- Cause for the missing tooth. Aplasia may indicate inadequate development of the alveolar crest, trauma or severe periodontitis may imply persistent severe bony defects. Time of tooth loss.
- Clinical/radiographic evaluation of the oral health state, condition of all teeth and gingiva/mucosa. Do not focus on the tooth gap solely and make sure that the implant is placed in a healthy environment.
- Consider general health of patient, medication, allergies. Consider patient´s expectations.
Cause of a missing tooth
Missing a permanent single tooth may be due to aplasia, trauma, or extraction of a decayed or periodontally compromised tooth.
The cause of aplasia is not fully understood, but one suspects genetic and/or environmental disturbances during tooth development. There is a huge variation in prevalence depending on ethnic background and population. Lower second bicuspid is most affected followed by the upper lateral incisor. Lack of tooth formation may impede the development of the alveolar bone process.
A traumatized missing tooth is frequently a result of daily mishaps, sports activities, and various accidents. High prevalence figures are reported worldwide of traumatic injuries to the permanent dentition in school children. A repositioned avulsed tooth may subsequently become ankylotic and most difficult to remove without causing a huge bony defect.
Dental caries and periodontitis are the main causes for tooth extractions. Periodontitis is regarded the second most common chronic disease after decayed teeth and 5 to 20% of any population suffers from severe periodontitis, while mild to moderate periodontitis affects most adults. The remaining amount of alveolar bone to support such teeth and the way the extraction procedure was handled, will have an impact on the persistent alveolar bone volume either immediately post extraction or after a period of healing.
Put focus on information to the patient, especially when dealing with traumatic injuries in the esthetic zone. Evaluate patient´s expectations and explain conceivable outcomes in terms of esthetics.
In case of one or several missing single teeth (hypodontia), consider early orthodontic treatment to eliminate the tooth gap or to widen the gap for subsequent prosthetic treatment.
In case of extraction of a traumatized or decayed/periodontally compromised tooth, evaluate post-extraction conditions. Always consider immediate implant insertion if the buccal bone plate is intact, if there is a risk for bone collapse inducing insufficient bone volume for implant treatment, if any tooth-connected infection is eliminated, etc.
In case of decayed or heavily restored teeth adjacent to a gap, consider a tooth-supported fixed partial denture.
In some situations rehabilitation is not needed or adds limited improvements, thus no treatment is also an option.