Tooth Restoration Across Different Age Groups
Whether a missing tooth should be replaced depends on several factors, Lee said, with age being one of the most significant.Children Under 18
Lee does not recommend dental implants for children who have lost a permanent tooth, as their jawbones are still developing, and implants may interfere with the growth of surrounding teeth and bone. Instead, dentists may explore alternatives, including:- Orthodontic treatment to shift existing teeth into the gap
- Autologous transplantation of wisdom teeth
- A removable denture to preserve the space until the child reaches adulthood and becomes eligible for implants
Adults
For adults, neglecting to replace a missing tooth can cause adjacent teeth to tilt into the empty space. If the missing tooth is in the lower jaw, the opposing upper tooth may gradually shift downward, resulting in an uneven bite. This can lead to tooth fractures, excessive wear, and the formation of hard-to-clean areas that increase the risk of periodontal disease.Though these effects may develop slowly, they worsen over time.
Older Adults
The concept of a “shortened dental arch“ suggests that, for older adults—typically 60 and above—restoring every missing tooth may not be necessary.Why Teeth Tend to Tilt Forward After Tooth Loss
A cross-sectional study associated tooth loss with changes in facial bone structure. When front teeth are missing for an extended period, it may result in facial asymmetry, Lee noted.Pros and Cons of Dental Implants and Bridges
When replacing missing teeth, the two most common options are dental implants and bridges—each with distinct advantages and considerations, Lee said.
A dental implant involves surgically placing a small screw—typically made from titanium or a titanium alloy, though some are zirconia—into the jawbone to act as an artificial tooth root. After the implant fuses with the bone through a process called osseointegration, an abutment is attached to support a custom-made crown that mimics the look and function of a natural tooth.
Implants offer several benefits as they:- Don’t require altering adjacent teeth
- Preserve natural tooth structure
- Can be cleaned just like natural teeth using regular dental floss
These features help maintain both oral hygiene and long-term dental stability.
Before implant technology became widespread, dental bridges were the standard solution. A bridge uses the healthy teeth on either side of a missing tooth as anchors, which are filed down to support a false tooth between them.
While bridges can effectively restore function and aesthetics, they also have certain drawbacks:
- Teeth on either side of the bridge may weaken due to enamel removal.
- Standard flossing isn’t possible. Special tools like interdental brushes or floss threaders must be used and are often less effective, increasing the risk of plaque buildup and gum disease.
- Teeth tilting, root fractures, and decay at the edges of the crowns can occur over time, particularly in the back of the mouth, where the bite force is stronger.
However, with proper care, bridges can last for many years and remain a reliable option—especially for those unsuited for implants due to medical conditions or bone loss, Lee said.
Ultimately, the right choice depends on a range of factors, including oral health, bone density, budget, and long-term goals. A thorough dental evaluation can help determine the most appropriate solution.
Who Should Avoid Dental Implants?
While implant technology has been used for more than 30 years, it is still a surgical procedure that requires careful evaluation of each patient’s suitability.
A CT scan is usually performed to assess whether the jawbone can support an implant. If bone width and height are sufficient, the implant may be placed directly. However, in the following cases, patients may need additional procedures or be advised to temporarily avoid implants.
Alveolar Bone Resorption
Patients with a history of severe periodontal disease may have a narrowed jawbone. Others may have experienced long-term tooth loss, leading to progressive bone resorption.In such cases, supplemental procedures, such as bone or soft tissue grafting, may be required before placing implants. Such procedures typically involve placing synthetic bone material in the affected area and using specialized techniques to promote blood flow and support natural bone regeneration. However, it’s important to note that bone grafts do not always integrate successfully, and some patients may require additional procedures if the initial graft does not take.
Osteoporosis or Cancer Medications
Patients who have recently taken or received medications to treat osteoporosis or cancer may not be suitable for immediate implant placement. These medications can interfere with wound healing and increase the risk of jawbone necrosis.Chronic Conditions
Patients with chronic conditions such as high blood pressure, diabetes, or heart disease can undergo dental implant procedures, provided their health is stable and well-managed.The Crucial Role of Postoperative Care
Lee emphasized the importance of understanding the distinctions between various tooth replacement options and making informed choices based on individual needs. Key considerations include chewing efficiency, ease of long-term maintenance, and overall cost. Equally important, patients must be reminded of the need for proper postoperative care, which is critical in preserving oral health and ensuring the longevity of treatment outcomes.
Dental Implants
Dental implants are fixed individually and provide the highest level of chewing efficiency among tooth replacement options. Postoperative maintenance, such as regular brushing and routine dental checkups, is typically sufficient.
However, the internal screws used in implants can loosen or develop metal fatigue over time, necessitating occasional replacement. Without regular follow-up care, patients with strong bite forces may risk screw fractures. Inadequate oral hygiene can also lead to peri-implant inflammation or infection.
Dental Bridges
Fixed dental bridges also offer better stability and higher chewing efficiency than removable dentures. Regular cleaning between the connected units using interdental brushes or other specialized tools to prevent plaque buildup and decay, and support ongoing dental health.
Removable Dentures
Removable dentures consist of a resin base that rests on the gums and are held in place by clasps attached to adjacent teeth. Food particles frequently become trapped under the denture after meals, making it necessary to remove and clean the appliance thoroughly.
While they are a more affordable option, removable dentures offer lower chewing efficiency and are more prone to shifting during eating or speaking. This may lead to discomfort and an increased loosening over time, especially in patients with extensive bone loss or multiple missing teeth.
Prioritizing Natural Teeth Over Implants
Despite being a specialist in dental implants, Lee encourages patients to prioritize periodontal treatment to preserve their natural teeth rather than opting for implants as a first-line solution.Implants can never fully replicate the function of natural teeth, she noted.
Treatment decisions should be made on a case-by-case basis to determine which teeth can be preserved and which require extraction and replacement with implants, Lee said. For instance, in cases of tooth fracture, a break above the root can often be treated, whereas a root fracture typically means the tooth cannot be preserved.
“I’ve had patients whose teeth were still in treatable condition—manageable with periodontal care—but they wanted to have them all extracted for full-mouth implants. Fortunately, they came to me. If they had seen a dentist more focused on profit, their natural teeth might have been unnecessarily removed.”
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