One missing tooth, several, or a whole arch. Each situation calls for something different, and there’s rarely a single best answer that fits everyone. The real question isn’t which option sounds nicest. It’s which one fits your bone, your bite and your budget.
This page is the map. Each option has its own page with the detail.
Waited a while? Many people who call us have. What’s still possible depends mostly on how much bone is left, and even lost bone can often be rebuilt first. That’s the first thing we look at.
Don’t wait longer than you have to
A missing tooth doesn’t stay a small problem. The teeth next to it drift into the gap, the tooth above or below it drops down looking for something to bite against, the bone underneath shrinks because nothing is loading it any more, and your bite shifts to compensate.
None of that is urgent in the way a toothache is urgent, which is exactly why it gets put off. But the sooner we look, the more options are still on the table. Bone you still have is easier to work with than bone you have to rebuild.
You may not need every tooth replaced
That’s why every gap is worth a look. But looking at a gap isn’t the same as filling it, and not every missing tooth has to be replaced.
When we reasonably can, we rebuild a bite back to the first molars. When we can’t, a bite that ends at the premolars, the two teeth just in front of the molars, often holds up well. A nine-year study comparing shortened bites like that with complete ones found the same tooth wear and the same bite depth, and the small differences between them stayed put instead of growing. It isn’t free: there was more spacing between the premolars and a little less bone support. But it settled, rather than breaking down.
So if what’s missing is a molar or two at the back, leaving the space can be a reasonable choice, and we’ll tell you if it is in your case. How many teeth is enough, and why →
The four paths
- A dental implant. A titanium post replaces the root itself, with a crown on top. Usually the strongest and longest-lasting answer for one tooth or a few, as long as there’s enough healthy bone, or bone that can be built back up. It doesn’t involve the teeth either side.
- A fixed bridge. A replacement tooth anchored to the healthy teeth on each side of the gap. A good answer when an implant isn’t the right fit, but it means preparing those neighboring teeth, which is a real trade if they’re currently untouched.
- A full-arch implant bridge. When an entire arch is missing or failing, one fixed bridge carried on four to six implants. Often called All-on-4. It doesn’t come out, and it’s a very different decision from a denture.
- Dentures. A full denture for an arch, an acrylic flipper to hold a space in the meantime, or a denture that snaps onto implants for stability. All removable, and a different proposition from anything fixed.
Who does what
We’ll be straight about this, because it affects how your treatment runs.
We plan and restore implants. We don’t place them. Dr. Sandquist used to place implants himself, so this isn’t unfamiliar territory. We plan the case together with the periodontist or oral surgeon who places the implant. We bring where the finished tooth needs to sit; the surgeon brings the surgical judgment about what the bone will support, and sometimes that has to lead. Once it has healed, it comes back to us for the abutment, the crown and the bite, and we follow it at every visit after that.
You don’t have to set up the surgeon yourself. Our team handles the referral and schedules your appointment with the surgeon for you. The surgeons we work with offer IV sedation, if you’d rather not be fully aware of the surgery.
Bridges, dentures and flippers we make and fit here.
How we work out which one is right
Every case starts with your bite, not with the gap. A replacement tooth is a new chewing surface, and if it lands where your jaw doesn’t want it, the problem shows up in the muscles and the joint rather than in the tooth.
When an implant is on the table, we take a 3D CBCT scan to see exactly how much bone is there before recommending anything. That’s one of the few situations where that scan is genuinely indicated.
Sometimes the answer is straightforward. Sometimes it takes a staged plan to get there, and sometimes the honest answer is that the ideal option isn’t available in your case and here’s the next best one and why.
Real cases
One patient needed a full bone graft before implants were possible at all, years after an old accident. It wasn’t a quick fix, but rebuilding the bone first is what made the rest of it possible.
See the bone graft and implant rebuild →
Another had years of mixed dental work from different offices that had stopped working together. Implants and ceramic restorations resolved it into one bite that functions as a whole.
See how we resolved B.R.’s case →
Every case we’ve photographed, grouped by what brought the person in →
What it costs
These options differ a lot in price, and the cheapest one today isn’t always the cheapest one over twenty years. We’d rather show you the real numbers for each path that’s actually open to you, before you decide.
We’re a fee-for-service office. Here’s how insurance works here, including why a single implant and crown will use up most annual maximums on its own, and here are our prepaid programs.
Getting started
Bring us the gap, or the treatment plan somebody else has given you. We’ll look at the bone, the bite and what you want out of it, and tell you which of the four actually fit. Call 702-734-0776 or tell us what’s going on.