Treatment Alternatives

If the prognosis of a root canal or other endodontic procedure is questionable or poor, then extraction may be the best option for the tooth. Replacing the missing tooth is usually beneficial or required to maintain function and esthetics, and to prevent the remaining teeth from shifting, but this depends on the location of the missing tooth and how the remaining teeth will contact each other. If a tooth is extracted and the tooth is to be replaced, the main replacement options are: implant, bridge, or removable denture. If extraction is indicated, consultation with your general dentist is recommended to help determine which option(s) is best for you. Dr. Palte would not be completing any of the following treatment himself; this section is simply meant to inform patients of some of the options that exist.

A dental implant is a threaded post made of surgical titanium that is placed into the jaw bone where a tooth had been extracted. In many cases, bone grafting at the time of the extraction will be done to maximize available bone for the implant (if there is not enough height or width of bone in the area, then implant may not be possible). The ideal time to place the implant is usually 3-5 months after the extraction was completed. (In some cases implants can be placed right at the time of the extraction but often there is a healing period). The implant is usually left undisturbed for another 3-5 months to allow the bone to fuse to the implant. After the implant is integrated into the bone, it is typically restored with a single crown. There are cases where implants can be used to support bridges or removable dentures when multiple missing teeth are present. Also, if the missing tooth is going to be an esthetic concern during the early stages of the process, a temporary flipper appliance can be made to fill the space. Some general dentists do place implants, but often you will be referred by your dentist to an implant surgeon and treatment will be sequenced and coordinated between the two.

A dental bridge is a permanently cemented appliance that uses the teeth adjacent to the missing space to hold it in place. Most bridges are three units, meaning three teeth total in length with the missing tooth in the middle. The benefits of a bridge over an implant is that it is usually a little cheaper than the implant (although price is getting much more comparable than it used to be) and treatment is typically finished quicker than the implant (because of the healing stages required during implant treatment). One downside of the bridge is that the adjacent teeth have to be prepped for crowns (unless they already have crowns that can be removed) and healthy tooth structure may need to be cut away to accommodate the bridge. The other drawback is that since the bridge is one solid piece and the crowns are fused together, you can no longer floss down in between those teeth like you can with natural teeth or an implant. There are special hygiene aids available to keep the underside of the bridge clean, but if hygiene is neglected, the abutment teeth holding the bridge in place may be prone to developing cavities.

A removable denture (partial or complete) is in appliance that can be made when there are multiple missing teeth that need replacing. A single tooth removable denture is possible also, but most commonly then are made to replace multiple teeth. Removable partial dentures use the remaining teeth as anchors to stabilize the denture. The more points of anchorage and the more spread out they are, the more stable the denture tends to be. A complete denture relies on the gum tissue and jaw bone for support and stability. If there are not enough natural teeth to support a partial or if a complete denture is unstable due to the shape of the remaining jaw bone, implants can be placed in strategic area to gain stability.