This can be confusing–too many options exist when a tooth is missing.  Let’s assume you’re missing an upper premolar, one of those sorta-in-the-back teeth, the ones in front of the much larger molars.  It could be restored several ways (fees listed are estimates valid December 2012)

  • You could do an implant, with an abutment (post) and crown.  This has the big advantage of being a stand-alone solution, independent of all other teeth, and unaffected if you fracture or split an adjacent tooth.  Cost ranges from $2300 – $3700, depending on who does the implant part of the surgery (specialist or GP).  It typically won’t look quite as good as a bridge, but it’s far enough back it’s usually not an issue.
  • You could do a three unit bridge, placing crowns on the teeth to either side of the gap, and welding a false tooth between them.  The disadvantage is that the adjacent teeth must be cut back for crowns, although if they already have large fillings, and are at risk of needing crowns soon anyway, this could be an advantage.  A bridge ($2750) would be much cheaper than an implant (fee above)  + two crowns (fee $1800).  The bridge does not provide quite as much support as an implant, since there are three teeth, but only two sets of roots, but it’s generally adequate.  Bridges can replace two missing teeth, or even more, but long bridges are rarely done, since they are less reliable than implant solutions.
  • You could do a removable partial, which is a metal framework with a plastic tooth attached.  The cost is $1350, and for a single missing tooth, this is rarely done.  If several teeth are missing, a partial makes more sense, since the cost is the same regardless of the number of teeth replaced.  The partial must be removed and cleaned after meals, and it is a foreign object in your mouth, covering part of the palate.  It has to be large enough that you can’t possibly inhale it by accident.  Construction of the partial requires some minor drilling on the teeth to create attachment points.
  • You could do an acrylic partial, which is the same basic idea as a regular partial, only not as strong.  These are basically for show, not function, and are preferably used on an interim basis only, when front teeth are missing.  They can be used for eating occasionally, but if they’re used for chewing on a regular basis, they will fracture.  The fee is $479.
  • You could do nothing at all.  This will generally result in the adjacent teeth drifting into the space, tipping and creating food traps, and the opposing tooth drifting upward into the space.  This can happen in as little as 6 months, or it can happen only slightly over many years–everyone’s different.  Generally, rapid drift is associated with younger people, and people in their 50’s and 60’s have more stable teeth, but there are exceptions to this rule.