Since the 18th Century, children have been comforted by the idea that when a tooth falls out they will gain a little pocket money by placing it under their pillow. Although this appealing notion sadly doesn’t carry through to adulthood, we still seem to hold on to myths about losing teeth.
Dentures, Bridges and Implants
The loss of teeth can be an unpleasant surprise, but dentures offer an attractive, rapid and cost effective option. Clever use of materials such as resins to allow simple adjustments and relinings with reduced costs, while metal frameworks provide precision fitting, reduced bulk and greater longevity. Dentures are particularly useful when there is uncertainty regarding the prognosis of some remaining teeth so that if one or more teeth are later lost, additions are able to be made.
Remaining healthy teeth may be used to support bridges that are cemented in place. Traditionally this necessitated considerable preparation of the adjacent teeth for crowns that were joined to support the “pontics” that replaced the missing teeth. Since 1978, research at the University of Maryland in Baltimore developed resin-retained bridges that allow for the adjacent teeth to be left intact and so preserve the integrity of healthy tooth structure.
In the early ’70s, Professor Brånemark of Gothenburg presented pioneering clinical research material with the first scientific approach for the use of Implantology (previously the domain of independent, self-promoting mavericks). His meticulous documentation and rational scrutiny has now revolutionised the use of this treatment. The use of implants allows for dentures or bridges to be fixed, to function like original teeth. The provision of this treatment requires the combined skills of surgery and deep understanding of Prosthodontics.
The Specialist in Prosthodontics is able to manage those difficult situations that may arise whereby the functional or cosmetic aspirations of the patient are much higher than the norm. Patients experiencing long term problems with dentures due to their lack of stability and retention or patients experiencing tooth grinding, tooth wear associated with eating disorders or acid attack may contribute to much more complex treatment. Public figures and celebrities may have much greater “cosmetic” needs for restoring a beautiful smile or a professional singer in opera will be particularly sensitive to any changes with their teeth.
All dentistry will fail given enough time, unless the patient dies first. Clinical studies, with follow up of treatments, have clearly demonstrated that prosthodontics carried out by the Specialist has a considerable greater success rate and longevity. Recent research has shown that review and maintenance are as much a necessity as the servicing of your car. Dentures may require relining and additions every 5-7 years. Mechanical wear and tear of bridgework accounts for 25% of bridges failing at 10 years and 50% of bridges failing at 20 years. Implant failure rates are very much dependent upon the patient with respect to general health and the meticulous attention to detail with surgery and the subsequent dental reconstruction. All dental treatment is dependant upon effective home care and a healthy diet. Smoking contributes significantly to poor oral health and, in my opinion, contraindicates the use of dental implants. Previous gum disease and tooth grinding have also been shown to increase the failure of implant treatment.