Filling the Space
When a tooth is extracted there will be a space, does the space need to be filled?
If it is the last tooth at the back of the mouth then the answer is often NO. You will notice the lack of tooth initially but over time you may find that you function well without it. Spaces in other areas of the mouth will depend on aesthetics, the way your teeth bite together and the health of adjacent teeth.
It is important to wait for healing to finish (about 6-8 weeks) to see the final bone height. If we place something too early the bone may shrink back more and you end up with a gap (which will look black) under the restoration.
If you want to fill the space there are three main options
Implants-a titanium fixture is placed in the bone and a porcelain tooth is attached to it
Bridges-the tooth/teeth beside the space are used to support a porcelain tooth
Partial dentures- removable denture with acrylic teeth
These are the most expensive of the options, and the most time consuming. However they cause no damage to surrounding teeth and can be the most “tooth-like” replacement as they “grow” out of the gum just like a real tooth. They are a long-term treatment but need to be checked and maintained like any other tooth.
The specialist, (while you are sedated,) will drill a hole on the bone and place a titanium fixture. The bone has to heal (a couple of months) then the fixture is re-exposed and a porcelain crown is placed on it. Some implants can be fairly immediate depending on the situation; the specialist can let you know your options. You may need to wear a plastic partial denture for aesthetics while waiting for the bone to heal.
Advantages: tooth like, long-term, no damage to other teeth
Disadvantages: surgery, cost, time
These rely on adjacent tooth/teeth to support the replacement tooth.
There are different types of bridge depending on where in the mouth the space is and the quality of the adjacent teeth.
Maryland bridge- these are used only at the front of the mouth to replace a single missing tooth where the tooth adjacent to it is fairly filling free. Minimal preparation is done on the back of the abutment tooth and an impression is taken. The laboratory will make a porcelain tooth with a “wing” of metal that is glued to the prepared tooth. This should have a life of approximately 10 years.
Advantages: minimum damage to other tooth, can be used on teeth affected by gum disease
Disadvantages: can’t be used on posterior teeth, can become unglued
Fixed-fixed bridges - a crown is placed on the teeth on either side of the space and the replacement is hung between them. As this means that the teeth beside the space must be cut down, this is not suitable for teeth without any fillings, as we would be cutting sound teeth. It is also not suitable for teeth that are loose due to gum disease as we would be splinting the mobile tooth to another non mobile tooth, this doesn’t make the loose tooth firmer, it just makes the firm tooth as loose This should have a life of approximately 15-20 years.
Advantages: non-removable, good aesthetics
Disadvantages: adjacent teeth need to be cut down for crowns, more difficult to floss, increases loading on adjacent teeth
These come out at night and for cleaning. The framework can be made of plastic (with a life of about 5 years) or metal (with a life of about 15 years). Metal is stronger and will fit and stay in better. Plastic is cheaper but less comfortable in the mouth. Some small dents may need to be placed in the remaining teeth so that the denture sits on them without interference.
Advantages: minimal damage to other teeth, can fill multiple spaces
Disadvantages: food will get caught underneath, fairly bulky in the mouth, metal clasps may be visible