A missing tooth–especially an incisor, which is located near the mouth–is something that needs to be treated right away. Even when there’s no actual physical pain, in the long run it can cause dental displacements; which will further result in problems like bone density loss, or biting and chewing difficulties. Plus there’s the aesthetic reason, as it does affect your smile. Going to a dentist and starting to take care of it as soon as possible is essential, because some treatments can span months and even years.
Why Is the Tooth Missing?
Before anything else, your dentist will likely figure out why the tooth is missing in the first place. There are only so many reasons behind the absence of a permanent tooth. You may have lost it due to physical trauma or a tooth extraction, or both; for example, a severely cracked tooth that needed to be pulled out. Sometimes, it can be congenital; that is, you may have been both without that tooth. It’s more common than you think, although it’s much more common for wisdom teeth to be genetically missing, compared to incisors. In other cases, the tooth is not actually missing!
Treating a Trapped Incisor
What if the incisor is there, but can’t come out because there is no space for it? Sometimes a tooth can be trapped, meaning there’s not enough of a gap between the teeth on either side of where it’s supposed to be.
In the latter case, the solution is often one or a combination of dental surgery and orthodontic treatment, typically to make space for and encourage the trapped tooth to come out naturally. This is best done at an opportune time–likely during young adulthood.
Closing the Gap
When the tooth is just not there, these are two basic options: close the gap or replace the tooth. Again, to leave it as it is would only encourage tooth shifting and harmful changes in dental architecture down the line. This is often a major decision, and you, your dentist and your orthodontist must consider everything from the duration and cost of the actual treatment, to things like face and tooth shape.
To move the posterior tooth forward is especially common when the missing tooth is a lateral incisor, the gap isn’t very large, and the patient is a young adult. What happens is orthodontic treatment–typically this will require wearing braces for years–guides the canines to close the gap. This is called a canine substitution. It isn’t always aesthetically pleasing, though, as canine are differently shaped when compared to incisors; and that will be all the more noticeable if only one lateral incisor is moved up. Of course, further cosmetic dental treatment can be undertaken to improve the way your smile looks; from teeth contouring and reshaping to using porcelain veneers.
Replacing the Tooth
There are a few common ways to replace a missing tooth, and all of them have their own benefits and disadvantages–not to mention the fact that in some cases orthodontic treatment to widen the gap is still needed.
Traditional bridgework used to be quite a common and conventional solution, but it is slowly becoming a less common choice due to the fact that two otherwise healthy teeth often need to be involved and permanently changed in order to accomplish the procedure. Basically a fake tooth is held in place by a dental crown on each side; these crowns are cemented onto the filed and prepared teeth on either side of the gap. Less common is a procedure that uses only one cemented crown, as this may lead to complications later on due to a lack of equal support for the replacement tooth. The upside is that it looks good; the downside is that if something goes wrong, that’s more teeth to treat. A more conservative bridgework option can be to leave the healthy teeth intact; instead of reshaping them, the replacement tooth can be secured with a metal or porcelain frame bonded to the back of the adjacent teeth. However, this procedure is not as sturdy long term and may even affect your bite.
Removable bridges or dentures are another option. Basically this is a custom appliance that you can put in and take out at any time, resting on your gums and natural teeth while creating the illusion of a perfect smile. However, this often less expensive option is more common if you have more than one missing tooth–or anticipating further tooth loss. There is also the issue of comfort, as some removable bridges may not fit well and may be a hassle to remember to take care of and store properly when you take them out for the day.
A dental implant is probably the most recommended and currently common treatment of choice these days for a missing tooth. It integrates a dental prosthesis-topped small screw–usually a titanium alloy–with your jaw bone and looks just like a natural tooth–no mess, no fuss, and for the most part, no special upkeep. This option, however, is limited to adults with no health issues that may be affected by such a major procedure. It’s also more commonly used for molar replacements.