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No Back Teeth, What Are My Options For Replacement?

If you're missing your back teeth, the only options for replacing them would be implants or removable partial dentures (RPD). Both procedures will restore the missing posterior teeth but they have their own respective pros and cons.


x-ray of mouth full of implants
x-ray of mouth full of implants

We will explain all of the benefits and disadvantages to each procedure. By the end of this article you should be more informed so that you can make a better decision on how to replace the teeth.


Table of contents:


Replacing back teeth with implants

If you have no back teeth, dental implants are a fantastic fixed option for replacing them. They are titanium fixtures that get implanted into the jaw bone. Afterwards an implant crown gets placed on top of the implant, thus restoring your missing posterior tooth.


Since each jaw has a total of 8 back teeth, four on each side, you do have a couple of options in regards to implants. There are three different ways you can utilize them to replace them.

  • 8 individual implants

  • 2 implant bridges

  • 2 implant to natural tooth bridge


Individual implants

Restoring all 8 back teeth with individual implants is the most natural option but also the most expensive.

  • Natural. Since they're fixed, they don't come in and out just like your natural teeth. You can also floss in between them which makes them even more like your teeth!

  • Expensive. The downside is that you have to pay for 8 individual implants and crowns.


implant crown and screw fixture
implant crown and screw fixture

We believe this is the most preferred and desired option if finances were not a problem. It is biomimetic in that it mirrors how your natural dentition is supposed to be.


implant crown on molar
implant crown on molar


Implant bridges

In lieu of single implants, you can opt to do two implant bridges with one on each side. They're still natural in that they're fixed and non-removable. The downside is that you can't floss in between them. You must use a floss threader or superfloss to clean underneath of it.


Credit: 4G Dental lab
dental implant bridge

The benefit is that you only have to pay for 2 implants on each side instead of for 8. You still need to get a total of 8 implant crowns though. The teeth in between would be dummy teeth or as your dentist would call them, pontics.


Note: Alternatively if you want, you can choose to replace only 3 teeth on each side. That way you can save on two implant crowns. You would still need 4 implants total. When we restore a patient to just the first molar, we call it first molar occlusion.


Implant to natural tooth bridge

Alternatively, an even bigger cost saving measure would be to do an implant to natural tooth bridge. Instead of having a bridge connected to two implants, you would have one side as an implant and the other side as a natural tooth.


implant to natural tooth bridge
Credit: W Chee & S Jivraj

The advantage is that you save money in needing less implants. The disadvantage is that you're connecting two different materials. The natural tooth can still get cavities so if that happens, you would need to replace the whole bridge.


Note: As a word of caution, studies have shown that your natural tooth and an implant have differing ways of loading forces. That means there could be restorative and prosthetic failure over the long term due to these differences in forces.


A safer and proven method would be to choose the implant-implant bridge instead.


 

Replacing back teeth with a partial denture

If you have no back teeth, partial dentures are an affordable removable option for replacing them. It is a prosthetic appliance that you can remove from your mouth and put back in at will. Patients commonly refer to them as false teeth or dentures for short.


kennedy classifications of partially edentulous arches

If you're missing all of the back teeth, the partial denture kennedy classification would be class I. Essentially the denture would have a bilateral distal extension that is connected to one another along the front teeth. The denture would be held in by some type of clasp at the back-most tooth on each side.


partial denture with no back teeth
Credit: Glidewell

kennedy class I diagnostic model - no back teeth
Credit: George E. Bambara, DMD, MS

The two images above demonstrate what we're talking about.

  • One photo shows what the partial denture may look like.

  • The second photo shows a diagnostic stone model of someone missing back teeth.


Pros and Cons


Benefits:

  • Very affordable since it costs a fraction of implants

  • Can be made within 2 months.


Disadvantages:

  • It's removable and not fixed.

  • Not as stable since it is kennedy class I

  • Metal hardware shows through


We wish to expand upon why this type of partial denture isn't very stable.


When you're missing all of your back teeth, you don't have a posterior tooth to anchor the denture. The photo below shows a kennedy class III partial denture which has a back tooth to anchor and place a clasp on.


partial denture with a back tooth on each side
Credit: George E. Bambara, DMD, MS

As you can imagine, a class III RPD is MORE stable than a class I RPD. Unfortunately since you don't have any back teeth, there is no way to make it more stable.


 

Implants vs Partial dentures


Attributes

Implants

RPD

Type of appliance

Fixed

Removable

Appearance

Natural looking

False teeth

Tooth material

Porcelain crowns

Acrylic teeth with metal

Treatment time

8-12 months

2 months

Cost

$4773.46 per tooth

$1964.62 for entire denture


For clarity, the implants are significantly more expensive than the partial denture. As you can see, a single implant already costs more than twice as much as the RPD. The cost for the RPD will replace all 8 teeth for that price. If you wanted to replace all 8 teeth with implants, it would cost a whopping $38,187.68 which is similar to an entry level luxury sedan.


Of course, patients much prefer implants since they are fixed and non-removable. It's usually the finances that are prohibitive to their decision.


Are there other alternatives?

Unfortunately, there are currently no other alternatives to replace missing back teeth. You either go with the more expensive fixed option (implants) or the affordable removable option (RPD).


I guess alternatively you could simply choose to not replace the teeth at all but there are consequences for that.

  • Difficulty chewing. The posterior teeth are where you grind and mash up the food. Without them it would be more difficult to chew. There would also be increased digestive stress since you're not chewing up the food as well before you swallow.

  • Front teeth wear. You'll be relying on mostly the front teeth for eating, which puts extra wear on them. You may end up losing these faster than if you had back teeth.

  • Decreased aesthetics. When you smile, people can certainly see that you're missing the posterior teeth. It will look like you have a black corridor on each side when you smile.


Hopefully that helps you in deciding which route to go for replacing the missing posterior teeth. There really aren't that many options to be honest! If you need a dental consultation and you're in the Long Island City area, our dentists can help you.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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