A missing tooth should be replaced soon after it is lost, if not immediately, with a dental implant. There are several consequences to waiting too long to replace a missing tooth. The consequences typically involve significant costs and potentially functional and/or esthetic compromises. I’m going to focus on three of the biggest problems that can occur when patients wait too long to replace a single tooth with a dental implant.
Bone Loss. After a tooth is lost or extracted, the bone in the area that held the tooth in begins to resorb. Our teeth strain and stimulate the bone that holds them in, and when they are gone our jaw no longer has the stimulation in needs in that area to maintain the bone. As a result, the bone goes away over time. Every body is different, so it happens at different rates in different people, so there’s no hard and fast rule about it. Patients sometimes ask, “How soon do I have to get the implant after you take the tooth out?” I don’t know the answer, so all I can say is the sooner the better.
So what happens if significant time passes and the bone is lost, can a patient still get a dental implant? It depends, of course, how much bone is lost and how much is needed. Two dimension and three dimensional images like x-rays and cone beams can help dentists determine if there is adequate bone. In some cases, there is, even if a significant amount of time has passed. Some patients resorb bone slowly. These are very fortunate situations! In cases where resorption is too significant to put in an implant, grafting bone is necessary. Of course, there are sometimes cases where the amount of bone missing is too significant and grafting is either nearly impossible or impossible.
Shifting of Teeth. When a tooth is lost, sometimes the tooth behind it, in front of it, and above or below it shift into the space. If there are no forces preventing this from happening, it can happen and make it physically impossible to place an implant into the space where the tooth used to be. If the shifting is insignificant, sometimes minor adjustments can be made to compensate. If the shifting is significant, it is often necessary to involve an orthodontist in the case to move teeth back to where they used to be.
I’ve seen cases where patients were treated with a dental implant for a molar that was lost a long time ago, and the molar behind it shifted forward and appeared to have a 45 degree tilt to it on the x-ray. Sometimes this looks ok in the mouth, but on the x-ray it is very obvious. The patient has the implant, has the crown, no longer has a space….but food gets stuck between the implant and the tooth behind it all the time! The patient wishes they had never had the thing placed in the first place and would prefer going back to having the open space. At least you can clean it! This is what happens when you skip using braces to upright the tooth: a food trap is created. Braces typically aren’t necessary to move teeth to make room for dental implants, but when time has passed, quite often it is completely necessary. When orthodontics is necessary, it typically triples the cost and treatment time!
Gum Loss. This is of particular concern in the front teeth, especially with patients that have a big smile. When bone is lost, the gum tissue goes with it, too. Let’s compare two scenarios:
Scenario #1: A patient finds out their front tooth is cracked and needs to be extracted and replaced with a dental implant. On the day of surgery, the surgeon carefully removes the tooth and places a dental implant almost exactly where the root of the tooth used to be. A temporary crown is placed on the implant that very same day, and the natural shape of the gum tissue never changes from the original tooth to the new implant and crown. A few months later, a beautiful final crown is placed and everyone is pleased with the result. The End.
Scenario #2: A patient finds out their front tooth is cracked and decides to have the tooth extracted. The patient opts not to have the dental implant placed and instead chooses to have a removable partial denture made to fill in the space. After about a year, they just can’t take it anymore, having a removable piece of plastic in their mouth all of the time, and decide to go for a dental implant. When the dentist evaluates the area, they notice that the gums and bone that used to hold the tooth in have atrophied significantly. Bone grafting and tissue grafting procedures are offered to the patient, and the investment ends up costing thousands more to reconstruct everything as it was only one year ago. After almost a year of bone crafts and connective tissue crafts, the dentist finally makes a final crown. Despite everyone’s best efforts, it never quite looks the same.* The End.
*Sometimes, we still can get a great result, but it is so much more difficult than Scenario #1!
In summary, delaying the placement of a dental implant for a missing tooth makes the case more complicated to fix in the future, which often results in considerable expense in both time and money when the patient does eventually decide to fix the problem. In some cases, it becomes impossible or close to impossible to replace the missing tooth. The time to replace a missing tooth with a dental implant is either the day the tooth is lost or shortly thereafter, depending on the advice of the dentist that is placing the implant.
Every patient is different and every clinical situation is different, so it’s important to discuss the pros and cons of any treatment plan with your dentist. If you’re in San Antonio, Texas and want my advice, I’d be happy to help you.