Tooth Replacement

Bone Grafting
A dental implant (replacement root) placed into the site of an extracted tooth does not fit the socket exactly. The top of the socket is usually wider than the diameter of the top of the implant. This usually leaves a gap that must be filled to facilitate integration of the implant into the bone. The surgeon may recommend placing a small amount of freeze-dried bone into this gap.

Once a tooth is removed, it no longer places function in the bone, so the bone will likely atrophy over time. This is called “ridge resorption,” and it occurs at different rates in different patients. When the implant cannot be placed at the time the tooth is extracted, the surgeon may recommend that a bone graft be placed into the extraction socket to act as scaffolding for the healing bone so that there can be adequate bone volume after healing to support the implant. This is known as “ridge preservation” grafting, and it eliminates 75-80% of ridge resorption during the healing period.

Tooth Replacement Method
This does not need to be done in all cases, but if you are considering replacing the extracted tooth with a
dental implant, it is a simple “insurance policy” to assure that there should be adequate amount of bone for an implant after the extraction heals.

We use platelet-rich fibrin (PRF) to enhance bone healing and reduce inflammation, swelling and post-op pain. This is made by spinning your blood in a centrifuge and mixing it with the bone graft. A membrane is also made from a component of the PRF to protect the graft. This uses your body’s own regenerative properties to get optimal results.

If appropriate to your case, these bone grafting options will be discussed with you at the consultation appointment.

We want you to understand your treatment options. Please write down any questions you may have, so we can address them at your consultation appointment.

Your dentist has referred you to Advanced Oral Surgery, Bakersfield for removal of one or more diseased or decayed teeth. This may affect your ability to chew food and the function of your mouth and jaw. Depending on the number and location of these teeth, it may be beneficial to replace the missing teeth in order to maintain oral function and comfort. Some tooth replacement options require additional procedures, which may be done at the time of your extraction. Your options are presented here, and our surgeons and medical team will gladly answer any questions you may have.

There are a number of ways that missing teeth can be replaced. The time, possible discomfort and cost involved in this process vary greatly. Each method of tooth replacement has its own unique advantages and disadvantages. This informational pamphlet was written to explain these options to you so that you may make an informed, intelligent decision regarding tooth replacement therapy.

A Little Dental Anatomy

A tooth has two major parts: the crown, which is the visible part of the tooth above the gumline, and the root, which is below the gumline and anchors the tooth in the jawbone. When the crown of a tooth is diseased, it can be restored partially by placing a dental restoration (silver, gold or tooth-colored) to replace the damaged tooth structure, or completely by placing an artificial crown (also called a “cap”) on the tooth.

When a tooth is removed, both the root and crown of the tooth are lost. Most methods of tooth replacement only replace the crown of the missing tooth.

Removable Appliances

As the name suggests, this type of tooth replacement can be removed from the mouth at will. The replacement tooth is attached to a metal or plastic support, which rests on the roof or floor of the mouth and some of the teeth. This is known as a “removable partial denture.” One with a metal substructure is usually designed to function for many years. When made of all plastic, it is designed to last for months. This “temporary” appliance can be delivered at the same appointment when the tooth is removed so you are never “toothless.” It is referred to as a “flipper” or “stay plate.” This type of appliance helps prevent drifting and shifting of teeth around the extraction site until a definitive replacement is made. This type of prosthesis is relatively inexpensive. The disadvantages are that it may move slightly with function, can be uncomfortable, can be lost and that it relies on the remaining teeth for support, which can cause them to weaken or break. Also, pressure from the appliance on the gums where teeth are missing causes underlying bone atrophy (deterioration of the bone.)

Fixed Prosthetics

A”fixed partial denture” is more commonly called a “bridge,” because it spans over a gap. It is cemented on both ends to existing teeth, so it is not removable. This requires supporting teeth (abutment teeth) to be prepared for crowns. The replacement crowns are suspended between the abutment teeth. One advantage of this type of tooth replacement is that it can be in place about six to eight weeks after the tooth is extracted. It is also generally covered by most dental insurance plans. The major disadvantage is that the adjacent teeth, which may be otherwise healthy, need to be ground down to allow the abutment crowns to be placed. This turns a one-tooth problem into a three-tooth problem. Also, dental hygiene around a bridge is more difficult. Because the artificial crowns and abutment teeth are attached to each other, floss cannot be passed between them. A bridge generally has a lifespan of about 10 years, after which a replacement bridge will likely be required. This may involve preparation of more natural teeth for support. Where the teeth are missing, the bone underneath the bridge will atrophy (the bone will degenerate) over time. This may create an aesthetic defect, especially in the front areas of the mouth.

Dental Implants

As mentioned above, a natural tooth has a root and a crown. A dental implant is simply an artificial root that replaces the root of the missing tooth, so your dentist can make an artificial crown (cap) to go on top of it. The implant is made of surgical titanium, so it is accepted very well by the body. Tooth replacement using dental implants is becoming increasingly common. Dental implants allow the missing tooth structure to be replaced without altering the adjacent teeth. Since the replacement tooth is free standing, dental floss can be easily passed between the teeth. Because the dental implant acts as a replacement root, it helps to maintain the level of bone where the tooth was removed. In most cases, the new crown is made for the implant (artificial root) about three to six months after it is placed. This is to help ensure that the implant properly integrates with the jawbone and is strong. During the three to six months needed for healing, you may choose to use a temporary removable appliance (such as a “flipper) for aesthetic purposes. Design and insertion of the final crown is done by your dentist.

In select cases, the replacement root (implant) can be placed at the same time the tooth is extracted. This shortens the total length of treatment.

If you have questions about tooth replacement in Bakersfield, California, please contact our oral surgeon, Dr. Sirish Makan, at 661-863-9995.