Tooth Replacements

Dental Implants
A dental implant is a metal (titanium) structure that is surgically placed beneath the gums over a series of appointments. The implant must be given time to fuse (integrate) to the jawbone which then serves as a stable base for the replacement of teeth that may be a crown, bridge or denture.

Well-integrated implants are very stable providing patients with a natural “feel” that is almost identical to that of normal teeth especially when eating or speaking. Most patients report that the teeth also look more natural and more comfortable in long term use.

Fig1. X-ray showing 2 dental implants.

What is the procedure of placing implants?
Surgery is first done to place the metal implant under the gums into the bone. Thereafter, depending on the type of implant system as well treatment needs, the connector that connects the metal implant to the artificial teeth may be placed immediately or up to 6 months later via a second surgery.

After the gums have healed sufficiently, the artificial teeth are then made and fitted to the implant. This process can take up to 2 months to complete.

Fig2. Decay was present on the premolar supporting the bridge.

Fig3. The bridge was removed and decayed tooth extracted.

Fig4. Placement of implants. A new crown was made for the molar.

Fig5. Laboratory stage – the prosthetic teeth are fabricated on a model of the implants. This is similar to how crowns on natural teeth are done.

Fig6. The full porcelain implant-supported crowns are cemented to the implant.

Can anyone have an implant?
No. Placing of dental implants requires surgery, hence there is a pre-requisite that patients must be in good health with healthy gums as well as be committed to maintaining good oral hygiene. Your general dental practitioner would be able to advise you on your suitability to receive dental implants after a thorough evaluation of your condition.

Can an implant last forever?
The average lifespan of an implant is about 10-15 years based on current evidence. There can be many reasons for the failures of implants with some failures due to the poor oral health of the patient. However, recent developments in the research and development of implants have enabled implants to last longer. A daily, meticulous oral hygiene practice is still recommended not just for implants to last longer, but to get good oral health and lower incidences of gum disease and tooth decay.

Dental Bridge
Dental bridges are also known as fixed partial denture; and as the name goes, are “fixed” onto remaining teeth in order to replace the missing teeth between them. The artificial teeth literally acts as a “bridge” between the remaining natural teeth and the gap caused by the missing teeth.

The restoration can be made from a variety of materials like gold, ceramics, metal alloys and a combination of these materials. The finished bridge and is cemented (or glued) to the surrounding teeth for support. In other words, the bridge can only be removed by a dentist once it has been cemented.

Dental bridges can also be used together with implants to replace a few missing teeth with the difference that instead of relying on natural teeth for support of the bridge, these implanted-supported bridges will rely on the implant (which is a metal structure that has been fused to the bone) for support.

Procedure involved in the making of a bridge:
Your general dental practitioner will first assess and do a thorough evaluation of your oral health and needs. Once that has been done and both you and the dentist have decided on using a dental bridge as the treatment option, the dentist will begin to prepare the natural teeth that is used for the support.

Thereafter, the dentist will make a model of your prepared teeth as well as the gap and fabricate the bridge. The whole process usually takes a few weeks. In some cases, where the bridge is extensive and the bite or facial appearance needs to be changed, the process can take several months. For more information, please check with your general dental practitioner.

Fig7. Preparation of abutment teeth for bridge. The bridge will consist of two crowns for the trimmed teeth with a false tooth in between to replace the missing tooth.

Fig8. Bridge replacing missing front tooth.

Dentures
Dentures which are also known as removable partial dentures are appliances that usually consist of artificial teeth connected to a pink (or gum-coloured) plastic base which may or may not be attached to a metal structure.

These dentures are removable in that they can be taken out or inserted by the patient. Dentures are attached to your natural teeth by metal clasps or attachments.

How long should I wear the denture and can I wear the denture to sleep?
Your general dental practitioner will be able to provide you with the specific instructions on how long the denture should be worn and when it should be removed. Generally, these dentures can be worn throughout the day and only removed at night before sleeping and worn again the next morning.

It is not advisable to continue wearing the denture at night while sleeping. A denture is a foreign object and can trap plaque and bacteria causing gum disease and dental decay especially at night when our teeth are more susceptible to bacteria attacks.

Initially, your dentist might ask you to wear your denture all the time for about a week. This would likely be uncomfortable but would help the dentist identify areas of high pressure caused by the denture and adjust the denture to ensure a better fit.

How long will it take to get used to wearing a denture?
It will generally take a few weeks for you to get used to the denture. Initially you might experience some difficulty in speech as the denture might feel bulky and awkward in the mouth. Never attempt to use any appliance to bend the wires on your own as the denture might be damaged. Always feedback any concerns to your general dental practitioner and allow your dentist to advise you or to adjust the denture accordingly.

How do I take care of my denture?
Brush your denture daily to remove food and plaque deposits with a denture brush or any soft-bristled toothbrush. Brushing daily will prevent the denture from becoming permanently stained as some stains do get incorporated in the denture. Do remember to either place a folded towel or bowl of water under the denture while cleaning it to prevent accidents where the denture is dropped and damaged. Your general dental practitioner will also be able to recommend you on the necessity of using denture cleaners.

How long can my denture last?
As we age, our bodies and bones continue to undergo structural changes and our denture might not be properly fitting in a few years. Poorly-fitting denture can do damage to the remaining teeth and gums. So do continue to go back to see your general dental practitioner for yearly reviews so that adjustments can be made to ensure a good fit. Generally, full dentures may need to be re-made every 3-5 years.

Fig9. Full edentulism (all teeth missing)

Fig10. A set of full dentures.

Fig11. Partial cobalt chrome (metal) dentures. The teeth are secured to a plastic base which is in turn supported by a metal base.