Tooth loss and implant replacement.

Osseointegrated dental implants are increasingly used to replace missing teeth in a variety of situations ranging from the missing single tooth to complete edentulism. The implant possibility must be carefully considered because treatment involves extended time frames, considerable expense and is not without risk. Accordingly, treatment-planning decisions should have an evidence-based strategy with appropriate risk assessment. Implant systems need to be adequately tested before they are released for general use and success rates should be assessed from peer review scientific publication data and not commercial promotional literature. It is the responsibility of the dentist to ensure the patient is educated so an informed decision can be made on difficult treatment alternatives. The clinical decision making process must respect the issues to assure quality of care and reduction of liability for negligent care. Today, the three-unit fixed bridge can no longer be considered as the standard of care for restoration of a single missing tooth. The evidence has accumulated that the single tooth implant supported replacement is more conservative, more cost-effective and more predictable with respect to long-term outcome in uncomplicated cases.