I’m am about to lose a front tooth because an old broken crown can’t be fixed anymore. What are my options?

This is a question we get fairly often.  Many times patients have teeth that become un-restorable.  It may be due to bone loss, fractured teeth, old posts that won’t stay in anymore, etc.  The answer to the question depends on a bunch of different factors including where it is, bone levels, the teeth next to the missing tooth, whether the patient smokes, and many more.

Option #1: Do nothing.

This is the cheapest option in the short term, but it may actually become the most expensive in the long run.  Over time, the teeth next to the space shift towards the space and can cause problems with the gums, bone and the bite.  It may require braces or other procedures to correct this down the road.  Also, when the missing tooth is in the front, aesthetics becomes a big concern.  This may make this choice not so good.

Option #2: A Removable Partial Denture

This is where you have an appliance made with metal or acrylic. It stays in by clasping onto other teeth in the mouth.  A portion of the appliance fills the missing tooth area with a plastic tooth.  This option can work very well for some, but for others, food getting caught under the partial, taking the partial in and out, and aesthetics make this not a good option.

Option #3: A Fixed Bridge

This option is a good option for many people.  It is where crowns are done on the teeth next to the space.  The framework of the bridge spans across the space over to the other crown.  The lab then creates a piece that looks like three teeth.  The bridge is cemented in and is not removable.  It can look very good, be very comfortable, easy to clean, etc.  There are factors that we need to think about when deciding that a bridge is right for the patient.  Are there fillings on the teeth next to the space?   How stable are those teeth?  What does the gum look like?  How big does the patient smile? What materials will work well?  A bridge is a great option for many, but what if the teeth next to the space have bone loss or crowns with very little natural tooth left?  Will they be strong enough in the long run to support all this?  Maybe,  maybe not.

Option #4: An Implant

This option is a great option for many people.  An implant is made of Titanium and placed into the space of the missing tooth.  Once the bone around the implant grabs onto the implant (integrates), the implant is ready to restore.  This integration takes about 3 months.  During this time, a temporary of some sort is used.  There are many factors that go into making an implant successful, but they are typically very long lasting, comfortable, aesthetic, and conservative.  With an implant you don’t have to do any restorations on the surrounding teeth.  This “keeps a one tooth problem, a one tooth solution”.  If you were to ever have a problem, it is only limited to that area.  I like to think of it as having a new tooth put in.  There are factors that make an implant more difficult, such as uneven gum levels, active gum disease, tooth width, and smoking.  Many of these issues can be overcome, but it does require some pre-planning.

As you can see, there is a lot to think about.  It is best to talk over you options with your dentist before finalizing your choice.

• Archives