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Missing Teeth

Tooth loss is common with age, bringing unwanted changes to a person's facial appearance, confidence and self- esteem. Patients can choose from a variety of options to replace the missing teeth. There are removable partial dentures held in place by wire clips, fixed dental bridges cemented into position by crowns placed on the teeth adjacent to an empty space, traditional full dentures and the implants.

Importance of replacement

After a tooth is lost space is created in the mouth. Due to the functional loading of the teeth adjacent to the site of missing tooth, the adjoining teeth tends to move and occupy the vacant space. Thus the teeth functioning get disorganised. The stress also weakens the supporting bones and gums. It may also lead to deteriorating changes in the joint. All this can be avoided with tooth replacement. A substitute to the natural tooth which functions on similar lines.

Removable Partial Dentures (RPD)

The removable partial denture is a prosthesis that is designed and fabricated to be removed by the patient. All definitive RPDs will have the following components major connector, minor connectors, direct retainers, indirect retainers, denture bases and prosthetic teeth. There are several types of RPD's. All of them use standard plastic denture teeth as replacements for the missing natural teeth. Conventional RPD’s are made from acrylic denture base.

Cast Metal RPD's : Removable Partial Dentures with cast metal frameworks are probably one of the oldest forms. This type of partial denture offers numerous advantages since they sit on the teeth, as well as is attached to them, they are extremely stable and retentive. The teeth are altered slightly before-hand in order that the partial denture can rest upon them without interfering with the way the patient bites. The metal framework does not contact the gums. This type of partial does not sink with them and rarely requires relines. Because the teeth are altered, there are fewer limitations in the placement of clasps and they are less likely to be seen than the wrought wire clasps of the treatment.

Modern frameworks are cast from an extremely strong alloy called chrome cobalt which can be cast very thin and are much less likely to break than the all plastic variety. They are also much less noticeable to the tongue. The largest single advantage that cast metal framework partial dentures have over the newer flexible framework partials is that sore spots are almost never an issue since neither the framework, nor the plastic extensions contact the soft oral tissues with any force.

Valplast : The most recent advance in dental materials has been the application of nylon-like materials to the fabrication of dental appliances. This material (the most common name brand is ValPlast) generally replaces the metal and the pink acrylic denture material used to build the framework for standard removable partial dentures. ValPlast is similar to the material used to build those fluorescent orange traffic cones you sometimes see on highways. It is nearly unbreakable, coloured pink like the gums, can be built quite thin and can form not only the denture base, but the clasps as well. Since the clasps are built to curl around the necks of the teeth, they are practically indistinguishable from the gums that normally surround the teeth.

Flexite : A second type of nylon partial denture base is a brand called Flexite. This polymer is also flexible and is built with tooth coloured clasps, but unlike Valplast, it is much easier for the dentist to adjust making it a much more "user friendly" denture base. This type of partial denture is extremely stable, retentive and they remain that way due to the elasticity of the flexible plastic clasps.

Fixed Partial Denture / Dental Bridges

A bridge, by definition, is a link or connection between two permanent structures. A dental bridge is very similar in that it attaches the restorative teeth (bridge) to the natural teeth on either side of the gap.

Dental bridges are false teeth, which are anchored onto neighbouring teeth in order to replace one or more missing teeth. The false tooth is known as a pontic and is fused in between two crowns that serve as anchors by attaching to the teeth on each side of the false tooth, thereby bridging them together. The two crowns that are attached to healthy, adjacent teeth are called abutment teeth A fixed bridge is designed to remain in the mouth and cannot be removed and replaced like removable dentures. A fixed dental bridge may be used to replace just one tooth or several.

There are three main types of dental bridges :

  • Traditional fixed bridge : This is the most commonly used type of bridge and consists of a pontic fused between two porcelain crowns that are anchored on neighbouring teeth. The pontic is usually made of either porcelain fused to metal or ceramics. This procedure is used to replace one or more missing teeth. These are fixed and cannot be removed.
  • Resin-bonded bridges or Maryland-bonded bridges : These are chosen when the gap to be filled is in between the front teeth, or when the teeth on either side of the missing tooth are strong and healthy without large fillings. The false tooth is fused to metal bands that are bonded to the abutment teeth with a resin which is hidden from view. This type of bridge reduces the amount of preparation on the adjacent teeth.
  • Cantilever bridges : Cantilever bridges are used in areas such as the front teeth that are under less stress. They are used when there are teeth present on only one side of the space, where the false tooth is anchored to one or more adjacent teeth on one side.

Bridges may be made of porcelain, porcelain bonded to precious metal and all-metal dental bridges (gold).

Complete Dentures

A complete denture replaces all the natural teeth and associated structures in both the maxilla and mandible. The complete denture is fabricated using maxillo-mandibular relation in function and non function. Parts of the denture are denture base, denture flange, denture border and denture teeth.

The upper denture covers the whole palate, making an air-tight zone. Usually with the complete upper dentures we can get a pretty good suction and retention due to the large surface area of the denture base. The full lower denture is the one where most of the people have tremendous problems. The anatomy of the lower jaw does not allow us to get a good suction of the denture. The fact that the lower jaw is the mobile bone (we move it constantly speaking, eating, swallowing) and because there is not much of the attached gum on the bottom, it makes it almost impossible to get good retention on the lower jaw.

Fixed dentures

It is the sturdiest tooth option. For the procedure the adjacent two teeth too are prepared for crowns and a false tooth is attached between these two crowns to replace the missing tooth. It provides stability and facilitates the functioning of the oral cavity.


Dental implants are a restorative dentistry option that allows patients to replace missing teeth with ones that look, feel, and perform like their own. Dental implants are sturdy titanium posts, anchored directly into the jawbone and topped with realistic replacement teeth, provide the security and stability of permanently placed teeth. During the first step of this procedure, a doctor skilled in implant dentistry surgically places a titanium screw or post in the patient's jaw. After the gums have healed around the embedded post, a replacement tooth is attached to the top of it.

An implant restoration is made up of 3 main parts:

  • Implant Posts : An implant post is a titanium "screw" surgically inserted into the bone of the jaw that act as a replacement root for the missing tooth. Implant posts are normally threaded on its external surface and the internal aspect of the implant is usually a hollow well with screw threads. Titanium is chosen for this purpose because titanium is inert, biocompatible and integrates with the surrounding jaw bone with minimal risk of infection.
  • Abutment : An abutment acts as the "stump" that holds the crown or false tooth that is screwed into the implant posts.
  • Crown : The crown is the visible false tooth of the implant restoration. Crowns on implants resembles a crown on natural tooth in almost every way. Crowns on implants can be porcelain fused to metal crowns or full ceramic crowns.


  • Dental implants are placed in adults who are good or moderate in health.
  • Certain uncontrolled medical conditions decrease the effectiveness of implant treatment.


Q : Is the implant placement painful?

A : No, as it is usually done under local anaesthsia.

Q : How much pain will I feel after implant placement?

A : There will be minor discomfort. Above all your dentist will prescribe appropriate medication to alleviate the pain.

Q : How long does it take to place dental implants?

A : Usually 30-60 minutes, depending upon the location of dental implant and their number.

Q : What can I eat after having an implant placed?

A : A diet which you can follow for the next few days will be outlined for you. It will mainly include soft foods.

Q : How long does placement, healing of the replacement teeth take?

A : The entire process usually take about 3 to 9 month, depending upon your treatment plan.

Q : How do I care for my implant?

A : Home care for implants would include proper brushing and flossing. Regular visits would also be required for long term success.

Q : How long does an implant last?

A : If your body accepts the implant, it should last many years under proper care. Many implants are known to last for more than 40 years.

Q : If my body rejects an implant, what happens?

A : The implant is removed and the site is allowed to heal. Another implant can usually be placed after healing.
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Indian Dental Association
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