t see the gap, but you’ve read my post on why you should replace a missing tooth and were persuaded. There are two important considerations: how to make the replacement tooth look good, and how to make it as functional as possible.
For looks, ceramic is more tooth-like than plastic (see Bondings vs. Veneers).
In terms of function: when you bite, you’re exerting about 150 pounds per square inch on your teeth. That's a lot of pressure. Fixed teeth are more stable, more efficient, and usually also more comfortable than removable teeth.
The most expensive options are not necessarily the best for everyone; your health and the state of your finances are both legitimate considerations. What are your options?
Implants
Today’s top-of-the-line tooth replacements are implants, which have been around for decades. In look and function, an implant is the closest you can get to having your real tooth back. It’s a ceramic tooth on top of a metal post that’s anchored in your jawbone. If we decide you’re a good candidate for an implant, you first need to visit an oral surgeon to have the post set into your jaw. After 3 to 6 months of healing, the post is firmly set. During that time, you have a temporary tooth to fill in the gap. Then you come back to my office to have an impression made for the ceramic tooth, which can be fabricated in about 10 days. The current way to do this is via computer-assisted design / computer-assisted manufacturing (CAD/CAM), which carves the tooth out of a solid block of porcelain, creating a tooth that’s precisely shaped and extremely durable.
A well-made implant will last decades. However, implants are not a good choice if you have problems with your bones or if you have a condition that makes surgery inadvisable. You should also be aware that many insurance plans do not cover implants, because implants are an expensive option that require the services of both a dentist and an oral surgeon. (See my post on insurance.)
Crown-and-bridge units
A “crown and bridge” is a ceramic tooth that’s permanently anchored to teeth on either side, rather than anchored into your jaw. (That’s why it’s called a “bridge”.) Depending on how many substitute teeth are between the two teeth that anchor it, it could be a 3-unit, 4-unit, or 5-unit bridge—or even more. To have a bridge made, you must have teeth on either side of the missing tooth whose roots are still solidly attached to the bone. To make one, I create a crown for the top of each anchor tooth, and then recreate the missing tooth or teeth between them. Then the whole unit gets permanently attached to the two teeth on the ends. Years back, a crown-and-bridge unit meant having silver or gold metal showing in your mouth. Today a crown and bridge can be metal free, and almost indistinguishable from your real teeth.
Like the tops of implants, the crowns and the replacement teeth are carved from porcelain blocks. On average, a well-made crown-and-bridge lasts 5 or more years. I have patients who’ve had them for more than 20 years.
You’re a good candidate for a crown and bridge if you have a condition that makes implant surgery inadvisable, or if you can’t afford implants. You’re not a good candidate if you have many teeth missing in a row, or if you don’t have teeth on either end that can serve as strong anchors for the replacement teeth.
Removable bridge
A removable bridge is like the crown-and-bridge described above, except that the ceramic replacement teeth aren't permanently attached to the supporting teeth on either end. Instead the rest on the gums and "hold onto" the remaining teeth. This is less expensive than a crown and bridge because it doesn’t require the making of the crowns to anchor the bridge. On the other hand, because it’s not permanently attached, a removable bridge might wobble a bit when you chew.
If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net or through my website,www.DoctorDurante.com. The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.
