The stability of an individual tooth depends on a balance of the forces exerted on that tooth by the adjacent and opposing teeth and supporting tissues and by the soft tissues of the cheeks, lips, and tongue. When a single tooth is not replaced, this balance is upset (Fig. 3-14). The consequences may be supra-
Fig. 3-14. Loss of a mandibular first molar not replaced with an FPD. The typical consequences are supraclusion of opposing teeth (1), tilting of adjacent teeth (2), and loss of proximal contacts (3). Redrawn from Rosenstiel SF: In Rayne J, editor: General dental treatment, London, 1983, Kluwer Publishing.)
elusion of the opposing tooth or teeth, tilting o€ the adjacent teeth, and loss of proximal contact (with resulting disturbances in the health of the supporting structures and the occlusion). Although simple replacement of the missing tooth at this late stage may prevent further disruption, it may be insufficient to return the dentition to full health. Extended treatment plans, including orthodontic repositioning and additional cast restorations (to correct the disturbed occlusal plane), may be needed to compensate for the lack of treatment at the time of tooth removal.
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