When I extract a tooth, I talk about replacing it before the patient leaves the chair. Not in order to schedule a second procedure, but because timing genuinely matters here. The sooner the space is addressed, the less there is to correct later.

The Space Does Not Stay a Space

Your teeth hold one another in position. Remove one and the teeth beside it begin drifting toward the opening, while the tooth above or below it moves down or up into the gap.

As those positions shift, your bite changes with them. A bite that no longer meets evenly places uneven load on the teeth you still have and on the jaw joint, and that is where bite problems and jaw problems begin. They are considerably harder to correct than the original gap. This happens at any age, not only in older patients.

The Options I Give You

• Do nothing

  A real choice, and occasionally the right one for a period of time. You should simply understand what it costs you: continued movement, and a more complicated correction later.

• A bridge

  Fills the space using the adjacent teeth for support and stays fixed in place, usually within about two weeks. The tradeoff is that those neighboring teeth must be prepared for it, and they are often perfectly healthy.

• A removable partial denture

  Replaces one or several missing teeth and comes out for cleaning. When cost is the deciding factor, this is often the practical place to begin, and it is what many patients choose.

• An implant

  Treats the site on its own, without touching the adjacent teeth at all. It is the closest thing dentistry has to putting the tooth back, and if you ask me directly which I would choose, this is it.

You Will Not Be Without a Tooth While It Heals

The hesitation I hear most often about implants is not the cost. It is the time. An implant takes roughly eight to nine months from placement to the final tooth, because the bone has to integrate with the implant before anything can be loaded onto it. Next to two weeks for a bridge, that sounds like a long stretch to go without a tooth.

You do not go without one. I always provide a temporary, usually an Essix retainer, which is a clear removable retainer with a tooth set into it. For a front tooth I do this without exception. For a back molar, most patients find they neither need nor want one.

Not Everyone Is a Candidate

Implants are not appropriate for every patient, and I would rather say so at the consultation than partway through treatment. Severe bone loss, smoking, and uncontrolled diabetes all interfere with healing, as do a number of common medications that affect bone. When an implant is not the sensible option, a bridge or a partial denture is not a consolation prize. It is simply the right treatment for you.

The expensive option is usually the one where nothing is done for several years.

If you have a gap you have been living with, whether it happened last month or ten years ago, it is worth knowing where you actually stand.