13. Methods To Replace Missing Teeth — Implants And Their Restorations

In the last topic, the option of fixed bridges, includ­ing their advan­tages and dis­ad­van­tages to replace miss­ing teeth was dis­cussed. In this topic, the option of using den­tal implants and their restora­tions to replace miss­ing teeth will be dis­cussed. Also the advan­tages and dis­ad­van­tages of the implant option will be dis­cussed. For many peo­ple, the implant option is the best option for replac­ing miss­ing teeth.

You can think of den­tal implants as arti­fi­cial roots placed in the jaw bone under the gums. Once the bone has fused to the implant(s), the implants can be restored with post(s) and crown(s) or bridge(s) or remov­able par­tial or full overdenture(s). An over­den­ture is a den­ture that cov­ers nat­ural teeth or implants with attach­ments con­nect­ing to the overdenture.

Implants are often screw shaped, come in dif­fer­ent diam­e­ters and lengths, are made of tita­nium or tita­nium alloy and often have dif­fer­ent sur­face coat­ings or treat­ments. The designs of den­tal implants have the pur­pose of pro­mot­ing bet­ter or faster heal­ing with the bone, with­stand­ing forces dur­ing chew­ing and resist­ing future bone loss around the implants.

The advan­tages of using implants to replace miss­ing teeth are numer­ous. Implants can be restored with crowns or bridges that are fixed or non-removeable restora­tions, which are viewed by many peo­ple to be a sig­nif­i­cant advan­tage. When implants are restored with posts and sin­gle crowns, there is more poten­tial for a bet­ter cos­metic result than with bridges (whether on nat­ural teeth or implants ) or remov­able par­tial or com­plete den­tures. Implants with sin­gle sep­a­rate crowns can be cleaned with floss and brush­ing just like nat­ural teeth, which is an impor­tant advan­tage. Implants do not get cav­i­ties and do not become sen­si­tive to hot and cold, which can be viewed as other advantages.

One of the most impor­tant advan­tages of implants and sin­gle crowns over fixed bridges on nat­ural teeth is that with implants there is no touch­ing or reduc­tion of the adja­cent nat­ural teeth to the miss­ing tooth space, unlike bridges on nat­ural teeth. Also if an implant restora­tion fails, the fail­ure is con­fined only to the implant, which can be replaced in the future. When a bridge fails due to bone loss, root frac­ture or caries of one sup­port­ing teeth of the bridge, often the entire bridge is affected. If a future bridge is desired and pos­si­ble, it will be larger than the orig­i­nal bridge, involv­ing more new sup­port teeth, with the poten­tial of the same prob­lem in the future.

Another advan­tage is that on implant sup­ported restora­tions, forces are trans­mit­ted to the implants, which helps main­tain the bone in the area of the implant. When an area of the jaw bone is not used or does not receive trans­mit­ted forces, that area over the years will decrease in width, height and often den­sity as well. In addi­tion, use of implants can sta­bi­lize loose remove­able par­tial and full den­ture, require delib­er­ate removal of the den­ture by the patient and result in smaller den­ture designs, which are other advan­tages of using implants.

It is because of these advan­tages that den­tists view replace­ment of miss­ing teeth by implants and their restora­tions as the pre­ferred method of replac­ing miss­ing teeth for many patients.

Like all meth­ods used to replace miss­ing teeth, there are dis­ad­van­tages to using the implant method to replace miss­ing teeth. How­ever unlike the dis­ad­van­tages of remove­able pros­the­sis or bridges to replace teeth, the dis­ad­van­tages of using implants are more based on non-dental rea­sons and not rea­sons directly related to the implant and its restora­tion treat­ment. Implants and their restora­tions often cost more than the other options, which may be viewed by some peo­ple as a dis­ad­van­tage. The process of implant place­ment and restora­tions takes longer than the other option, which may be viewed as dis­ad­van­tage by some people.

In some cases, where there is a lack of bone to place implants, the bone must be built up before the implant place­ment, which adds addi­tional time and cost to the treat­ment. Also the short and long term suc­cess of implant place­ment and restora­tion is depen­dent on a person’s health ( not age ) and habits, such as smok­ing and oral hygiene. In other words, it can be viewed as a dis­ad­van­tage that not every­one may be a good can­di­date for implant place­ment and restoration.

In sum­mary, for many peo­ple, replac­ing miss­ing teeth with implants and their restora­tions is the best option. Gum spe­cial­ists ( peri­odon­tists ) are involved in the place­ment of den­tal implants in the jaw­bone, while the gen­eral den­tist pro­vides the implant restora­tions. In the next topic, the rela­tion between the untreated advanced peri­odon­tal dis­ease to one’s over­all gen­eral health will be discussed.