14122 West McDowell Road Suite 200
Goodyear, AZ 85395
Gutman, Jonathan D.D.S.
310 N Wilmot Rd # 102
Tucson, AZ, 85711-2626
Clark, Adam T D.D.S.
706 E Bell Rd # 106
Phoenix, AZ, 85022-6641
Johns, Laurence D D.D.S.
13920 W Camino Del Sol # 8
Sun City West, AZ, 85375-4438
Elseed, Mohammed A D.D.S.
2979 W Elliot Rd # 4
Chandler, AZ, 85224-1641
There are many cosmetic dentistry options available today that dentists can use to replace missing teeth. The decision to use one instead of another depends on many factors. The best cosmetic dentistry treatment option can be different from person to person or from one area to another in the same mouth.
The purpose of this article is to list the major treatment choices and some of the key factors involved in the cosmetic dentistry treatment decision.
There are four major categories of restorations available for single tooth replacement:
The goal in restoring a missing tooth is choosing the most conservative treatment that will provide you with a restoration that not only looks good but is functional and has long-term stability.
Bonded dental bridges use the teeth adjacent to the empty space to help support the missing tooth. To do this, a very thin piece of metal or tooth-colored material is overlaid and bonded onto the back of the adjacent teeth. Running between these two bonded pieces is a tooth that fills in the empty space.
The main advantage of bonded dental bridges is that it is the most conservative type of dental restoration that uses the adjacent teeth for support. So, if the teeth next to the empty space look good and are not in need of any other type of restorations (fillings), bonded dental bridges may be an option.
However, because this restoration mainly gets its strength from bonding only, the long-term success depends highly on how your teeth fit together, how hard your teeth come together (grinding), and if your teeth are loose or not.
So, how long can this type of dental bridge be expected to last? Looking at long-term research studies, the failure rate is about 25% at five years. This means that one out of every four dental bridges will come off within five years. Generally, they can be re-bonded when they come off, but once it is re-bonded, the chance of it coming off again increases.
A cantilevered type of restoration only uses one tooth next to the empty space to support the missing tooth. Designs for this type of dental bridge can range from only using the back of the tooth (more conservative) to using a full crown to help support the missing tooth (less conservative).
The choice of which is done again involves the amount of force (grinding) that is placed on the teeth and whether the tooth is in need of a full dental crown for any other reason. If used in the correct situation, with no history of grinding, this type of dental bridge has a higher success rate than bonded dental bridges. This type of design is particularly useful for replacing missing lateral incisors.
Conventional dental bridges are generally what people think of when they hear the word "dental bridges." This type of restoration uses crowns on the teeth next to the empty space that are hooked together to help support the missing tooth.
This type of bridge is also the treatment of choice if the two adjacent teeth need to have crowns for other reasons.
Conventional dental bridges are also one of the most predictable of all the options for replacing missing teeth. The failure rate of conventional dental bridges in the dental literature has a wide range of variation, ranging from 20% over 3 years to 3% over 23 years.
A dental implant is a titanium metal "screw" that is placed directly into the bone in the area of the missing tooth. Once the dental implant is integrated into the bone, it will act as the root of the missing tooth. A dental crown can then be made to fit onto the implant.
By far, a dental implant is considered the most conservative of all the aforementioned procedures regarding the adjacent teeth. On the other hand, it may not seem conservative due to the surgical implant placement.
To be able to place a dental implant in the correct position, two main things need to be addressed. The first is whether there is enough bone to hold the dental implant and the second is whether the roots of the adjacent teeth are tilted and in the way of where the implant needs to go.
To overcome these concerns, you may require either bone grafting to increase the amount of bone or orthodontics (braces) to help move the roots of the adjacent teeth out of the way. Although this seems like a lot of work to do in order to place a dental implant, if the teeth next to the empty space look good and are healthy, a dental implant is the only way to replace the missing tooth predictably without altering your own teeth.
As with the other treatment options like dental bridges, the amount of force placed on your teeth (grinding) can have an effect on the long-term predictability of implants and should be evaluated. The failure rate of the dental implant in the front part of the mouth is currently around 5% at ten years.
By Greggory Kinzer, DDS, MSD
If you require a dental crown to be placed, it is a good idea to talk to your cosmetic dentist about how you feel about the color of your existing teeth before beginning the process. If you like the color of your teeth, your cosmetic dentist will then find a color that matches the crowns.
On the other hand, teeth bleaching may be an option for you. If you feel you would like to whiten or lighten your teeth, it is a good idea to communicate this to your cosmetic dentist beforehand. Once the final restorations are made, it will not be possible to change their color without redoing them.
If you desire whiter teeth before the cosmetic crowns are placed, the best way to achieve this is to talk to your cosmetic dentist about at-home teeth bleaching. With this procedure, custom-fitted plastic trays will be made for your teeth and you will be given some small tubes of teeth bleaching material.
Your cosmetic dentist will show you how to place a small amount of teeth bleaching material in the tray and then place the tray in your mouth. If any excess material squirts out of the tray onto your gums, you will want to remove it with your finger or a toothbrush.
The tray is then worn for one to two hours in the evening, depending on the type of teeth bleaching material. The biggest advantage of this method of teeth bleaching as compared with procedures that are done in your cosmetic dentist's office is that you are the one that can control how white you want your teeth to be.
Since you are the one in control, you can stop the teeth bleaching whenever you feel you have achieved the desired color. The typical teeth bleaching time is one and one-half to two weeks, but it may be longer.
You may experience that your teeth become sensitive to cold air or liquids during the teeth bleaching process. This is normal and will subside and finally go away when you stop the teeth bleaching.
There are a couple of things you can do to decrease this sensitivity if it arises during the teeth bleaching process. One is to only bleach every other night. By taking a break after each night of teeth bleaching, your teeth will not be as sensitive.
The other is to have your cosmetic dentist prescribe you a fluoride gel that you can place in your custom teeth bleaching trays every other evening. The fluoride acts to decrease the sensitivity by coating or sealing the tooth surface and it will not affect the color of your teeth. This is the most reliable way to decrease sensitivity while you bleach.
Once you get your teeth to the desired color , your cosmetic dentist will have you wait about three to four weeks before taking a color match of your teeth in order to make the final restoration. During this time, the color of your teeth is stabilizing.
Teeth bleaching is very predictable, but the results will not last forever. Since the restorations were placed when your teeth were at their whitest, you will most likely find that in one and one-half to two years, the restorations may begin to appear lighter than your natural teeth.
This result is to be expected. It is not caused by a change in color of the restorations, but rather by your own teeth getting darker. At this point, all that is required is to, once again, bleach your natural teeth until the color is evened out. Usually, this only requires teeth bleaching a couple of times.
After the color is evened out, you can then expect to have the color stability last for another one and one-half to two years. On the other hand, if no restorations were placed by your cosmetic dentist after your teeth bleaching, you will most likely not notice the teeth changing color because there is no reference to help judge this change.
By Greggory Kinzer, DDS, MSD