Missing Teeth
Thursday August 7, 2003

Dear Dr. Mady: My wife has two teeth missing. They are the ones right next to the front teeth. They never developed and she has been wearing a removable plate with two teeth on it for the past twenty years. Is this common and what is the best way to replace them. -George in Tilsonburg.

Dear George: What your wife has is known as congenitally missing teeth (lateral incisors). It means that these merely did not develop at all when they were supposed to, resulting in empty spaces where permanent teeth should have been. This is not as unusual as you may think. The most common teeth to be congenitally missing are lateral incisors (next to the two front teeth), second premolars (two teeth behind the canines or eye teeth), and the wisdom teeth.

Congenitally missing teeth can occur in two variations, hypodontia and oligodontia. Hypodontia is characterized by the absence of six or fewer permanent teeth, while oligodontia is characterized by the absence of more than six permanent teeth .

Spaces left by missing teeth affect the rest of your teeth. These gaps can cause chewing problems, along with esthetic problems. If even one tooth is missing, other teeth may slowly shift out of place. This can change the way your teeth fit together (your bite), depending on where the missing teeth are. A poor bite may make your jaw sore. Your teeth may become harder to clean, leading to tooth decay and gum disease. And shifting teeth may change your smile.

In your case the three most common ways of replacing these missing teeth are a removable partial like she presently has, a fixed bridge or with dental implants. Her partial most likely is a removable replacement prosthesis fabricated from all acrylic or a metal base with acrylic and teeth on it.

A fixed bridge is one or more replacement teeth attached to the natural teeth next to them. The bridge can only be removed by a dentist. A bridge can be made of metal, tooth-colored porcelain, or a combination of the two. Your dentist will suggest the best material for your mouth. There are two main types of bridges: conventional and Maryland. A conventional bridge has replacement teeth that are attached to crowns. The crowns are placed over the natural teeth on either side of the space to be filled. A Maryland bridge has replacement teeth that are attached to the back of nearby natural teeth using a metal strip. This type of bridge may be an option if the teeth next to the bridge are in good condition and if the biting forces where the teeth are placed are not too powerful.

Dental implants are the closest relative to natural teeth. They are permanent false teeth anchored right into your jawbone. A titanium post is threaded right into the bone and a process known as osseointegration takes place. This means that the bone migrates and grows directly into the threads of the implant and causes it to be firm in place over time. Later a tooth colored porcelain crown is placed on the implant. They are more stable than dentures, and you'll be able to eat almost anything with ease and comfort. Many patients find implants give them a more positive self-image and more confidence. The entire process takes about six to seven months but can be completed in less time with some types of implants. Dental implant treatment does require a greater investment of time and money, but it can be well worth it .

In my opinion, implant restorations have become the most optimal kind of replacement for congenitally missing lateral incisors. The central incisor and canine or cuspid often erupt in less than optimal positions adjacent to the open lateral incisor space, and therefore preprosthetic orthodontic treatment is frequently required. Space closure, derotation and correction of root proximities may be needed to ensure proper space for implants and their esthetics. Good Luck!


This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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