Overcome the issues associated with multiple missing teeth at any age

Demajo - Smiling man

Are you one of those patients missing multiple teeth in either your top or bottom jaws…. or both? If so, for how long have you missed out on chewing on your back teeth? Missing multiple teeth is a very common scenario, which often goes untreated for a very long time. In some individuals patients aren’t interested in replacing these teeth as they aren’t visible with the normal aperture of the mouth.

Effects of missing teeth

  1. Toothwear: Biting and having to chew on just the front teeth leads to tooth-wear. Over a long period these front teeth lose height and appear very smooth as they are being overused.


  1. Tooth fracture: Missing teeth puts additional pressure on remaining teeth resulting in micro-cracks which may lead to tooth fracture and/or de-coronation (breaking the crown of the tooth leaving just the roots).


  1. Tooth mobility: Teeth are supported in their sockets thanks to the gingival tissue, in particular to the periodontal ligament fibres attaching them to bone. If teeth are under excessive stress, this ligament suffers and with time teeth start moving resulting in tooth loss. This may also cause the teeth to drift outwards, splaying themselves increasing the spaces between them.


  1. Tooth pain: overloading of the remaining teeth may result in them dying off requiring root canal treatment and further prosthetic work.


  1. Bone loss: Loss of posterior or anterior teeth in either jaw results in bone loss as the bone does not receive a stimulus due to the lack of tooth roots. In the top jaw the bone loss causes a reduction in distance between the maxillary sinuses and the mouth. In the bottom jaw the distance between the mouth and inferior dental nerve present in the mandible is also reduced. Over a long period of time, the volume of bone loss may be very large. This would mean that if implants are planned, maxillary sinus bone grafting would be required in the top jaw and bone grafting would be required in the bottom jaw increasing the element of surgery for the patient and complexity for the implant surgeon.


  1. Tooth migration: Missing teeth would cause present teeth to drift into the resultant space creating odd contacts on chewing, excessive tooth-wear facets as well as inconvenient food packing around the remaining teeth. Upper teeth often over-erupt into the space of the lower missing teeth due to lacking their antagonist to chew on. Over a number of years upper molars may completely descend into the space of the lower missing molars causing traumatic biting onto the gum. These upper teeth would also appear very long, exposing their roots reducing their aesthetics. Adding insult to injury these upper over-erupted teeth would on closure of the anterior teeth, take up the space of the missing lower posterior teeth not leaving any space for the dentist to replace the lower missing teeth.


  1. Dento-Facial aesthetics: Cheeks and lips tend to collapse inwards resulting in poorer aesthetics giving rise to an older looking appearance.


  1. Digestive problems: Chewing our food mixed with our saliva is the first stage of digestion. If food is not chewed but gobbled instead, this may result in indigestion and acid build-up. Patients, who lack teeth, also stir away from eating certain foods resulting in a lack of nutritional intake.

The list goes on and on. It is never too late to replace your missing dentition both with removable or fixed teeth. The repercussions are serious.

Take action now and ask your dentist for advice!

A Case Study

  • 87 year old patient wearing a partial denture replacing 7 teeth. The original natural teeth where bridged but due to tooth failure the patient was forced to remove the natural teeth and have them replaced with a removable denture
  • After some time the patient wished to eliminate the removable denture and have his teeth replaced with a fixed prosthesis supported by dental implants.


Demajo Dental - Removable Denture

Removable denture

 Intra-oral image of implants in-situ

Intra-oral image of implants in-situ

3. Fixed porcelain implant bridge on laboratory model

Fixed porcelain implant bridge on laboratory model

4. Intra-oral image of implant bridge in-situ

Intra-oral image of implant bridge in-situ

Dr Jean Pul Demajo

Dental and Implant Surgeon                                                                                                                                                                              

Trained in London working in private practice in Malta


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