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Biologic Challenges When Missing Multiple Teeth

Replacing multiple missing teeth can be one of the most difficult challenges in dentistry. This can involve teeth, implants, or dentures. No matter the material being used, there are many items to consider.

  • What you can see is important, but so is the amount and quality of bone.
  • Best possible scenario for implants or a bridge is a patient who has teeth present but no bone loss.
  • Braces (or orthodontics) can help to enhance the bone levels.
  • If teeth have been missing for a long time, implants can be tricky because of difficulty managing the papilla.
  • All those factors can help the dentist decide if a tooth supported fixed bridge or an implant supported fixed bridge or a traditional denture or a implant supported removable prosthesis may be the ideal choice.
  • Braces, or orthodontics, as well as bone grafting can also be involved

There are items to consider when choosing the ideal restoration. Even when the ideal restoration is chosen, how it is executed is extremely important. Even the type of material can make a significant difference.

  • The facial profile is also important when evaluating the smile.
  • The bone always had to be present prior to placing the implant in terms of height.
  • Several different types of restorations can be used at the same time, including implants, veneers, crowns, and bridges.
  • The biologic width on an implant is subcrestal, so resorbs bone.
  • 3mm of space between implants is ideal.
  • The most bone loss occurs after placing the final abutment.
  • If bone is still present on a natural tooth next to a single tooth implant, there will typically be 4.5mm to 5mm of papilla above the bone.
  • If the implants are 3mm apart on adjacent implants, the bone height (of approximately 3mm) will likely stay, but the papilla will shrink by at least 1mm
  • If you cannot get enough papilla, consider using a pontic, which will allow you to graft significant amounts of bone.
  • A supracrestal implant placement may also help.
  • Placing a permanent abutment at the time of implant surgery, it may preserve more soft tissue height.