Missing Tooth: Your Options

A missing tooth can be replaced with an implant, a bridge or a removable partial denture, and most teeth from the first molar forward should be replaced, because they carry the chewing, hold the bite and show when you smile. Which option fits depends on the bone, the neighboring teeth, your health, the time you have and the budget. Before replacement we ask whether a failing tooth can be saved, because a saved natural tooth is nearly always better than any replacement.

Can the tooth be saved?

Before replacement is discussed, we ask whether the tooth has to go. Many teeth that look lost, with deep decay, a cracked cusp or a failed old root canal, can be kept with a root canal, a crown or gum treatment. The exception is a failing tooth that is slowly destroying the bone around it; then earlier replacement protects the foundation for whatever comes next.

Which teeth need replacing

• Wisdom teeth are never replaced.
• A second molar, the last tooth before the wisdom tooth, is replaced in some mouths and not in others; an implant there is useful but not essential.
• Everything from the first molar forward almost always should be replaced: those are the teeth that do the chewing, hold the bite, and show when you talk and smile.

What happens if you wait

• The bone that held the root begins to shrink within months and keeps shrinking for years, so that a later implant may need a graft that would not have been needed early on.
• The teeth either side tip into the space.
• The tooth above or below grows down into it.
• The bite shifts in ways that make the eventual replacement harder to fit and the neighbors harder to clean.

The three ways to replace a tooth

• An implant

  A titanium post placed in the jaw where the root was, carrying a crown. It stands on its own: nothing is done to the neighboring teeth, it keeps the bone stimulated, it cannot decay, and it is cared for like a tooth. It needs enough bone, healthy gums, reasonable general health and a few months for the bone to fuse with it; the whole process takes four months to a year.

  For a single missing tooth with good bone, often the least invasive option there is. Dr. Kottar plans, places and restores implants here.
• A bridge

  A false tooth suspended between crowns on the teeth either side of the gap. It is fixed, it needs no surgery, and it is finished in about two weeks. The trade-off is that the supporting teeth are shaped for crowns, and the bridge must be cleaned underneath daily.

  When the bone is poor, when an implant would need grafting or a sinus lift, or when you would rather avoid surgery. For a front tooth its appearance can be as good as an implant or better.
• A removable partial denture

  An appliance that replaces one or several teeth, clasps to the remaining teeth and comes out at night. It is the least expensive route and the right one in some situations, particularly when several teeth are missing or finances decide.

  Most people prefer something fixed when that is possible.

Each has its own page: dental implants, dental bridges and dentures.

When many teeth are missing

For a whole arch, or most of one, the choices widen:

• A conventional complete denture rests on the gums.
• An implant-supported denture snaps onto two implants in the lower jaw or four in the upper and stops the denture moving, which transforms eating.
• A fixed bridge on implants stays in and is removed only by the dentist.

Which is right depends on how much bone is left, your health, how you will clean it, and cost; we lay out the realistic options after a scan.

Planning the space before the tooth comes out

If a tooth is still to be removed, the best time to decide about its replacement is before the extraction, because it changes what we do that day. When the plan is an implant and the site is sound, the implant can often go in at the same visit, with a temporary tooth for a front tooth. When it cannot, a bone graft in the socket preserves the bone for a later implant. When the tooth will never be replaced, no graft is needed. Our extractions page explains that conversation.

How we decide with you

From the scan, the examination and what matters to you, one option usually stands out, and we recommend it, with a written estimate for each route you are considering. The decision is yours.

Frequently asked questions

Do I have to replace a missing tooth?

Wisdom teeth, no. A second molar at the very back, sometimes. Any tooth from the first molar forward, almost always, because those teeth carry the chewing and show when you smile, and the neighbors drift into the gap over time.

What happens if I wait?

The bone where the root was shrinks over months and years, the neighboring teeth tip into the space and the opposing tooth grows down into it. All of that makes a later replacement harder and sometimes more expensive. The one case where waiting is right is when a tooth should be saved instead.

Implant or bridge?

If the bone is good and the neighbors are healthy, an implant leaves them untouched and stands alone. If the bone is poor or you would rather avoid surgery, a bridge is quick, fixed and often just as good-looking. Cost before any grafting is similar; a bridge takes two weeks, an implant four months to a year.

Can the tooth be replaced the same day it is removed?

Often. When the plan is an implant and the site is sound, we place it at the time of extraction and, for a front tooth, usually fit a temporary tooth so you are not without one. When the bone or the gum needs rebuilding first, a graft at the extraction protects the site for a later implant.

What if I am missing many teeth?

Then the options are a partial denture, a conventional denture, an implant-supported denture that snaps onto two or four implants, or a fixed bridge on implants. Which is right depends on how many teeth remain, your bone, your health and your budget, and we go through all of them.

Sources

Professional guidelines and peer-reviewed reviews this page draws on.

1. Torabinejad M, Anderson P, Bader J, et al. Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review. Journal of Prosthetic Dentistry. 2007;98(4):285-311. PubMed
2. Pjetursson BE, Bragger U, Lang NP, Zwahlen M. Comparison of survival and complication rates of tooth-supported fixed dental prostheses and implant-supported fixed dental prostheses and single crowns. Clinical Oral Implants Research. 2007;18(Suppl 3):97-113. DOI
3. Avila-Ortiz G, Elangovan S, Kramer KWO, Blanchette D, Dawson DV. Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. Journal of Dental Research. 2014;93(10):950-958. DOI