After tooth extraction, dentists recommend the patient to get the replacement of missing teeth. Replacement of missing teeth is important as if the missing teeth are not replaced, it can lead to series of complications. Complications which can occur if the teeth are not replaced are:

1.    Misalignment of Teeth
Teeth adjacent to the extracted teeth will tend to move in the vacant spaces created by the extracted teeth. It will affect the alignment of teeth and in long run due to wrong alignment; the patient may have temporomandibular joint disorders (TMJ) or can have traumatic bite. Teeth wearing and teeth grinding that is bruxism may also occur.  

2.    Chewing Problem
Loss of tooth can affect the mastication of the patient. Chewing ability is mainly affected if a molar is lost. The opposing tooth will cause discomfort and pain by pressing hard foods against soft tooth socket of the extracted tooth.

3.    Esthetics
If there is loss of one or more front teeth, then esthetics are severely compromised. Patient’s appearance will be affected by the loss of any of the front teeth. Sagging of lips may take place because of missing teeth.

4.    Loose Teeth
The adjacent teeth on the sides of the extracted tooth will start getting loose because of loss of lateral support.  

5.    Speech Problem
Speech of the patient is also affected in case of missing teeth. For good speech, integrity of dental arch is very important. In speech, teeth articulation, tongue and muscles of mouth, lips have an important part to play. If teeth are missing, then there is difficulty in articulation of speech. If the missing teeth are replaced with flippers, then also the speech is affected. Flippers have a plate which is there to give support. Plate will decrease the space for tongue and articulation becomes difficult.


Supra-eruption of upper teeth due to missing lower teeth


When there is a missing teeth present, the adjacent teeth drift into the spaces created by the unreplaced missing teeth.  Failure to replace extracted teeth initiates a series of changes that produce various degrees of periodontal disease.
For example- If the first molars are extracted and are not replaced, then the patterns of changes that may follow are characteristic. In extreme cases, it consists of the following:

1.   The second and the third molars will tilt towards the missing tooth which will further result in a decrease in the vertical dimension.

2.   The premolars/ bicuspids will also move towards the missing tooth that is they will move distally in case of unreplaced missing first molar. Along with that, the incisors will also tilt or will drift. The lower incisors may become a bit retroclined by the unreplaced missing lower molar tooth and the upper incisors may be pushed a little outwards and will move laterally. The front teeth will extrude because the incisal opposition is largely disappeared.

3.   The overbite which is the vertical overlap will increase due to unreplaced missing tooth and the lower front teeth will strike the upper front teeth near the gums or may traumatize the gums. Recession of gums can also occur by this which can even lead to the pain and sensitivity of the tooth structure.

4.    By the separation of the front teeth, diastema that is the gap between the front teeth will occur. It is created by separation of the front teeth.

5.  The contact between the teeth is lost because of missing tooth and is loss of proximal contact relationship leads to food impaction in the areas of gap and further leads to the gum inflammation.  The inflammation of the gums may progress to pocket formation in the teeth which further leads to bone loss and causes the teeth to become mobile.  

Emphasis is laid on saving the tooth than getting it removed.  If the tooth is carious, then the tooth should be restored. If the decay is small, then simple fillings will restore the tooth and if the tooth is grossly decayed, then root canal treatment is done for the tooth followed by capping. If there is loss of large amount of tooth structure, then post and core procedure is performed to provide strength to the tooth. If there is some gum problem present, then gum surgeries can be done to treat the condition but the tooth should not be removed.  If the tooth is mobile, then splinting and capping should be done to save the tooth. Extraction of the tooth should be the last mode of treatment.

If the tooth needs to be removed, because of unrestorable caries or grade 3 mobility (Tooth is very loose) of the tooth or some other condition, then it’s important to get the missing tooth replaced. The various options which are available for replacing the missing tooth are:

  1. Dental Implants
  2. Fixed bridges
  3. Partial Dentures
  4. Complete dentures if the patient is edentulous that is there are no teeth present in the patient’s mouth.

Cost involved in replacing missing teeth is significant. Many patients can’t afford the cost of replacement. Implants are the best option for replacement of missing teeth but if there are some cost strains and patient can’t afford the price of implants, then the patient can opt for fixed bridges.

Replacement of Missing Teeth with Implants

Dental implants: It is a new revolution in the field of dentistry. It is the best option for the replacement of the missing tooth. It is a prosthetic device which is made up of alloplastic material and is implanted in the oral tissues beneath the mucosal layer or it is placed within the bone to provide retention for fixed or removable prosthesis.   It is a better method for replacement of missing teeth than removable prosthesis in which the prosthesis rest on the gum line or the fixed prosthesis in which the adjacent teeth are used for the support.   

Cost of dental implants
On an average cost of dental implants range from $1200-$3000 depending on the type of dental implant which is given to the patient and the dental implant needs. If procedures like sinus lift or bone grafting is done, then the price of dental implants is also increased. Mini dental implants are comparatively cheaper.  

 Replacement of Missing Teeth with Fixed Prosthesis

Dental Bridges: They are commonly used to replace one or more missing teeth. Bridges are cemented to the natural teeth or the dental implants surrounding the empty spaces. These teeth are called as abutments and the function of these teeth is to provide support to the bridge. Replacement tooth is called as pontic and is attached to the crowns that cover the abutments. Metallic, porcelain and porcelain fused to metal (PFM) bridges are available. Porcelain bridges are preferably given for the front teeth and for back teeth, porcelain fused to metal bridges (PFM) can be given. Porcelain bridges are very esthetic. Metal bridges are usually not recommended by the dentist as they are uncomfortable and might irritate the gums.  



  
Dental bridge to replace missing teeth



Ceramic crown to replace missing tooth


Cost of dental bridges
Cost of porcelain fused to metal (PFM) bridges is around $600-$1000 per tooth and the cost of porcelain bridges is $900-$1200 per tooth. Dental insurances usually agree to pay half the cost of bridge.

Replacement of Missing Teeth with Partial Dentures

Flippers or Partial Dentures: They are usually given when the few teeth are missing in the mouth.  Prosthesis rest on the gum line in case of partial dentures. The partial dentures are further of 2 types: cast metal partial dentures and Acrylic partial dentures. Cast metal partial dentures are the best partial dentures. They are also known as removable partial dentures or flippers.

 

Cost of partial dentures
Cost of partial dentures range from $500-$1000. Flex partials which are made of flexible acrylic range from $700 to $1300.

Replacement of Missing Teeth with Complete Dentures

Complete dentures: they are given in those patients who don’t have teeth present in their mouth. In case of complete dentures, support is taken from the jaw bone. The base of the denture is made of acrylic and the teeth are made of either acrylic or porcelain depending on the patient’s status and the patient’s choice.   

Cost of Complete dentures

Cost of complete upper and lower denture both is $1000-$5000. Basic of denture may cost you $300 but they don’t offer a lot in terms of function and esthetics. They are not really comfortable and are not long lasting too. Mid range dentures come in the range of around $1000 and have warranty of 1 to 2 years.

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