When a person seeks to replace or restore damaged teeth, the options extend far beyond removable artificial teeth, which are commonly known as dentures. Modern dentistry offers a variety of fixed prosthetic solutions, meaning they are permanently cemented or anchored into the mouth. These restorations are designed to mimic the appearance and function of natural teeth, providing a more stable and long-term substitute for missing or compromised dental structure. These fixed replacements fall into different categories based on whether they repair an existing tooth, bridge a gap between teeth, or replace the entire tooth root.
Fixed Restorations for Tooth Structure
Restorations for existing teeth preserve the natural root and remaining healthy tooth material by covering or filling the damaged area. The dental crown is a common example, serving as a full-coverage cap placed entirely over a compromised tooth. Crowns are often necessary after a root canal, or when a tooth has extensive decay, a fracture, or a large filling that jeopardizes its structural integrity. They restore the tooth’s shape, size, and strength, extending its functional lifespan.
Less extensive fixed restorations include inlays and onlays, which are custom-fabricated pieces that fit into the tooth’s chewing surface. An inlay repairs damage contained within the cusps, the raised points on the tooth. An onlay is a slightly larger restoration that extends over one or more cusps, providing greater coverage when damage is more widespread than what an inlay can address. Both are created outside the mouth and then bonded into place, offering a more durable alternative to traditional fillings for larger cavities.
For issues that are primarily cosmetic, such as discoloration, minor chips, or irregular shape, dental veneers are often the selected treatment. A veneer is a wafer-thin shell, typically made of porcelain or composite resin, custom-designed to be bonded directly onto the front surface of the tooth. This procedure requires the removal of a minimal amount of enamel to prepare the tooth and ensure a natural fit. Veneers create a uniform, aesthetically pleasing surface without requiring the full structural coverage of a crown.
Replacing Gaps Using Adjacent Teeth
When a tooth is completely missing, a dental bridge (or fixed partial denture) is a fixed, non-surgical solution. A traditional bridge replaces the missing tooth by using the adjacent natural teeth for support. This restoration consists of three primary parts: the pontic (the artificial tooth suspended in the gap), and an abutment on each side.
The abutments are custom-made crowns placed over the natural teeth immediately next to the space. These anchor teeth must be prepared, meaning they are filed down to allow the abutment crowns to fit securely. The pontic is then fused between the two abutment crowns to create a single, continuous unit. This structure is cemented onto the prepared anchor teeth, effectively “bridging” the open space. A bridge restores the ability to chew, prevents remaining teeth from shifting, and helps maintain facial shape.
The success of a dental bridge relies on the health of the adjacent teeth, which must be strong enough to bear the additional chewing forces. Because the anchor teeth are permanently altered to support the abutment crowns, this restoration is a long-term commitment. Alternatives include a cantilever bridge, which relies on support from only one side, and a Maryland bridge, which uses a framework bonded to the back of adjacent teeth instead of full crowns.
Surgical Replacement of the Tooth Root
The most comprehensive and structurally independent fixed alternative to dentures is the dental implant, which replaces the entire tooth from the root up. An implant is a small, screw-like fixture, most often made from titanium, surgically placed into the jawbone. Titanium is used because of its high biocompatibility and resistance to corrosion.
The implant fixture acts as an artificial tooth root, providing a stable foundation that does not rely on neighboring teeth for support. This stability is achieved through osseointegration, a biological process where the jaw’s bone cells naturally grow and bond directly to the titanium surface. This fusion creates a structural connection that locks the implant into the jawbone, providing the strength needed to withstand chewing forces.
The complete implant restoration involves three distinct components. The fixture is the part embedded in the bone, while the abutment is a connector piece that sits on top of the fixture, usually positioned at or above the gum line. Finally, a custom-made prosthetic crown is secured onto the abutment. The process of osseointegration typically takes several months, but once complete, the implant offers a stable, durable, and self-supporting replacement option.