‘Gaps’ usually refers to the space left by missing teeth, although sometimes they may be due to natural spacing between the teeth. Teeth may be missing because they have been removed due to disease [e.g. dental decay (caries) or gum disease (periodontal disease), or because they have failed to develop (hypodontia). This failure for a tooth or teeth to grow is relatively common affecting 3-8 percent of the population. Although it is not always necessary to replace missing teeth it is often done for appearance reasons or because of problems with speech or eating.
There are a number of ways to replace teeth and these include dentures, bridges, and implants.
Dental implants are one of several ways of replacing lost teeth. They can be used to replace one tooth or all of the teeth. They are made of titanium or one of its alloys and have no known harmful side effects. Titanium makes a special bond to bone, which dentists call ‘osseointegration’.
There are two main stages in the implant process. The first is the placement of the implant into the jaw, and the second is the attachment of the replacement tooth to the implant. The replacement tooth may be a crown, a bridge or a denture.
Most studies have shown that implants are successful in around 90 percent of cases. Those inserted into the lower jaw are slightly more successful than those in the upper jaw.
There are very few specific illnesses that would prevent the use of implants. But there are some things that make the outcome potentially less successful and one of the most important of these is smoking. This reduces the success rate by about 11 percent.
Implants can be placed in the elderly but they should not be placed in children.
If a large amount of bone has been lost where the false tooth needs to go (due to a difficult extraction or to normal bone shrinkage), there may not be enough anchorage for an implant. However, there are ways to build up the missing bone.
The placement of implants is a minor procedure so it can be done under local anaesthetic and/or sedation. Most patients say it was as easy if not easier than having a tooth extracted. Any stitches in the gum will be need to be removed a few days later.
Dentists will often prescribe painkillers after the placement of the implants but most patients do not need to take them.
For some implant systems it is necessary to have a second stage of surgery some months later. This is because with these systems the implant is fully buried in the gum during the first operation and needs to be exposed at the second.
Obviously if bone is to be built up then the operation becomes more complex and a general anaesthetic may be needed.
For some people the exciting prospect is that dentures can be discarded after implant therapy. Unfortunately, not everyone can move away from dentures completely. If there is a loss of a lot of the jaw bone a denture is the only way to achieve a successful result. In this case, the implants act as a secure support for a denture and prevent the embarrassment and pain of it moving during eating and speaking. The appearance is restored with the denture teeth and gums.
They are more expensive than a denture or most other methods of replacing teeth but have these advantages over other treatments:
The cost is higher because the implants are custom shaped, precision made and specially sterilised. They need a lot of planning and preparation before placement. Some of this work is done outside the dental surgery.
These may be used to replace one or all teeth except the very back molars because to do so would make wearing the dentures more difficult. Dentures that replace a few teeth are called partial dentures while those replacing all the teeth are called complete dentures. Complete dentures stay in place by suction and muscular control. When complete dentures are worn for the first time many people may find them strange and difficult to control. However, with guidance from a dental professional, within a short time control is usually acquired.
Partial dentures are made of acrylic or metal and acrylic. Sometimes they incorporate wires which are attached to remaining teeth to help to keep the dentures in place. In certain circumstances, the teeth are prepared with small depressions in them (rest seats) to aid in supporting the more sophisticated metal alloy dentures. Partial dentures made of metal are more easily designed to rest on the remaining teeth. This is healthier than covering the gums. Metal is stronger than acrylic and is therefore thinner and often more comfortable to wear, however it is much more difficult to add additional teeth to a metal denture if more teeth are lost.
It is most important that dentures and the remaining natural teeth are kept very clean to prevent the damaging effect of plaque.
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