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Missing Teeth – How To Replace

Most of us started experience tooth loss at the aged of 6.  Our baby teeth start to fall out to make way for our permanent teeth. If everything goes well, our ‘adult’ teeth will grow in without a problem and stay there for the rest of our lives.

Unfortunately, keeping our teeth for a lifetime isn’t always the case. Adults experience missing teeth due to several reasons.

Missing Teeth Can Result From:

  • Extraction due to dental problems (tooth decay or gum diseases)
  • Trauma or injury,
  • Teeth not formed or descended after primary teeth fell out
  • Removed for orthodontic reasons

Not everyone experienced various difficulties with missing tooth or teeth. This depends on the number of teeth missing and on where they are in the mouth. It may not be much of a concern or have any significant impact on eating. However In other cases, this can be a huge concern for either cosmetic or functional reasons or drive the individual to find a way to replace the missing tooth.

As we know, tooth has many functions some being to chew, to speak, to keep the facial muscles and tissue in a proper position, to smile, and to keep the other teeth from shifting. Once a tooth is lost, this whole balance is disrupted and it leads to many various problems.

Some Of The Problems With Lost Teeth Include:

  • Difficulty in eating or chewing
  • Difficulty in speech
  • The cheeks or the lips can appear sunken in
  • Shifting or drifting of the adjacent teeth
  • over eruption  of the opposing teeth
  • Aesthetic
  • Pain of the joint between upper and lower jaw (temporomandibular joint)

Missing teeth do not necessarily need replacement in all conditions. A replacement is needed when you need to improve one or any combinations mentioned above.

With the advances in modern dentistry, these missing teeth can be replaced via a few different methods. The method that we choose to replace missing tooth or teeth depends on a number of different factors, all of which are nearly equal in importance.  The factors to consider include cost, time, longevity, comfort, aesthetics, convenience, and the effects of the treatment on the adjacent teeth and the rest of the mouth.  In replacing missing tooth or teeth, four basic options should be considered:

  • Do not replace the tooth
  • Removable partial denture
  • Fixed bridge
  • Dental implant

Not Replacing A Tooth Or Teeth

Not every missing tooth or teeth need replacement. It depends on what tooth or teeth are missing and where they are in the mouth. If the missing teeth do not affect our functions and aesthetic, no replacement will be the best option. For example if it is a third molar (wisdom tooth), we will not perceive a loss of chewing ability, will not see a defect in our smile, and we will not see any effect on our facial structure.  If the tooth is the second molar, we could seriously consider not replacing it as well. Clinical studies indicate that even with all four of our second molars missing, our ability to chew food properly is not significantly altered. A lost second molar rarely affects our smile or facial structure and appearance. However we must be aware that the tooth that opposes the lost tooth may over erupt. (That is, an upper tooth that does not have a lower tooth to chew against will migrate down until it finds something to stop it, and vice versa). This does not always happen, but the dentist can monitor for it at the regular check-ups visit.

Removable Partial Denture

It is a removable appliance that stays in place via a friction fit, and has to be removed on a regular basis for cleaning. It can be made from metal (eg: Cobalt-chromium) and/or acrylic. Normally it requires time to learn to wear it.  Eating and speaking will be a more pleasant experience once the adaptation process takes its course. Over time, the ridge bone underneath the denture can change. This will of course impact the fit of the denture and require a repair procedure to get the original fit and comfort.



  • Cheap and Cost effective way of replacing multiple teeth
  • Minimally invasive and easily reversible
  • Can replace both hard (teeth) and soft tissues (gum)
  • Removable appliance may shift while eating.
  • Decreased chewing power compared to other replacement options.
  • Bulkier than other replacement options
  • Does not preserve bone tissue where tooth was lost.

Fixed Bridge

Unlike removable partial denture, bridge is cemented to the natural teeth or implants placed on the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments.



  • Fixed in place and does not move.
  • Similar size to natural teeth.
  • Can be a close cosmetic match to the missing tooth.


  • Require significant modification to the abutment teeth.
  • Harder to keep clean than natural teeth.
  • Increased stress on abutment teeth that can decrease their lifespan.
  • When a bridge fails, it can often take a tooth with it.
  • Do not preserve bone where missing tooth is.

Dental Implant

Dental implant is a titanium fixture that is imbedded into the bone to replace the root of a missing tooth. It is locked in place and helps to preserve and stimulate the bone. They can be done as single tooth or used for implant supported bridges to replace multiple teeth. They can also be used as anchorage for complete and partial dentures. In the case of single or multiple tooth replacement, dental implants provide the best function without compromising the adjacent teeth. They are also easier to maintain in the long run as they are not susceptible to decay and are more resistant to gum disease than a natural tooth.



  • Do not rely on adjacent teeth for support.
  • Full chewing function.
  • Can be very cosmetic as it emerges from within the gum tissue like a natural tooth.
  • Potential for best longevity over other options.
  • Prevent excessive bone loss.
  • Higher cost compared to bridge and denture.
  • Longer process which can take up to a year to complete.
  • May require bone grafting to complete.
  • Higher risk of complications with some medical conditions.

Cobalt-Chrome Partial Denture


Acrylic Full & Partial Denture


A Fixed Bridge Replacing Front Missing Teeth


Replacing Missing Tooth With Implant Supported Crown


Last Reviewed : 23 August 2019
Writer : Dr. Zaini bt. Aziz
Accreditor : Dr. Kamarul Hisham bin Kamarudin
Reviewer : Dr. Roshima bt. Mohd Sharif