You may think how we are going to fix missing teeth. In teenagers or children, damages to the teeth may cause fractured or tipped teeth. In adults, the caries in teeth can get into the bad condition that one or some teeth are completely worn out. Insufficiency of fluoride in water ,poor nutritional conditions, accidents, deep dental caries, congenital absence of teeth, poor gum condition are all factors for why we miss our teeth. Prosthodontics treatments for missing teeth replacement and restorative dentists by considering our financial situation, time and beauty of the smile on our face can give us what we need to have our smile again.
Type of denture to replace missing teeth
Generally, there are 3 ways to fix missing teeth:
- Bridges or fixed partial denture
- Removable partial denture
In this article we will discuss fixed dentures (bridges) and removable dentures.
First, we need to know about some terms. Crown is a restorative cover that is bonded or cemented to the reaming part of our damaged tooth. The root that the fabricated tooth is secured by is abutment. The abutment can be the implant or our remaining tooth root or portion of a tooth. The artificial tooth to stand on the abutment is pontic.
What is dental bridge or fixed partial denture?
Fixed partial denture or bridge is the appliance that is permanently and with mechanical prosthodontics attached either on abutment implant root or our tooth root. The fixed partial denture is one way to replace one or some missing teeth. The design of bridges should consider the amount of force that retainers, pontics and connectors are putting on abutments. Challenges appear when the decision over the implant, removal or fixed dental replacement should be selected. For example, just 2 posterior teeth should be replaced with fixed partial denture. The more teeth we lose in on side of our arch in the jaw, the better it is to use removable partial denture or implant-supported fixed dentures. The types of dental bridges or fixed partial dentures are:
- Resin bonded tooth-supported bridges: the success of this technique lies in adaptability of resin bonding to different materials with newer technological advances. Resin-bonded fixed dentures are suitable when in missing teeth replacement, the preservation of tooth structure is important. It can be suitable for young patients because of tooth immaturity and if healthy teeth can be used as abutments.
- Conventional tooth-supported bridges : in fixed bridges, conventional supported teeth as the name suggest uses teeth as abutments in nearby missing teeth to hold the denture and this offers the usual fixed bridge as a replacement for missing tooth.
- Cantilever fixed brides: the abutment for the pontics is secured on just one side is called cantilever prosthesis. It is easier to make compared to other fixed dentures and easier adhesion work in case of failure is useful advantage of cantilever fixed dentures.
- Implant-supported bridges: it can be beneficial for either single missing teeth or long-span missing teeth. If the abutments to hold the crown and pontics don’t have enough strength, implant-supported bridges are better choices.
The advantages of fixed bridges:
- In the anterior teeth even with removable dentures, bridges can keep our smile
- If it used with removable partial dentures, the number of missing teeth can be reduced for easier removable dentures
- When we have better condition in our gums and bones to support the abutments, the fixed bridges are favorable choices
- In single missing tooth, it is the dominant choice
- Fixed bridges can serve us for a long period of time if made with great care considering the oral, periodontal and occlusal factors
What is removable partial denture?
If more than two teeth are missing in each side of our arch, removable dentures are better choices. One of the differences between removable and fixed denture is the abutment features. For fixed denture, if the poor condition of soft tissue in the ridge (where the tooth is grown and rooted) exists, it may require augmentation with graft. Since these processes may need more budgets, removable partial dentures again are the options to choose. The abutments and the pressure on retainers should all be managed so that force is equally distributed and harmful forces to the soft tissues and gums will be decreased.
In these situations we need removable partial dentures:
- In case when bone loss exists in the anterior region
- Because of periodontal disease, abutment teeth can’t support bridges (fixed dentures)
- Too many missing teeth and a high degree of edentulous space (the space that teeth are lost)
- When support is necessary to stabilize the pressure vertically
- When in each side of arch, there are remaining teeth to support the long edentulous space
Finally, for choosing the material and other restorative strategies we need to be aware of the best treatment for our oral health and function.
Restorative dentists and oral surgeons have all the factors in mind when choosing removable partial dentures or fixed partial dentures (or bridges as we repeated in the text).
Some of the important denture treatment plans for replacing missing teeth are:
- Patients desire and wishes ( the most important factor)
- Time and financial factors that the patients afford
- Periodontal status (gum tissues surrounding the teeth are examined for any disease or inflammation)
- Biological and functional factors (from tooth size and occlusion to the space and the amount of load that is going to be on other adjacent teeth)
- TMJ (temporomandibular joints) is analyzed for any symptoms of harm and habits like bruxism or other parafunctional activities. Therefore, recommended space and size to prevent damages to the interior muscles and jaw bones are predicted