Often times if you lose a tooth you will have several options to restore the tooth or teeth. Most of the time you'll be given several options. Namely you could do nothing, have a removable denture(s), have a full denture(s), have a crown, crowns and/or bridge(s), or have an implant(s). Dr. Bohannan, his staff and your general dentist or prosthodontist will try to make each option clear.

Doing nothing after an extraction is certainly an option.  Where this often times makes sense is in the very far back.  Rarely do people need their wisdom teeth, and if you are planning to have an erupted wisdom tooth removed because of decay, lack of restorability, or your dentist indicated it could be restored but it would be of little value, it is not necessary to plan to restore the missing tooth. 

Occasionaly due to your occlusion (the way your teeth come together), removing one tooth has little change to your bite and its functionality.  In these cases, restoring that missing tooth may not yield enough of a benefit to you to warrant a restorative procedure.  This is common when dealing with upper second molars and to a lesser extent lower second molars.

Less commonly, multiple back teeth being lost may not need to be replaced.  If your occlusion is relatively normal, most people do most of their chewing at or about where their first molar is and just forward of the first molar.  The second molar provides some chewing efficacy, but not a tremendous one if the first molars and teeth forward of the first molar are intact.  As such, most people who lost all of their teeth and then are restored back to first molar occlusion, find that there is little benefit with respect to chewing by having the second molars present.  Dr. Bohannan will evaluate your condition and provide you with a treatment plan that is based on functionality and benefits to you, rather than just restoring everyone back to a normal compliment of teeth. In some cases, Dr. Bohannan will restore patients back to a first molar "bite" and have them get used to it.  On rare occasions, patients often ask to add to the treatment plan by having the second molars replaced.  Some patients often indicate they "miss their teeth in the back". 

In most cases, teeth lost should be replaced.  If they are not replaced, the teeth on either side of the missing teeth can shift and the teeth above and below the missing one can also shift and over-erupt.  This can create biting problems and lead to bone and gum disease of the surrounding teeth and may even lead to premature tooth loss.

Removable dentures

When many teeth are being replaced and cannot be restored using crowns and bridges, removable dentures can be utilized.  These devices usually have a metal frame work and have pink colored acrylic that mimics the gum tissues and of course has the teeth that you are missing.  It requires other teeth be present to work as the device uses the other teeth for support.  These devices usually work well but some complain of being able to see the metal clasps which are used attach to the other teeth and complain about having to take the device in and out. 

The device is often a food trap, but normally provides an adequate chewing platformfor most patients. One thing to note, where the teeth are missing with respect to the bone where there are no tooth roots present, the bone will begin shrink --- called resorption. As the bone shrinks, often times the denture will need to be adjusted and even remade. The retention of the device not only comes from "clasping" to the teeth, but also the support derived from the volume of the bone present.

Full Dentures

These are devices made normally from acrylic with the plastic teeth imbedded within the acrylic. Of all the restorative options, this is one patients complain about the most. Normally they are initially satified by their upper denture retention, but complain about the retention of the lower denture. Since dentures rely on surface tension (patients call "suction), the upper jaw normally yields much more surface tension than does the lower jaw. Regardless, biting in to harder food like apples are normally not a pleasant experience as the force placed on the front of the dentures causes the back of the dentures to tip and they lose their seal and come loose. Morever, as time goes one, the bone under the denture becomes smaller, than leads to less surface area and that means less retention. If implants to restore all the teeth are not an options, than often just a few implants to secure the denture solidly, makes a huge difference in the patient's ability to chew. Properly designed implants with denture anchors allows to patient to chew and eat just about anything they want --- and yes this normally includes apples. As with partial dentures, over time your denture will need to be adjusted and remade. Additionally, as with removable dentures, you will have to take them in and out every night.

Crowns and Bridges

For about a century, give or take a few years, missing teeth are restored using crown and bridge techniques. These are excellent methods to restoring damaged and/or missing teeth. For these techniques to work, just like bridges who connect two land masses separated by water or other natural phenomenon, dental bridges span between two teeth. For instance, if a patient lost his first molar and he had his second molar and lower second premolar intact (the teeth on either side of the missing one), a dentist could crown the tooth in front and behind the missing one. Metal with porcelain connects the two crowns together replacing the missing tooth.

In this case, a patient is missing a front central incisor.

Over time, the area where the tooth is missing can receed and lead to food trapping. Over time, bridges do fail and need to be replaced. Most bridges last 8-10 years and some much longer. Each time a bridge has to be remade, more tooth structure is lost and eventually there will not be enough tooth structure to support the bridge or insulate the pulpal tissues (the alive portion of the tooth). The tooth will either need an extraction or need a root canal. Bridges cannot span an infinite number of missing teeth. Your dentist will be able to inform you what can be restored with bridge work.

One complaint patients have regarding their bridge work is access for hygiene. Since the teeth are connected, floss cannot pass in between the teeth. Therefore, to clean around the teeth and gums, you need to use floss threading devices which can be cumbersome and annoying to some patients.

The advantages of implants over bridges are:

• Less Damage-Adjacent teeth do not have to be touched. Often a significant portion of a tooth or teeth must be reduced to accept a crown.
• Hygiene- Cleaning normally requires no different techniques or devices that what you typically do
• Success-Implant success rates are over 95% (10 year survival rates) and normally last much longer than bridges. Should an implant fail, you typically could replace the implant or then decide on a conventional bridge.

Advantages of bridges over implants:

• Time-Most implants cases can take 4-12 months to complete. Bridges can typically be complete shortly after the extraction
• Non-surgical- Implants are a surgical procedure. Most implant cases are tolerated much better than extractions, but it is still a surgery.
• Cost-The cost of a three unit bridge (replacing one missing tooth requires three crowns) is rougly about the same a single implant with a crown. However, most insurances are not covering implant placement surgery but are beginning to cover the restorative (crown placement) portion of the procedure. In the short run, implants may be slightly more expensive, but over a lifetime they are much less expensive. You have to check with your insurance to see if you have implant benefits. Dr. Bohannan's staff can assist you in that research. To see if your crowns may be covered, you can ask the dentist that is going to restore your case for that information.

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