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Post-Extraction Restorative Strategies for Comprehensive Oral Rehabilitation and Aesthetic Preservation

Updated: Jun 20

Wenjing Hu, Phyu Mi Ko

Project Smile Global 

June 18, 2024


(Photograph of dental professional explaining to patient)


Tooth extraction, while a necessary intervention for various oral pathologies, can disrupt the functional and aesthetic integrity of the dentition. This article presents a critical evaluation of post-extraction restorative options with a focus on achieving optimal oral rehabilitation and preserving aesthetics. We will explore the current evidence-base for various tooth replacement modalities, including dental implants, dental bridges, and partial dentures, analyzing their advantages, disadvantages, and long-term implications for both oral health and patient satisfaction. By critically evaluating the available restorative options through the lens of comprehensive oral rehabilitation and aesthetic preservation, this article aims to equip patients with knowledge towards optimal post-extraction treatment plans. The information presented can empower patients to participate actively in treatment discussions and make informed decisions regarding the restoration of their smile.


Fixed dental bridges are a well-established treatment modality for replacing one or a limited number of missing teeth. They function by utilizing the surrounding healthy teeth as abutments for support (“Bridges, Implants, and Dentures” 490). These abutment teeth are prepared, and the bridge structure—typically comprised of metal, ceramic, or a combination of both—is cemented onto them (“Bridges, Implants, and Dentures” 490). This creates a stable and natural-looking restoration that restores both function and aesthetics. While less permanent than fixed bridges, removable bridges offer a more cost-effective solution. Also called removable partial dentures (RPDs), they can be employed for similar situations (“Bridges, Implants, and Dentures” 490). These dentures are fabricated from acrylic resin and incorporate metal clasps or frameworks to attach to the adjacent teeth (“Bridges, Implants, and Dentures” 490). Full dentures are also constructed from acrylic resin and designed to resemble the natural dentition and gingiva. Retention is achieved through a combination of suction and the proper fit of the denture base against the underlying alveolar ridge (“Bridges, Implants, and Dentures” 490). While dentures offer a cost-effective solution for extensive tooth loss, they may present challenges with speech and mastication, and require regular adjustments and maintenance (“Bridges, Implants, and Dentures” 490). Moreover, dental implants represent a more advanced and increasingly popular approach to tooth replacement. This surgical procedure involves the placement of biocompatible titanium screws into the jawbone (“Bridges, Implants, and Dentures” 490). Following a healing period, these implants osseointegrate—that is, fuse with the bone—providing a stable foundation for restorations (“Bridges, Implants, and Dentures” 490). Implants offer several advantages, including improved chewing ability, superior long-term prognosis, and a more natural appearance compared to traditional prostheses (“Bridges, Implants, and Dentures” 490). Regardless of the type of restorative option, it is important to note that the location of missing teeth affects whether they will be replaced. People tend to care more about replacing teeth in the front of their mouth as they are more easily seen (“Bridges, Implants, and Dentures” 490). 


Dental bridges serve as a cornerstone treatment for patients missing teeth, offering a comprehensive solution that restores both aesthetics and function. By meticulously replacing missing teeth with artificial substitutes, bridges address a multitude of concerns, improving masticatory function, speech clarity, facial structure, and preventing adjacent teeth from drifting (Ifwandi 77). Perhaps most importantly, bridges restore a complete smile, boosting a patient's self-confidence. The procedure itself is a multi-step process typically spread across several appointments. The dentist begins with a comprehensive oral examination to assess the patient's suitability for a bridge. This meticulous evaluation involves a thorough inspection of the teeth adjacent to the gap (abutment teeth) to ensure their health and strength (Ifwandi 79). Additionally, the dentist assesses the presence of any periodontal disease and the overall health of the jawbone. Radiographic imaging (X-rays) may be necessary to gain a deeper understanding of the underlying bone structure and ensure sufficient support for the bridge. Following this detailed evaluation, a personalized treatment plan is formulated. This plan considers the number and location of missing teeth, the condition of the abutment teeth, and the patient's specific preferences and expectations.


Once the dentist determines the patient is a suitable candidate for a bridge, the next step involves preparing the abutment teeth. This meticulous procedure requires the dentist to remove a minimal amount of enamel from the abutment teeth to create space for the bridge structure (Ifwandi 79). Local anesthesia is administered to ensure patient comfort throughout the process. With the abutment teeth prepared, precise impressions of the prepared teeth and the edentulous space are taken (Ifwandi 80). These impressions are crucial for creating an accurate and well-fitting bridge in the dental laboratory. In some cases, digital scans may be employed using intraoral scanners, offering a more precise and efficient method of impression taking.


While the permanent bridge is being fabricated based on the impressions or digital scans, a temporary bridge may be placed (Ifwandi 79). This temporary prosthesis serves several purposes. It protects the prepared abutment teeth from sensitivity, maintains the space for the permanent bridge, and allows the patient to experience the restored function and aesthetics with a provisional restoration (Ifwandi 76).


Upon receiving the permanent bridge from the laboratory, the dentist carefully assesses its fit and verifies its color and aesthetic integration with surrounding teeth. Any minor adjustments are made at this stage to ensure optimal fit and function. Once satisfactory, the permanent bridge is securely cemented onto the prepared abutment teeth using a strong dental adhesive (Ifwandi 76). Following bridge placement, the dentist provides detailed instructions on proper oral hygiene practices to maintain the bridge and surrounding dentition. Regular dental check-ups are crucial for monitoring the bridge's health, assessing the health of the abutment tooth, and ensuring the bridge continues to function effectively over time.


Depending on the number and location of missing teeth, as well as the condition of the surrounding dentition, different bridge types can be employed. This includes traditional bridges. This is the most common type of bridge, utilizing two healthy adjacent teeth as anchors for the pontic (artificial tooth) (Ifwandi 79). Crowns are placed on the abutment teeth, and the pontic is securely attached between them (Ifwandi 79). This method offers excellent stability and durability, but requires modification of the healthy teeth. Cantilever bridges are used when only one healthy adjacent tooth is present (Ifwandi 79). It requires careful consideration of bite forces and potential stress on the supporting tooth (Ifwandi 79). This design is less stable than traditional bridges and may not be suitable for all situations (Ifwandi 79). Another option is a Maryland bridge. This conservative option utilizes a metal or ceramic framework bonded to the lingual surfaces (backs) of the adjacent teeth (Ifwandi 79). This approach avoids the need for extensive tooth preparation on the abutment teeth, making it a good choice for patients who want to preserve as much natural tooth structure as possible (Ifwandi 79). However, Maryland bridges may not be as strong as traditional bridges and may not be suitable for all areas of the mouth. Implant-supported bridges are considered a modern advancement, these bridges are anchored by dental implants surgically placed in the jawbone (Ifwandi 79). This approach offers superior stability and longevity compared to traditional bridges relying on natural teeth for support (Ifwandi 79). Additionally, implant-supported bridges help preserve jawbone health by stimulating the bone through the process of osseointegration (Ifwandi 79). However, this option requires a surgical procedure to place the implants and is typically more expensive than other bridge types (Ifwandi 79).


RPDs represent a cornerstone restorative option for patients with partial edentulism (Davenport et al. 364). However, the decision to recommend RPD treatment hinges on a complex interplay between objective need and subjective patient demand. Furthermore, we will explore the specific challenges and considerations associated with RPD treatment in the elderly population. Despite the dentist's assessment of a patient's objective need for RPDs based on the number and location of missing teeth, a significant discrepancy often exists with patient demand for treatment (Davenport et al. 364). The location of missing teeth significantly influences demand (Davenport et al. 364). Loss of anterior (front) teeth, impacting aesthetics, often prompts a stronger desire for replacement compared to missing posterior (back) teeth with less aesthetic consequence (Davenport et al. 364).


The decision-making process for RPD treatment becomes even more nuanced when considering the elderly population. The oral health status of elderly patients often presents unique challenges. Increased tooth wear and root surface caries are more prevalent in this population  (Davenport et al. 366). RPDs themselves can contribute to plaque accumulation, potentially exacerbating existing periodontal disease (Davenport et al. 367). Therefore, a meticulous assessment is crucial to weigh the potential benefits of RPDs against the risk of oral health complications, particularly for elderly patients with limited dexterity or cognitive impairment that may hinder proper oral hygiene practices (Davenport et al. 423).


The Shortened Dental Arch (SDA) concept offers an alternative approach for some elderly patients. This concept proposes that focusing on maintaining good function with the remaining natural teeth (no further back than the second premolars) might be a viable alternative to RPDs, particularly when patients express low demand for replacement of missing posterior teeth (Davenport et al. 365).


The decision to recommend RPD treatment should encompass a broader evaluation than simply counting missing teeth. Dentists must critically analyze both the objective need based on dental status and the subjective patient demand influenced by a multitude of sociodemographic factors (Davenport et al. 363). When treating elderly patients, additional considerations related to their oral health status, acceptance of RPDs, and ability to maintain oral hygiene are paramount (Davenport et al. 414). The SDA concept might offer a viable alternative treatment approach for some elderly patients with limited demand for replacement of missing posterior teeth (Davenport et al. 364). By carefully considering all these factors, dentists can arrive at treatment plans that optimize both functional and aesthetic outcomes while minimizing the risk of oral health complications for their patients, particularly the elderly population.



(Image of dental implant)


Dental implants have become a cornerstone in modern dentistry, offering a superior alternative to conventional fixed partial dentures for replacing missing teeth (Gupta et al., 2023). With a success rate exceeding 97% over ten years, dental implants provide several advantages, including a decreased risk of caries and endodontic issues in adjacent teeth, improved maintenance of bone in the edentulous site, and reduced sensitivity in neighboring teeth (Gupta et al., 2023). 


The history of dental implants dates back to around 600 AD when the Mayans used pieces of shells to replace mandibular teeth (Gupta et al., 2023. Significant advancements occurred in 1809 when J. Maggiolo inserted a gold implant tube into a fresh extraction site (Gupta et al., 2023). By the 1930s, the Strock brothers were using Vitallium screws to replace missing teeth, and the 1940s saw the development of the post-type endosseous implant by Formiggini and Zepponi, as well as the subperiosteal implant by Dahl in Sweden (Gupta et al., 2023).


Successful implant placement requires a thorough understanding of anatomical landmarks to prevent complications (Gupta et al., 2023). Important structures include the mandibular canal, maxillary sinus, cortical plates, and bone density (Gupta et al., 2023). In the maxilla, the nasal floor, nasopalatine canal, and maxillary sinus must be carefully evaluated (Gupta et al., 2023). For the mandibular arch, the location of the inferior alveolar canal is crucial to avoid nerve injury and excessive bleeding (Gupta et al., 2023). 


Complications can occur during and after implant surgery, such as perforation of buccal or lingual plates, bleeding, and nerve injury (Gupta et al., 2023). Postoperative issues may include incision line opening, implant exposure, and mobility (Gupta et al., 2023. Management includes rinsing with chlorhexidine and, if necessary, trimming the epithelial margin or removing the implant if it fails to integrate properly (Gupta et al., 2023).


With people living longer, dental implants will continue to play a vital role in treating minor and major dental issues (Gupta et al., 2023). They offer a viable solution for replacing single teeth, especially in posterior regions, without compromising adjacent teeth (Gupta et al., 2023). The acceptance of implant dentistry by the dental community ensures its continued growth and utilization as a primary option for tooth replacement (Gupta et al., 2023).


Navigating tooth extraction and subsequent restoration requires a nuanced approach that balances functional needs with aesthetic considerations. By carefully evaluating the available options through the lens of comprehensive oral rehabilitation and long-term success, dental professionals can effectively guide patients toward optimal post-extraction treatment plans. This collaborative approach, coupled with an understanding of the factors influencing restoration selection, empowers patients to regain a complete and aesthetically pleasing smile, fostering improved oral health and overall well-being.


Works Cited 


“Bridges, Implants, and Dentures.” The Journal of the American Dental Association, vol. 146, no. 6, June 2015, p. 490. https://doi.org/10.1016/j.adaj.2015.04.004.


Caporuscio, Jessica. “What to Know About Dental Implants.” Medical News Today.

Healthline Media, 17 Jan. 2020, www.medicalnewstoday.com/articles/327515.


Davenport, J., et al. “Removable Partial Dentures: An Introduction.” British Dental

Journal, vol. 189, no. 7, Oct. 2000, pp. 363-423.


Gupta, Ranjan, et al. “Dental Implants.” StatPearls - NCBI Bookshelf, 8 Aug. 2023, www.ncbi.nlm.nih.gov/books/NBK470448.


Ifwandi, Ifwandi. “Dental Bridge Procedure to Straighten Loose Teeth, a Review.” JDS (Journal of Syiah Kuala Dentistry Society), vol. 8, no. 1, June 2023, pp. 76–83. https://doi.org/10.24815/jds.v8i1.33361.


Image of dental implant. Medical News Today, 17 Jan. 2020, www.medicalnewstoday.com/articles/327515.


Photograph of dental professional explaining to patient. Wichita Family Dental, 8 Mar. 2024, wichitafamilydental.com/restorative-dentistry/dental-implants.


Wichita Family Dental. “Dental Implants | Permanent Tooth Solutions From Wichita Dentists.” 8 Mar. 2024, wichitafamilydental.com/restorative-dentistry/dental- implants.

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