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Replacing a tooth

Root-treated tooth at the front of the mouth?

Here?s what we can do. If you have a back tooth (that cannot be seen when smiling) that has been root-treated, our recommendation is simple: take out that tooth because chances are, there is still remnants of infection around it which may be causing other systemic issues in your body.

This is the holistic philosophy when dealing with root canals. However, what if that tooth was in the front of the mouth, say one of the upper central incisors?

This poses 3 immediate challenges:

Short-term: How to replace the missing tooth in the front, aesthetically and functionally? (Because yes, it is at the front of the mouth and it shows when you smile, eat, talk, etc.)

Medium-term: How do we eventually replace the missing tooth after the bone and gums heal?

Psychologically: Taking the big step of saying ?Yes? to removing a front tooth.

Let?s look at each individual challenges individually. For the short-term, we recommend replacing the missing tooth with a partial acrylic (hard plastic) denture. It solves the day-to-day issue of the looks and functions of the missing tooth – without much compromise. The denture tooth colour can be matched well to the existing teeth and the only drawback is probably the metal ball clasp showing in-between the 4th and 5th tooth. For this to happen, a little more planning needs to go in before taking out the tooth. At the first visit, we will also have to take impressions for the upper and lower jaw to allow the lab to make the denture. This usually takes 2 weeks. The extraction of the tooth is carried out as normal at the next visit. Total soft-tissue and bone healing takes place in roughly 3-6 months. It differs from individual to individual and we can only give a guess-estimate. The denture is used as a short-term measure during this period, but dentures can last a longer time than that – on average of 3-5 years. This remains a viable option if cost is an issue for the bridge or implants.

For those looking for a more permanent solution, this is where the planning comes in for the 2nd challenge: how to we eventually replace the missing tooth, maybe with something more permanent?

There are two options: a bridge which is ?glued? onto the neighbouring teeth, or an implant. In terms of cost, both are roughly the same. We would recommend a bridge if there are restorations in the teeth next to the gap. This is because to make a bridge, we have to cut away tooth structure and the worst we can do is to cut away healthy tooth tissue. We always recommend a ceramic bridge. Implants provide a stand-alone option to replacing a missing tooth without interfering with the neighbouring teeth. Some planning has to go into it to make sure there is enough bone to support the implant (if there isn’t, bone graft can be done). We do recommend ceramic implants over metal implants, because metal implants do suffer from corrosion in the mouth.

At the present moment, we are working hard behind-the-scenes to introduce ceramic implants to Perth, so stay tune for that.

 

The above two solutions highlight what a dentist can do (and we can do it well!) and this should alleviate the patient?s fear of replacing a missing front tooth.

The last challenge, is something for the patient themselves: taking the big step of saying ?Yes? to removing a front tooth. We have had patients in their 20s who have taken out their front tooth. We have had patients with chronic sinus problems who found their sinus cleared up after taking out a root-treated front tooth. We also have patients who complained of blurred vision (halo-like effect) who found improvements after taking out their tooth. That said, it remains the biggest and most difficult hurdle for the patient as you have to weigh the drawbacks against the potential health benefits.