Cosmetic & Restorative Dentistry
Space Closure

What  To Do?

  1. Do Nothing:  There are some disadvantages  to leaving spaces between teeth and may cause problems in the future with:  eating, speaking, keeping teeth clean and your “bite”.  Eventual tooth loss may occur because of the shifting and the bone loss.  The opposing teeth on the top or bottom may slowly shift into the opposing space.  The teeth on either side may start tilting into the space.
  2. Partial upper and lower dentures:  Impressions can be made of your teeth for the fabrication of removable partial dentures.  This treatment option is most desirable when multiple spaces are found in the upper and lower jaws.  The denture can be taken out while eating, if you choose, or may aid in chewing, food more efficiently.  It must be removed at bedtime for cleaning of the teeth and gums.  The denture involves a metal plate which has acrylic or plastic teeth on it to fill in the spaces and has clasps on the teeth surrounding the space to hold the denture in place.  This option is least expensive and least invasive to dental tissues.  Only very minimal tooth structure is removed.  Comfort may be an issue if an upper denture is made to fill in spaces because the metal portion may cover the palate.  With a lower denture, there will be metal running behind your lower front teeth.
  3. Dental Implants:  This option has the best long term prognosis, with high success rates.  The missing tooth would be replaced with self-standing units which do not involve the adjacent teeth.  The advantage of this treatment is that vital teeth are not involved.  The space is only treated.  However, excellent oral hygiene and frequent visits to the oral surgeon to assess the health of the implant area are required to prevent any infection around the implant.  There is also a possibility that the implant will not integrate in the jawbone.  A referral to an oral surgeon or periodontist is required for a consultation to assess your medical history and dental records to see whether you are a suitable candidate.
  4. Conventional Bridge:  A bridge is used to replace a missing tooth or teeth.  Replacing missing teeth with a bridge restores the normal bite and prevents a number of serious additional problems from developing.  When a tooth is lost, the biting forces change on the teeth next to the space, and they begin to shift.  When an opposing tooth no longer has anything to bite against it slowly begins to extrude from the socket.  This opposing tooth may eventually be lost.  As the bite changes, it becomes difficult to chew food.  The change in the bite also affects the jaw joint or TMJ.  It is more difficult to clean teeth that have shifted and thus there is an increased change that harmful bacterial accumulate in these hard to reach places.  This may result in gum disease, decay and permanent bone loss.  The bridge corrects the problem by filling the space left by the missing on extracted tooth, stabilizing  the bite and remaining teeth.  Appointment sequence and scheduling is very similar to crowns.  Two appointments are required to complete the procedure.  Material that are available: gold, porcelain fused to metal.
  5. Maryland Bridge:  This bridge does not involve crowning the tooth in front and the tooth behind the space.  The lab, again, would make a single unit that joins the two to fill the space.  In this case, small preparations or slots are made “between” the teeth adjacent to the space.  The bridge has “wings” that are fitted and bonded onto these slots.  It is not removable from the mouth.  The advantage is that supporting healthy tooth structure is not removed to compromise the tooth’s longevity.  On the other hand, because the bridge is bonded on, it has a high chance of debonding from everyday functions like eating and grinding at night.  Care must be taken while eating and cleaning, otherwise frequent visits to your dentist to get the bridge rebonded will be necessary.

Keeping your gums healthy is just as important as keeping your teeth healthy.  Gum disease is caused by plaque.  It irritates the gums, causing them to become tender and swollen.  It also causes the gums to bleed easily.  If it is not removed, the plaque hardens and forms tartar or calculus around your teeth.  Eventually, the tissue that attaches the gums to the teeth is destroyed by the irritants in plaque.  Pockets are formed, that are filled with tartar and plaque, and the jawbone supporting the teeth is destroyed,  causing bone loss and eventual tooth loss.  Thus, it is very important to practice good home oral hygiene and to come in for regular cleaning and check-ups to maintain the health of your teeth and gums, along with the longevity of your prosthesis.

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