Missing Teeth

Hidden Danger of Losing Teeth

We now have many options to restore teeth which were lost due to various unreparable dental problems or the teeth which were congenitally missing.  However, many people would choose to do nothing to restore them.  If the missing teeth are not restored in time, there could be many severe cosmetic, dental and medical consequences, and they are:

  1.  If the front teeth are missing, a person’s appearance can be severely affected.  The unsightly gaps can profoundly affect a person’s psychie.
  2. The bone which were once supporting the teeth will be shrinking.  The bone will no longer receive mechanical stimulation from the teeth.  These stimulation from teeth helps promote natural remodeling of the bone.  Without these stimulation, the bone remodeling would be affected and thus the bone will become atrophy or shrink in volume.
  3. With the shrinkage of supporting bone, the lips and cheek would appear sunken in.
  4. The teeth which directly opposes to the missing teeth would extrude out of the supporting bone.  For example, if there is missing teeth on the lower jaw, the upper teeth directly above empty space would extrude downward.  Eventually, the upper teeth would extrude out of the upper alveolar bone and the teeth would be lost.
  5. Also the upper teeth would hit the gum in the empty space.  These would create chewing problem.
  6. The adjacent teeth near the missing teeth would receive excessive pressure from a person’s chewing movement, and this would cause increase in risk of tooth fracture.
  7. The adjacent teeth would collapse into the empty space and this exacerbate the already compromised bite.  Eventually, the person would have difficulty in chewing because teeth adjacent to the missing teeth would become misaligned.
  8. Due to bone shrinkage, the person would have new risk for jaw fracture.

Written by Daniel Tee, DDS, MS

General Dentist Office in Tempe AZ

Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona. Practicing General Dentist

Missing Posterior Molar Teeth Can Start Series of Dental Problems

It is common that people have one or two missing teeth and sometimes people would ignore restoring those missing posterior molar teeth, because people would think it is at the back and nobody can see their missing teeth.  Also, people chose not to restore them because of cost of replacing them and they believe they are chewing fine with their remaining teeth.

Tooth Split

Tooth split due to excessive biting pressure. The patient has missing posterior molar teeth and mainly use the small premolars to chew.  Excessive biting pressure cause the premolar to fracture.

However, posterior teeth are especially important for chewing.  Lack of posterior molar teeth can dramatically decrease a person’s chewing efficiency.  Also the lack of posterior molar teeth can put additional stress on the rest of remaining other teeth.  I will show a photo of a patient who recenlty come to my office.  She has missing posterior molar teeth on both side of her mouth.  She mainly only chew with the premolars and anterior teeth which are relatively small and are not designed to handle the stress in chewing and grinding food.  Thus, with times, the right upper premolar tooth becomes fractured.  The photo shows that the tooth has a fracture line down thru the mid-section of the tooth.  Upon clinical examination, the fracture actually goes deep down to the mid root and this tooth cannot be repaired and needs to be extracted.

Another problem with missing teeth is that the teeth around the missing tooth area would start to shift in position.  The other teeth may collapse into the empty space.  The bite will be in disharmony and excessive wear and tear will happen to the other teeth.  Opposing teeth would start to come down and eventually they would touch the gum.  The opposing teeth will be affected and may have the risk of losing them, in addition to the already missing teeth.

Teeth Collapse

Upper teeth start to drift downward and eventually would come out of the bone socket.


Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.


Implant Restoration of Missing Teeth — The real world example

Today, I am going to share one of my implant restoration case.  Patient has tooth #31 extracted in many years ago.  It was recommended to him that implant would be the only good option to restore the tooth.  In his case, a bridge cannot be made because he does not have another posterior tooth behind the missing tooth for the bridge.

The patient had the implant placed more than six months ago for the tooth #31 location.  Today we took an xray to review the implant and its adjacent bone.

Implant Restoration, Implant Fixture, Implant Xray, Nobel Biocare Replus Implant, Tempe DentistFrom the Xray radiograph image, I can inspect the condition of the gum and the position of the implant.  The condition of bone around the implant seems to be in excellent condition.  The bone height around the implant is exactly where it should be.  There is no bone recession noted on the xray radiograph.  Ideally, the bone height should be at the level of the first screw thread of the implant fixture.  Also, the implant is upright and is within good distance from the adjacent tooth.  Theoretically, there should be a minimum of 1.5mm of space between the implant and adjacent tooth.  Clearly, from the xray, it shows there is a least 2 mm of space in this implant case.

Next, I would review the implant inside patient’s mouth.  Currently, the patient has a healing cap placed on top of the implant.  This is how it looks like in the mouth.

Implant Restoration of Missing Teeth, Implant Healing Cap, Dental Intraoral Photograph, Tempe DentistThe tissue around the implant healing cap seems to be normal in appearance.  The color and texture of the tissue is normal.  The patent confirms feeling fine.  No pain or swelling complaint.

With the examination complete, I would proceed to the clinical procedure of taking impression of the impant so that I can use the impression to make the implant crown for the patient.  In the current state, the implant still sits with the bone.  It serves as the anchor for the implant crown.  I would need to find a way to record the position of the implant so that I can make the implant crown correctly to fit on top of the implant fixture.  This is how I would begin.

I would take off the implant healing cap.  After the cap is removed, this is how the implant fixture sits within the jaw bone.

Implant Top View, Implant Fixture, Implant Xray, Nobel Biocare Replus Implant, Tempe Dentist

Implant Bitewing Xray, Dental Implant, Tempe DentistThen I would insert an impression device called the implant impression coping into the female portion of the implant fixture and tighten it lightly so that it does not move or come off.  The height and orientation of the impression coping accurately reflects the position of the implant fixture in the bone.  Then I would take a putty impression of the patient”s lower right arch.  The impression coping would leave an indentation mark within the impression putty in the impression tray.

I would take this impression to my favorite dental laboratory and the implant crown will be fabricated.  When the laboratory finished the implant crown, I would schedule the patient to come for another appointment to have the implant crown  inserted.  At that time, then I will post a follow up article about how I go about inserting the implant crown.  Stay tuned!

 For Part 2 of the same topic, Click here.


Written by Daniel Tee, DDS, MS

If you have any questions or want to schedule an appointment, Please call 480-820-6131

Practicing General Dentist in Tempe Arizona