The Tooth Was Extracted. Now What? Exploring Options for Tooth Replacement

By Dr. William Plumb, DDS, Plumb Dental

I experience this scenario with one or more of my patients nearly every day: the patient has a tooth that is fractured or decayed beyond restoration, and extraction is the only treatment option. This news can be devastating and leaves the patient wondering what will happen once the tooth is gone.

Everyone is different. What may be an ideal treatment or an acceptable outcome to one may not be for another. If you ever find yourself in this situation, you’ll need to determine the course of action that is right for you, so education is key.

First of all, the way the tooth is extracted plays an important role in the success of the final outcome. Extractions can be complicated, and the procedure should be performed in a manner that preserves as much bone and gum tissue as possible. Grafting should be considered so that the socket heals with minimal bone loss.

Once the tooth has been pulled, there are four basic options:

1. Do nothing. That’s right—just leave the space. This option has the benefit of not costing any extra money, but it has its downside. Spaces are unsightly and don’t function well. Leaving a space will lead to bone resorption. Additionally, the teeth surrounding the space may drift, causing chewing and jaw issues.

2. A removable appliance. These are typically made of metal and acrylic and have clasps that hold them to the adjacent teeth. Price varies depending on the design and the materials used but usually ranges between $1000 and $2000. These partial dentures are great for maintaining a space, and in many cases, they are cosmetic enough that others won’t know you’re missing teeth. The drawback is that they don’t function well. They are miserable to eat with, and they create unnatural forces that can lead to further tooth loss. If worn regularly, these appliances should keep the teeth from drifting, but they do not prevent bone resorption.

3. A fixed bridge. This is a great restorative option that does not come out of the mouth. A bridge costs between $3000 and $4000 and is natural and functional. It is basically a crown on the tooth in front of the space, a crown on the tooth behind the space, and a crown that is connected in the middle. The downside: you sacrifice tooth structure as the teeth on either side of the extracted tooth are reduced to accommodate the crowns. And because you can’t floss normally, maintenance also becomes an issue. Finally, the bone that once held the missing tooth degrades over time, negatively impacting the stability of the abutment teeth.

4. An implant. This is the most ideal option for most situations. Implants are conservative (a one-tooth solution to a one-tooth problem), and because they integrate into and stimulate the bone, they restore essentially every aspect of the missing tooth—not just the part that shows in the mouth. Implants have become the most predictable restoration in dentistry. Although they cost more than other treatment options (normally between $4000 and $7000), their longevity and other great benefits make them well worth the extra expense.

Perhaps losing a tooth seems like the end of the world. But as you and your dentist discuss the options and work together, you can achieve the restorative outcome that is right for you.

About the Author Dr William Plumb graduated from the State University of New York School of Dentistry in 2006. He opened Plumb Dental in St George, Utah, in 2009. He has received extensive continuing education in cosmetic dentistry as well as oral surgery and implantology. Dr. Plumb loves living in southern Utah with his wife Kari and their four children.