Monday, 9 September 2013

OMG ! My Teeth ... ?!!

LOOKS FAMILIAR ??? No way he is going on a date till he gets that tooth fixed ! 

Nobody wants to have a missing tooth, especially if its right in front ! It stares right at you, like a scar. Fortunately the technology today gives us the privilege to replace any defects from missing teeth any the palms of our hands. We just have to decide how we want to replace it, with a removable or fixed prosthesis.

Replacing a  missing tooth basically means restoring a false toothin the location of the missing one. In order to support the false tooth, there are mainly three means of doing so :-

1. Denture - acrylic base platform supporting false 
2. Bridge - metal/porcelain/zicornia base platform 
                    using neighbouring teeth as anchorage 
                    supporting false tooth
3. Implants - titanium screws placed into the jaw
                     supported by the bones to prepare a platform

                     for the placement of future prosthesis

  It is essential to recognize the difference between these three types of dental intervention. 


   ... are the one of the earliest and oldest dental prosthesis used to restore missing teeth. It could be used to replace any number of missing teeth, from as big as the whole arch to as small as one tooth. The main physics of how a denture functions is basically retention, suction and neuromuscular control of an individual with the denture. It is more like a plastic plate held in place by those 3 factors, restoring  dentition for functional purpose. The problem with a denture however is the extensive acrylic plate covering the gums. This can really be annoying especially when it comes to the lower jaw -interference with the tongue and cheeks. As for the upper jaw, a full palatal coverave denture causes disturbance with
speech ( especially on pronouncing words containing letters such as "S", "T", "L" ). Some even claim that wearing a denture gives them a retching sensation, while others complain about not being able to taste food properly ( as some taste and smell receptors are located in the palate ). Wearing dentures would not prevent bone resorption at missing tooth site, so eventually the denture will becomes loose overtime due to ill fitting denture bearing surface. 

  Well enough about dentures, the question these days is whether to restore a missing tooth, or teeth  with a bridge and whether we choose an implant. 


Previously, we discussed about Whether Or Not to restore a tooth that has a low prognosis to survive. 

In case of removal of a "hopeless" tooth, with a
good justification and consent from the patient, we then have to decide which dental intervention would be best for the patient. The factors that mainly decides the treatment depends on :-

1. Longevity of prosthesis installed
2. Duration of treatment (number of visits and time
    frame required)
3. Cost of treatment
4. Conditional restrictions - severe loss of bone, 
    space with opposing tooth, smile line, soft 
    tissue condition, number of teeth needs
4. Medical problems - diabetes, gum disease


   Considering all the above, deciding on the type of prosthesis that best suits the patient it is very subjective from one case to another. A simple bridge construction would require shaving down a substantial amount of  the neighbouring tooth
structure in order to support the incoming prosthesis. 

In modern dentistry today, the objective of a dental treatment is to restore function and aesthetics for the patient with the most minimal invasive procedure. Bridging in this case does not comply to that,although in quite a few cases it is wise to do a bridge when the neighbouring teeth is indicated or due for a crown. The advantage of a bridge over an implant is mainly the time frame needed to construct the prosthesis. An implant would require a window peroid of 2 monthsor more for a full healing and restoration of the tooth, where else a bridge only requires around 2 weeks of waiting period before the prosthesis is ready to be installed. Also a properly constructed bridge on vital teeth (not root canal treated with posts) has a 10 year success rate as much as 86%. 

As far as implants are concerned,  they hold the
highest survival rate. The bone surrounding the titanium plate of the implant undergoes osteointergration and ankyloses with the implant., giving it strength 10 times stronger than a normal teeth. To achieve good aesthetics for the anterior region, it is crucial that the implant is placed properly with good bone grafting and soft tissue augmentation ( if needed ). In cases of severe bone loss due to traumatic accidents or extractions, other alternatives can be considered besides an implant alone. A proper treatment plan must be drawn up to maximize the results for the patient. 

Conclusion ... the option to restore a missing tooth fairly relies upon several factors as discussed earlier. Eventually the decision to restore it would be either to :-

1)    Wear a denture

2)    Construct a bridge 
3)    Place an implant
4)    Orthodontic treatment - provided the gap that needs closure is small and manageable


The implants that we know of today didnt appear overnight, but they came from a long historic transition. The early implants ages back as far as the Maya civilization around 1350 years ago. Back then, there were evidence of implants used to replace missing lower incisors on a young woman using shells. This evolved through time, inspiring researches to invent an implant system that could be used in the medical field.This research caught Per-Ingvar Branemark's attention. He started developing implants for knee and hip surgery, but soon after he decided to concentrate on constructing dental implants. His 1st implant was placed in 1965. However the 1st dental implant ever placed in the modern world of dentistry is by Dr. Leonard Linkow in 1952 ( known as the father of modern dentistry ). After an article published in 1966 by Stefano Melchiade Tramonte, the fear towards dental implants started to fade away, and many people started to embrace the concept of having a dental implant placed in the mouth. However, the implants back then were much larger, longer and wider as in compared to the ones now.   Many research has been done over the decades
to improve the quality of dental implants  manifacture. The research caught Pen-Ingvar Branemark's attention. After Stefano Melchiade Tramonte's published article in 1966 on his successful cases on titanium dental implant placement, the concept of dental implants was more widely accepted. Branemark started placing his own implants in 1965, soon after he started doing research on dental implants. He entered a commercial partnership with a Swedish defense company, Bofor AB. This  company was later restructured as Nobel Industries, giving birth to  NobelBiocare in 1981. They were the leading implant suppliers for many years. These days other implant suppliers such as Strauman, backed up by decades of case studies and research are among the leading dental implant supplier in the market.

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