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If a single tooth is missing and replaced by an implant we call this a single-tooth implant. In the past a gap caused by a single missing tooth was usually closed by a bridge. The filing down of the adjacent teeth that this involves is not necessarily a good idea, particularly if these are healthy teeth with no signs of tooth decay. It can sometimes result in the death of the tooth nerve (dental pulp) and a consequent need for root canal treatment. Also, the crown margins often provoke gum recession with poor cosmetic results.
In the past a missing front tooth was replaced by a bridge after filing down the adjacent teeth. Today the preferred procedure is insertion of an implant.
In the case of a single-tooth implant the missing tooth is replaced by an implant which is inserted in place of the lost dental root. During the healing phase of usually a few weeks the implant remains under the gums without loading. During this time the patient wears a provisional restoration which can be either removable or fixed (e.g. adhesive bridge). After uncovering the implant and taking an impression the crown that has been made in the dental laboratory is attached to the implant. If a tooth has to be extracted, the implantation can be performed at the same time as the extraction. This is called an immediate implant. This spares the patient an additional visit and is a standard procedure today. Only in some cases, e.g. in the case of an acute infection, is it better to first remove the tooth and wait until the gum and bone tissue has healed before placing the implant. If the implant is fitted with a firmly attached provisional crown immediately after implantation, this is called immediate loading. This procedure is, of course, particularly comfortable for the patient because he leaves the practice with a fixed tooth replacement and does not need a provisional bridge or denture. However, immediate loading is not possible or advisable in all cases and the implantologist needs experience to weigh up the potential benefits and risks in the individual case.
Example I from our practice
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Our 27-year-old patient S.G. was dissatisfied with the cosmetic appearance of her front teeth. Her two lateral incisors had been missing since birth. On the right the corresponding milk tooth was still there, while on the left the canine tooth had taken the place of the missing incisor and the milk tooth was behind it. She was particularly unhappy about the gaps and the asymmetric gum contours. We removed the two milk teeth and replaced them with implants. We evened out the gum margins by surgically extending the crowns. After bleaching, we then installed all-ceramic crowns on the implants and provided the adjacent front teeth with ceramic veneers. The implant crowns are now indistinguishable from the natural teeth.
Example II from our practice
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The 48-year-old patient Maria C. had lost both middle incisors a few years ago as a result of an accident and had since then been wearing a clasp-retained removable partial denture. As she was dissatisfied with her appearance and the fit of the denture, she came to see us about implant treatment. Unfortunately, through the accident and the long time without teeth a lot of bone had already been lost.
After bone and gum augmentation and placement of two implants, all four incisors were provided with all-ceramic crowns. The natural cosmetic appearance of the front teeth is restored.
The alternative to a single-tooth implant is still a conventional bridge supported by the adjacent teeth. This is an option particularly if the teeth on either side of the gap are already crowned, have large fillings or are decayed and would need crown treatment anyway. In the case of healthy teeth with no tooth decay the preferred solution today is definitely implants, which can be fitted without having to file down healthy teeth. A three-unit bridge costs approximately the same as a simple single-tooth implant with crown.
|Advantages of bridges||Advantages of implants|
|Disadvantages of bridges||Disadvantages of implants|
Implants for larger gaps (partially edentulous jaw)
If there are several teeth missing we speak of a partially edentulous jaw. In the past, when a bridge was not possible, a removable partial denture was often the only option. These dentures partially cover the roof of the mouth (palate) and can impair speech or trigger a gag reflex in sensitive patients. With implants the gap can be closed with an implant-supported fixed bridge, without removable dentures and without having to file down healthy adjacent teeth. Cosmetic appearance and chewing function are excellent with implant-retained bridges in comparison with clasp-retained removable dentures.
Dental prosthetics yesterday
Missing teeth in the upper and lower jaw are replaced with clasp-retained removable dentures (cast partial dentures). These partially cover the roof of the mouth and do not offer optimal chewing function and cosmetic appearance.
Dental prosthetics today
The back teeth of the lower jaw on both sides are replaced with natural looking, fixed ceramic bridges and crowns on implants.
|Advantages of removable partial dentures||Advantages of implant bridges|
|Disadvantages of removable partial dentures||Disadvantages of implant bridges|
Chapter overview: Implants
- What is an implant?
- Single-tooth implant
- Implants in the toothless jaw
- Bone augmentation
- New surgical procedures
- Immediate implants
- Risks and complications of dental implants
- Costs an guarantee of implant treatment
- Questions and answers about dental implants
Download the entire illustrated text Better Quality of Life with Dental Implants:
Better Quality of Life with Dental Implants (pdf 2 MB, possibly long download time)