Expert: Lawrence Spindel DDS, www.lspindeldds.com - 11/19/2008

Question
I'm 53 years old and lost my first adult tooth two years ago.  After reading about the risks of root canal and implants, I decided not to go that route.

I understand I can go with a bridge attached to the teeth on both sides of the space, but I wonder how much trouble I'll have with food getting caught underneath.

Is there any other technique to fill the gap?  I would even consider some alternative treatment.

I thank you in advance for your careful consideration of my question.

Answer
Dear Sandra,

You have a number of option for you missing tooth. You seem concerned with the 'risks' that go along with treatment options.
Although there are risks with every treatment in dentistry, they can be minimal when handle by a competent dentist.  I will give you all the options I can think of.

The easiest and least risky option is to not replace your tooth. If it is in a non esthetic zone this is fine.  You should consider having retainers made to wear at night, to keep the teeth near the missing tooth from shifting.  Sometimes the bite is such as to not allow shifting. When the patient closes the teeth come together in a way that discourages shifting of the teeth adjacent to the missing teeth.

You could have a 'nesbit partial' made. This is one tooth removable partial denture. It can be made with valplast(vinyl) and has pink gum like clasps that are not noticeable. It also can be made with metal clasps which are less flexible, and work slightly better, but the esthetics are not as good as with valplast nesbits.  Many patients who choose not to have an implant or fixed bridge go this route.

If you are not a smoker, and you have sufficient bone at your extraction site, then implants are my favorite way to replace a missing teeth.  If used properly, they have an extremely high success rate (better than 97% for 15 years!)

A three unit fixed bridge is an acceptable option, but does involve preparing adjacent teeth. In my practice, this option works well and I teach my patients how to clean around the bridge with proxa brushes or floss. This is a good option and the bone quality of the extraction site does not matter.

I hope this answer has been helpful to you and welcome your future dental queries.