Dentures for missing teeth

Tooth loss can occur for many reasons (periodontal disease, decay or trauma). Dentures have been used to replace missing teeth for many years now. Alternative methods used to replace missing teeth include dental implants and fixed bridges.

The loss of your teeth can have negative effects on your self-confidence, your ability to chew food and your bite. Since your teeth provide structure and support to your cheeks, tooth loss can result in the sagging of your cheeks and make you appear older than you are. It is essential that your missing teeth are replaced as soon as possible.

Dentures are removable replacements for your teeth, designed to look and function like your own natural teeth and surrounding gum tissues. Modern-day dentures can look very realistic and natural and feel comfortable.

Types of dentures

When all your teeth are missing, a complete denture is used to replace them, whereas if only a few teeth need replacing, a partial denture or overdenture is used. Partial dentures can prevent your existing healthy teeth from shifting following tooth loss.

Dentures are generally fabricated from acrylic resins. With advances in modern cosmetic dentistry, there are a wide variety of materials available for dentures, and your dentist may give you some options, including the latest flexible Valplast cosmetic dentures.

Holding dentures in place

Dentures should be held in place by their natural suction to your gums; sometimes a fixative may also be used. However, they tend to come loose and this can cause difficulties when trying to eat certain foods. Dentures can be fixed securely in place by dental implants or mini implants, which can give you the confidence to eat whatever you want without having to worry about your dentures coming loose or falling out. More patients seem to be opting for treatment with implants now. Despite their high cost, they have a dramatic effect on improving the quality of life.

How should I look after my dentures?

It is important to keep your dentures clean at all times. You should remove your dentures at night to give your gums “a rest” and the chance to be exposed to your natural saliva, which will keep them healthy. It is highly recommended that you brush your dentures and soak them in a glass of cold water whilst you aren't wearing them. You can add special cleaning tablets to the water when you soak your dentures. Always brush your dentures before putting them back into your mouth. If your dentures begin to collect debris or stains that you cannot remove by normal brushing, your dentist or hygienist will be able to professionally clean your dentures for you. It is important to visit your dentist regularly to ensure that your dentures are in good condition and continue to fit your gums, as the shape of your gums and underlying bone can change with time. Loose fitting dentures can cause irritation and inflammation of your gums and problems with eating and speech.

How long do dentures last?

This depends on many factors, including how you take care of them and also how much you use them in terms of general wear and tear. Over time, dentures can become loose as your gums shrink and your bite changes. When this happens, you may need a new set of dentures, or in some cases, a simple modification of your existing dentures may solve the problem.

The procedure

On your first appointment, your dentist will assess your needs and thoroughly examine your mouth for suitability for dentures. Some of your existing teeth may need to be extracted first or you may need treatment to get your gums into good health before commencing any treatment.

An impression (mould) of your gums will be taken and used as a model to fabricate your dentures to fit the contours of your mouth exactly. A dental technician will make your dentures to your dentist’s exact specifications.

Immediate dentures

In cases where teeth need to be extracted, the structure of your gums and surrounding tissues needs to heal before your final dentures are made. In such cases, an immediate denture will be placed to enable the gums and surrounding tissue to heal properly. Immediate dentures can be easily modified during the healing process, which could take several months.

Dentures: A Restorative Solution for Missing Teeth

Complete dentures are used to replace missing teeth for people with no remaining teeth. Dentures may also be used for people who have lost several teeth. In this case, the appliance is called a partial denture or an overdenture.

Tooth loss may result from periodontal disease (gum disease), tooth decay, or traumatic injury. It is very important to replace missing teeth. The ill effects of not doing so can be a shift in remaining teeth, an inability to bite and chew properly, as well as a sagging facial appearance, which makes one appear older than they are.

The beauty of dentures today is that they are designed to be comfortable and functional. They are very similar in appearance to natural teeth, and can improve a smile or facial appearance.

Selecting a Dentist for Dentures

It is important to inquire about the dentist's training and experience when investigating the denture procedure. For example, many general dentists perform the denture procedure. Yet, prosthodontists receive three years of advanced training in restorative dentistry. The American College of Prosthodontists offers additional resource information about the training of prosthodontists in the U.S.

Denture Costs

The cost of dentures depends on several factors, including:

• The possible requirement of an additional procedure such as extractions of remaining teeth or oral surgery to refine bony ridges.
• A prosthodontist specializes in crafting dentures and may charge more for his services.
• The location of the dentist.
• The type of dental insurance you have.
• The complexity of the removable denture that is required.
• Dental materials selected by the patient and the dentist. For example, highly cross-linked polymer denture teeth are more esthetic and do not wear as much as conventional plastic teeth and are more expensive. There are different metals that can be used in removable partial dentures that may also increase the cost.
• The type of warranty offered. Some warranties may be for one to two years, while others may run up to 10 years.

Denture Care: Adapting to Your New Smile

It is extremely important to practice healthy dental hygiene when wearing dentures. There is an increased risk of developing a more serious medical condition should oral irritation result from improper dental hygiene. These conditions include, but are not limited to, periodontal disease (gum disease), leukoplakia (thickened white, potentially precancerous patches on the mucous membranes, also called smoker's tongue) and fungal (denture stomatitis) infections.

The gums, tongue and palate should be brushed with a soft bristle brush every evening when the dentures are removed, and each day before you insert the dentures to stimulate the gums and remove plaque accumulation. When removing dentures at night, brush the dentures carefully to remove any loose debris and plaque then soak them in a cleansing solution. Your dentist will be able to recommend one. Some people keep their dentures in an ultrasonic cleaner, but keep in mind that an ultrasonic cleaner doesn't replace brushing. When cleaning your dentures, place a towel beneath the denture or clean them over a sink filled with water to avoid breakage.

Adapting to Dentures

You should see your dentist 24 hours after delivery of your new dentures. It is not unusual to experience some initial discomfort. Minor adjustments to the denture can increase comfort and eliminate problems before they become more serious. Initially, a new denture may feel unusual in the mouth. The cheeks, lips, and tongue are very sensitive areas that require time to adjust to new dentures. It is not uncommon to bite one's cheek or tongue while acclimating to new dentures. However, persistent soreness or irritation should be reported to your dentist.

In addition to adjusting to the feel of new dentures, it will also take some practice learning to chew with them. Begin by slowly chewing on very small pieces of soft food, using both sides of the mouth simultaneously. As your comfort and confidence increase you can progress to larger pieces of soft food and then proceed to harder foods.

Speaking may also require practice. It may be difficult to pronounce certain words. Usually, this problem is overcome within two weeks. New denture wearers can adjust more quickly to their new prosthesis by practicing reading aloud.

With a well fitting denture and practice, denture adhesives may not be necessary. Denture wearers should expect the lower denture to fit somewhat loosely. They may need to learn how to use the muscles of the cheeks and tongue to keep the denture in place. Although this might sound bothersome, with practice, it becomes second nature.

Denture Readjustment or Replacement

If your dentures fit poorly, cause persistent mouth irritation, chip, crack, or break, it is important to see your dentist. Although most gum remodeling occurs within the first year, changes in gums and bone continue throughout one's lifetime. Over time this may result in ill fitting or loose dentures and may compromise facial appearance.

In addition, movement of the dentures on the gums may cause significant irritation. For this reason, it is recommended that complete dentures be remade or at least relined every five to seven years.

Dental Crowns: Preserving Damaged Teeth

Dental crowns, also known as “caps,” preserve the functionality of damaged teeth. Crowns may be used to protect a cracked tooth, restore functionality of a tooth with excessive decay, or replace a pre-existing crown. The purpose of a dental crown is to encase a needy tooth with a custom-designed material. Dentists today have a variety of conservative treatment options through which to restore teeth. If possible, these options should be explored and discussed before selecting the full coverage crown.

The Clinical Procedure

During the crown procedure, your dentist prepares the tooth and makes a molded impression of the teeth to send to a dental laboratory. A fitted, temporary crown is created during this visit to temporarily protect the tooth while the final restoration is being made in the dental laboratory. Once completed, the crown is cemented or adhesively bonded at a later visit.

A recent technology, CAD/CAM technology (computer-aided design/manufacturing technology) has evolved to display a 3-D picture of the teeth. A restoration is then created through milling of a ceramic block. If this technology is located in the dental office (chair-side CAD/CAM), there will be no need for a temporary crown or return visit for the final cementation.

Fixed Partial Dentures, Dental Implants and Crowns

Fixed partial dentures (aka dental bridges) are an extension of the dental crown treatment for replacement of missing teeth. Crowns are placed on the teeth adjacent to the missing tooth or teeth and connected to a missing tooth-like replica. Although fixed partial dentures may serve as a functional and esthetic restoration, today's treatment-of-choice for a missing tooth or teeth is with dental implants. A dental implant replaces missing teeth with a titanium root replica. A crown is then placed on the implant above the gumline. Dental implants are a very predictable treatment choice, returning support to the bite and preventing the need for the unnecessary crowning of adjacent teeth.

Crown Materials: Gold, Ceramic and Porcelain Crowns

The three predominant choices of restorative materials for the full coverage crowns are:

1. Porcelain-fused-to-metal
2. All-ceramic (all-porcelain)
3. Gold

The material selected is determined by the clinical demands at hand; esthetic demands, strength requirements, material durability and restorative space available.

Porcelain-Fused-to-Metal Crowns

Porcelain-fused-to-metal crowns provide for a strong, durable, and esthetic treatment option. One of the key factors for the esthetic and functional success of this type of crown is ensuring the preparation of the underlying tooth structure provides adequate space for the appropriate thickness of the material selected. Additionally, the artistic skill of the laboratory technologist creating the crown will determine its esthetic appeal.

One consideration in the porcelain-fused-to-metal crown is that these crowns may tend to show the underlying metal or gold margin at the gum line as gums recede over time. Some patients opt for this type of crown, but replace the crown at a later date in order to maintain a higher esthetic benefit. Porcelain-fused-to-metal crowns with an all porcelain collar can eliminate this vulnerability.

All-Ceramic Crowns

The predominant material choice for all-ceramic crowns today is either zirconia, or aluminous materials. They provide a metal-free esthetic option with a number of benefits.

By eliminating the need for the supportive metal core, an esthetic all-ceramic crown can be created with a reduced thickness of material. This makes them a more favorable treatment choice in areas with limited space. Additionally, the elimination of the metal core allows for light transmission through the porcelain for better optical, life-like properties and a higher level of esthetics.

All-ceramic materials continue to evolve in strength and durability, but caution should still be exercised for areas of the mouth requiring heavy function. Continuing research is exploring the significant vulnerabilities of the porcelain systems in such areas.

Gold Crowns

Although not as popular a treatment choice for esthetic reasons, gold crowns are still indicated in some instances. For example, patients with strong bites and those with parafunctional habits (such as grinding or clenching) might be better served with a gold crown. The traditional restorative material can provide stronger support to the remaining healthy tooth structure. Gold crowns offer a level of durability that is appropriate for teeth located in the back of the mouth (such as the molars), where they will not be highly visible. Gold crowns tend to offer greater longevity and require less preparation than porcelain and porcelain-fused-to-metal crowns. When chewing, gold tends to be less abrasive to the opposing tooth than porcelain. This helps to prevent wearing of the teeth.

Porcelain crowns and caps

Dental crowns are restorations that protect damaged, cracked or broken down teeth. A crown strengthens your existing, damaged tooth so as to preserve its functionality. Dental crowns are also commonly known as caps (because a crown sits over your existing tooth, covering the entire outer surface). The animations below graphically illustrate the procedure of placing dental crowns:

Dental crown on back tooth	Dental crown on front tooth

Why might I need crowns?

• If your tooth has undergone significant decay and there is not enough tooth structure remaining to support a filling or an inlay and maintain functionaility.


• If a large portion of your tooth has fractured and it cannot be built up using traditional composite bonding techniques .


• If you have a large cavity and opt for the additional protection a crown offers to your tooth over a large composite filling or an inlay.


• If you have had a dental implant to replace a missing tooth, a crown will be fitted to the abutment of the titanium implant.


• Following root canal treatment, a crown is often needed to strengthen the tooth.


• If you grind your teeth and have a poor diet, acid errosion may reduce your teeth to a point where the only option available is to crown them.


• For cosmetic reasons, to improve the aesthetics of your smile, you may opt for all porcelain cosmetic crowns.

Are dental crowns always the best option?

Crowns should not be the first choice just to improve the aesthetics of your teeth, because a dentist needs to grind a significant portion of the original tooth away. Less invasive alternatives include veneers or dental bonding. Crowns are required when the strength of the tooth supporting the restoration is compromised, since veneers and dental bonding restorations are only as strong as the supporting tooth.

What materials can crowns be made from?

In modern-day dentistry. there is a wide variety of dental materials to choose from. Some crowns are made from full gold, where as others are made from an alloy of metals fused to a porcelain outer shell. After time, crowns that are made from a combination of metal fused to porcelain can begin to show dark gum lines that are not aesthetically attractive. All-porcelain or -ceramic crowns are the best choice for a natural cosmetic look. There are many different brands and types of porcelain crowns, and the variation between the costs of dental crowns at different dental practices may well reflect the quality of the materials used.

What does the procedure of having dental crowns fitted involve?

Once you have had a consultation with your dentist and discussed all the treatment options, he/she will prepare the tooth for crowning. The first stage is to clean the tooth, remove any decay and reshape it using a burr (a special dental drill for shaping teeth) under local anaesthesia. The shape of the prepared tooth is usually tapered to allow the crown sit comfortably over the top of it. Once the tooth is prepared, an impression (mould) of your teeth will be taken using a special “dental putty”. This impression is sent to a dental laboratory, which will use the impression of the prepared tooth as a guide to fabricate the new crown to fit perfectly. It usually takes between two to three weeks for a laboratory technician to custom-fabricate your new crown. During this time, your dentist will fit you with a temporary crown to cover and protect your prepared tooth.

On your second visit, your dentist will remove the temporary crown and roughen the outer surface of your prepared tooth with a special etching acid to give the dental cement a good surface to bond to. Your dentist will sit the crown over your tooth to see if it fits with your smile correctly and is the right colour and shape. Once you are both happy with the restoration and how it looks, your dentist will cement the crown firmly into place.

How long do crowns last?

This will depend largely on how well you look after your teeth. Dental crowns require the same level of care and attention as your natural teeth. Provided you have a good oral hygiene program, attend regular checkups at your dentist, don't grind your teeth, maintain a tooth-kind diet and don't do things like open beer bottles with your teeth, a high-quality dental crown can last 10-15 years.

Dental bridges for replacing missing teeth

What are dental bridges?

Dental bridges are false teeth, which are anchored onto neighbouring teeth in order to replace one or more missing teeth. The false tooth is known as a pontic and is fused in between two crowns that serve as anchors by attaching to the teeth on each side of the false tooth, thereby bridging them together.

What are the parts of a typical dental bridge (fixed)?

A dental bridge essentially consists of:

• A pontic or false tooth used to replace the missing tooth, which is made from gold, alloys, porcelain or a combination of these materials.
• Two crowns - serving to anchor the false tooth in place.

When are dental bridges needed?

Bridges are recommended when there are one or more teeth missing that affect:

• Your smile and appearance.
• Your bite, as a result of adjacent teeth leaning into the space and altering the way the upper and lower teeth bite together.
• Your speech.
• The shape of your face.
• The rates of gum disease and tooth decay as a result of food accumulated in the gap.

Must missing teeth be replaced?

Yes, missing teeth must be replaced for many reasons:

• To improve your appearance.
• To reduce the strain on the teeth at either side of the missing tooth.
• To prevent the neighbouring teeth from leaning into the resulting gap and altering the bite.
• To prevent gum disease and tooth decay due to accumulation of food in the gap.

There are three main types of dental bridges:

1. Traditional fixed bridge
This is the most commonly used type of bridge and consists of a pontic fused between two porcelain crowns that are anchored on neighbouring teeth or implants. The pontic is usually made of either porcelain fused to metal or ceramics. These are fixed and cannot be removed.

2. Resin-bonded bridges or Maryland-bonded bridges
These are chosen when the gap to be filled is in between the front teeth, or when the teeth on either side of the missing tooth are strong and healthy without large fillings. The false tooth is made of plastic and is fused to metal bands that are bonded to the adjacent teeth using resin that is hidden from view.

3. Cantilever bridges
These are opted for in areas such as the front teeth that are susceptible to lower stress. Cantilever bridges are used when there are teeth present on only one side of the space, where the false tooth is anchored to one or more adjacent teeth on one side.

What are bridges made of?

Bridges may be made of

• Porcelain.
• Porcelain bonded to precious metal.
• All-metal dental bridges (gold).

How are dental bridges fitted?

At the first appointment:

• The dentist will numb the area with a mild anaesthetic.
• The teeth on either side of the space are prepared by trimming away a small area in order to accommodate the new crown over them.
• The dentist then uses dental putty to make an impression of the teeth, which will be used to make the bridge and crown in the laboratory.
• A temporary bridge is fitted in to protect the exposed gums and teeth.
• A Vita shade guide may be used to determine the right shade for the dental bridge, by selecting a shade that resembles natural colour variations in your teeth, as well as suits your complexion, hair colour, the colour of your natural teeth and even your eye colour.

At the second appointment:

• The temporary bridge is removed and the custom-made bridge is fitted, checked for its fit and bite, and adjusted accordingly. It is then cemented into place
• Multiple visits are often required to check and adjust the fit.
• In case of permanent or fixed bridges, the bridge is temporarily cemented for a couple of weeks and checked for its fit. It is permanently cemented only after several weeks.

How long will dental bridges last?

Dental bridges can last 10-15 years, provided that you maintain good dental hygiene and eating habits.

How to take care of your dental bridges?

Practise good dental hygiene:

• Clean the dental bridge every day to prevent tooth decay, bad breath and gum disease.
• Clean under the false tooth every day.
• Keep the remaining teeth healthy, as these serve as the foundation for the dental bridge.

Brushing and flossing:

• Brush twice and floss daily.
• To floss, use a bridge floss threader, which is a flexible piece of plastic with a loop at one end to thread the floss.
• Thread one end of a 14-to-18-inch piece of dental floss through the loop, making sure to leave one side about half as long as the other.
• Insert the end of the flosser without the hole between the bridge and the gumline.
• Hold onto the longer piece of floss, gently bring it up and pull the pointed end all the way through.
• Floss using both hands, moving the floss back and forth under the bridge.
• Floss the bridge completely from one end to the other.

Diet and eating habits:

• Eat soft foods or food cut into small pieces until you get accustomed to the dental bridge.
• Eat a balanced and nutritious diet for good general and dental health.

What are the advantages of dental bridges?

• They are natural in appearance.
• They generally require only two appointments with the dentist.
• They have a good life period, lasting for 10-15 years, providing you maintain good dental hygiene.
• They improve your appearance, bite issues and speech problems occurring as a result of missing teeth.

What are the disadvantages of dental bridges?

• Teeth become mildly sensitive to extreme temperatures for a few weeks.
• They require healthy tooth tissue from neighboring teeth to be prepared.
• Your teeth and gums are vulnerable to infection as a result of accumulation of bacteria due to the food acids (if proper hygiene is not maintained).

Bridging the Gap with a Dental Bridge

One or more missing teeth can adversely affect the appearance and functionality of your smile. Missing teeth can cause a change in occlusion (bite), shifting of the teeth, temporomandibular joint disorder (TMJ), speech impediments, an increased risk for periodontal disease and a greater chance of tooth decay.

Dental bridges, like implants and partial dentures, are used to replace missing teeth. There are several types of fixed dental bridges (cannot be removed), including conventional fixed bridges, cantilever bridges and resin-bonded bridges.

Typically, conventional and cantilever bridges require shaping of the teeth surrounding a missing tooth. Crowns are then placed on the shaped teeth and attached to an artificial tooth (called a pontic).

A resin-bonded bridge requires less preparation of adjacent teeth. It is often used to replace front teeth, provided that the gums are healthy and the surrounding teeth do not have extensive dental fillings.

The Dental Bridge Procedure

During the first visit, your dentist examines the health of your gums and other teeth to evaluate if you are a candidate for a dental bridge. If you are a candidate for a dental bridge, you are given a local anesthetic so your dentist can prepare the teeth required to support the bridge. If the support teeth are decayed or badly broken down, your dentist may have to build them back up before they can be used as support teeth for a bridge.

Next, your dentist takes an impression of the prepared teeth with a putty-like material that is used to create a model of your teeth. Your bridge is fabricated based on this model by a skilled lab technician so that it precisely fits the prepared teeth. It is important that your restoration fit perfectly to avoid additional oral health problems such as tooth decay.

While your bridge is being fabricated, your dentist fits you with a temporary bridge so the teeth and gums can be protected from damage until your permanent bridge is ready.

To complete the dental bridge procedure, you must return to the dental office for a second visit to have the bridge fitted and cemented.

The Cost of Dental Bridges

The cost of dental bridges depends on several factors, including:

• The potential need for additional procedures (such as fillings or root canals) in one or two of the adjoining teeth.
• The artistic technique of the dentist and lab technician.
• The location of the dentist.
• The coverage provided by your dental insurance.
• The type of material used in the bridge.
• The preparation of teeth involved in the bridge procedure.