Even with great advances in dentistry in the last 50 years, people still face the unfortunate event of tooth loss. I am frequently asked about the need and approach for tooth replacement. Fortunately, with the advancements in dentistry we can replace teeth in a lifelike, aesthetic restoration with natural beauty and function.

There are several options for replacing a missing tooth or teeth. The possibilities depend on: where in the mouth, how many teeth are missing, the age and overall health of the individual, and the health of the adjacent teeth and surrounding gum and bone.

The options for replacing missing teeth are:
- Do nothing
- Removable partial or complete denture
- Non-removable bridge
- Implants with removable dentures
- Implants with non-removable bridge, denture or crown

Doing nothing is usually not a good option. A missing tooth is a cosmetic issue and/or severe food trap. Besides the annoyance, food trap areas lead to decay and periodontal disease, and neighboring teeth tend to shift into the gap changing the bite. The only time I recommend a do nothing approach is in the case of an acute medically compromised individual.

Removable partial or complete dentures were the treatment of choice years ago when options for more stable outcomes were not available. There are many disadvantages to dentures. Dentures tend to move around causing difficulty in eating, talking and smiling. They need to be removed for cleaning and soaked at night to keep the mouth and denture from getting infected. Full dentures rest on the gums and bone and cause sore spots and bone loss, eventually leading to dentures that don't fit. Partial dentures rest on teeth and sometimes gums and bone. The pressure put on these anchor teeth weakens otherwise healthy teeth often leading to more tooth loss. This is the least expensive option. For some patients medical health may not allow for alternative treatment. Dentures need to be relined periodically and replaced every 5 to 7 years due to bone changes or when the denture wears out.

Non-removable bridges have been the standard for replacing single or multiple teeth for decades. These bridges are attached to other teeth. If you are missing one or more teeth but still have several healthy natural teeth a bridge may be fitted to the existing teeth. As long as the adjacent teeth and gums are healthy this is a very successful long term solution. The cost is higher than removable dentures but the benefits outweigh the cost differential. Bridges are stable for chewing, they do not move, longevity is very good, cleansing ability is good, and they can be made to match your natural teeth. On average, well made bridges tend to be replaced every 15-20 years.

Implants with removable dentures are an option for replacing multiple teeth. Implants are titanium posts placed in the jaw bone to replace the roots of missing teeth. Implants can be placed singularly or in multiples. The age and health of the patient are extremely important. Patients taking bisphosphonates for osteoporosis will need to consult with their dentist and physician about this procedure. Children, teens and some young adults may not be good candidates since their jaw bones are still growing. Dentures can be fully or partially supported by implants and by the gums and bone. Like other removable dentures they do need to be removed for cleaning and are left out at night. If they rest on any gum tissue they can cause sore spots and bone loss. The big advantage to having implants is stability of the denture and bone preservation in the area of the implant. These dentures tend to last longer than non-implant supported removable dentures because there are fewer gum and bone changes. They do need to be relined if there is gum and bone contact because the gum and bone will recede. This option is more costly than removable dentures but much more stable and longer lasting.

Implants with non-removable bridges, dentures or crowns are usually the most stable and longest lasting way to replace missing teeth. Implants are placed in the jaw bone and a non-removable bridge, denture or crown is made to fit to the implants. Maximum stability is attained and the implants help prevent bone loss. Patients can resume normal chewing with no restrictions. These implants can be made to mimic natural tooth and gum tissue. Single teeth can be replaced with an implant and crown. Multiple teeth can be replaced with implants and bridges or implants and dentures -- all non-removable. Deciding which approach to take can be achieved through a patient – dentist discussion about the advantages and disadvantages of each. Implant replacement of teeth is generally more expensive than tooth supported bridges or removable dentures but has better longevity.