Many of our patients face losing a single front tooth through trauma or the irreversible failure of a heavily restored tooth. This leaflet will provide background information on the possible solutions that may be available, depending on their individual circumstances.

Acrylic Denture 

This is a denture made from acrylic and is often used as an interim before one of the other methods is used to restore the missing tooth.

Like its more sophisticated relative, the chrome denture, acrylics are able to restore many teeth in one treatment.

To be strong enough and stay in place acrylics have to be 2-3 mm thick and often cover a large surface area.

As they cover a lot of gum edges the risk of decay & gum disease is enhanced, and the coverage of the palate can alter taste.

Despite all this, many patients have had an acrylic for years and appear to manage well.

Pro      Good aesthetics are possible

            Low cost and easily repaired

Con     May rely on suction or additional clasps for retention and can be bulky & intrusive

Cost    From £250

 Maryland or Resin Bonded Bridge

It is named after the University of Maryland who pioneered the technique. It relies on using plastics to bond a metal or plastic wing to a tooth.

A bridge unit is made by a dental laboratory to replace the missing tooth with a thin metal or plastic wing that accurately fits the back (palatal or lingual) of an adjacent tooth. The tooth will usually need some adjustment to allow the bite to be correct afterward, but the amount is minimal. The wing is then stuck to the tooth.

In some cases there can be problems with the 'wing' tooth darkening owing to reduced light transmission and an all plastic version is used if this is thought to be likely.

Pro      Minimal preparation to one adjacent tooth usually required

Good aesthetics

Fit and forget

Relatively low cost: From £400

Cons   Darkening of winged tooth possible

            Could detach and need recementing

Chrome Frame Denture

 This is a denture where the main structure is built from a casting of thin stainless steel. Standard acrylic denture teeth are attached to this frame.

Recently, an alternative version has been developed which uses a milled off white plastic. Tooth shades are being developed.

Pro      Good aesthetics in most cases

            Little damage to teeth

            If other teeth are missing, then a chrome denture can replace them as well

            Can last a very long time

Cons   Can get some movement of the frame

            Needs clasps around back teeth to stabilise denture

            Some patients prefer 'fixed' solutions to 'removeable'

            Some risk of increased gum disease or decay in the areas the denture covers.

Cost    £700 plus

Implant

A cylinder of titanium with a machined central post space is placed in a carefully prepared hole in the jaw bone and, allowed to 'osseointegrate' for several months.  What this means is the jawbone grows up to and around the implant, holding it firmly in place. It is then uncovered, and a post is placed in the implant and a crown made to fit the post. In some cases, a temporary crown can be fitted when the implant is placed but often a temporary solution is required.

Pros    Cutting edge technology

            Avoids any damage to other teeth

            98% successful

            Near perfect aesthetics can be obtained

            Fixed & permanent solution

Con     Expensive: £2500-3000 per tooth.

            Potentially not suitable for smokers or those with advanced gum disease.

Conventional Bridge

 For these a full coverage crown is prepared on the adjacent tooth or teeth and so there is a need to do substantial reduction to this tooth. The lab technician then makes a crown with a cantilevered blank tooth, very similar to that used in a Maryland bridge. Another design uses a crown at either end of the bridge, so two teeth need preparing.

Pro      Can be a good solution if the adjacent tooth/teeth is discoloured, has poor aesthetics, or is heavily restored or is already crowned.

            Service life of 15 – 20 years

Cons   Extensive & irreversible loss of tooth structure

            Repair can be difficult.

            Unsuitable for patients with 'active' lifestyles or those with active decay or gum disease.

Cost     From £750