It is very common for the patient to seek our dental clinic to repair only one tooth, when it has lost a part of its structure or when it usually has pains. However, most of the time, when the patient is examined we realize that there are other related factors that contributed to that event, such as when the patient has already lost some teeth and the tooth that supports chewing broke because there was a large restoration, being old or not, and there was no support from neighboring teeth. This is a common case of complaint from patients.
The oral cavity is complex and composed of gums, teeth and bone. In this sense, it is always essential to think about the Oral rehabilitation in order to remake the whole set that is damaged or lost, seeking to return the patient to its functional structure, through good chewing and also create better standard of aesthetics, which will improve the quality of life and help self-esteem.
In the case above, it is not only a question of rebuild a specific tooth, but relining the set of teeth, either through implants or removable prosthesis.
Dental Aesthetics and Oral Rehabilitation
Many people seek dental clinics because they want to improve their dental aesthetics.
DentalArt professionals perform a thorough work that begins at the first consultation, where the patient will be examined, photographed and tests that will assist the diagnosis will be requested, such as orthopantomography.
Once this is done, we can propose the best treatment plan to the patient.
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There are different ways to replace a tooth, or more than one tooth, when teeth have been lost for various reasons. The teeth to be replaced can be fixed or removable.
Missing teeth always need to be replaced, as the lack of just one in the dental arch will affect the functionality of the other teeth.
The option for removable or fixed teeth will depend on the most suitable treatment for each patient, which may involve not only the economic factor but also the biological conditions and biotype of each patient. Therefore, a good dental medical analysis is always necessary before deciding on the best type of treatment.
In this text, you will find out which treatments to choose, which can be fixed on your own teeth, removable dentures or implant.
Why do I need to replace lost teeth?
There are several reasons why you may need to repair or replace your teeth:
• You pulled out one or more teeth.
• Teeth have been worn for some reason
• You have lost teeth due to a tooth loss disease.
• The teeth have been damaged by caries and dental fillings, so they should be removed and replaced.
Many people can get used to missing teeth, especially on the sides of the jaw where the tooth is not so visible. The important thing is that the balance of the dental arch remains so that the teeth do not start to lean or move.
If a tooth is so badly damaged that it can no longer be repaired with a minor repair, the dentist may need to repair the tooth further and make a new crown. A crown is an artificial part of a tooth that covers most of the tooth like a cap. The crown is attached to the ground tooth with a cement called, a ceramic material that holds it in place.
A bridge is attached in the mouth and replaces two or more teeth. The bridge is sometimes called a bridgework and is joined together in one piece. If a tooth needs to be removed, it can be replaced with a bridge that rests on the teeth on either side.
To be able to replace lost teeth with a fixed bridge, there must be enough teeth remaining in the jaw to provide good support for the bridge. The teeth should also not be too far apart.
Dental implants are usually titanium metal screws that are operated into the jawbone. The titanium screws act as artificial roots in the jawbone. Once the implant has healed in the jawbone, the crown or bridge can be attached to it.
It is possible to replace a single missing tooth with a crown on an implant. If several teeth are missing, a bridge can be attached to several implants.
Usually, you need to visit the dentist several times before having a bridge or crown fitted. First, the tooth or teeth are ground down and the dentist takes an impression in order to make a model. Then you decide together the colour of the artificial tooth or teeth.
The impression is sent to a dental technician, who fabricates the crown or bridge. The replacement teeth are made of different materials.
Sometimes it is necessary to do one or more tests in the mouth to get a perfect fit. While you wait for the finished crown or bridge, it is usually necessary to temporarily replace the material. When everything is ready, you can try the crown or bridge in your mouth for a few days to feel that everything is fine before it is placed. Finally, the dentist places a cement on the crowns and attaches them to your teeth.
Keep cleaning around crowns and bridges
An artificial crown or bridge does not protect teeth from decay or tooth loss. Sometimes bridges can create places between teeth that can be difficult to clean. For example, bacterial coatings easily adhere to the transition between the tooth itself and the artificial crown.
The most important aids for keeping your teeth clean are a soft toothbrush and a fluoride toothpaste. Often, you need more fluoride in the form of tablets, chewing gum or mouthwash. You may also need extra small brushes and dental floss to get access everywhere.
You should see a dental hygienist regularly if you have many crowns or bridges in your mouth. The dentist or dental hygienist can advise you on how to take better care of your teeth.
If you don’t have many teeth, it can be difficult to replace them with artificial teeth that are stuck. Then you can get a removable denture, a full denture or a partial denture.
In addition to artificial teeth, the prosthesis also consists of an artificial material that replaces gums and jaws. You can insert and remove the prosthesis from your mouth yourself.
The partial denture can be attached with clips or some other attachment device to the teeth left in the jaw. A complete denture replaces the teeth in a completely edentulous jaw.
A full denture in the upper jaw connects like a suction cup to the upper jaw and palate. A complete denture in the lower jaw rests on the edentulous jaw. It can also be attached to ground teeth or implants and is then called a denture.
A partial prosthesis is usually better fixed than a full prosthesis.
If you still have some teeth
This can be done in two different ways when getting a new denture. It depends on whether you still have teeth or not.
The dentist makes an impression of the jaw and teeth if there are still teeth in the jaw. The dental technician builds a prosthesis that mimics your own teeth and has an approximate fit to the jaw.
When bad teeth are pulled, you can get your new dentures with a fit that is temporary until your gums and jaws have healed. Then the shape changes and the denture is adjusted until it fits perfectly.
With this method, you do not need to run out of teeth after removed.
If you don’t have teeth anymore
The dentist takes a cast of the edentulous jaw to make a wax cast. This is used to be able to measure where the new teeth should be located. Together with your dentist, you choose the colour and shape of your new teeth.
You need to visit the dentist four to five times before the denture is completely finished. With this method, the fit of the denture is good immediately and you usually avoid major adjustments for a few years.
The prosthesis should be checked
It is important that you check the prosthesis regularly, at least once a year. It may need to be adjusted. A denture that does not fit well can cause abrasions.
The jaw changes rapidly the first time after teeth are pulled. The denture may need to be adapted to it. A dental technician needs a maximum of a few days to make the necessary adjustments. In the meantime, you can be without a denture.
Sometimes the prosthesis needs to be remade. You can have a copy made of a denture that works well and that you like. It usually works well if what you are copying is not too worn out. You can also order an extra copy of your denture to keep in reserve.
How do removable prostheses work?
It is different for each person the time it takes to get used to a prosthesis.
It is more difficult to have a removable denture in the lower jaw than in the upper jaw. Dentures in the upper jaw can usually be placed on the palate. In the lower jaw, the tongue and other muscles can move the dentures out of position.
If you get a removable full denture in the lower jaw that doesn’t work well, it may be helpful to insert two implants. The implants have springs that hold the denture in place better, a so-called cover denture. If it works well, it is usually possible to insert more implants and make a bridge that is attached to the implants.
Certain diseases, such as Parkinson’s disease, Sjögren’s syndrome or stroke, can make it more difficult to have removable dentures. So, denture covers can work well.
Clean the prosthesis with a brush
A removable denture is easy to clean because you can take it out and brush it. You can use a toothbrush and mild soap. You can brush the gums gently with a soft toothbrush and warm water.
Do not use toothpaste to clean dentures. Toothpaste contains abrasives that can scratch the plastic material and make it easier for bacteria to stick to the denture.
In a dental implant,a new artificial tooth or a row of teeth is connected directly to the screws that have been connected on the maxillary bone. Sometimes the teeth are attached to small extensions of titanium or other material that protrudes from the gums. Extensions are called distances.
You can count on an implant holding up much like your own tooth, if you take good care of it.
Different degrees of lack of teeth require different implants
Before an implant treatment, you will be examined by your dentist. You will discuss your health and explain how the treatment will be carried out.
There are different treatments depending on which teeth are missing:
If you have lost or lost only one tooth, usually only one implant needs to be operated on. The implant then carries a single artificial tooth. It is called implant of a single tooth.
If you do not have a tooth in the first row of teeth, it is not enough for the implant to be placed in the jaw bone. The surrounding tissue should also have a shape that gives a natural appearance. Sometimes it is so hard to get well that a bridge is needed instead to support the surrounding teeth.
If you’ve lost several teeth, you can get multiple implants to support a fixed bridge. If you have lost large parts of your jaw, the dentist sometimes needs to extend the bridge with artificial teeth to make your face look as it did before.
If you don’t have teeth in your jaw, it usually takes four to six implants to be able to carry a whole row of teeth with artificial teeth. Sometimes more implants are needed.
When are implants inadequate?
There are diseases that prevent the placement of implants and sometimes the dentist needs to consult a doctor before the operation. Treatment may need to be postponed, for example in the following situations:
• You have osteoporosis.
• You are taking certain medicines.
• He is being treated for cancer with radiation.
• Their jaws have not fully grown.
• You have few bones in your jaw to be able to insert implants.
If you have cardiovascular disease and use blood-thawed medications, a medical evaluation is required.
Preparations for an implant operation
Usually, no pre-treatment is needed if you have a strong, healthy jaw. If you have bad teeth, it may be necessary to have them pulled. Then the jawbone may need to heal before treatment.
If you are a smoker, you should stop smoking well before the operation.
You can get a temporary denture if you are missing a tooth. It fills in the gaps in your teeth and makes it easier to chew.
Sometimes the jaw needs to be built
You can get a bone framework or bone graft if you do not have enough bone for the implants. It is most common for the operation to be performed in the upper jaw.
An X-ray examination of the jaw is performed first to examine the possibilities of operating implants. Sometimes it is done with CT scan, X-ray.
Next, a maxillofacial surgeon operates on bones from another part of the body. Sometimes artificial bone replacement materials are used.
For a minor operation, you will receive local anaesthetic. If the bones are operated on, for example the hip, this is done under anaesthetic.
You are operated on once or twice when you receive the implants, depending on how many implants will be inserted.
The operation is usually performed under local anaesthetic and is painless. You may be given sedatives if you are worried about the operation. If you are very worried, you can have the whole treatment under anaesthetic.
The first operation takes one to two hours, depending on how many implants will be inserted.
First, the gums are folded and holes are drilled in the jawbone. The surgeon then attaches the implants to the jawbone. Next, he sews the gums over the implants so that they are not visible.
For about a week, do not use the prosthesis and do not chew where you did the surgery.
Spacers are fixed to implants
In the second operation, the mucosa opens at each implant and small extensions, called distances, are attached to the implants. The distances go up through the mucous membrane. In these, subsequently, the new artificial tooth or bridge can be screwed in or fixed with cement, usually the second operation is faster than the first.
Treatment in just one step
Sometimes a treatment is done with just one operation. The surgery takes one to two hours, depending on how many implants will be inserted.
Basically, the same technology is used as in the first operation. But instead of stitching the mucous membrane and covering the implants, the implants or spacers can protrude a few millimetres from the mucous membrane from the start. So no further operation is needed.
After the operation of implants
Titanium implants need to heal firmly in the jawbone. The healing time can take up to six months.
In the meantime, you may have temporary teeth. If the implants are very stable, the dentist can sometimes build the artificial teeth into the implants the same day or weeks after the operation.
In case, it is not possible to build fixed temporary teeth, you can wear your old denture again, which has been reshaped to fit the jaw. In smaller spaces, you can sometimes get permanent temporary teeth that rest on the neighbouring teeth immediately after the operation.
Crowns on implants
When the implants are stably fixed and the mucous membrane has healed, the new artificial teeth are placed.
The dentist first makes an impression of the jaw and implant for the dental technician to take a model. On the model, the dental technician then builds the bridge. It’s important that the artificial teeth fit exactly into the implants.
It usually takes about two to four weeks to make the artificial teeth. The dentist attaches the artificial teeth to the implants.
You can’t remove the new teeth by yourself.
Keep your teeth clean
Smoking can make healing difficult after an implant operation.
You will often be given antibiotics after the operation. Sometimes you may need painkillers. As the surgeon punctures the jawbone, there is usually inflammation which passes quickly. It is usually with swelling, tenderness and sometimes there is bleeding.
To keep it clean, you can rinse your mouth with saline and chlorhexidine solution. If you have undergone full jaw surgery, you may need to eat a liquid diet for a few days.
It may seem unusual to have permanent teeth after being without teeth for a long time. Artificial teeth can look new and unusual. Sometimes speech is affected so that you read, for example. But you can find out by reading aloud.
Keep your teeth clean
It is just as important to keep implants and new teeth clean as regular teeth clean. The shape of the new teeth can cause food debris and bacterial coatings to stick more easily around the implant and bridge. Ask your dentist or dental hygienist for advice.
You can even check your implants and artificial teeth every day when brushing your teeth. Check that the bridges and crowns are stable, that they are intact, that the gums do not bleed or swell and that they do not hurt.
To check the jawbone around the implants, the dentist must perform an X-ray examination. This is followed by more so that the dentist can compare with previous X-ray examinations whether the implants are in place. During the first two years after surgery, it is important to check if the implants change.
After about two years, the time between X-ray examinations can be extended to, for example, five years if the bone around the implants is healthy.
At regular check-ups at the dentist or dental hygienist, this is checked:
• What the mucous membrane looks like around the implants.
• If there are bacterial coatings, called plates, around the implants and in the artificial teeth.
• What the bite looks like in artificial teeth.
• How the bite fits when you bite together.
• How well the bridge or crown is secured.
Complications and sequelae of implants
Implants usually work well for a long time. But it can become infected or the pressure from the prosthesis causes the implant to become overloaded and the implant comes loose. If you smoke, this can impair the healing and increase the risk of complications after a while.
Implants that loosen
It is unusual for implants to come loose. If the implant comes loose a few months after the operation, it is usually because they have not grown properly into the bone.
If you drop the implant later, it may be because you chewed too hard. To reduce the risk of congestion, you can wear a brace at night.
It can become infected around the implants. This can be compared to losing a tooth. Bacteria can build up around the implants and cause the bone around the screw to break. It can be very difficult to get rid of the bacteria. In this case it may be necessary to remove the implant.
The implant may need to be replaced
If you need a new implant for any reason, a new operation is necessary. The hole in the bone after the lost implant must heal and the tissues must be healthy before a new implant can be operated on. This can take several months.
Most dentists provide a financial guarantee that the crown or bridge that sits on the implants lasts two years.
Implants are guaranteed for at least two years. After that, manufacturers offer different lengths of warranties. If it is a lifetime guarantee, it means that you can get a new implant from the manufacturer if it breaks or becomes loose. In that case, you only have to pay for the surgery and the adjustments.
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