People who have lost or are missing a single tooth face a special type of problem.  Appearance usually motivates the individual to replace the tooth, but the continual natural development and movement of the other teeth make replacement especially important even if appearance is not a critical factor.  If nothing is done to replace the missing tooth there is a risk of movement of the teeth in the opposite jaw as well as a risk of neighboring teeth drifting into the space.  This simple fact that there is one less tooth for the person to chew on reduces chewing ability.

There are several restorative options that a patient may choose to replace a single missing tooth.  There are advantages and disadvantages to each option.  Appropriate information concerning treatment allows an informed decision to be made for the most appropriate treatment.

1.      Fixed Partial Denture (Bridge)

A fixed partial denture is also commonly referred to as a bridge.  This procedure involves cutting down the teeth on either side of the missing tooth.  A metal or porcelain and metal bridge which contains the missing tooth is cemented on the shaped teeth.            The advantages of this technique is that it is relatively expedient.  The bridge will stabilize the bite and prevent movement of the opposing teeth.

Disadvantages of this technique are that there is a risk of nerve damage and future decay to the neighbouring teeth.  Porcelain fracture may also occur on the prosthesis.

2.       Resin-Bonded Fixed Partial Denture

A resin-bonded fixed partial denture is a metal and porcelain replacement of the missing tooth.  It is cemented to the inner or back side of the adjacent teeth.  Like a conventional fixed partial denture it is non-removable.   This technique requires less preparation of the adjacent teeth. Advantages of this technique is a short treatment time.  The replacement tooth stabilizes the adjacent teeth and bite. 

           

Disadvantages of this technique include possible metal show through and esthetic compromise.  The prosthesis may become loose and the longevity of this restoration is variable.  Some dentists may consider this a temporary restoration for younger patients until a more definitive restoration is placed when they are older.

3.       Removable Partial Denture

This treatment option is usually performed as a temporary procedure.  The advantage of this treatment option is that it is the least expensive option for replacement.  This treatment may be accomplished quickly. 

Disadvantages of this treatment include that the prosthesis is not as durable or stable as other forms of treatment, it may require occasional repair.  Some patients have difficulty in speaking clearly and in chewing with the prosthesis due to coverage of the palate.  Over an extended period of time, there may be detrimental effects on adjacent teeth and supporting tissues from this type of a prosthesis.

4.       Implant Supported Crown

An implant supported crown is a replacement tooth held in place by a single implant.  The implant replaces the missing root of the tooth.  The advantage of this procedure is that there is no tooth preparation or reshaping of adjacent teeth..  The adjacent teeth are not tied to the replacement tooth and cleaning the teeth is easier.   Studies have shown that there is bone preservation in the area where the implant is placed.

The restoration may be designed to be held in by a screw.  The advantages and disadvantages of cemented or screw retained prostheses will be discussed by the dentist. 

The disadvantages of a single implant crown restoration are that the time required for treatment is longer and the expense of treatment may be slightly higher.  The implant crown is not able to replace the missing gum tissue between teeth.

Studies have shown that implants placed more than 25 years ago have had a 90% success rate.  Implants supporting single teeth since 1984 have shown similar success.

5.       How Implant Treatment is Done

            Treatment planning is required for treatment success.  Planning involves the restorative dentist in conjunction with the dentist providing the surgical support. Diagnostic information required may include conventional dental radiographs (X-rays), diagnostic casts and a template to guide the surgery.

            Following the surgery in which the implants are placed, care is taken to allow soft-tissue healing.  The bone around the implant heals for 4 to 6 months.  Following implant integration into bone, a second surgery may be required to add a connector to the implants.  The connector becomes an extension of the implant through the gums.  A temporary crown may be fabricated at this time. Three to six weeks after the second surgery is required for soft tissue healing before fabrication of the final crown.

            After placement of the definitive prosthesis, the patient is instructed in the required daily maintenance.  As with natural teeth, regular evaluation, maintenance and hygiene visits with the restorative dentist and/or the surgical dentist are necessary to maintain optimal dental health of the implants.