Under tooth loss , a reduction of the total of 32 teeth comprehensive tooth stock (not the natural loss of an adult milk teeth - see dentition ) understood. Tooth loss can affect one or more teeth and have various causes.
Possible causes of tooth loss are:
Tooth loss as a result of an accident, falls and blows can occur immediately or delayed due to complications. Here, an external force leads to severe damage (in children and adolescents usually damage to the front teeth ) or to complete destruction of the tooth , so that in the worst case it can no longer be preserved.
Dental plaque from bacteria caused by inadequate oral hygiene is the main cause of tooth decay , the disease of the tooth. Although tooth enamel is considered the hardest natural substance in the body, it is attacked by plaque and becomes porous, allowing bacteria to penetrate the unprotected tooth, which damages the softer tooth substance dentin , the inside of the tooth and the tooth root and ultimately leads to tooth loss.
Like tooth decay, periodontitis is bacterial too, but does not affect the tooth itself, but rather the tooth holding apparatus , which includes the gums , the tooth socket (the bony area in which the tooth is anchored) and the tooth root . If such a bacterial infection is left untreated, inflammatory changes and degradation of the jawbone substance can result, up to and including tooth loss. Periodontal disease is the leading cause of tooth loss in adults.
Serious general illnesses and chronic conditions such as diabetes , rheumatic joint inflammation and osteoporosis increase the risk of tooth and gum diseases, which lead to tooth loss. Diseases caused by bacteria in particular and a weakened immune system can cause bacteria in the body to reach the gums via nerves and blood vessels , where they cause inflammation and the destruction of the gums.
Classifications of tooth gaps
The classification of tooth gaps can be done according to different approaches:
In the Kennedy Classification (1932), the various possibilities of tooth gaps are divided into four classes based on their location (topographically). Only the single jaw is considered.
- Kennedy class I: double-sided shortened row of teeth or free-end gaps on both sides
- Kennedy Class I1 bilaterally shortened row of teeth and a gap
- Kennedy class I2 bilaterally shortened teeth and multiple gaps
- Kennedy class I3 bilaterally shortened row of teeth with still little remaining teeth
- Kennedy class II: row of teeth shortened on one side
- Kennedy Class II1 unilaterally shortened row of teeth and a gap
- Kennedy Class II2 unilaterally shortened teeth and multiple gaps
- Kennedy class II3 unilaterally shortened row of teeth with still little remaining teeth
- Kennedy class III: lateral gap
- Kennedy Class III1 row of teeth interrupted by two gaps
- Kennedy Class III2 row of teeth interrupted by multiple gaps
- Kennedy class III3 row of teeth interrupted by several gaps with still little remaining teeth
- Kennedy class IV: frontal interstitial space (reaching over the center line)
The most distal tooth gap is decisive for belonging to a Kennedy basic class - apart from Kennedy class IV. Missing wisdom teeth (8th) do not result in a shortened row of teeth in the sense of the Kennedy classification.
The Wild Classification (1949) provides for a purely descriptive classification of gap bites: shortened, interrupted or combined.
- Wild category I: shortened row of teeth ( unilateral , bilateral )
- Wild category II: interrupted row of teeth (unilateral, bilateral, frontal, multiple)
- Wild category III: combination of interrupted and shortened teeth
Classification according to Eichner
In the Eichner classification (1955) a functional division of the gap bites into three groups is carried out according to the existing support zones . Eichner took up the concept of support zones introduced by Steinhardt in 1951 . A complete set of teeth has four support zones, whereby the front teeth are not taken into account. A support zone consists of two opposing pairs of teeth, i.e. four teeth:
- 1. Support zone: premolars on the left side
- 2. Support zone: premolars on the right side
- 3. Support zone: molars on the left side
- 4. Support zone: molars on the right side
The identification of the functional value of the gap bite according to the number of remaining support zones is decisive for the division into the following 3 main groups, with a further subdivision according to the number of gaps:
- Group A: all 4 support zones have antagonistic contact
- Eichner group A1 both jaws fully dentate, individual teeth damaged, but buildable
- Eichner group A2 one jaw fully dentate, one jaw with tooth-limited gaps
- Eichner group A3 both jaws with gaps, full support in four support zones
- Group B: less than 4 support zones show antagonistic contact
- Eichner group B1 contact only in 3 support zones
- Eichner group B2 contact only in 2 support zones
- Eichner group B3 contact only in 1 support zones
- Eichner Group B4 Contact only outside the support zones
- Group C: lack of antagonistic tooth contact
- Eichner group C1 residual teeth in both jaws without contact
- Eichner group C2 one jaw edentulous, remaining teeth in the other jaw
- Eichner group C3 both jaws edentulous
Incorrect bite caused by gaps in teeth (disturbed contact between tooth and opposing tooth as well as neighboring teeth tilting into the gap) can lead to consequential damage to health: tense chewing muscles, painful jaw joints, neck tension, chronic headaches and back problems. An incorrectly loaded temporomandibular joint causes teeth grinding at night , which can trigger dizziness and tinnitus . Missing teeth can also cause a breakdown of the jawbone and, at the same time, incorrect and overloading of the remaining teeth. Tooth gaps can pose a risk to oral and general health, so missing teeth are not only replaced for cosmetic reasons.
To treat tooth loss, dentistry offers several options for replacing the original tooth:
A dental bridge is a fixed denture that is attached to the neighboring teeth that are still present. Your problem lies in the stress on the adjacent teeth supporting the bridge. The necessary preparation (grinding) of the teeth and the bridge fixation damage the enamel of the abutment teeth, which can promote further tooth loss. The increased, redistributed stress on surrounding teeth when chewing can lead to excessive stress. In the worst case, this leads to tooth loosening with subsequent further tooth loss.
A dental prosthesis is a removable denture that replaces a row of teeth ( partial denture ) or an entire set of teeth ( full denture ). These dentures can be removed and cleaned by the patient every day. The problem here is the unnatural pressure load on the jawbones and a lower stability due to missing teeth: the bone substance can slowly recede, which means that the removable dentures no longer have an optimal fit and therefore no longer have a reliable hold, which leads to pain when wearing can. In advanced stages, additional teeth can be lost due to the load.
With dental implants , the above-mentioned risks and problems do not arise, since the teeth adjacent to a tooth gap do not have to be ground. Implants enable a fixed denture solution in the event of tooth loss by replacing individual teeth in a natural way so that complete, functional teeth can be reconstructed. The artificial tooth crown , which sits firmly on the implant anchored in the jawbone, can be cleaned like your own tooth. Removable dentures can also be attached to implants. Implants reduce or prevent bone loss caused by prosthetic saddles. Implants can add stability to removable dentures. The disadvantages are high costs, surgical intervention, long treatment times and the risk of losing the implant.
- IMC, Gap Bites: Classification accessed on March 12, 2013
- prosthetics including model cast prosthetics , Freiburg University Medical Center. Retrieved November 16, 2015.
- G. Steinhardt, On the chewing pressure and its importance for the prosthetic treatment of the gap dentition. (1951) Zahnärztl Welt 6: 291-294
- University of Greifswald, classification according to Eichner, p. 196 ( Memento from November 17, 2015 in the Internet Archive ) (PDF; 193 kB)
- University of Freiburg, partial prosthetics including model cast prosthetics (PDF; 1.1 MB)