Dr Siti Mariam Ab Ghani Deputy Dean (Academic & International), Universiti Teknologi MARA
Our teeth are not just for eating. As seen in people who have lost most or all of their teeth, the ability to speak effectively also can be affected by the loss of teeth. Losing a tooth, especially the front tooth may also lead to a loss in self-confidence, affecting our ability to socialize with other people.
Missing a front tooth?
It is very important to replace the missing anterior tooth. Not only will this restore our ability to eat and communicate normally, as well as our self-esteem, it is only necessary to prevent future oral problems.
You see, the empty space formerly taken up by the missing tooth will allow neighbouring teeth to move into that space. This can eventually cause problems such as tilting and overgrowth of these neighbouring teeth.
Therefore, if you are missing a front tooth, you should visit a dentist as soon as possible to explore your options. Here are three of the most commonly recommended options. These options are not arranged by the best sequence as each option has its own advantages and disadvantages.
Removable Partial Denture (RPD)
RPD is more commonly known as false teeth or plastic teeth. It is one of the cheapest and simplest prosthesis to fabricate in order to replace missing teeth.
It is considered the best option when the person is missing all of his or her teeth (upper and lower). However, it may not always be the best option for people who are just missing a single front tooth.
An RPD will have a base made from cobalt-chromium (metal) or acrylic (plastic) covering the palate (upper arch) attached to the artificial tooth with metal clasps to hold the removable prosthesis in place. All these components will occupy the tongue space, have high tendency to accumulate plaque and the bulkiness of the prosthesis will cause discomfort to the patient.
A dental bridge is a prosthesis device with a false tooth (known as pontic) linked to it. It is permanently cemented to cover the gap left by the missing tooth.
There are two types of dental bridges: conventional bridges and resin-bonded bridges. The main difference between the two types is the tooth preparation needed to allow the bridge to be set into place.
For conventional bridges, the neighbouring tooth structures are removed to provide sufficient space for a caps (crowns). The pontic is linked between the two caps (crowns) to fill in the area left by the missing tooth.
To fabricate resin-bonded bridges, none or very minimal removal of neighbouring tooth structures are required. It has a more conservative approach and works primarily on the principle of adhesion. The bridges will have wings (retainers) that will be attached to the neighbouring tooth surfaces to hold a pontic in place. However, as the wings are usually metallic, it can be very obvious when one is wearing such dental bridge – something that certain patients may not appreciate. However, the aesthetic can be improved by placing the metal wing at the palatal (back) surface of the anterior teeth.
An increasingly favoured option, this involves the insertion of a titanium-based prosthesis into the jawbone of the missing tooth area, to act as a root and to hold an artificial tooth (implant-crown). This prosthesis is expensive and the procedure must be performed by a dentist trained in implantology.
Anyone seeking dental implant must be fit and healthy to undergo surgery under local anaesthesia. Once the titanium implant has integrated with the jawbone, the next stage of the treatment is to provide the artificial tooth (implant-crown) for the implant.
The main advantage of this prosthesis is that the neighbouring teeth will not be touched or altered. The implanted crown will only occupy the space left by the missing tooth, and is highly tolerated by patients due to the natural shape and design of the prosthesis.
So, which option is best for you?
Only your dentist can give you the answer, as the best option for one person may not be the best for another person. Each case of missing tooth (or teeth) should be thoroughly assessed by a dentist in order to decide on the best treatment. Therefore, if you are missing a front tooth, visit your dentist for advice.
Figure 1: Removable Partial Denture
Figure 2: Conventional Dental Bridges
Figure 3: Resin-Bonded Bridges
Figure 4: Dental Implants