Q: I recently had a routine extraction because of a previous root canal gone bad. I am kind of asking this question after the fact as my dentist did the extraction and grafted material at the same time, saying that this was necessary for the implant that I will need. After reading your last column, it occurred to me that I should have asked why was a graft needed before the implant was placed and also why do I need to replace the tooth, anyway. It does not show and it would be stressful to my budget. Do all teeth lost need to be replaced?

W.R.

A: The answer is an unequivocal NO. It is very possible to function well without all teeth present. There is no question, this should have been explained to you prior to your having the extraction. The pros and cons of tooth replacement are many and varied. In addition, if replacement is the decided upon treatment, there are a number of ways that this can be done, with the choice of an implant being only one.

Replacement of a lost tooth is the ideal but depending on what tooth was lost and how it will affect the rest of your dentition is paramount to discuss before treatment decisions are made. I am sorry this was not discussed with you before the extraction since grafting is a very expensive addition and need not have been done if the implant replacement alternative was not selected. This is something that all dentists need to pay attention to, as the accepted way of treatment is always to discuss treatment alternatives as there always are some.

In your case, there are a few that come immediately to mind. One, is to extract the affected tooth and not replace it. Your dentist would need to evaluate your overall complement of teeth as to their health and whether movement of the other teeth might be an adverse consequence. But movement does not always take place but can be easily predicted based on a thorough dental examination. If the health of your teeth around the lost tooth is good and movement is not anticipated, it is ideal to replace the tooth but ideal treatment is your decision in consult with your dentist. Factors that come into play in making that decision are your age, your budget, your personal desire and whatever else your dentist may advise of.

In today’s dental treatment world, the implant is considered to be the ideal form of replacement. But again, that assumes that you have been advised of other less costly alternatives and chosen the implant. One less costly alternative is what is called a fixed partial denture where teeth on either side of the missing tooth are restored with an artificial tooth attached to replace the missing tooth. This was the gold standard before implant treatment became an alternative in the mid 1980s. This alternative demands that a healthy tooth be present in front of and behind the missing tooth. If that is not the case or even if it is, another very inexpensive way to replace a missing tooth or teeth is with a removeable partial denture. There are some significant cons to this treatment but you deserve that it be explained to you in any event.

Treatments, including implant restoration, have various considerations but suffice it to say, it is incumbent on the dental practitioner to review with you, all of them prior to making this most important decision.

Now that the extraction has been done as well as the graft, you still have all of the same treatment options to consider. Do you leave the space or do you truly need to replace it and if so why and with what type of restoration? You can also take your time in making the decision. There is no emergency as long as you can function comfortably. Do not let anyone push you into making a treatment decision until you are completely comfortable with whatever it is.

Feel comfortable sharing my thoughts with your dentist but remember that he/she may think otherwise and if so, should have a good and understandable reason why.

Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at dr.richard@nothingbutthetooth.org.