By Dr. Riste Panajotu
Dentistry today evolved in to a modern science using a modern tools in order first and primary to save teeth from extraction. Everyday chalenge of any dentist is to save the teeth and to keep the integrity of the mouth unchanged as long as posible.
The dentist can see better now using dental microscope or even dental loupes,and seeng means treating.We can treet only what we can see.We can choose a variety of dental digital x-ray imaging even 3D imaging and we can do it realy fast.Nothing cant be hiden.We can choose from an unlimited kinds of biomaterials ,we can use them properly and we can save some teeth. But lets be honest. The dentist is not an magician Some teeth cant stay in the mouth at some point.
What hapens when patient lose tooth. Beside the cosmetic problem ,when a missing tooth shows as you smile or your face appears gaunt due to lack of cheek support,there are many other more serious and harmful concequences. Your teeth tend to move until they hit something. adjacent teeth will often begin to drift into
the space vacated by the missing tooth. This movment negatively affects your bite (a condition called malocclusion) to the point where the strain on one or both of your TMJs (jaw joints) can cause pain or even locking.
The truth is one- it’s not so much about teeth as it is about bone. The jawbone need stimulation to maintain its form and density. In the case of alveolar bone which surrounds and supports teeth, the necessary stimulation comes from the teeth themselves. Teeth make hundreds of fleeting contacts with each other throughout the day. These small stresses are transmitted through the periodontal ligament that suspends each tooth in its socket, prompting the bone to remodel and rebuild continually.
When a tooth is lost, the lack of stimulation causes loss of alveolar bone This condition is known as afunctional resorption. As bone loses width, it loses height and gum tissue also gradually decreases. Ability to chew and to speak can be impaired. The more teeth lost, the more function is lost. The distance from nose to chin decreases and with it, the lower third of the face partially collapses The chin rotates forward and upward, and the cheeks, having lost tooth support, become hollow, making the person look older.
Replacing a single tooth
The most common,but not necessarily the best option for replacing a single back tooth has been a three unit fixed bridge. In this case, the two teeth on either side of the gap, known as abutment teeth, are crowned and the two crowns together support a “pontic” a false tooth in the middle. This type of prosthesis can be fabricated very fast and provides normal shape, function and health. Because of these benefits fixed denal bridges have been the treatment of choice for a long time Every dentist is familiar with how and when to use them; they are widely accepted by the dentists and the patients too.
Dental bridges are not invariably successful over time. If not well maintained, the pontics can act as reservoirs for bacterial biofilm and the abutment teeth can decay. As a result, the supporting abutment teeth are susceptible to structural failure from decay, failed endodontic therapy and/or fracture, increasing their risk of loss.
What can be done to replace missing teeth and avoid bone loss? That depends on how many teeth have been lost. A better treatment option to replace a single missing back tooth is a single-tooth implant. A dental implant is actually a tooth root replacement, to which a crown is attached. The implant, made of commercially pure titanium, has a uniquely biocompatible property, which allows it to “osseointegrate” with the jawbone. A crown attaches to the implant, which looks, feels and functions like a natural tooth. And better yet, if for any reason the crown needs to be removed or replaced, it is removable, so that the implant is not compromised or damaged.
For years, patients were advised to accept the limitations of a fixed bridges as it was the best treatment for tooth replacement. The primary reasons for suggesting a fixed bridge were its clinical ease reduced cost and treatment time. However, if this concept were expanded, extractions would replace root canals and removable partial dentures would be used instead of fixed bridgework.
But the primary reason to suggest a particular treatment should not be related to time, costs or difficulty of the procedure; it should be the best possible long-term solution for each individual. Health-related advantages of a dental implant tooth replacement include no risk of decay and decreased risk of periodontal (gum) disease. There is also a decreased risk of abutment tooth decay, endodontic (root canal) failure, and improved aesthetics since the adjacent teeth remain un-capped.
Psychological advantages are significant as well.
Moreover, a single-tooth implant compared to a bridge becomes more advantageous financially over time. Although a single-tooth implant may be a little more expensive initially, survival time is greater making the implant option more cost-effective.
Replacing Multiple Teeth
Implants can also benefit those missing some or all of their teeth — and the number of these individuals is growing. For these individuals, implants offer many advantages. They can be used to support bridges without the need for abutment teeth, or even a full arch of false teeth that would otherwise rely on support from pressure on the gums and underlying bone, which continues to resorb and melt away. A removable denture pressing on the gum and oral membranes accelerates bone loss.
Biting force is transferred to the bone surface only, not the bone structure. As a result, blood supply is reduced and total bone-volume loss occurs.In fact, denture-wearers are not always made aware that bone loss will cause their dentures to slip, and bone loss accelerates when dentures fit poorly. Implants prevent this A fixed bridge or even a removable partial denture secured in place by implants is much more stable than a denture that relies only on the soft tissues of the mouth for support. Removable dentures (unsupported by implants) affect a person’s ability to chew.
A primary reason to consider dental implants to replace missing teeth is the maintenance of jaw bone. As you may recall, bone needs stimulation to stay healthy. An implant-supported tooth, or teeth, allow for normal function of the whole mouth both jaws, including the nerves, muscles and jaw joints. Moreover dental implants fuse to the bone, stabilizing and stimulating it to maintain its dimension and density.
In addition implant-supported fixed bridges function the same as natural teeth The success rate of dental implant prostheses (tooth replacements) varies, depending on a host of factors that change for each individual. However, compared with traditional methods, they offer improved function, bone preservation, and better psychological well-being. Dental implants regularly attain a 10-year survival of more than 90% and most can last the life of the person. Life is too short to have a missing teeth and loose dentures.