Missing Teeth
 

What are the Options for Restoring Missing Teeth?

We can split our options for restoring teeth neatly into:
Fixed options. These are options that stay in your mouth the whole time once they have been put in and include:

  • Implants.
  • Bridges (of which, there are a few types)
  • A combination of both. A bridge supported by an implant may be needed if there is not enough support available from your natural teeth or if the space you are trying to replace is quite large.

Removable options. These options as the name suggests can be taken in and out of your mouth. They are referred to as partial dentures, partial plates or sometimes, removable bridges. We have three different types of material we can use to construct them:
More information about each of these options can be found by clicking on them, this will take you to series of articles that clearly explain what they are and discuss the advantages and disadvantages together with the associated costs. If you have lost all your teeth, see- Full Dentures for more information.


These options may be considered in certain cases where only a small space exists:

  • Orthodontic treatment. This has the advantage of not filing down naturally healthy teeth or adding anything extra to your mouth.
  • Dental bonding. If the space is very small, then building out the teeth either side in white filling material or using a dental crown, may be an option.
  • A combination of the above. Often a combination is suitable if you require multiple spaces to be restored with a fixed approach, but both fixed and removable components may also be required to achieve a suitable outcome. It depends on many factors. For example, sometimes it is hard to get a removable plate to grip properly, particularly if many teeth have been lost and there is no back tooth giving support -(we call this a free end saddle). Sometimes an implant can be placed with a crown or simply an attachment (such as a magnet,) that fits to the denture to help support it.

What are the Advantages and Disadvantage of the Removable Options?

Advantages of removable options:
  • Cheaper- though they do often require more frequent maintenance, repairs and adjustments.
  • If significant bone loss has occurred, a flange can easily be placed to help improve the appearance.
  • Replaces multiple teeth as easily as a single tooth- great for many missing teeth, as you can use the gum, as well as teeth for support.
  • Very versatile- easy to change as your mouth changes
  • Useful if more teeth are likely to be lost and need to be added
  • Good for healing areas as they can be easily relined
  • Can be removed for cleaning
  • Don’t involve preparing/damaging your remaining teeth
  • You can take them out, so if playing contact sports they won’t get damaged
  • Good where there is no back tooth to support a bridge and an implant is inappropriate
  • Keeps all your options open
  • Shorter appointments.
Disadvantages of removable options:
  • Can be difficult to get used to wearing
  • Can be quite bulky
  • May show metal clasps or base of metal partial denture
  • May move around or not grip well (if very few teeth left to support)
  • More likely to affect speech (initially)
  • Not as good aesthetics as 'fixed'
  • Fit can loosen with time (but can be modified fairly easily)
  • If poorly cleaned can lead to lots of plaque accumulation around the remaining teeth, which can lead to caries or gum disease.
  • Some patients are conscious of the stigma of removing your teeth
  • Coverage of the palate, if necessary, can affect the eating experience in terms of taste and sensation.
  • Need to get used to chewing with them
  • Have to take them out to clean
  • Not placed permanently in your mouth
  • Whilst you get used to them, you are much more conscious of wearing them
  • Would be expected to have a lifespan of about 10 years.

What are the Advantages and Disadvantage of the Fixed Options?

Advantages of fixed options:

  • Most patients prefer this
  • Don't have to take them out
  • Doesn't affect your eating experience
  • Doesn't affect speech as much
  • The best aesthetics
  • Not conscious of having it in your mouth (after the first week)
  • Can function pretty much as normal
  • Can change the shape and colour of existing teeth (with a bridge)
  • Can provide protection and strength to heavily filled teeth either side of the gap
  • Doesn't cover the palate of your mouth
  • Less likely to cause plaque to collect
  • Would be expected to have a life span of near 20 years (not resin- retained bridges).

Disadvantages of fixed options:
  • Irreversible
  • May involve removing healthy tooth structure therefore be destructive in some circumstances (bridges not implants)
  • If not planned properly and carried out well can result in more teeth being lost (a good dentist is crucial)
  • Can fail and need to be replaced
  • May get problems which can be expensive and difficult to rectify
  • Requires extra cleaning/maintenance
  • Implants may not be successful
  • Require long appointments
  • Can take many months to complete (in complex cases and those involving implants).

Which is the Best Option for me?

This is very hard to answer, but I can certainly help shed some light on the situation. It is hard because I haven't met you, I don't know what you want, I haven't seen your mouth and I have no idea about your financial situation.

Dentists train for many years and clearly understand the importance of treatment planning, so find a dentist you like and trust- have them run you through the best options for your mouth.

Now it is important to understand, that not every treatment may be available to you. This maybe a cost thing, tooth thing, dentist thing or just a preference thing.

First let me give you the overview I give my patients in terms of cost and the most appropriate circumstances for each of the options. Then in treatment planning missing teeth we will break this down further into the sorts of questions you need to be considering to select the right treatment for you.

To give you a rough idea of the different costs…

Fixed options are much more expensive than removable options.
In order of cheapest to most expensive the treatments look like this:
  • Acrylic denture cost (700A$- cheapest]
  • Metal denture cost (1000A$)
  • Valplast denture cost(1000A$)
see partial denture costs
  • Implant cost (5000A$-most expensive).
The figures in brackets are a very rough ball-park figure of what it may cost to replace a single tooth. Check the 'costs page' of each of these procedures for more information, as there are many factors that can dramatically change the price.

For every extra tooth that you replace with a fixed option, you will increase the final cost considerably. For removable options, extra teeth will cost only marginally more.

Here are some generalizations before we get to the ‘nitty gritty’ in the next article.

A removable option is advisable if:
  • You want the cheapest
  • You have multiple missing teeth (unless you are prepared to spend many thousands of dollars)
  • You are likely to lose more teeth in the near future because fixed options would be more likely to need replacing
  • You are still playing contact sports
  • You have just had a tooth or teeth out (to allow healing).
A fixed option is advisable if:
  • You can afford it
  • Your mouth is unlikely to change
  • You want something that will stay in your mouth permanently
  • You want the best aesthetics
  • You only have a single missing tooth missing
  • I advise an implant where possible if the teeth either side are healthy and relatively untouched.
  • I advise a bridge if the teeth either side are heavily restored and full crowns would help to protect them.