Tooth loss through trauma is tragic. Stu in ‘The Hangover’, his character being a member of the dental profession, was positively shocked that, whilst under the unfortunate influence of Rufilin (for the dentolegal gang he didn’t consent to this), had his tooth knocked out. One could only imagine how he felt and how any of us would feel if this happened to us. At least we have the knowledge to know that tooth replacement can be predictable-our patients facing the prospect of a traumatised tooth with poor prognosis or a clean avulsion without appropriate management can be understandably horrifying. This can be compounded when the thought of a denture enters the fray.
Dental trauma generally occurs in young patients who may otherwise have minimal plaque associated disease. Patients of a certain generations may be more likely to accept dentures as their peers may already have them. During my time in Wales I noticed that it was common for young Rugby players to wear dentures and those newly partially edentate would accept this as a modality whilst they were still actively playing due to team mates utilising the same type of prosthesis.
In any case a single tooth denture is unlikely to be acceptable socially and functionally for the a number of patients. Socially removing dentures before going to bed just muffles any amorous tones. Functionally a single tooth denture maybe retentive but can destabilise on mastication.
If adjacent teeth are minimally restored a resin bonded bridge is a noteworthy consideration. The amount of chair side time for preparation is minimal and the same could be said at the cementation stage as long as moisture is controlled and the initial records are accurate with clear definition of what is needed from the design. Then we get to implant provision, which show excellent outcomes. In comparison to both dentures and resin bridges, they do require a lot more effort from both the patient and the providing clinician with significant financial and biological cost.
Where multiple adjacent teeth are missing the threshold for achievement of a predictable and acceptable outcome becomes high. Loss of papilla, reduction in bone height and width in addition to the risk of impaction on adjacent vital structures increases. As such implants will require greater time and biological investment that is likely to require 3D digital imaging, grafting and multiple implant fixtures.
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