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How can I replace missing teeth?

How Are Teeth Lost?

Teeth can be lost by severe physical trauma, which is a complicated way of saying they can be knocked out. That is not, however, the most common reason for losing a tooth. More often it is due to unrestorable destruction from decay, fracture, bone loss, or untreatable infection which makes it necessary for the dentist to extract (pull) the tooth.

Why do missing teeth need to be replaced?

Leaving an empty space after a tooth is lost can result in:

1. Shifting, tipping or super eruption of remaining teeth (super erupting is a tooth erupting into a space on the opposite jaw).

2. Bite collapse (the jaw closes farther than it should because shifting teeth no longer give proper support); an increased chance of fracture, root canals or accelerated bone loss due to excessive force on the remaining teeth; or, pain in the joint of the jaw due to improper bite (you may have heard the term TMJ which is short for the jaw joint, the Tempromandibular Joint).

The longer missing teeth are not replaced, the more complex the treatment may become. Dramatic tipping, shifting or super eruption of teeth may require braces to be straightened. Replacing missing teeth can be accomplished by bridges, partial dentures, or implants. Complete tooth loss requires full dentures or implants.


What is a fixed bridge?

A fixed bridge is a permanent replacement for missing teeth which can not be removed by the patient. Bridges are sometimes referred to as "crown and bridge" or a "fixed bridge".

 A bridge is constructed by preparing the teeth on both sides of a space so they can receive crowns. The teeth are reduced and shaped around the outside and across the top so a crown can fit tightly over them. Crowns are joined together to replace the missing teeth and cover the prepared teeth on each side providing support of the replacement. A bridge can be used only if there is enough strength to support the replacement teeth. This generally means there should be as many teeth providing support as there are being replaced. The type of replacement needed is also determined by careful evaluation of bone loss, size and shape of the root structure, the force which will be generated on the bridge and the strength of the remaining tooth structure.

fixed_bridge1

A missing tooth is replaced by a fixed bridge.  Teeth on either side of the space are prepared for crowns.  Three crowns are joined together so crowns on either side can support the missing tooth in the middle.

 
Before
 
After
 Stewart-before(1)_resize STEWART-after(1)_resize


Is it difficult to make a bridge?

Bridges require two or more appointments. At the first appointment, precise drilling is done, impressions are taken to make plaster models and a temporary bridge is placed. The permanent bridge is fabricated in a dental laboratory through a series of complicated procedures and is then returned to the dentist.

At the second appointment, the temporary bridge is removed, the permanent bridge is tried in the mouth, checked to ensure proper health, function and aesthetics and is then cemented into place. Occasionally bridges need subsequent adjustments which require additional appointments.


Are there different types of bridges?

fixed_bridge2Yes. Bridges are classified by the materials used in constructing them. Porcelain fused to metal or all metal bridges are most common. Metal bridges, such as gold, give maximum strength with poor aesthetic quality due to color. Porcelain fused to metal retains much of the strength from the metal core while the outer porcelain layer improves the aesthetics. Further classification of bridges is based on bridge design and the method of construction.


fixed_bridge3The Maryland Bridge is one alternative to the standard "crown and bridge" design. There is less drilling and expense with this type of bridge as it does not require full crowns on the teeth adjacent to the space. The replacement teeth, usually porcelain, have metal wings which are bonded to adjacent teeth to provide support. The Maryland Bridge can only replace a limited number of teeth and must have strong teeth to support it. There can not be excessive force which may dislodge it. For these reasons, it is not used as often as the standard design.

fixed_bridge4

 

Badly broken down teeth are restored and missing teeth replaced with a complex restoration referred to as a full mouth reconstruction.  The full mouth reconstruction consisted of individual crowns and two fixed bridges.



What are partial and full dentures?

Dentures are removable replacements for missing teeth. Partial dentures are used when there are remaining healthy teeth which help provide retention and strength in resisting chewing forces. Complete, or full, dentures are used when all of the teeth in a jaw are missing, and retention is achieved through suction.

Complete dentures are combinations of plastics carefully moulded to fit the gums comfortably and securely while providing natural color and aesthetics. Partial dentures also use a combination of plastics, but some sections are made of metal to join parts together and provide strength. The replacement teeth may be made of porcelain or plastic.


When are dentures used?

Partial dentures are used in instances similar to those where a fixed bridge might be used. Partial dentures, however, are used exclusively when the remaining teeth are not strong enough to support the missing teeth as they do with fixed bridges. With a partial denture the gums and bone of surrounding areas provide additional support. Full dentures are supported entirely by the gums and bone structure.

denture1
 

A partial denture for the upper jaw replaces missing teeth.  Clasps, which look like hooks, clip onto teeth to provide retention.  A metal connector which sits on the roof of the mouth joins the parts together.



 

How are dentures made?

Dentures are fabricated in a dental laboratory. Plaster models are constructed from impressions of the teeth and gums. Full dentures require impressions which may be done in several phases so precisely made models can be constructed. Tooth color, shape and size are selected and the relationship of one jaw to another is registered. With full dentures, the denture teeth are mounted in wax for evaluation in the mouth. If the appearance, bite and fit look correct, the denture is finalized. If a partial denture is elaborate, the metal framework or denture teeth will also be evaluated in the mouth before being finalized. Follow up appointments for adjustments can be expected, especially with full dentures.


What keeps dentures from falling out?

denture2With partial dentures, metal clasps are used to grip teeth and hold the denture in place. Drilling modifies the teeth to maximize retention and resistance while minimizing adverse forces to teeth.

Full dentures are retained through suction. That is why the precise design and fit of full dentures are so important.

Retention and aesthetics of partial dentures can also be improved by the use of precision attachments. Precision attachments are snap like devices which are placed in crowns and partial dentures so partial dentures can "lock" into place. Partial dentures designed this way, in combination with crowns, can eliminate clasps so no metal shows and less adverse force is placed on teeth.


Is there an esthetic alternative to a metal-supported partial denture?

denture3YES! It is called Valplast®. Designed for the utmost in functionality, in order to provide the needed strength without bulkiness. You will be able to confidently resume normal - and comfortable mastication very soon after the insertion of the denture. In addition, the flexibility of the resin achieves the effect of a stress-breaker without complicated attachments. The gum tissue is gently stimulated under mastication, and unnatural stresses on the remaining natural teeth are substantially reduced. The strength of the material and resistance to chemical breakdown provides a long-lasting, unbreakable partial. By distributing the stress more naturally in the mouth compared to conventional partials), the remaining teeth and gum typically stay healthier longer than with a conventional partial. Valplast® functions for your comfort, confidence, and oral health.

denture4Valplast® is a thermoplastic nylon with excellent elastic memory and outstanding aesthetic qualities. The unique translucency of the material allows your natural tissue tone to show through, making Valplast® virtually invisible to the untrained eye. The strength and durability of Valplast® is unmatched

Take decades of research; add years of refinement, mix with determination, experience, and perseverance. The result: The Valplast® Flexible Partial, the leader and original flexible dental restoration in our industry. That's why Valplast International is so proud of its product, and why its quality remains unsurpassed. Valplast® exercises the strictest quality control with every unit of material, designing the colour to match the visual effect of veined gum tissue. Our techniques allow the processing laboratory to add any number of teeth or retention to an existing partial without sacrificing security.

denture5denture6



What do dentures look like?

denture7The classic denture look is pearl-white perfectly straight teeth. Fortunately, people today want their teeth to look more natural. For a natural appearance, your own teeth are the best indicator of color, shape, and position. If a dentist can not use your own teeth as indicators, correct color is matched to your skin tones, shape is matched to your face shape and position is determined by profile, jaw position, etc.



How successful are dentures?

Partial dentures have a very high success rate. Most people are able to adapt to their use without great difficulty. There is a substantial difference, however, between full dentures and your own teeth since it is only suction which holds a full denture in place.

Dentures may move or come loose when the tongue, lips, cheeks and muscles push against it. Good impressions provide an accurate fit and seal around the edges. Retention and stabilization can be aided by the shape of bone and firmness of gums which make it more difficult to break the suction.

It is difficult to predict how a patient will adapt to dentures. A stable, retentive denture increases success, but people must adapt psychologically and learn techniques of functioning with a denture. Speech patterns must be relearned and chewing efficiency may be dramatically reduced. For these reasons, full dentures are the last resort of dentistry.

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