Tooth Replacement Options

This page sets out each option: how it works, what it asks of the neighboring teeth and the bone, how it is cleaned and how it feels, how long it can last, and what it costs where we publish a price.

A tooth with a sound root and enough structure above the gum to hold a crown is usually worth saving, and saving it comes before any replacement. A root canal removes the infected or inflamed pulp from inside the tooth and seals the canals; a crown then covers what remains, because a tooth treated this way becomes more brittle. The neighboring teeth are not involved, the root keeps the bone around it in use, and the tooth feels and cleans as it did before. A tooth saved this way can last many years.

Some teeth cannot be saved. In this case, a fracture ran beyond what any restoration could hold. In another, two failed root canals on the upper front teeth had led to an abscess, and the teeth were no longer restorable. Dr. Mehdizadeh makes that call at the examination. A root canal and crown is quoted at the consultation.

A bridge places crowns on the two teeth beside the gap and suspends a replacement tooth, the pontic, between them, all made as one piece. It asks the most of the neighboring teeth, since both are shaped down to take crowns, so it makes most sense where those teeth already need crowns or where an implant site would need extensive grafting. The bone under the pontic carries no load and continues to shrink slowly. It is fixed, and a floss threader or water flosser cleans under the pontic. Bridges typically last around ten to fifteen years, and often longer, depending on the health of the supporting teeth and gums. A conventional bridge is quoted at the consultation.

In this case, an upper front tooth had been missing since childhood, and the site would have needed significant grafting, with a less predictable gum line, to take an implant. A three-unit bridge was the more dependable route.

In this case, the infection had taken bone and gum with the two front teeth, so the gum line over the gap sat higher than over the teeth beside it. Rebuilding only the teeth onto a receded gum line leaves them too long. Our laboratory added pink porcelain to the bridge: a gum-colored ceramic, matched to natural gum in color, translucency and texture, that replaces the lost gum and bone height so the teeth are the right length and the gum line reads as continuous. It is the choice when that tissue cannot be predictably rebuilt; the alternative is grafting to regrow the bone and gum, which this site could not reliably support.

An implant-retained denture clips onto implants. It still comes out for cleaning, but the implants hold it steady while eating and speaking, and they keep the bone in use where they sit. The clips are wearing parts and need replacing from time to time. It is $14,000 per arch. $168/month per arch: 144 payments at 9.99% APR, on approved credit.

See also: Implant dentures.

Leaving a space costs nothing today, and for some back teeth, where the bite is stable, it can be a reasonable choice. Over time, though, the neighboring teeth drift into the space and the bone that held the tooth resorbs. That narrows the options later: a gap left for years can need grafting before an implant, as in this case.

Healthy neighboring teeth point toward an implant, which leaves them alone; teeth that already need crowns make a bridge more reasonable. The bone, measured on a 3D X-ray (CT scan), decides whether an implant can go in directly or after grafting, and general health shapes the plan as well.

See also: Am I a candidate for implants?.