My Blog

Posts for tag: missing teeth

By Dr. Mark C. Pothitakis
September 16, 2020
Category: Dental Procedures
Tags: missing teeth  
3WaysWeCanImproveaSmileAffectedbyUnformedTeeth

On the way to adulthood, permanent teeth steadily erupt until, if all goes normally, you have a full set of teeth. Sometimes, though, one or more teeth may fail to form. This not only can affect your dental health, but it could also diminish your smile.

For example, if the lateral incisors on either side of the central incisors (the two teeth front and center) don't develop, it could create a smile that's “not quite right.” But we can vastly improve such a smile in one of three unique ways.

The first is to fill the resulting gap through canine substitution. This is an orthodontic method in which we use braces to move the pointed canine teeth, which normally position on the other side of the missing laterals, closer to the central incisors. This choice is determined by the size of the canine teeth. If they are slim in width, they can be re-shaped to make them appear more like a lateral incisor, and the gums possibly reshaped as well around them through cosmetic surgery.

We can also install a dental bridge, an appliance that fills the missing lateral space with prosthetic teeth. A traditional bridge requires the teeth on either side of the gap to be reduced in size, which becomes a permanent alteration to accommodate these crowns. This is a disadvantage in a young person.  We can also use a “bonded bridge” which uses adhesives to attach extended pieces (or “wings”) of dental material from either side of the prosthetic tooth to one or more supporting teeth.  These wings are behind the permanent teeth.  Though not as durable as a traditional bridge, it does avoid altering the support teeth.

Finally, we can replace the missing teeth with dental implants. In this method, we install titanium metal posts into the jawbone at the missing tooth locations and then attach a life-like crown to each one. Implants may be more costly than other restorative methods and can take several months to complete. But they are life-like, highly durable, and don't require any alteration to other teeth. A disadvantage is that you should wait until at least 19 years of age to consider this option.  What many people do is use a temporary solution until the proper age to do a dental implant.

Each of these methods have their advantages and disadvantages, which should be thoroughly reviewed in consultation with your dentist. And each may also require other dental work, such as initial orthodontics to open adequate space for a restoration. But any of these methods for correcting a missing lateral tooth can be effective and help restore both a healthier mouth and a more attractive smile.

If you would like more information on treating congenital dental defects, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “When Permanent Teeth Don't Grow.”

By Dr. Mark C. Pothitakis
July 11, 2018
Category: Dental Procedures
Tags: missing teeth  
TeenagerswithMissingTeethUsuallyNeedaTemporaryRestoration

Anyone at any age, including older children and teenagers, can lose or be born missing a permanent tooth. And while those missing teeth can be restored, replacing them in patients who haven’t yet reached adulthood can be tricky.

That’s because their dental and facial development isn’t finished. This is especially problematic for dental implants because as the jaws continue to grow, a “non-growing” implant could eventually appear out of alignment with the surrounding natural teeth. That’s why it’s often better to install a temporary restoration until the jaws fully mature in early adulthood. Two great choices are a removable partial denture (RPD) or a bonded (“Maryland”) bridge.

While “dentures” and “teens” don’t seem to go together, an RPD in fact can effectively restore a teen’s lost dental function and appearance. Of the various types of RPDs the one usually recommended for teens has a hard acrylic base colored to resemble the gums, to which we attach prosthetic (“false”) teeth at their appropriate positions on the jaw.

Besides effectiveness, RPDs are easy to clean and maintain. On the downside, though, an RPD can break and—as a removable appliance—become lost. They can also lose their fit due to changes in jaw structure.

The bonded bridge is similar to a traditional fixed bridge. But there’s one big difference: traditional bridges crown the natural teeth on either side of the missing teeth to secure them in place. The supporting teeth must be significantly (and permanently) altered to accommodate the life-like crowns on either end of the bridge.

Instead, a bonded bridge affixes “wings” of dental material extending from the back of the bridge to the back of the natural teeth on either side. While not quite as strong as a regular bridge, the bonded bridge avoids altering any natural teeth.

While a fixed bridge conveniently stays in place, they’re more difficult than an RPD to keep clean. And while less prone to breakage, they aren’t entirely immune to certain stresses from biting and chewing especially in the presence of some poor bites (how the upper and lower teeth come together).

Choosing between the two restorations will depend on these and other factors. But either choice can serve your teen well until they’re able to permanently replace their missing teeth.

If you would like more information on dental restorations for teens, please contact us or schedule an appointment for a consultation.

By Dr. Mark C. Pothitakis
March 19, 2018
Category: Oral Health
Tags: missing teeth   bone loss  
BoneLosstheHiddenConsequenceofYourMissingTeeth

Losing teeth will certainly disrupt your otherwise beautiful smile. It could also potentially affect your food choices and whether or not you receive proper nutrition.

But something else just as consequential could be happening beneath the surface of your gums—you could be losing bone. Significant bone loss in the jaw could adversely affect remaining teeth and facial structure, as well as limit your future restoration choices.

To understand why this occurs we must first consider what bone is: living, cellular tissue. Like the body's other cells, bone has a life cycle: cells form, live and eventually dissolve (or resorb), and are then replaced by new cells. Stimulation from forces generated during chewing traveling up through the tooth roots to the jawbone keep this cycle going at a healthy pace.

But when a tooth is missing, so is this stimulation. This could slow the replacement rate and cause bone volume to gradually decrease. The jawbone width could decrease by as much as 25% the first year alone and several millimeters in height after just a few years.

Although dentures (a popular and affordable choice) can restore lost function and appearance, they can't duplicate this needed stimulation. They even accelerate bone loss by irritating and creating compressive forces on the bony ridges and the gums they rest upon.

One restoration, however, can actually help stop bone loss and may even reverse it: dental implants. This happens because an implant's metal titanium post imbedded in the jawbone attracts bone cells to grow and adhere to its surface. This could actually increase bone density at the site.

To gain this advantage, it's best to obtain implants as soon as possible after tooth loss. If you allow bone loss to occur by waiting too long, there may not be enough to properly support an implant. Even then it might be possible to build up the diminished bone through grafting. But if that's not possible, we'll have to consider a different restoration.

To determine the condition of your bone after losing teeth, visit us for a complete examination. Afterward, we'll be able to discuss with you the best way to address both your overall dental health and your smile.

If you would like more information on treating missing teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”

By Dr. Mark C. Pothitakis
May 04, 2017
Category: Oral Health
Tags: missing teeth  
ComplicationsfromMissingTeethCouldLimitYourReplacementOptions

There are plenty of options today for replacing missing teeth, including dental implants. But if the teeth have been missing for some time, complications can arise that limit your restorative options.

The most consequential possibility is bone loss. Bone has a life cycle: old cells dissolve (resorb), and are then replaced by new cells, stimulated to grow by the forces applied to the teeth during chewing. But the bone won't receive this stimulation if a tooth is missing — so growth slows down, which causes the bone volume to diminish with time.

Another complication can occur involving other teeth around the open space. These teeth will naturally move or “drift” out of their normal position into the missing tooth space. As a result we may not have enough room to place a prosthetic (false) tooth.

If either or both of these complications occur, we'll need to address them before attempting a restoration. Bone loss itself could eliminate dental implants as an option because they require a certain amount of supporting bone for correct placement. Bone loss could also make correcting misaligned teeth difficult if not impossible.

It might be possible, though, to regenerate lost bone with a bone graft. The graft is placed, sometimes along with growth stimulating substances, within the diminished bone area. It then serves as a scaffold upon which new bone can form.

If the bone becomes healthy again, we can then attempt to move any drifted teeth back to where they belong. Besides braces, there's another treatment option especially popular with adults: clear aligners. These are a series of removable, clear plastic trays that, like braces, exert gradual pressure on the teeth to move them. Patients wear each individual tray for about two weeks, and then switch to the next tray in the series to continue the process.

Unlike their traditional counterparts, clear aligners can be removed for cleaning or for special occasions. More importantly, they're much less noticeable than traditional braces.

Once any problems with bone health or bite have been addressed and corrected, you'll have a fuller range of options for replacing your missing teeth. With a little extra time and effort, you'll soon be able to regain a smile you'll be proud to display.

If you would like more information on dental restoration, please contact us or schedule an appointment for a consultation.

By Dr. Mark C. Pothitakis
May 30, 2013
Category: Oral Health
TheEffectsofMissingTeeth

If you are one of the millions of Americans with missing teeth, then you're probably aware of some of the obvious side effects. You may feel self-conscious during conversations or simply avoid smiling altogether to conceal your dental issue. It is not uncommon for missing teeth to affect your confidence, but did you know that there are other problems that result from tooth loss?

For starters, if you have lost enough teeth, eating may become more difficult, in particular healthy foods, such as fruits and vegetables. This is one of the main reasons that inadequate dental care frequently results in nutritional deficiency.

Another very serious issue that results from missing teeth is bone loss. We sometimes refer to this as a “hidden consequence,” because you may not actually see or feel this issue right away. Did you know that bone is actually living tissue that needs constant stimulation to maintain its form and density? Thus, when a tooth is lost, the bone in the jaw that surrounded and supported that tooth melts away. There is a 25% decrease in width of bone during the first year after tooth loss and an overall 4 millimeters decrease in height over the next few years. The longer you have missing teeth, the greater the loss of bone.

As bone loss continues, it can actually affect the structure of your face. If you lose your teeth early in adulthood, by age 45 you might start to notice sunken cheeks. By age 60, your cheeks and lips will lose their support, resulting in a collapsed and aged look. If your teeth are not replaced, this process will continue, and you will be in danger of losing much of the structural support of your lips and cheeks.

Luckily, we can use dental implants to not only restore your smile, but also to halt this bone loss. Implants look, feel and function like your natural teeth and are made of titanium, which has the unique ability to fuse with your living bone. Among the many benefits of implants, they continue to provide stimulation to your bone, preventing further bone loss.

With a success rate of more than 95%, implants are the best long-term solution for tooth replacement.

If you would like more information about implants and bone loss, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”