Q. I had a tooth extracted because it was broken and missing part of it. Anyway, I have to decide if I want an implant there. It is tooth No. 4. It doesn’t show at all so that is not an issue. Behind that missing space is one tooth. So it is a little hard to brush because I have to brush that one tooth separately. It is a little weird to eat because of the missing tooth there but I am getting used to it. The oral surgeon says I won’t need a sinus lift; if I did, I would not get the implant for sure. I guess the issue now is my age. I am in great shape but I am 79-years-old. Should a person my age bother with an implant that will probably cost close to $5,000 including the crown and the implant? The oral surgeon would do the implant for about $2,100 and the dentist would install the crown at about $2,300. What would you suggest for me?
A. There are a number of factors to consider in deciding whether or not to replace a missing tooth.
You address one in your question, which is looks. In your case, you say it does not show and for my other readers, the tooth in question is on the upper right of the patient’s mouth and it is two behind the cuspid or eye tooth. It most likely will show when you smile unless you have a smaller than average mouth. But it does not bother you anyway, even if it were to show, so that is not an issue.
The most important factor to consider is that for most of us, we do about 60% of our chewing, on the right side, on that tooth (the second bicuspid) and the one behind it (the first molar). When you lose either of these teeth, your function will be significantly affected. As you state, you are getting used to that which is the norm. However, you state that you have only one tooth behind No. 4 which is uncommon. This would mean that you lost your upper right second molar earlier. Assuming that I am correct, that would mean that you now have only one tooth in a comfortable functioning position on the upper right. This will put much more force on the single tooth remaining and the one in front of the space. More force than nature designed for either to take.
If you chose to live this way, then you must realize that in the years to come, the health of the remaining first molar and first bicuspid (the one in front of the space) may suffer. You do not want to lose that tooth as well, since you then would have nothing to function with on the upper right. As you say, you are in good health, late 70’s as am I, and wonder if a $5,000 investment is worth it, trying to consider life span. If you have no significant medical history, such as heart disease, diabetes or the like, statistics would say that you probably are looking at another 15 or more years of life.
If your upper right first molar has never been restored and the bone support around it is excellent, you might be able to take that gamble. I would say, that from my perspective, assuming you can afford the expense, that it would be worthwhile to replace this tooth No. 4. Understand that an implant is not the only way to replace a missing tooth. You could also have a fixed or removeable partial denture placed, both of which would be less expensive. I would advise you speaking to your dentist about the pros and cons of each of these replacement options that would be specific to your dentition. Usually, if the teeth on either side of the space are very healthy, then the implant is the best option if you decide to replace. It is surgery, it is expensive and it is not always guaranteed successful, especially in the area of bone that you are considering. Something else to discuss with your dentist.
I believe that the greatest gain for the argument to replace the tooth, is to distribute the chewing force in your mouth over more than just one molar and one bicuspid. Replacing tooth No. 4 would give you added insurance that for the next expected 15 years of lifespan, you would not have to be concerned about the issue, would not have to bite more gently on the single first molar, and would also have the looks issue enhanced on a very broad smile.
I believe that as long as money is not the overwhelming issue, yes, I am leaning toward replacement. However, please consider the other options I have discussed above with your dentist before the final decision.
Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at email@example.com.