Part 2: Replacing Multiple Teeth

Replacing multiple teeth can be achieved using one of several therapeutic options: a conventional fixed bridge, multiple single-tooth implant restorations, a fixed implant supported bridge, a removable partial denture, or an implant-assisted removable partial denture.  Treatment options vary with individual needs.  Appropriate space, gum tissue, underlying bone and overall health are all important factors when discussing your options.

 

Conventional Fixed Bridge

When missing multiple teeth a fixed bridge is one option. A conventional  fixed  bridge or a fixed partial denture can be used if the surrounding teeth are healthy and the space is short. A fixed bridge utilizes the adjacent teeth on each end of the space to support the prosthesis. The maximum number of posterior teeth that can be safely replaced by a fixed bridge is three. A space created by the loss of four adjacent teeth, other than four anterior teeth, is typically restored with either a removable partial denture or an implant supported fixed bridge. Furthermore, tipped or angled teeth, or loose teeth may not be able to withstand the forces from a conventional fixed bridge.

Lower FPD

Lower FPD 2

Multiple Single-Tooth Implant Restorations

As discussed previously in Part 1: Single Tooth Replacement, a dental implant is another fixed option to replace a missing tooth.  When multiple teeth are missing, individual implants can be used as single unit restorations to restore form, function and esthetics. Typically, the implants themselves are placed and allowed to heal for 3-6 months. After the native jaw bone has grown around and integrated with the implants, the replacement teeth can be fabricated and fit to the body of the implant.

Individual implants

Individual implants with crowns

Fixed Implant Bridge

Fixed bridges supported by implants are utilized when there are insufficient numbers of natural abutment teeth, 3 or more adjacent teeth are missing, the space is too long to place a conventional fixed bridge, the strength of the teeth adjacent to the space is inadequate to support a conventional fixed bridge, or when the patient does not care for something removable like a removable partial denture. Implant supported fixed bridges can also be used in the replacement of teeth when there is no posterior abutment tooth for a conventional fixed bridge.

The length of the implant supported fixed bridge is limited only by the available jaw bone with suitable density and thickness in three dimensions. It is also important to note that implants may be a better choice to support a fixed bridge if the prospective natural tooth abutments will need root canal therapy, post and core build-up, and/or periodontal surgery.

IMG_4919

IMG_4924

Removable partial denture

A removable partial denture is usually indicated for areas where two or more teeth are missing. A space without a posterior tooth also is an indication for a removable partial denture. The requirements and status of the remaining teeth for a removable partial denture is not as stringent as those for a long span fixed bridge. Tipped and angled teeth or periodontally  weakened teeth may be better served retaining a removable partial denture than bearing the increased forces from a fixed bridge. Short teeth are usually poor choices for a fixed bridge. Short teeth and/or a limited number of remaining teeth may also be a reason for a removable partial denture.

RPD before

RPD after

Implant assisted removable partial denture

Implant-assisted removable partial dentures utilize a few select implants placed in strategic positions and connected to the overlying partial denture by some means of attachment mechanism or clip assembly. Many problems associated with conventional removable partial dentures can be overcome with the proper placement and use of one or more implants. Common complaints among patients wearing removable partial dentures include lack of stability, insufficient retention, poor esthetics, and discomfort of the gum tissues when chewing. Strategic placement of implants can minimize these difficulties.

A number of attachments can be used with implants today. These attachments provide excellent retention and stability. Implant attachments also can minimize or eliminate the need for unappealing conventional clasping in the esthetic zone. In addition, implant assisted removable partial dentures do not significantly rely upon the support from the residual ridges as due traditional removable partial dentures. Consequently, soft tissue coverage may be minimized, and the increased stability and support from the implants may help prevent increased pressure on the residual ridges and reduce the potential for denture sores.

Implant assisted removable partial dentures can be exceptionally stable, retentive, and esthetic restorations that are biomechanically sound and easily maintained.

IA RPD 2

IA RPD 1

IA RPD before

IA RPD after

 

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