Many of our patients face losing a single front tooth through trauma or the irreversible failure of a heavily restored tooth. This leaflet will provide background information on the possible solutions that may be available, depending on their individual circumstances.
Acrylic Denture
This is a denture made from acrylic and is often used as an interim before one of the other methods is used to restore the missing tooth.
Like its more sophisticated relative, the chrome denture, acrylics are able to restore many teeth in one treatment.
To be strong enough and stay in place acrylics have to be 2-3 mm thick and often cover a large surface area.
As they cover a lot of gum edges the risk of decay & gum disease is enhanced, and the coverage of the palate can alter taste.
Despite all this, many patients have had an acrylic for years and appear to manage well.
Pro Good aesthetics are possible
Low cost and easily repaired
Con May rely on suction or additional clasps for retention and can be bulky & intrusive
Cost From £250
Maryland or Resin Bonded Bridge
It is named after the University of Maryland who pioneered the technique. It relies on using plastics to bond a metal or plastic wing to a tooth.
A bridge unit is made by a dental laboratory to replace the missing tooth with a thin metal or plastic wing that accurately fits the back (palatal or lingual) of an adjacent tooth. The tooth will usually need some adjustment to allow the bite to be correct afterward, but the amount is minimal. The wing is then stuck to the tooth.
In some cases there can be problems with the 'wing' tooth darkening owing to reduced light transmission and an all plastic version is used if this is thought to be likely.
Pro Minimal preparation to one adjacent tooth usually required
Good aesthetics
Fit and forget
Relatively low cost: From £400
Cons Darkening of winged tooth possible
Could detach and need recementing
Chrome Frame Denture
This is a denture where the main structure is built from a casting of thin stainless steel. Standard acrylic denture teeth are attached to this frame.
Recently, an alternative version has been developed which uses a milled off white plastic. Tooth shades are being developed.
Pro Good aesthetics in most cases
Little damage to teeth
If other teeth are missing, then a chrome denture can replace them as well
Can last a very long time
Cons Can get some movement of the frame
Needs clasps around back teeth to stabilise denture
Some patients prefer 'fixed' solutions to 'removeable'
Some risk of increased gum disease or decay in the areas the denture covers.
Cost £700 plus
Implant
A cylinder of titanium with a machined central post space is placed in a carefully prepared hole in the jaw bone and, allowed to 'osseointegrate' for several months. What this means is the jawbone grows up to and around the implant, holding it firmly in place. It is then uncovered, and a post is placed in the implant and a crown made to fit the post. In some cases, a temporary crown can be fitted when the implant is placed but often a temporary solution is required.
Pros Cutting edge technology
Avoids any damage to other teeth
98% successful
Near perfect aesthetics can be obtained
Fixed & permanent solution
Con Expensive: £2500-3000 per tooth.
Potentially not suitable for smokers or those with advanced gum disease.
Conventional Bridge
For these a full coverage crown is prepared on the adjacent tooth or teeth and so there is a need to do substantial reduction to this tooth. The lab technician then makes a crown with a cantilevered blank tooth, very similar to that used in a Maryland bridge. Another design uses a crown at either end of the bridge, so two teeth need preparing.
Pro Can be a good solution if the adjacent tooth/teeth is discoloured, has poor aesthetics, or is heavily restored or is already crowned.
Service life of 15 – 20 years
Cons Extensive & irreversible loss of tooth structure
Repair can be difficult.
Unsuitable for patients with 'active' lifestyles or those with active decay or gum disease.
Cost From £750