When a patient first loses a tooth, many changes happen that they may or may not notice: The adjacent teeth drift toward the space, causing:
- Food to pack between teeth and the bite to change
- The upper teeth drift down, further worsening the bite
- This promotes gum disease around the shifting teeth
- The teeth next to the space lose bone
- The teeth next to the space become more sensitive at the roots’
- All the teeth in the area have to do more work
- Often then, without treatment more teeth are lost due to overwork
- Bone is lost at the tooth space
- Soft tissue is lost from the extraction as well
These changes all lead to continued bone loss: 25% in the first 3 months after a tooth is extracted and up to 60% in the first 6 months after the extraction. The more teeth are missing the sooner the next tooth loss occurs.
This patient’s situation shows how in the upper space the bone is collapsing inward. At the lower space the bone and tissue have been lost, along with the tooth. This has allowed the lower left back tooth to shift forward and the upper left teeth to shift down.
At this point the treatment is relatively simple and the least cost and trauma for the patient is to have the spaces filled with dental implants.
As this problem worsens and more teeth are lost, without treatment designed to stop and reverse the problem the teeth shift more as this patient experienced. The front teeth and the teeth on the other side are left to do all the work of chewing.
The upper back teeth have shifted significantly and the treatment options get more serious yet this is still easy to solve.
This patient has a more advanced problem. Here you can see that the top teeth have shifted even more and the options available require more extensive treatment.
Without treatment the problem then looks like this:
Yet this problem still progresses without treatment. Note more teeth are lost, crowns have come off of the front teeth from over loading and the back teeth cannot be saved without extreme treatments. This progression is much like ignoring your car or not getting the problems fixed.
So a typical patient that comes in, like this attractive lady (in her late 60’s early 70’s), comes in with multiple missing teeth and wants to chew better. “As is” she will beat up her upper front teeth and cause them to become hopeless. This is a VERY COMMON situation for patients and one we regularly help people with. She has multiple options.
In her case growing bone in the back of her mouth and placing implants in the newly regenerated bone has left her feeling like she did when she had all her own teeth. No more worries on the implanted teeth about decay or root canals.
As more teeth are lost, so is the bone. This patient wanted to replace her missing front teeth and a novice might say: “it looks like there is enough bone for dental implants or a partial denture”.
In the process of figuring out where she needed the teeth for esthetics it became obvious that she had lost a lot of bone and the teeth would have to be suspended a lot toward the lip if a partial was used. If implants were placed here, without bone regeneration then they would be impossible to keep clean and fail long term.
These type of situations bring up the questions of:
- How important is it for you to save your remaining teeth (my preference) or
- Are you willing to give up the remaining teeth ( as the man below did) to get a more predictable, or quicker or less costly treatment plan?
This patient came in with a long history of multiple bridges, partials and crowns that had all failed long before he and his dentist expected them to and as he put it “none of them lasted”.
His final implant treatment with the strongest metals available looked like this:
With most treatments today, we seldom resort to having metal show. His restorative dentist and he decided together that they would rather take the fewest chances and get the most predictable results.
Even though he had invested significant time, energy and money in the implant treatment, he didn’t expect it to last him 2 years!! He got 9 years of problem free use out of the implant supported teeth before he passed away.
He was so appreciate of what the implanted teeth had done for him that he baked countless loaves of specialty breads (every other week for years) for our team and Dr Kammeyer, to show his appreciation. He, like so many others said it was the best money he’d ever spent! Here are his before and after photos.
As you can see, from these examples of just one type of problem (ie teeth shifting) that leads progressively to many other problems. Although bridges and partial dentures are still (possibly adequate) alternatives, dental implants provide the most predictable solutions to missing teeth. Since this senerio is very common, we focused on it. Certainly I could show you slide series of all the other problems associated with untreated tooth loss.