If you are like most of my patients, diligent about your dental care, learning that you are going to lose a tooth can cause a feeling of dread and panic. While helping you to keep your teeth and to keep them healthy is my primary goal, at certain times a tooth may be “too far gone” or “too unstable” to save (at least with any level of confidence). Should this happen to you, fear not, for you do have some options.
Your dentist should present you with the following four choices, although you may not be a candidate for all of them. He or she may also try to help you select the option that may suit your circumstance, financial or otherwise. The options are listed in increasing order of complexity and cost.
Option 1: Do Nothing
As the name implies, once the tooth is extracted or lost, you have the option of doing nothing. This means livings with a gap that can be socially awkward. From a financial perspective, this is the cheapest option and does not necessarily preclude you from pursing options 2,3, or 4 down the road.
There are some dental consequences that can result from doing nothing. The opposing tooth will try to grow out to try and make contact with the now missing tooth and you can eventually lose that tooth simply because it extruded too much, a phenomenon called “super eruption.” You may also find that the teeth on either side of the space start to move and tip. This happens because the contacts between our teeth also help prevent them from shifting. Losing a tooth means losing those contacts. How quickly the teeth move varies from person to person and from tooth to tooth.
Option 2: A partial denture
Assuming you have lost only one or a few teeth but not all, your dentist may propose a partial
denture. Wearing a partial denture, that replaces the missing tooth or teeth, does reduce the risk that you will see tooth movement that can result from selecting option 1. The partial denture also will improve the esthetics of your smile.
There are a few cons that accompany this option. The partial denture is removable so you must take it out at night to avoid accidentally swallowing it as well as to allow your tissues some time to breathe. The number one reason I have to remake a partial denture is because patients tend to lose them!
A partial denture also anchors on to your remaining teeth to help hold it in place. This can put extra forces on those “abutment” teeth, which need to be in good shape themselves or else could eventually be damaged by these forces.
Option 3: A bridge
Not unlike a bridge that allows you to cross a river by connecting land to land, a dental bridge connects the teeth on either side of the gap created by the missing tooth. Like the partial denture, a bridge uses the remaining teeth as anchors to hold the bridge in place. The big difference is that it is not removable (at least not without the help of a dentist).
The teeth on either side (you must have usable teeth both in-front of and behind) of the missing tooth are “prepped” or made to look like pegs (that must be parallel so that the bridge draws). This is a great option if those teeth have large restorations as they will eventually need crowns and this is almost like killing two birds with one stone. If, however, the remaining teeth are in pristine condition, prepping them would now compromise perfectly good teeth.
Bridges can look and feel great, but the risk lies in the reliance upon multiple teeth. Should anything go wrong with any of the supporting teeth, the patient may lose the entire bridge. Also, because it is not removable, you oral hygiene routine will require some new tools and techniques to ensure that the tiny gap under the bridge is kept clean.
Option 4: An implant
The Cadillac of all options, the implant is considered the most reliable. It is the only option that attempts to replace both the missing tooth and the missing root in the bone below. Patient who have lost some or all teeth will often note that their bone changes because we have some bone that is only designed to hold teeth. When the teeth are lost, this bone resorbs fairly quickly. An implant can prevent this resorption because it stimulates the bone and gives it a reason to stay.
With regard to the other options, the implant once again tops the list because it achieves a great esthetic result, prevents any tooth movement in the long run, is not removable, and does not rely on any of the remaining teeth for support.
Anatomically however, there are some considerations when opting for an implant. Just as a screw that is placed into drywall requires an adequate thickness of drywall, so too does an implant require adequate thickness of bone. The upper jaw contains a sinus space and the lower jaw contains a prominent nerve canal both of which must be avoided when placing an implant. The placement of an implant does require a small surgery (almost always outpatient), and like any surgery involves a healing period. This can draw out the process of replacing the missing tooth, but implants have a great long-term track record that offsets the wait.
I hope this helps you understand the pros and cons of each option, but as always, prevention is better than the cure!