Replacing one missing tooth at the Birbe Clinic

People who have lost just one tooth often decide to replace it for purely aesthetic reasons. However there are also functional reasons to do so. If nothing is done to replace the missing tooth, the teeth on the antagonist arch run the risk of becoming loose and the adjacent teeth will move into the edentulous space (where the tooth is missing), leading to problems in these teeth and increased risk of losing them as well. The bone below the lost tooth starts to atrophy immediately once the tooth is gone.

Treatment options

There are several options the patient can choose from in replacing one missing tooth. The replacement options include a bonded prosthesis (Maryland style), a fixed partial prosthesis, a removable partial prosthesis or a single crown on an implant.

Each of these options has its advantages and disadvantages:

Option 1: Crown over implant

This means replacing a lost tooth with a crown placed over a single implant, which acts as an artificial “root”.

  • The most significant advantage of this treatment is that there is no need to file down neighbouring teeth. The patient can clean the gap between the teeth with dental floss, just like natural teeth.
  • The bone around the implant is stabilised or preserved, as the space left by the root of the missing tooth has been filled. The prosthesis can be designed so a dentist can remove it for repairs or updates if necessary (crown screwed into the implant).
  • The disadvantages of this treatment include occasional loosening of the screw that holds in the prosthesis, that the crown may come loose, that the prosthesis may break or that the implant may fail. Nevertheless, clinical studies show that 90% of all implants (Branemark system) put in 25 years ago in patients who had lost all of their teeth are still functional today. Since 1984, there has been a similar success rate for single prosthesis on implants.
  • The prosthesis doesn’t replace the atrophied bone and soft tissue, which means it requires a bone or soft tissue graft as part of the implant.

Before and after treatment photos

The patient only wanted to replace the missing tooth without wanting to improve the appearance of the adjacent teeth.

Option 2: Fixed partial prosthesis on top of teeth (bridge)

With this treatment, the teeth on either side of the edentulous space (the hole without a tooth) are filed (worn down) in order to bond (glue) a fixed partial prosthesis, made of metal or metal and porcelain, including the missing tooth to be replaced.

The advantages of this treatment method include: it’s quick (no need to wait for the bone to heal, as you do with an implant), it is more affordable than an implant and it tends to have good aesthetic results in the middle term. A fixed partial prosthesis replaces the missing tooth, stabilises the occlusion (how the teeth fit together) and prevents movement in antagonist teeth.

  • A fixed partial prosthesis can’t be used when teeth don’t have proper bone support or dental structure to keep the length of the partial prosthesis in place. There’s a higher risk of cavities and possibly nerve damage during the filing process, which must be treated with endodontic therapy (root canal), with the issues this treatment entails.
  • There is a risk of affecting the gum tissue and the bone around the teeth, which may lead to periodontal problems (pyorrhea).
  • Some partial prostheses may come loose and occasionally break. Daily hygiene can be difficult with some partial prostheses.
  • There may also be aesthetic difficulties, given that the goal of this prosthesis is to blend in with the other teeth, which is often difficult.

Option 3: “Maryland” bonded prosthesis

The partial bonded prosthesis is a metal and porcelain prosthesis that is bonded (stuck) onto the palatal or lingual surface (the back) of the teeth adjacent to the one missing.

  • Like the conventional partial fixed prosthesis, the partial bonded prosthesis is attached and not removable (the patient can’t take it out). However, this type of prosthesis requires less preparation of the adjacent teeth.
  • It replaces the missing tooth, stabilises the occlusion and prevents movement in antagonist teeth. Treatment time is short. This option can be used in situations when the available space is so small that an implant won’t fit.
  • There is a risk of the prosthesis coming loose or detaching completely in many patients.
  • There’s a risk of the tooth becoming more sensitive or the prosthesis breaking.
  • Sometimes the metal can be seen through the adjacent teeth, compromising the aesthetic results.
  • Sometimes, there is a problem with the soft tissue under the partial prosthesis due to more difficult daily oral hygiene.
  • The lifespan for sort of replacement also varies. This option is often chosen for very young patients, as some dentists see it as a temporary replacement until they are older and have finished growing. Then a final prosthesis (over an implant or a bridge to adjacent teeth) is put in.

Option 4: Removable prosthesis

This means replacing a lost tooth with a crown placed over a single implant, which acts as an artificial “root”.

  • This treatment method is often less expensive and faster. If necessary, additional teeth can be added to the prosthesis in the future.
  • Many patients see a lot of disadvantages in this treatment, including the fact that the prosthesis is removable (not fixed), which makes it uncomfortable and bothersome for many patients in the long term. It can also affect the teeth it rests on, leading to a greater a risk of cavities there as well as gum issues.
  • In some situations the prosthesis requires a metal piece to keep it in place, which is visible when the patient smiles. These metal “hooks” can overload the teeth they rest on, making them loose if there is any sort of periodontal pathology (pyorrhea). It is difficult for some patients to adapt to this prosthesis. Difficulties speaking and chewing. Patients often complain it is too big.
  • It is important to note that, no matter which treatment you choose, success depends on following a regular oral hygiene plan with your dentist. All teeth need to be cared for, whether natural or prosthetic and proper oral hygiene is necessary for optimal dental health. If you have any questions about your treatment options, please contact your surgeon or your dentist.

Why replace a lost tooth at the Birbe Clinic

  • Prevent nearby teeth from moving.

  • Reduce surgery time.

  • Avoid problems in neighbouring teeth caused by movement.

  • Reduce bone loss under the loss tooth.

Loss of one tooth:

If you have the same problem as María, we can help

“I had a lot of problems with my mouth, I had had some implants that didn’t work out well, and then I discovered the Birbe Clinic… I’m so thankful for their kindness, for Dr Manresa and the whole team. I’m very happy and I have beautiful teeth… My level of satisfaction? 100, I can’t say anything more, it’s all been said.”- María
See other patients’ experiences with restoring lost teeth

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Extraordinary Undergraduate Award in Medicine 1991. Doctor in Medicine and Surgery from the Autonomous University of Barcelona “Cum Laude” 1997. Only Spanish maxillofacial surgeon certified by the American Board of Oral and Maxillofacial Surgery 2001.

Why should I have the operation at the Birbe Clinic?

  • Our facilities were designed for optimal hygiene and sterilisation, and to ensure our patients’ comfort. We have an on-site scanner and operating room, with sedation and out-patient treatments.
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