Category Archives: Dental Implant

Dental implant is the best structure to replace missing teeth. It is strong and bonds with human bone very well through by osteo-integration. Currently, the success rate of implant placement is between 95-98% which is very high indeed.

Computer Guided dental Implant Surgery

Tooth loss is a serious oral health problem that can have a significant effect on overall quality of life, making it difficult to chew or embarrassing to smile. Dental implants are a solution for people who have lost one or more teeth due to periodontal disease, trauma or injury, or other reasons. Implants are artificial tooth roots that are placed into the jaw bone and are used to support the crowns.

Dental Implant

Traditionally, a dentist will create impressions of a patient’s teeth and gums. X-ray will also be done in order to get an image of the mouth structures before placing the dental implants free hand. These technique require the dentist’s experience and expertise. Computer guided implant surgery represents a giant step forward in the replacement of teeth with dental implants.

What is Computer guided dental implant surgery?

Computer-guided implant surgery is a great advance in dental implant treatment planning. A computer program, cone-beam CT 3D X-ray and intraoral scanner will be used for planning an accurate position of dental implants. The computer program will combine x-ray images, intraoral scans and cone-beam 3D CT images and translate into a 3D model of the jaw. The dentist will be able to plan the placement of dental implants and determine their optimum position with a high degree of accuracy. A surgical guide will be fabricated by our in house 3D printer for use during implant surgery for accurate placement according to computer planning.

Benefit of computer guided implant surgery:

  1. Reduced Risks Computer-guided implant technology makes it possible to see the anatomical structures of the jaw, teeth, and surrounding tissue, thereby reducing the risks of unexpected complications during surgery as well as allowing the dentist to know exactly where the implant should be placed.
  2. Reduced Surgical Time Because a precise surgical guide is created, there is no guesswork with guided implant surgery. This allows the procedure to be completed faster than traditional dental implant surgery so patients can start the recovery process sooner.
  3. Better Patient Education Computer-guided implant technology is based on detailed scans of the oral structures. These images may be used to explain the dental implant procedure as well as to educate patients about their oral health.

Case Example: Patient of ours requesting for dental implant to replace his lower left first molar tooth.

Situation before dental implant placement
Computer planning of implant placement on lower left first molar combining 3D CT X-ray, intraoral scan. Dental Implant planning is done virtually and surgical guide is designed
Surgical guide printed out by our in house 3D printer in patient’s mouth
Dental implant placement according to computer planning
Final Implant crown screwed into place

At Prestige Dental, we are fully equipped with Cone Beam 3D CT X ray machine, Intraoral scanner and 3D printer to fabricate the surgical guides

Our new CBCT, OPG and Lat Ceph X-Ray unit
Intraoral 3D scanner available in Prestige Dental
3D printer for fabricating surgical guide available at Prestige Dental

These computers can also be a valuable tool when it comes to our explanation of how exactly your implants will be placed. The patient will be able to look at clear images, as well as ask any questions.

With the help of computer guided surgery, we able to better pinpoint the exact location within your mouth for each implant, considerably simplifying the overall procedure. As our patient, you can look forward to a less invasiveness procedure, safer with less complications, a shorter recovery time, and an overall process that is much smoother from beginning to end.

Dental Implant: A case of an implant placement over missing canine.

Dental-Implant

A lady came to our clinic requested for dental implant to replace her missing upper left canine. Upon examination and radiography image  taken, we found out that her missing canine is hidden way up in her upper jaw bone. (OPG below – white arrow)

The condition where the canine teeth develop displaced from their normal position is referred as etopic canine.

ImplantLEP27

If we leave the etopic canine there and place an implant over the gap, there might be a chance that the implant will hit the etopic tooth. Therefore, after discussed with her, we decided to  remove the tooth surgically and at the same time, we placed the implant into the gap. The extracted socket with be filled up with bone graft.

ImplantLEP29

End result!!

ImplantLEP22
Continue reading Dental Implant: A case of an implant placement over missing canine.

Dental Implant: A case of an Implant at the upper front jaw – immediate placement

Dental-Implant

This young man came to us complaining of his broken tooth (upper left central incisor). The tooth was root treated (RCT) many years ago and it fractured at the level below gum margin.

Implant01

Before

The tooth was un-saveable  and extraction was the only choice.

Treatment option:

  1. Immediate dental implant placement
  2. Denture to replace missing front tooth
  3. Full porcelain bridge

After discussed with him, he decided to have dental implant to replace that broken tooth and later crown for the right central incisor.

Implant25
Final result

 

Continue reading Dental Implant: A case of an Implant at the upper front jaw – immediate placement

Dental Implant: A case of an Implant at the lower front jaw

A young lady had a lower  front tooth exacted a few months ago due to tooth decay and she came to us requesting for a permanent replacement of that missing tooth. She didn’t want a denture as it was a removeable appliance. She wanted something fixed in her mouth but wasn’t a bridge as she believe a bridge would damage her neighbour teeth.

Therefore, a dental implant was suggested to her.

  

After a few months a dental implant tooth was completed and she was quite happy about her implant now.

Below are the process of:

A simple case of Dental Implant Treatment

Continue reading Dental Implant: A case of an Implant at the lower front jaw

Bone Graft

Dental-Implant

What is bone graft in dentistry?

bone block
Bone Block

bone graft
Bone Graft

 

Bone graft is a material that used to replace missing bone or bone defect in the face and mouth region, particularly in jaw area for support of  implant during implant placement. Bone graft can also be use support the cheek or the chin area for aesthetic reasons.

Usage of bone graft in dentistry:

  • Orthognathic (Corrective jaw surgery) Surgery
  • Alveolar Bone Grafting (ABG) procedure in cleft patient
  • Periodontal surgery (eg. Guided Bone Regeneration)
  • In implant dentistry, bone grafts are widely used  in:
    • Sinus augmentation
    • To preserve the socket after dental extraction of implant placement later
    • To repair defect after dental extraction
    • To cover exposed implant fixture during implant placement

Bone augmentation is a term that describes a variety of procedures used to “build” bone so that dental implants can be placed.

 

Bone graft was use during open sinus augmentation
Bone graft was use during open sinus augmentation

When do we use bone graft in implant surgery?

Bone graft is used when there is not enough of bone at the site where implant is intended to be placed. Usually, when the width or the height of the jaw bone is not enough to support the placement of implant.

Bone graft can be obtain from outside or from patient’s own bone (autologous bone). Autologous bone is the best bone to substitute missing bone due to its high survival rate  and its capability of attract new bone formation.

 

Bone-graft-procedure
Xenograft material was used to graft bone defect after implant placement

 

Bone graft sources

Autograft (Autogenous Bone)

Autologous bone grafting involve taking bone graft from patient’s bone of the  same individual who is receiving the graft. Bone can be harvested from intra-oral (in mouth) or extra-oral (outside the mouth); example iliac crest, rib, cavarium.
In oral and maxillofacial surgery, bones are harvested extra-oral under general anaesthesia to repair alveolus in cleft patient, reconstruct mandible or maxilla after tumor resection, condyle reconstruction etc.
 

autologous-bone-graft
Autologous bone graft taken from the external ridge of the ramus of lower jaw

In implant dentistry, the usual site in the mouth that used to get bone graft (Donor site) usually depends on surgeon preference, the quality and quantity required:

  • External oblique ridge (bone behind the lower last molar)
  • Chin area
  • Tuberosity (bone behind the upper last molar)

Advantages of autograft:

  • Less rejection because graft originated from the patient’s own body
  • The graft doesn’t carry any disease
  • Using autograft bone as grafting material produce the highest successful outcome and predictability because the graft is a vital (living) bone which has the property of  osteoinductive and osteogenic, as well as osteoconductive to regenerate new bone.

Disadvantages:

  • Additional surgical site is required (2 site surgery)
  • Post-operative pain and complications

 

Allografts

Allograft bone, like autogenous bone, is derived from humans; the difference is that allograft is harvested from an individual other than the one receiving the graft. Allograft bone can be taken from cadavers that have donated their bone so that it can be used for living people who are in need of it.

puros-from-zimmer
Puros from Zimmer is allograft bone particles

 

There are three types of bone allograft available:

  1. Fresh or fresh-frozen bone
  2. Freeze-dried bone allograft (FDBA)
  3. Demineralized freeze-dried bone allograft (DFDBA)

Allograft bone used in dentistry uses bone from cadaver that undergo process of removal of unwanted material such as fats, cells, antigens, and inactivates pathogens, while preserving the valuable minerals and collagen matrix. This material is than freeze-dried before package.

Advantages of allograft:

  • Less antigenic rejection because allogaft bone originated from the same species
  • No need additional surgical site is required (2 site surgery)
  • The success of grafting using allograft will be lesser than autograft as the material used is basically a dead tissues
  • However, this material still carry property of  osteoinductive and osteoconductive to regenerate new bone

Disadvantages:

  • Allograft bone might carry certain unknown diseases that resist the cleaning process during preparation of the graft
  • The graft usually resorb faster than xenograft material
  • Additional cost to the surgery

Xenografts

Xenograft bone substitute has its origin from a species other than human, such as bovine bone (or recently porcine bone) which can be freeze dried or demineralized and deproteinized. This material still has the property of  osteoinductive and  osteoconductive to regenerate new bone.

 

Bio-oss
Bio-Oss from Geislich contains xenograft material

Advantages of xenograft:

  • No need additional surgical site is required (2 site surgery)
  • This material still carry bone regeneration property of  osteoinductive and osteoconductive.
  • However,  success of grafting using xenograft will be lesser than autograft as the material used is basically a dead tissues
  • Xenograft material last longer in the mouth therefore, it with maintain the bone thickness for years

Disadvantages:

  • Just like allograft, xenograft material might carry certain unknown diseases that resist the cleaning process during preparation of the graft
  • Additional cost to the surgery

 

Alloplastic grafts

Alloplastic grafts may be made from hydroxylapatite, a naturally occurring mineral that is also the main mineral component of bone. They may be made from bioactive glass. Hydroxylapatite is a Synthetic Bone Graft, which is the most used now among other synthetic due to its osteoconduction, hardness and acceptability by bone.

 

boneceramic
BoneCeramic isone of the example of alloplastic graft

 

Some synthetic bone graft are made of calcium carbonate, which start to decrease in usage because it is completely resorbable in short time which make the bone easy to break again.

Tricalcium phosphate which now used in combination with hydroxylapatite thus give both effect osteoconduction and resorbability.

Polymers such as some microporous grades of PMMA and various other acrylates (such as polyhydroxylethylmethacrylate aka PHEMA), coated with calcium hydroxide for adhesion, are also used as alloplastic grafts for their inhibition of infection and their mechanical resilience and biocompatibility. Calcifying marine algae such as Corallina officinalis have a fluorohydroxyapatitic composition whose structure is similar to human bone and offers gradual resorption, thus it is treated and standardized as “FHA (Fluoro-hydroxy-apatitic) biomaterial” alloplastic bone grafts.

 

Biological mechanism

Properties of various types of bone graft sources.
  Osteoconductive Osteoinductive Osteogenic
Alloplast +
Xenograft +
Allograft + +/–
Autograft + + +

Bone grafting is possible because bone tissue, unlike most other tissues, has the ability to regenerate completely if provided the space into which to grow. As native bone grows, it will generally replace the graft material completely, resulting in a fully integrated region of new bone. The biologic mechanisms that provide a rationale for bone grafting are osteoconduction, osteoinduction and osteogenesis.[1]

Osteoconduction

Osteoconduction occurs when the bone graft material serves as a scaffold for new bone growth that is perpetuated by the native bone. Osteoblasts from the margin of the defect that is being grafted utilize the bone graft material as a framework upon which to spread and generate new bone. In the very least, a bone graft material should be osteoconductive.

Osteoinduction

Osteoinduction involves the stimulation of osteoprogenitor cells to differentiate into osteoblasts that then begin new bone formation. The most widely studied type of osteoinductive cell mediators are bone morphogenetic proteins (BMPs). A bone graft material that is osteoconductive and osteoinductive will not only serve as a scaffold for currently existing osteoblasts but will also trigger the formation of new osteoblasts, theoretically promoting faster integration of the graft.

Osteopromotion

Osteopromotion involves the enhancement of osteoinduction without the possession of osteoinductive properties. For example, enamel matrix derivative has been shown to enhance the osteoinductive effect of demineralized freeze dried bone allograft (DFDBA), but will not stimulate de novo bone growth alone.

Osteogenesis

Osteogenesis occurs when vital osteoblasts originating from the bone graft material contribute to new bone growth along with bone growth generated via the other two mechanisms.

 

 

Dental Implants

BEST THING TO NATURAL TEETH

What is Dental Implant?

A dental implant is a small “anchor” made of titanium. It is inserted into the jawbone to take the place of your missing tooth root. After Osseointegration, or when the surrounding bone has attached to the implant, a replacement tooth is secured to the top of the implant. The new tooth looks, feels, and performs just like your natural teeth.

Dental implants can be used in a variety of situations, whether you need to replace a single missing tooth or many teeth. They can even be used to replace a full denture. As anchor points, implants can also securely attach a partial denture or bridge.

 

What are the benifits of dental implant?

Choosing implants offers you a number of significant advantages including:

More healthful and beautiful: When teeth are missing, the surrounding bone begins to shrink. This unhealthy bone loss can make your jawline recede. Dental implants can help prevent deterioration of the jawbone caused by loss of teeth, so your face retains its natural shape.

As an alternative to bridgework, dental implants eliminate the need to grind down healthy teeth when replacing one or more adjacent teeth.

More comfortable: Because dental implants are securely anchored, there is no slipping or movement as there is with dentures. This eliminates some of the key worries of dentures, including poor fit, gum irritation, and pain from exposed nerves.

More confident: With dental implants, you will never need to cover your mouth when laughing, smiling, or speaking. You can eat your favorite foods without pain or fear of embarrassment – and taste every bite. You will look better, feel better, and live more confidently.

Are you the candidate for dental implants?

If you’re healthy enough to have a tooth extracted, you’re probably healthy enough to have an implant – whether your missing teeth are the result of injury, disease, or decay. General good health and adequate bone in the jaw are the key requirements. Your doctor can tell you if implants are right for you.

What is involved in implant procedure?

The dental implant process involves several steps that take place over a time period that averages from four to nine months. The typical process will include:

Initial implant placement: This procedure is typically performed in your dentist’s office under either a local or a general anesthesia. Your doctor places the implant into your jaw. Over the next several months, bone will attach to the surface of the implant anchoring it into position. Depending on your particular case, an additional minor procedure creates an opening through which your artificial tooth will emerge.

Implant prosthetic attachment: During this phase, your dentist painlessly attaches a prosthetic “post” from Zimmer Dental to the implant. A simple impression will be taken and over the next few days an artificial tooth will be created for a functional natural restoration.

Implants can improve your appearance, confidence and freedom

Since dental implants look and feel like natural teeth, they naturally enhance your appearance. More importantly, the securely attached implant gives you the confidence of eating what you like, speaking easily and clearly, and freedom from embarrassment. And, by following a regular routine of careful oral hygiene and regular checkups, your implants can last for many years.

To find out if implants are a solution for you, ask your doctor to evaluate you today.

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Dental Implant (In-Depth)

Topics

What is dental implant?

Composition of an Implant

Anatomy of Implant

Who should perform the Implant placement?

Surgical procedure

Restoration Procedure

What is dental implant?

Dental implant is an artificial root of the tooth used in dentistry to support restorations that resemble a tooth or group of teeth.

All dental implants today (21st century) are root-form and they are placed inside the bone (endosseous implant). Prior to the advent of root-form endosseous implants, most implants were either blade endosseous implants, in that the shape of the metal piece placed within the bone resembled a flat blade, or subperiosteal implants, in which a framework was constructed

Implant is used to support a crown (for the case of missing a single tooth) or they can be used to support bridge or denture (for the case of multiple missing teeth) that are designed to look just like your natural teeth.

  • Dental implants are small screws made of pure titanium that are surgically implanted in your jaw.
  • They provide a permanent foundation for crowns, bridges and dentures.
  • They are proven technology backed up by more than 50 years of development.
  • Dental implants protect your jaw against bone loss.
  • Because dental implants anchor in the jawbone just like natural teeth, they are the best choice for natural-looking tooth replacement

Composition of an Implant

A typical implant consists of a titanium screw (resembling a tooth root) with a roughened or smooth surface. The majority of dental implants are made out of commercially pure titanium, which is available in 4 grades depending upon the amount of carbon and iron contained. More recently grade 5 titanium has increased in use which offers better tensile strength and fracture resistance.  Implant surfaces may be modified by plasma spraying, anodizing, etching or sandblasting to increase the surface area and the integration potential of the implant.

Anatomy of Implant

Implant/Fixture – titanium material for osteo-integration with the surrounding bone.
Abutment – structure which connects the implant to the crown and it is situated in the gum area.
Crown – Usually porcelain fused to metal material that can be seen in the mouth.

What is the difference between dental implant and natural tooth?

Who should perform the Implant placement?

Implant surgery may be performed as an outpatient under general anesthesia, oral conscious sedation, nitrous oxide sedation, intravenous sedation or under local anesthesia by trained and certified clinicians including general dentists, oral & maxillofacial surgeons, prosthodontists, and periodontists.

Surgical procedure

Surgical planning

Prior to commencement of surgery, careful and detailed planning is required. Two-dimensional radiographs, such as orthopantomographs (OPG) or periapicals radiograph are often taken prior to the surgery. They are used to identify vital structures (such as the inferior alveolar nerve or the sinus), as well as the shape and dimensions of the bone to properly orient the implants for the most predictable outcome. In some instances, a Cone beam tomogram (CBT) or CT scan will also be obtained.

Jaw X-ray — Dental Panaromic Tomogram (or OPG)

Cone Beam Images of the jaw bone

Implant placement procedure

In its most basic form the placement of an osseointegrated implant requires a preparation into the bone using either hand osteotomes or precision drills with highly regulated speed to prevent burning or pressure necrosis of the bone. After a variable amount of time to allow the bone to grow on to the surface of the implant (osseointegration) a tooth or teeth can be placed on the implant. The amount of time required to place an implant will vary depending on the experience of the surgeon, quality and quantity of the bone and the difficulty of the individual situation (usually between 30 minutes and 2 hours).

Preparation of recipient bone for implant insertion

Surgical procedure

An incision is made over the crest (highest point of the gum ridge) of the site where the implant is to be placed. The gum (which is referred to as a ‘flap’) was raised  to exposed the recipient bone. Then, a pilot hole is bored into the bone, taking care to avoid the vital structures. Drilling into jawbone usually occurs in several separate steps. The pilot hole is expanded by using progressively wider drills (typically between three and seven successive drilling steps, depending on implant width and length). Care is taken not to damage the bone cells by overheating. A cooling saline or water spray keeps the temperature of the bone to below 47 degrees Celsius.

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Implant insertion into recipient bone

The implant screw can be self-tapping, and is screwed into place at a precise torque so as not to overload the surrounding bone (overloaded bone can die, a condition called osteonecrosis, which may lead to failure of the implant to fully integrate or bond with the jawbone). Typically in most implant systems, the osteotomy or drilled hole is about 1mm deeper than the implant being placed, due to the shape of the drill tip. Surgeons must take the added length into consideration when drilling in the vicinity of vital structures.

Before implant insertion

After implant insertion on the upper right area

For Anxiety Patient…

If in a case of an anxious patient come for implant placement, usually, we will prescribe some medication of reduce anxiety before the surgery or patient will have to inhale nitrous oxide during the procedure so that he/she will feel relax and calm all the time during surgery. If the patient is extremely phobia of surgery, then he can opt for surgery done under general anaesthesia which required hospitalization.

Healing time

Practitioners usually allow 2–6 months for healing. If the implant is loaded too soon, it is possible that the implant may move which results in failure. The subsequent time to heal, possibly graft and eventually place a new implant may take up to eighteen months. For this reason many are reluctant to push the envelope for healing.

Wound healing – immediate after surgery

Wound healing – 7 days after surgery

One-stage or two-stage surgery?

When an implant is placed with a ‘healing abutment’, which comes through the mucosa (or the gum), it is referred as the one-stage surgery. (Picture above is one-stage surgery where the healing abutment – green and purple screw can be seen on the gum surface)

When an implant is placed with  a ‘cover screw’ which is flush with the surface of the dental implant and usually hidden under with the gum, this surgery is referred as the two-stage surgery. A second surgery is needed 3 months later to exposed the cover screw and the cover-screw is to be placed with healing abutment.

Two-stage surgery is sometimes chosen when a concurrent bone graft is placed or surgery on the mucosa may be required for esthetic reasons. Some implants are one piece so that no healing abutment is required.
In carefully selected cases patients can be implanted and restored in a single surgery, in a procedure labeled as “Immediate Placement“. In such cases a provisional prosthetic tooth or crown is shaped to avoid the force of the bite transferring to the implant while it integrates with the bone.

Surgical timing

There are different approaches to place dental implants after tooth extraction. The approaches are:

  • Immediate post-extraction implant placement.
  • Delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction).
  • Late implantation (3 months or more after tooth extraction).

Restoration Procedure

For missing single tooth

Implants can be made to replace missing tooth or teeth. If an implant is used to replace one missing tooth, it is  implant-supported crown.

Implant-supported crown is used to replaced a missing tooth

Multiple missing tooth

Implant-supported crown can be used to replaced multiple missing tooth. Every missing teeth will be replace with implants

Implant-supported crown

If in cases where the bone is too narrow and not suitable for implant placement then implant-supported bridge will be used to avoid those unsuitable area.

Implant supported bridge

Implant-supported bridge also can be used to reduce implant cost and surgical time!!

Impression taking

After the implant in well osteo-integrated with the surrounding bone, construction of the outer part — the crown/tooth procedure can be started. Usually it started with impression taking after the gum heals around the healing abutment.

Gum healing after a week with healing abutment in two-stage surgery

Impression is used to make a duplication of the gum and the implant position where the laboratory technician can fabricate crown/bridge outside patient’s mouth.

The impression transfer posts are inserted on the implant fixtures

And impression of the gum and implant are taken with silicone material

Crown/Bridge fabrication

In the dental laboratory, porcelain fused to metal crowns or bridges are fabricated. Usually it takes about 2-3weeks to be done.

A model with implant is made from the silicone impression.

On the model, crowns are fabricated and ready to be fit in patient mouth!!

Another case with two implant-supported bridges

Restoration of crown/bridge in the mouth

There are basically 2 types of ways by which the crowns/bridges that can be attached to the implant:

Screwed retained – The crowns/bridges are retained in the mouth with screw that screw into the abutment. The advantage of using this way is easy to be removed when ever need (eg. if the crown break or the abutment become loosen). However, the aesthetic will be compromised. Usually screwed retained method is used in posterior region where aesthetic is not an issue or in straight abutment type.

Cemented retained – The crowns/bridges are cemented onto the abutment with cement such as temp-bond, GIC etc. The advantages is very good aesthetic. Usually used in the anterior region or in angle abutment type.

Below are the procedures of installing the final restoration of a screw-retained type:

After removing the healing abutment, the implant ‘hole’ will be assessed
The abutments are screwed into the implants with force 15Ncm

Then, the crowns are fit onto the abutments and the colour, shape and occlusion will be assessed
After that,  crowns will be screw onto the abutments with force of 15Ncm
The hole at the palatal surface will be covered with filling material
Final result!!

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Problems with missing teeth

General-Dentistry

Topics

  • Problems with missing tooth/teeth
  • Treatment Options for Replacing Missing Tooth/Teeth

Problems with missing tooth/teeth

As soon as a tooth is being removed, we have to think of the options available for replacing that missing tooth. Most of us don’t really know the consequences or future problems that are going to be faced by us resulting from tooth extraction.

These are some of them:

1. Chewing efficiency decrease

The most common problem patient face immediately after extraction it lost of chewing efficiency. He will tends to chew more on the opposite side. If the extraction involved multiple teeth, then patient will have to switch to soft diet which might result in poor digestion and malnourished. Therefore replacement of missing teeth is crucial to regain back patient’s normal chewing.

2. Over eruption of opposite tooth

Over-eruption of upper molar tooth

Commonly happen after extraction of the lower molar causing the upper molar to erupt further downwards. This will result in food stagnant in the interproximal (in-between of the teeth) area making the teeth easily develop dental caries.

3. Migration of neighbour tooth

The neighbour teeth will migrate to the extraction site as soon as the tooth was remove. Usually, the patient will begin to notice it after a year or more. In some delayed cases, tooth extraction causes the front teeth to have multiple gaping which resulted in poor aesthetic. Both migration and supra-eruption of teeth will make restoration or replacement of the missing tooth difficult.

4. Bone lost

The gum become narrow due to bone loss after extraction

Alveolar bone lost significantly after missing teeth. As the result, the upper lip looks flatten due to lost of support from the anterior alveolus bone. Lost of bone also makes implant insertion difficult which might required bone harvesting before implant insertion.

5. Attrition of the remaining teeth

When patient loose most of his back teeth, he will try to use his front teeth to grind food and eventually all the front teeth will look much shorter due to attrition from chewing. Attrition also will make the teeth become sensitive to cold and sweet (dentinal hypersensitivity).

6. Over-closure of the mouth

As the result from attrition of front teeth and lost of posterior chewing, patient tends to over close his jaw. This will make his face shorter and his lip looks thin and easily get fungal infection at the corner of the mouth

7. Traumatic occlusion and Jaw joint dysfunction

Missing teeth will cause parafunction (abnormal) chewing. For example, when the back teeth are missing, the front teeth will be used for grind. This abnormal force will be exerted to the remaining teeth causing bone resorption around the teeth and lead to gum problem and loosening of teeth. Heavy and abnormal chew will also causing the TMJ (jaw) joint pain.
Due to abnormal function, the remaining teeth have a very high chance of fracture.

Conclusion

Delay in restoring missing teeth will result in:
1. Loss of chewing
2. Difficult in restoration/replacing missing teeth
3. Poor dental aesthetic – short teeth, teeth gaping, deep bite
4. Poor facial aesthetic – over closure, short face, chin protrusion
4. Prone to dental decay, gum problem, tooth fracture, dentine hypersensitivity
5. And finally, making you look older….

Smile!!

Treatment Options for Replacing Missing Tooth/Teeth

Option 1: Denture

Advantages
1. Cheap
2. Complexity: Simple
3. No need needle injection
4. No need surgery (No pain)
5. Maintenance: Easy to take care
6. Treatment duration: Short 1 – 3 weeks
7. Easy to adjust, repair

Disadvantages
1. Feel like not real (fake teeth) – can be removed from the mouth
2. Uncomfortable – Big and bulky
3. Palate coverage – less taste when eating
4. Lower ridge coverage – no space for the tongue
5. Teeth is made of plastic – easily worn off & stained
6. Easily trap food
7. For one missing tooth – wearer is not willing to wear it, very uncomfortable
8. Chewing food not the same as the natural teeth
9. Easily break

Option 2: Bridge

Advantages
1. Feel like real teeth – cannot be removed
2. Highly aesthetic – Look like natural teeth (with full porcelain), multiple shade to select
3. Very comfortable – No palate or lower ridge coverage
4. Teeth is made of porcelain – strong, durable
5. Good for missing one or a few teeth
6. Can correct the abutment teeth to a desirable shape and position
7. Chewing food almost as real as natural teeth
8. No need surgery

Disadvantages
1. Price: Moderate
2. Complexity: Simple to complex
3. Required needle injection
4. Involved neighbour teeth – the neighbour teeth required to be ground for support
5. Easily trap food under the bridge
6. Maintenance: Difficult (Required to floss under the bridge)
7. Treatment duration: Medium 2 – 3 weeks
8. No suitable for cases such as free end saddle, fully or near to edentulous

Option 3: Dental Implant

Advantages
1. Feel like real teeth – porcelain is sitting on the implant
2. Highly aesthetic – Look like natural teeth (with full porcelain), multiple shade to select
3. Very comfortable – No palate or lower ridge coverage
4. Teeth is made of porcelain – strong, durable
5. Does not involve the neighbour teeth
6. Trap food: very minimal (just like natural teeth)
7. Maintenance: simple to take care (just like natural teeth)
8. Can replace missing teeth in edentulous and free end saddle
9. Chewing food almost as real as natural teeth

Disadvantages
1. Price: Expensive
2. Complexity: Complex – required good planning
3. Duration of treatment: Long 3 – 6 months
4. Required needle injection
5. Required to undergo surgery (maybe required second or third surgery)
6. Required sinus augmentation, bone harvesting if not enough bone height for implant insertion (additional cost, additional surgery….additional pain)
7. Higher risk of failure in smoker, diabetic and medically compromised patient
8. Risk of injuring other structure during implant insertion: ID nerve, antrum

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Denture

Dental Bridge

Dental Implant