There are several ways to manage the spaces left by a tooth extraction. There is no ‘one-size-fits-all’ approach. Is there only one tooth missing or many? Is it in the back or front of your mouth? How many teeth are opposing the gap? How heavy is the bite in the area that needs restoring? There are many aspects that need to be considered.
Remember that all metals in the mouth will form a galvanic cell and will react electrically and chemically with other metals in the mouth. This is especially important if amalgam is present, as this galvanic reaction will increase the amount of mercury released from all these fillings. What is written below assumes that all amalgam and preferably all other metals have already been removed.
Remember that the only place mercury amalgam is NOT considered a toxic waste is in the mouth of a LIVING human.
This gap was filled with an Immediate Partial Upper non-metal denture. It was fitted at the same appointment that the tooth was extracted.
Implants
I will start with implants as these are now the ‘Gold Standard’ according to some dentists even though they are made of titanium alloys or Zirconia porcelain. I do NOT recommend implants. Rather than repeat myself click on this link to read why.
The last thing you want to do is have an implant inserted into the socket at the time of extraction. It is usually a disaster.
Bone Grafts
Also refuse any bone grafts that are offered which supposedly maintain the bone height. They don’t really work and may also act as a foreign body which your immune system will react to. There is no way of knowing where the bone came from. There is always a possibility that the foreign bone may be infected with prions that are impossible to kill or remove. Prions are bits of cell-wall-deficient protein. They are impossible to kill with normal sterilization procedures. Once in your body they can react with the DNA in your cells and produce all sorts of devastating conditions including Creutzfeldt-Jacob Disease. This is the human form of mad cow disease. It can take 14 years to incubate before becoming a problem. It is lethal. Aside from such contamination, the bone that will be implanted is dead. It is only calcium phosphate. It is not able to form healthy living bone and will always act as a foreign body.
Partial Dentures
The cons are that they may be a bit uncomfortable and may not give the desired aesthetic result. They may also be a little difficult to eat with. Usually this is not the case. The pros are firstly that they are removable. You can take it out whenever you feel the need. They are easily adjustable and can be made from materials which are a bit more biocompatible. They are much cheaper than bridges.
Some partials are still made with a metal frame and pink acrylic to hold the teeth in place and cover the gum area. Often the metal clasps may be visible.
There are also materials that can be used which are not metal, but are instead made from a plastic material which has a great deal of memory. The clasps are made from this material also and because they are pink, they tend to blend in with the gum and disappear from sight.
Non-Metal Dentures
These non-metal materials can easily be used to build much more complex dentures.
Again, my preference is for one of these newer materials and try to skip metal all together. I found that a material called Flexite was compatible with most of my patients. Frameworks for partial dentures are also now being 3D printed. As I retired before this technology was introduced, I cannot comment on the mechanics or the materials. There are some cases that metal will be a preferred material as it is stronger and usually smaller.
There are many people who live very comfortable lives with partial dentures. They have no interest in ‘upgrading’ to a bridge.
Bridges
This has in the past been the gold standard for replacing a missing tooth/teeth. Especially if they are made from gold. As the name implies, there will be a tooth that is replacing the missing ones which are attached to crowns that are cemented onto the adjacent teeth to hold it in place.
The pros are that a bridge will usually feel like it is a part of your body. It should be comfortable and highly aesthetic. Unless you are 100% delighted with the appearance do not accept it. The porcelains can be modified and tinted to look like your own teeth and should blend in perfectly. Bridges are the strongest replacement and should allow you to eat normally. They should fit perfectly with the teeth so that the chance of decay at the margin is minimized.
There are some cons also. Bridges are the most expensive way to replace teeth. This is both in $$$ terms and also in dental terms. The teeth that will support the bridge must be cut down to make room for the crowns that will sit on them. If this adjacent tooth is unfilled, then you will be removing a great deal of healthy tooth structure when doing the crown preps. If the teeth either side are very heavily filled than you will be removing mainly filling and the teeth will be strengthened in this preparation. An alternative that may be acceptable is a ‘cantilevered bridge’ which has a crown on the heavily filled tooth and rests on a small filling or inlay in the unfilled tooth. This is a way of minimizing the damage.
Gold/Platinum to Porcelain Bridge
These days many bridges are made from non-precious alloys which may contain any number of weird and unhealthy metals. Palladium is often used in these alloys. It is highly immune reactive, and you may end up with a variety of autoimmune diseases. See the melisa.org website. From a mechanical and aesthetic point of view they all function similarly. From a health point of view, palladium is a disaster waiting to happen. The non-precious alloys are cheaper, and the dentist can then make a bit more profit.
The more modern alternative to metal/porcelain bridges is a Zirconia porcelain bridge. This material has NO metal and is arguably stronger. It should be just as aesthetic and well fitting. I would always opt for a ‘no metal’ option if possible.
If you go for a metal/porcelain bridge than make sure the dentist will use only a Gold/Platinum alloy. Insist that you see the report of the alloy that is used, from the laboratory that is making it, before allowing it to be inserted into your mouth. Once cemented you are stuck with it. I know this sounds like you will be questioning the high moral standards of your dentist. You are. Keep them honest!
One More Option
This is your least expensive option. Leave the gap alone. Don’t fill it! This is the least profitable solution for the dentist but may be the best for you.
If a single tooth is missing, your face will not collapse into the space. You will not be ugly, and you will still be able to eat. Certainly, if there are other considerations like aesthetics, that may influence your decision.
If you leave a space, the teeth either side may drift into this space, and the opposing tooth may over-erupt into the space. This can cause problems with TMJ (Temporo Mandibular Joint). Usually this is not the case, and you will have time to observe these changes and then do something about it. See the TMJ page Here.
Having a few gaps may be your healthiest option.
