Tooth loss can occur due to many reasons such as extensive decay, pain, gum disease, or trauma, and can be quite distressing especially if it adversely affects the appearance or chewing. However, all is not lost as there are ways to restore missing teeth.
The most economical method of restoring missing teeth, dentures are normally fabricated from plastic teeth supported on a metallic or acrylic base. Although commonly associated with your grandparents’ generation, it is one of the quickest and cheapest way to replace multiple missing teeth, and is also more hygienic as you can remove the dentures for cleaning. Sometimes dentures can serve as a temporary measure to replace teeth until a fixed restoration is placed.
However, the bite force of denture teeth are a lot weaker compared to other alternatives such as bridge or implants, and first-time denture wearers will need some time to acclimatise to the sensation of wearing a denture, due to the larger size of the denture. Although there will be initial altered taste and speech, most people will eventually adapt to it and find wearing dentures comfortable.
- Most economical way to replace missing teeth
- Can be fabricated quite quickly and easily modified (by relining or adding teeth)
- Easy to clean as it is removable
- Weaker bite force
- Altered taste and altered speech – need some time to adapt to
- Can be lost or broken if dropped
Not to be confused with structures built to cross rivers, dental bridges consist of a replacement tooth or teeth (known as a pontic) fused to crowns which are carried by the adjacent natural teeth. Unlike dentures, these are fixed inside the mouth, and most patients find them more comfortable and easier to adapt to than dentures.
A conventional bridge requires the supporting teeth (known as the abutment) next to the missing teeth to be shaved down in order to create space for the bridge to sit on. If the supporting teeth are pristine, sometimes this may seem too aggressive, but necessary in order to provide sufficient support for the pontic.
Cleaning underneath a bridge is somewhat more challenging as you cannot floss in between the abutment and pontic like normal teeth, but not impossible. Additionally, if the missing tooth is the last tooth (where there will be only one supporting tooth available) or the supporting teeth are not in good condition (in the presence of active gum disease), a bridge is not recommended.
- More comfortable and feels more natural compared to a denture
- Bite force almost as strong as natural teeth
- Can correct alignment of adjacent supporting teeth (to a certain extent since these teeth will be shaved down and covered by crowns)
- Need to cut adjacent teeth in order to fabricate a bridge
- More challenging to floss
- Cannot be done if not enough healthy supporting teeth or in the presence of active gum disease
- More expensive than a denture
A dental implant consists of a medical-grade titanium screw (known as a fixture) which is surgically embedded into the jaw bone, and carries a crown above the gum line. The crown resembles a natural tooth and an implant is considered the most ideal teeth replacement with a well-documented success rate of 90-95% over 10 years when done in selected cases, despite being a relatively new concept compared to dentures and bridges.
The most important recipe for a successful implant is to have sufficient bone to support the implant. In cases where there is no sufficient bone, bone grafting procedures are necessary in order to regenerate more bone to allow implant placement.
Once an implant is successfully placed and restored, it will provide the most natural feel and is also easier to clean and floss. It will not decay and one can expect many years of service from the implant.
However, implants are subjected to gum disease as well, so in patients with active gum disease, failure rates are higher. Additionally, in patients with poorly controlled diabetes and also in smokers, implants do not perform well due to significant bone loss observed around the implants.
Due to the quality of the materials used in production, implants are generally more expensive, but part of the surgical costs can be claimed from Medisave, unlike dentures and bridges. Additional grafting procedures are also Medisave-claimable. And since surgery is involved, some time is needed to allow for better healing and hence higher success rate of implants.
- High success rate and strongest bite force, hence feels the most natural
- Easier maintenance (for single implants, as you can floss normally)
- Not susceptible to decay
- Does not require any cutting of adjacent teeth
- Most expensive (but partial Medisave claim is allowed)
- Susceptible to gum disease
- Performs unpredictably in patients who smoke or have diabetes
- Longer time needed to complete treatment, especially if insufficient bone and grafting is required
Can I Choose Not to Restore A Missing Tooth? Are There Any Negative Consequences?
Yes, you can choose to live without replacing a missing tooth, especially if you have sufficient teeth remaining to function. However, if you have too many missing teeth, you may not be able to properly chew your food, and the remaining teeth may get over-stressed as bite forces are now spread over less teeth. This may result in increased mobility and wear which may shorten the life span of your remaining teeth. Either you have to switch to a softer diet, or risk losing more teeth.
Additionally, teeth will drift and a missing tooth space may result in the adjacent teeth tipping into that space, and/or the opposing teeth over-erupting. That may lead to food trapping as gaps widen, and make the space difficult to restore in the future should you ever change your mind. For some patients, orthodontic treatment (braces) may be necessary to correct the alignment of the adjacent teeth first before any replacement can be done.
Which Replacement Option is the Best For Me?
It is recommended to have your teeth examined by the dentist first before deciding which replacement option is best for you, as you may have issues which you may be unaware of that may affect the longevity of the replacement teeth. For example, if you have gum disease, then having a bridge or implant is not advisable until the condition is treated and brought under control. Otherwise, the restoration will fail prematurely and may result in more tooth loss.
At the same time, due consideration of your budget must be taken into account, given the difference in prices. If you only have one missing tooth and you are willing to spend a bit more, then implant would be the best option provided there are no contraindications for it. However, if you have multiple missing teeth and a tight budget, dentures will be the most suitable option. Ultimately, you will need to discuss your preferences with your dentist and hopefully he or she can help to craft a treatment plan most suitable for you!