Options for Replacing a Missing Tooth

By Dr. David Scharf

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.

Retreating a Root Canal Tooth or Extracting it and Placing an Implant.

Sometimes a tooth that has a root canal becomes re-infected or never became healthy after root canal therapy. The patient and clinician must then decide whether to retreat the root canal, or replace the tooth with an implant. Success rates for root canal therapy are as low as 53% and as high as 95% according to Eriksen 1991. A root canal infected with bacteria will develop a hollow space in the bone at the tip of the root. If this occurs, the success rate for the root canal retreatment is reduced 10-20% according to Sjorgren 1997.

Cycle of Re-Restoration

Adult patients often have one or more crowns as a consequence of large restorations that had been broken down and needed to be replaced in order to restore the integrity of the teeth. Tooth decay and root canal therapy are the primary causes for failure of crowns and these teeth are at increased risk for extraction as a result of these complications, which are a leading cause of loss of back teeth.

It is interesting to note that as a result of decay or root canal failure, nearly 30% of the people between the ages of 50 and 59 years examined in a US National Survey had one or multiple missing back teeth.

Brantley published this data in 1995:

*

The more frequently a patient visited a dentist, the more restorations he was likely to receive. Furthermore the more restorations a patient had, the more he was likely to receive in the future.
*

70% of dental treatment recommendations result in an increased number of restored surfaces.
*

Prosthesis failure is common (due to failure of a tooth under the prosthesis).
*

Replacement restorations are larger than the ones that preceded them.

What this data shows us is that crowns and fillings have a limited life span and when they need to be replaced the next restoration is usually larger or more complex than the previous one. We call this the cycle of re-restoration. As we saw in the data above, the mean life span for a tooth supported bridge is 10 years. Think of how many cycles of re-restoration will be necessary (and the huge cost and time commitment) with a tooth supported tooth replacement verses an implant supported tooth replacement.

Success Summary:

In conclusion it is important to thoroughly evaluate the treatment options for tooth replacement and root canal treated teeth, taking into consideration the prognosis for long-term success.

Tooth Supported bridges

85% successful at 10 years
66% successful at 15 years

Implants

90% to 98% successful for periods of 5 to 30+ years

Root canal retreatment

53% to 95% successful
10% to 20% reduction in success with bone loss at tip of root

Dental implants are highly predictable both short term and long term and are more permanent than conventional options. They protect both the dentition and the bone, and decrease the need for future dentistry.

The 1990’s were a decade during which dental implants moved from the fringes of dental treatment into the mainstream of therapy. Today, there is substance to the claim that implants are the standard of care and the optimal solution for replacement of missing or failing natural teeth. The scientific literature supports this paradigm shift in dentistry. Of course every patient is different and each instance of tooth replacement must be evaluated on its own merits with the patient and their dentist. We hope that this material has provided some insight into the clinically documented data regarding the various tooth replacement methods. You only get one body and the choices you make are important.


When an individual loses a tooth there are important decisions to be made. To learn more about tooth replacement options including using dental implants to replace a missing tooth visit http://www.drscharf.com Dr. Scharf is a board Certified Periodontist specializing in placing dental implants and treating periodontal disease in Babylon, Suffolk County, Long Island New York. You can watch Dr. Scharf on youtube.com be interviewed on “The Wellness Hour” on the topic “Who is a Candidate for Dental Implants” at http://www.youtube.com/watch?v=1nX0dDUF0T8