When tooth is lost the individual faces many choices. The first choice is should I replace the missing tooth? The second is what is the best way to replace it? In making these decisions there are many factors to consider and research data to be evaluated. There are three basic ways to replace missing teeth. These include:

1) Removable partial dentures

2) Tooth supported bridges and

3) Implant supported teeth.

Removable partial dentures have metal clasps that clip onto teeth to hold the device in the mouth. Patients need to take these in and out for cleaning after eating.Tooth supported bridges rely on the adjacent teeth for support. 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 and relies on the integrity of the adjacent teeth for support.

Dental implants. The final method of tooth replacement is the dental implant, which is a replacement for the root of a tooth. The implant is placed where the root of the missing tooth used to be. The replacement root is then used to attach a replacement tooth.Should I Replace a Missing Tooth?

There are a number of studies reporting on survival of teeth next to missing tooth spaces. These studies look at the survival of the teeth next to the missing tooth space in cases where the missing tooth is replaced and the missing tooth is not replaced. Studies show that there is a significant loss of adjacent teeth if the missing tooth is not replaced. Tooth replacements with fixed bridges attached to teeth improves the survival of the teeth compared to no replacement. When removable partial dentures are used to replace missing teeth, the failure of the adjacent teeth is much higher than if there was no replacement, or if the replacement was with a tooth supported bridge. Patients who do not replace missing teeth may experience shifting of teeth, spaces opening between teeth (resulting in food impaction), collapse of the bite, alterations in their chewing ability, TMJ pain, and trauma to the remaining teeth. People sometimes don’t replace teeth that are "in the back" of the mouth because no one sees them. The back teeth are needed to support the bite and grind up food. We can all swallow food that is not chewed thoroughly, but this compromises the nutrition we extract from our diet. 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.Let’s look at some of the data from scientific studies that look at replacing missing teeth.

VA Medical Center Longitudinal Study Shugars JADA 1998

19% of adjacent teeth failed if the space was untreated

10% failed if the space was treated with a tooth supported bridge

30% failed if the space was treated with a removable partial denture

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:

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