Replacing that missing tooth

PHOTO: Replacing that missing tooth

A missing tooth on a six-year-old may look cute but it's not a pleasant sight on a grown-up. According to consultant dental surgeon Dr Muhammad Nazli Haffiz, when an adult is missing a tooth, it is a sign that something is seriously wrong with his or her dental health.

He says tooth loss is often due to decay, gum disease or injury.

"Loss of teeth causes problems with eating, speech and other basic activities that may worsen with time," says Dr Muhammad Nazli. He adds that a missing tooth can also weaken the overall structure of the mouth.

"Since each tooth supports the other, an untreated gap can cause additional tooth loss or injury that may worsen with time. When you have a missing tooth, the remaining teeth will shift to fill in the gap. This causes the opposite tooth to overgrow. The bones will also shrink," he says.

If that is not bad enough, missing teeth can also make you look older as it causes significant changes to the mouth structure. It causes wrinkles around the lips and adds years to your face.

"Missing teeth can mar an otherwise beautiful smile. It also causes complications to your diet and appearance and lowers your self-esteem."

Replacing the missing tooth will give support to the cheek, overall facial structure and delay the aged look.

Dentists recommend replacing missing teeth to prevent jaw bone loss. Previously, the only treatment options available were bridges and dentures. Today, dental implants are said to be the leading tooth replacement procedure.

Dental makeover

Traditional dental bridge involved cutting healthy teeth to construct and place the bridge.

Dental implants are an attractive, permanent and fully functional way to secure ill-fitting denture or replace the roots of a missing tooth or teeth.

A dental implant literally means replacing a missing tooth. It can be one tooth or several teeth. The tooth root fixture is made of titanium and shaped like a screw," says Dr Muhammad Nazli.

But this is not any screw that we find in the hardware store. Dr Muhammad Nazli says the titanium screw is much more sophisticated.

"Instead of resting on the gum like removable dentures or using adjacent teeth as anchors for a dental bridge, dental implants are surgically attached to the jawbone. Dental implants look and feel so natural that you may forget you have lost a tooth," he says, adding that it improves the ability to speak and chew.

"It also allows the wearer to smile confidently."

Are you suitable?

Am I the one?

To know if you are the right candidate for a dental implant, check with your dentist. A strong immune system coupled with proper bone density is important.

"Patients must be fit enough to go for a surgery. For example, diabetics must ensure that their sugar level is well controlled. The dentist will thoroughly review the patient's medical history before making a decision," says Dr Muhammad Nazli.

"If you are found suitable, the dentist will then determine where and how your implant should be placed and work out a treatment plan depending on the patient's needs.

"The dentist will thoroughly examine your teeth and gums and evaluate bone density and quantity. Based on the condition of your oral tissues, oral hygiene and personal habits, you will be advised on the most appropriate treatment plan."

Patients are also required to get an X-ray or a CT scan to check on the bone structure and the suitability of placing an implant. It will also help determine the length and thickness of the titanium to be used.

This is how a dental implant with retained bridge looks like. In this procedure, it does not require cutting of sound teeth but applicable to cases with 3 or more teeth loss.

How it's done

The procedure

Dental implant surgery is usually carried out under local anaesthesia. According to Dr Muhammad Nazli, the first phase involves creating an opening in the jawbone.

"The titanium is then placed into the bone socket of the missing tooth and usually followed by a cover screw. The gums may be sutured and temporary prostheses will be placed. The area will immediately begin to heal.

"A process known as osseointegration takes place where the surrounding bone molecules begin to attach themselves to the titanium surface of the implant. It usually takes between two and four months for the bone to securely bond to the entire implant surface."

Once it has bonded to the jawbone, an abutment, a small metal post, is attached to the implant to hold the new tooth securely.

"The dentist will make an impression of the patient's tooth. The final phase involves the custom prostheses, called a crown being fitted and securely placed using a resin based cement."

If the patient has more than one missing tooth, the dentist will use the implant-supported bridges to replace the missing teeth.

"Since the implant is secured within the jawbone, the replacement teeth look, feel, and function just like your own natural teeth," says Dr Muhammad Nazli.

The restored implant tooth is individually supported and is not connected to adjacent teeth.

Caring for the new tooth

Caring for the new tooth

Good oral hygiene and proper aftercare of dental implants is important to keep them problem free. Dr Muhammad Nazli says dental implants require the same care as real teeth, including brushing, flossing, and regular dental check-ups.

Dental care myths

Myth: I must not brush my teeth if my gums bleed.

Truth: Always brush with a soft toothbrush. Bleeding is a sign that the gums are unhealthy and it is time to see your dentist. Bleeding gums are usually caused by gum disease that starts with poor oral hygiene. It will get worse if not taken care of.

Myth: There is no need to see a dentist if there is no visible problem. Truth: Go to the dentist once every six months. This will enable problems to be detected early and addressed. If you seek treatment only when in pain, the problems could be very serious.

Myth: There is no need to take care of my baby's teeth because they will eventually fall out.

Truth: This is wrong. Baby teeth not only allows the child to chew well but also serves as space-maintainers for permanent teeth. Early loss of baby teeth will cause problems with the child's bite and result in improper development of his or her permanent teeth. Teach your children good oral hygiene at a young age.

Myth: Avoid dental procedures during pregnancy.

Truth: Pregnant women should go for regular dental treatment and check-ups as gums are more sensitive and irritable. Although X-rays or surgical procedures should be avoided, other treatments such as scaling and fillings can be done safely.

Myth: All dental treatments are painful.

Truth: Not anymore, thanks to advanced dental technologies. Besides fear of pain, overall fear of visiting the dentist is what deters some people from going for periodic check-ups. Periodic check-ups are just check-ups. Further treatment, if required, will be discussed with the dentist. Understanding the course of treatment and what you will go through may help alleviate your fears. Do not be afraid to ask questions.

Benefits of dental implants

Benefits of dental implants

Improved appearance

Dental implants look and feel like your own teeth. They are permanent and maintaining them is no different than maintaining your natural teeth.

Improved speech

Poor-fitting dentures can slip within the mouth, causing you to mumble or slur your words. Dental implants allow you to speak without worrying that your teeth might slip as they are permanently embedded in the jaw bone.

Improved comfort

Because they become part of you, implants eliminate the discomfort of removable dentures. Placement of dental implants do not involve cutting sound adjacent teeth as in dental bridges, reducing the chances of teeth sensitivity caused by tooth preparation involved in making a dental bridge.

Easier eating

Sliding dentures can make chewing difficult while food may get stuck underneath a dental bridge, causing discomfort and sometimes bad mouth odour. Dental implants function like your own teeth, allowing you to eat without pain.

Improved self-esteem

Dental implants can help you feel better about yourself.

Improved oral health

Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving your long-term oral health. Individual dental implants also allow easier access between teeth, improving oral hygiene.


With good care, many implants last a lifetime.


Removable dentures are just that, removable. Dental bridges will require you to floss underneath the pontic (the false tooth replacing the lost permanent one).

This is not easy. Dental implants ar permanent and eliminate the embarrassing inconvenience of removing your dentures, as wel as the need for messy adhesives to keep dentures in place.