When You Have a Missing Tooth, The First Step is ‘NOT’ to Replace It!

So you have a missing tooth and decide to pay a visit to your dentist to get it replaced.  After considering all your options, you decide on dental implants and are ready to go.  But here is the spoiler: The first step to replace a missing tooth is NOT to replace it! 

From the early days of dental school, we learned that all dental treatments start with basic diagnostics and then completed in 2 phases. Every patient should start with basic diagnostics which include a full mouth series of x-rays (FMS), restorative assessment, and periodontal charting. A cone beam CT scan may also be indicated depending on the state of oral health. These diagnostics provide the necessary data and information to assess the health of teeth and supporting bone and gum tissue. Proper diagnosis is vital for creating the right plan before starting any treatment.

Then during phase 1 dental treatment, the dentist performs basic teeth cleaning, restores any teeth with decay, and manages minor gum disease if necessary. Various specialists may be called upon to address extraction of guarded teeth, complete necessary root canal treatments, and manage more significant gum disease. Phase 1 treatment is all about eliminating immediate oral disease and stabilizing patients’ oral health. Phase 2 dentistry on the other hand is all about aesthetics and teeth replacement. We learned to always follow phase 1 and 2 dentistry in sequence in every patient.

A dental implant placed without proper initial diagnostics and phase 1 treatment carries high risk of failure as any undiagnosed inflammatory or infectious conditions of bone, gum tissue, or other teeth will impact the health of the dental implant. The success and longevity of any dental implant therapy depends on many factors which I described in an earlier article, ‘How long Will My Dental Implant Last?’

So the first step to replace a missing tooth is comprehensive diagnostics, assessment of total oral health, and completion of phase 1 treatments. In-fact the same rule applies to any phase 2 treatment including crowns, veneers, orthodontics, and teeth replacement. Following this evidence-based treatment sequence will help you achieve more predictable results with long-term prognosis while protecting your investment of time and money. 

Dr. H. Ryan Kazemi is a board-certified oral and maxillofacial surgeon in Bethesda, MD