I have had full mouth dental porcelain veneers. The second tooth from the upper left hand corner had a fracture in the root and had to be pulled . How important is it to have an implant done and replacing the tooth in the back when you can not see it?
– Bertie from California
It would be a shame to not replace this tooth after all the money you have invested in your mouth, with your porcelain veneers which have hopefully given you a beautiful smile. Let me explain why this is important.
Have you ever wondered how all of your teeth seem to get into the right positions? Each tooth touches the teeth on either side with just the right amount of force to keep food from packing in those spaces. And then when you close your mouth, each tooth on your upper jaw meets each tooth on your lower jaw at exactly the same time, so they all fit and you can clench all your teeth together. The way your body accomplishes this is that there are drifting forces built into the positions of the teeth. When your teeth erupt, they keep going until they hit something, and then they stop. And then your back teeth have a tendency to drift forward until they hit something, which keeps the adjacent teeth touching each other.
If you have a missing tooth, that completely screws up the system. So what happens, if you’re missing an upper first molar (which is the second tooth from the back) is that the tooth behind it will tip into that space, and the lower first molar will drift up looking for its mate on the upper jaw. This has several bad effects. First of all, it throws your bite out of harmony, and this is one of the main causes of TMJ disorder. It can result in spasms of the jaw muscles and headache pain. Second, it affects the long-term health of these other teeth. When the lower tooth super-erupts, it comes out of the bone somewhat and now that tooth is weaker because it has much less bony support. And when teeth start to tip, they form food traps and create other difficulties in keeping the teeth clean. Additionally, this creates unnatural angled stresses on the teeth which leads to vertical bone loss, which also weakens the teeth.
The first molars are anchor teeth, and when one of them is allowed to stay missing, it will disrupt your entire bite on that side of the mouth. If a second molar is missing, it may only compromise the companion tooth on the opposite arch. The reason for that is that there is no tooth behind it to tip into the space.
But you don’t have to replace the missing tooth with a dental implant. A dental bridge would also work fine. And if that is too expensive for you, I would at least put in a removable clip-in tooth, such as a flipper or other type of removable partial denture.