Tooth loss is a common problem we all face at various times throughout our lives, and for various reasons. Whether it is from non-restorable decay (cavity), severe gum disease, a failed root canal or accidentally being damaged beyond repair, the loss of a single tooth or multiple teeth can have dramatic and lasting effects on your pearly whites if not dealt with in a timely manner. Left untreated, gaps in your smile can not only appear unsightly, they can also lead to further problems through a cascade of negative events one might not be aware of. Tooth loss may cause you to need a dental implant.

Teeth adjacent to a space where a tooth has been lost often tend to shift or tilt into that space. This leads to further instability among neighboring teeth in the quadrant, and soon enough one may notice their bite suddenly seems misaligned. Additionally, teeth in the opposing jaw will often begin to “grow” further up or down, looking to make contact with a new mate once their previous counterpart has been lost. If none is encountered, the gum tissue in the area of the lost tooth may become the surrogate – a match that can lead to constant discomfort or a persistent sore spot. To compound the problem, the jawbone where the root(s) of the missing tooth or teeth used to sit is no longer stimulated during chewing, and hence it shrinks away slowly in a process known as “resorption.” Once jawbone volume is lost, it ‘s difficult to regain. Even with the sophisticated bone grafting techniques and materials utilized today, it’s difficult to duplicate the lost bone and gum tissue architecture that once existed when the tooth was still in place or just after it was lost.

As always, prevention is the best bet. But as noted earlier, at some point throughout our lives it’s inevitable. You will lose one or more teeth for whatever reason. So what to do? It’s simple: Replace them! But with what? A fixed bridge? A removable partial denture? Dental implants? What is the best solution?

For decades, the mainstay in dentistry for tooth replacement was the “fixed bridge.” Commonly, the teeth on either side of the space were shaved down, and a dental bridge that had a fake tooth in the middle was cemented over them. This certainly addressed the problem of adjacent or opposing teeth shifting, as well as provided an esthetic solution for the missing tooth or teeth. However, because chewing forces were now distributed to the bone surrounding the roots of the neighboring teeth, rather then the bone in the area of the space, the resorptive process often would continue, and over time a defect in the bone and gums in that area would develop and often a “food trap” would ensue. Furthermore, over time, the “margin,” or seam, where the natural tooth ended and the fake crown began would usually succumb to recurrent tooth decay, and thus the bridge would need to be redone every so often. If the recurrent decay were so severe that now more teeth needed removal, a longer bridge would then be made. This became a vicious cycle for many.

 For those with several or all missing teeth, or those who could ill-afford to replace their teeth with “permanent” or fixed bridgework, removable partial or full dentures were often fabricated. But again, because of the lack of physiologic forces being transmitted to the jawbone via the lost roots, bone resorption (shrinkage) progressively follows, leading to constant refitting or remaking of the removable dentures. Additionally, the clasps that are often used to anchor these devices to any remaining teeth would sometimes cause damage to them or to the gum tissue nearby. The biggest disadvantage in many patients’ eyes, however, is the fact that removable partial or full dentures tend to be unstable and thus can cause sores to develop on the gums as well as make it difficult to speak or chew effectively, let alone to smile with confidence!

Today however, most dental professionals would agree that replacing a missing (or soon to be missing) tooth or teeth with dental implant supported crowns or bridges is the way to go. A dental implant is like an artificial tooth root implanted in the jawbone that is capable of supporting one or more teeth. No longer do we need to rely on neighboring teeth to support either a fixed or a removable bridge. The crowns or bridges supported by dental implants are typically cemented or screw-retained so that they cannot be removed. And because the implant once again transmits the forces of chewing down to the underlying jawbone, preservation of bone volume in that area usually occurs.

So how can one know if they are headed for tooth loss and dental implant therapy? Let’s revisit each common cause mentioned above.

In cases where irreparable decay is the culprit, or if a root canal has gone awry, typically the first warning sign is recurring and lingering pain that is unprovoked (not in response to eating or drinking). If you’re just sitting around and you have a toothache that is severe and won’t let up, it’s possible your tooth may need removal and a dental implant placed. Another warning sign is swelling of the gum tissue in the area. In some cases (typically in the front part of our mouths where we have single-rooted teeth that closely match the size of the implant), the day the offending tooth is removed a dental implant can be surgically inserted. This is known as “immediate implant placement.” Furthermore, a temporary crown can also be attached to the dental implant, known as “immediate loading,” and so the patient never has to have a gap in their smile at all!

In situations not ideal for immediate implant placement, such as where there is considerable bone loss around the failing root, “delayed implant placement” is usually planned for. In these instances, it’s common to have bone graft material placed in the socket or at the site of the extracted tooth to help rebuild the volume of bone that’s needed for future implant placement. Typically this occurs a couple months later, after the bone graft has “healed.” Many times a temporary device can be fabricated and worn until the implant crown is placed.

Similarly, in cases where a tooth is suddenly damaged or fractured and is thus in need of removal, again, either a dental implant can be placed the same day as the extraction or soon after healing of the socket has occurred and bone has filled the site. The difficulty with traumatic injuries, however, is they often occur at the most inopportune time and, of course, without warning.

In the scenario where a tooth is suffering from periodontal (gum) disease, the early warning signs are recession of the gum line (due to underlying bone loss) and increasing mobility of the tooth. These cases tend to be more challenging because there may not be enough bone left in the area to support a dental implant. Or, even if an implant can be placed, often it’s not in a good position to lead to an esthetic restoration. Once again, bone grafting in these situations is often employed in order to regenerate the lost bone prior to dental implant placement.

Regardless of the cause, replacing teeth that need to be removed with dental implants as early as possible will give patients the best chance for a successful and esthetic outcome, as well as eliminate or minimize the risk of having adjacent or opposing teeth shift, which can lead to further dental problems.

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