At StoneRock our preferred choice is always to try and restore a tooth rather than remove it but sadly this is not always a viable option. If you have damaged or missing teeth this Mind The Gap page will give you more information on the options.
If the tooth in question is decayed or fractured to a point where there is not enough sound tooth tissue left to support a crown or a filling or if the tooth has lost too much bone support around it (through advanced gum disease) then we have no choice but to remove it. When the tooth has come out many patients find the presence of a gap or missing teeth unacceptable on aesthetic or functional grounds and we will always advise you as to whether we think it is unwise to leave a gap if we think it will lead to further problems elsewhere.
We have a number of ways to replace teeth and each approach has its own advantages and disadvantages which I will go through with you now. Where a tooth is lost through lack of bone support this can influence how we can replace it as implant retained crowns require an adequate depth of bone that may not be available if the bone has already been lost through gum disease. (Patients who are susceptible to gum disease are also at a higher risk of developing infections around implants so this can influence our decision making as well).
It is fair to say that no replacement option is as good as a solid, healthy well restored tooth but all of them are better than just gums!
Dentures are generally the cheapest way to replace a tooth and require little if any adjustment to any adjacent teeth. Dentures can be made from conventional rigid acrylic or from flexible acrylic or even cast chrome with each approach providing slight advantages and disadvantages in each approach. Millions of people wear dentures everyday and most of them manage to a reasonable degree with them. It is probably fair to say however that very few denture wearers love their dentures and most would rather have a fixed solution if possible. Where we have replaced multiple teeth with dentures patients report a significant loss in chewing function, taste and confidence but a single tooth denture can be better tolerated as you still have plenty of teeth to chew with. That said a single tooth denture is invariably much more bulky than the tooth it replaced and will always experience a small degree of movement on chewing. All dentures need to come out at night to allow for adequate cleaning and to give the mouth a chance to settle.
Bridges provide a way of attaching a false tooth to one or two adjacent support teeth so that the restoration is rigidly secured in the mouth and does not need to come out a night or for cleaning. There are really three different types of bridges and we can advise you of which one is most appropriate for you based on the health and strength of the adjacent support teeth, the length of the span required to bridge and the position in the mouth. In short however we have the following options-
- Direct Fibre Reinforced Composite (FRC) Bridge: in this scenario we build up the false tooth in the mouth (or, occasionally, use the existing natural tooth) and bond it directly to the adjacent teeth using strips of FRC to secure it. These bridges can be completed in one visit and require almost no adjustment to the adjacent teeth. They can be added to and repaired very well in the mouth which is often a huge advantage. They are almost exclusively used for smaller front teeth where they can provide excellent service.
- Cast adhesive bridge: this type of bridge is similar to the Direct FRC in that it is stuck on with very little, if any, adjustment to the adjacent teeth but are generally stronger and more highly polished than the direct versions. Because they involve a laboratory stage to make the bridge they require two visits and cost more than the direct version. They are often not repairable in the mouth and as with all adhesive bridges they can de-bond from time to time and require recementing. Again these are used primarily for front teeth.
- Conventional bridge work: in this approach we prepare the adjacent teeth for crowns that are linked together to a false tooth and cemented in place. Again this approach requires a laboratory stage and takes a minimum of two visits to complete. These are the most expensive types of bridges but also the ones likely to last the longest and can be used to replace back teeth and longer span gaps. The key disadvantage to this type of bridge is the impact it can have on the support teeth which can die off (require a root canal filling) as a result of the work done to them or fracture due to the increased loads put upon them. Conventional bridge work can last many years but there is an adage in dentistry that “when a (conventional) bridge fails it will take a tooth with it” meaning that a one tooth gap can become a two tooth gap.
Implant retained crowns
Implant retained crowns were developed as a replacement option for teeth in the late 1980s and have evolved over this time to their current form, with the ones we use today being the standard type for over 10 years. The big advantage that implants have over bridges is that they do not rely on or attach to or damage the adjacent teeth in any way; they are stand alone units that look and feel and function like a real tooth. The disadvantage of implants relates to time and cost with them usually taking a minimum of three months and sometimes much longer to complete. This time delay is needed to allow the body to heal around the implant and for the bone to fuse to it. Where there is insufficient bone we can graft additional materials (usually derived from specially prepared sterile cow bone) but this will always add to the healing time and the cost of the procedure. Implants can be used to replace anything from a single tooth to a full jaw of teeth depending on your individual need.
Implants can never decay but they are susceptible to a similar condition to gum disease (known as peri-implantitis) which can lead to the loss of an implant if left untreated. Patients who have gum disease or who smoke or who have diabetes are at a higher risk of developing per-implantitis and all patients who have implants need to keep the gums around them scrupulously clean on a daily basis and work regularly with one of our hygiene team to prevent infection developing around the implant.
It is a very common question to ask how long will my replacement tooth last and whilst this is a very reasonable question to ask it is a very difficult question to answer. A well restored tooth when compared to a bridge or an implant retained crown should all last around the same length of time (10-15 years under ideal conditions) but the mode and consequence of failure may be different so it is important to consider all of these factors when making a decision.
We will always try and help in giving answers to any questions you may have and will advise you if we think that certain options are clearly better or worse for you but ultimately the final decision is always yours.
Hemisection of multi rooted teeth
When we are dealing with molar teeth we sometimes have the option to section the tooth and remove one damaged root and retain any remaining strong roots. We can then restore the retained roots with a smaller crown that will not be quite full size but will still function reasonably well. We do not expect teeth treated in this way to give many years service but the survival rates to 5-8 years are reasonable and they sometimes represent a little bit of a “get out of jail” card if we have no other alternatives. Because of the way the roots are shaped this approach works better for lower molars