Options for Replacing a Missing Tooth
When a tooth is lost, a patient has several options for treatment should he or she decide to replace the missing tooth. Which method is best for a specific patient can only be determined by taking into account a wide range of factors. These factors will include data on the patient’s overall and periodontal health, bone structure, which tooth has been lost, how the tooth was lost (falling out, extraction, or broken), and the patient’s own wishes.
There are three basic ways to replace missing teeth. These include:
- Removable partial dentures
- Tooth-supported bridges
- Implant-supported teeth
Removable partial dentures have metal clasps that clip onto surrounding teeth to hold the device in the mouth. Patients need to take these in and out for cleaning after eating.
Tooth-supported bridges are not removable. The teeth next to the missing tooth space are ground down, and the bridge is cemented onto them. This bridge does not come in and out. It relies on the integrity of the adjacent teeth for support.
Dental implants are permanent tooth replacements. The implant is placed where the root of the missing tooth used to be. This replacement root is then used as a base for the replacement tooth.
Should I replace a missing tooth?
A number of studies have been done to determine the survival rate of teeth next to missing tooth spaces, comparing the rate of adjacent tooth loss in cases in which the missing tooth is replaced to cases in which the missing tooth is not replaced. These studies show that there is a significant loss of adjacent teeth if the missing tooth is not replaced.
The studies also compared the methods of tooth replacement as a way to prevent adjacent tooth loss. Removable partial dentures actually result in a higher rate of tooth loss than if there were no tooth replacement at all, as the constant removal and reinsertion of the dentures cause more strain on the adjacent teeth. In contrast, patients with fixed, tooth-supported bridges have a higher rate of adjacent tooth survival, and those with dental implants are most likely to retain their other teeth.
Patients who do not replace missing teeth may experience shifting of teeth, spaces opening between teeth (resulting in food impaction), the collapse of their bite, alterations in their chewing ability, TMJ pain, and trauma to the remaining teeth.
People sometimes don’t replace large molars (teeth that are in the back of the mouth) because “no one sees them.” This is a poor choice, as the back teeth are needed to support the bite and grind up food. Food that is not chewed thoroughly can be swallowed, but this compromises its nutritional value. When enough back teeth are lost, the front teeth can start to flare or become “buck teeth” as they carry forces in excess of what they were designed for. Here is some data from scientific studies on replacing missing teeth.
VA Medical Center Longitudinal Study, Shugars, Journal of the American Dental Association (1998):
- 19% of adjacent teeth failed if the space was untreated.
- 30% failed if the space was treated with a removable partial denture.
- 10% failed if the space was treated with a tooth-supported bridge.
Permanente Dental Associates looked at 317 patients who wore tooth-supported fixed bridges for an average of 6.7 years and removable partial dentures for an average of 4.2 years. Their findings:
- 13% of adjacent teeth failed if the space was untreated.
- 17% failed if treated with a removable partial denture.
- 7% failed if treated with a tooth-supported bridge.
Truman Medical Center looked at patients who wore tooth-supported bridges for 8.6 years and did 7 years of observation for removable partial dentures.
- 12% of adjacent teeth failed if untreated.
- 22% failed if treated with a removable partial denture.
- 7% failed if treated with a tooth-supported bridge.
In conclusion, we can see the following:
- There is a significant loss of adjacent teeth (ranging from 12–19%) if the missing tooth is not replaced.
- Tooth-supported bridges improve the survival rate, with adjacent tooth loss dropping to 7–10% at 6.7 and 8.6 years.
- Removable partial dentures actually increase adjacent tooth failure rates, ranging from 17–30% at 4.2–7 years.
- There is no significant difference in the statistics of the various studies.