Do I have to get an implant for a missing tooth? What if I cannot afford replacement?

Direct answer (within 60 words)

Not necessarily. For people with reduced dentitions, a systematic review found insufficient evidence to recommend one replacement method over another ¹. Guidelines put disease control before reconstruction ². A dentist must assess your situation.

Scope: This guide is specific to Taiwan's healthcare system (National Health Insurance and Taiwan's Medical Care Act). The clinical-evidence sections use international literature and professional-society guidelines, marked geo: universal in each fact; the system and subsidy sections are marked geo: TW. Readers elsewhere should use the system where they live.

Taiwan's Medical Care Act is a different law from medical-care laws in other jurisdictions. The English rendering of its provisions below follows the official English version: https://law.moj.gov.tw/ENG/LawClass/LawAll.aspx?pcode=L0020021

This is really two questions, with answers in different places

Someone searching “must I get an implant for a missing tooth?” and “I cannot afford to replace a missing tooth” may type both searches on the same evening. Yet the first asks whether alternatives exist; the second asks what to do over the next 3 months with this budget.

If the two are mixed, the result is often two incomplete answers: “without an implant everything will collapse,” or “if you cannot pay, just leave it.” This article separates them and identifies the kind of study and population behind each section. This section is this site's editorial framework for separating the questions, not a diagnostic tool ³⁴.

Division of coverage: “What changes may occur when a missing tooth is not replaced?” and a full discussion of the shortened dental arch concept are covered in another site card, KM-DENTAL-34. This article does not repeat them; it only summarizes them where needed and identifies the source. See the internal citation chain below for the full card.

1. How does the literature answer “Do I have to get an implant?”

Current systematic-review conclusion: no method has been proven superior to the others

• A systematic review including 10 studies—4 analyses of different outcomes from a German multicentre randomized controlled trial, 1 pilot phase of that trial, 2 randomized controlled trials from the United Kingdom and Ireland, and prospective cohort studies from Denmark and the Netherlands—states that current evidence is insufficient to recommend any tooth-replacement strategy over another ¹.
• Read the population limit carefully. Its title and objective specify adult patients with shortened dental arches, while its conclusion specifies adult patients with reduced dentitions ¹. It therefore directly covers situations such as posterior missing teeth and a shortened dentition, not every missing-tooth situation (for example, a single missing front tooth is outside that population). This article retains that limit and does not turn it into a rule for every type of missing tooth.
• The finding blocks exaggeration in both directions. In the population it covers, it supports neither “you definitely need an implant” nor “implants have no value.” It says the literature cannot decide for you; the decision must return to individual conditions and your preferences.

There is currently no valid, current Cochrane-level conclusion for this question

• The closely relevant Cochrane review, *Interventions for replacing missing teeth: partially absent dentition*, is marked WITHDRAWN, and PubMed lists its publication type as Retracted Publication ³.
• Under this site's rules, withdrawn literature is not used as clinical evidence. It is listed here to record honestly that a claim online that “Cochrane says one type of denture is better” currently has no valid source. This article cites none of its conclusions ³.

The reliable answer to “Do I have to get an implant?” therefore looks like this

Not necessarily. An implant is one option, not this question's default answer. Taken together: in the shortened-dental-arch/reduced-dentition population, the current systematic review expressly says there is insufficient evidence to recommend any strategy ¹; in the broader population with partial tooth loss, the Cochrane-level review is withdrawn and there is no current valid conclusion ³. Neither side has a proven winner, but their evidence strength and coverage differ; this article does not treat them as the same. Each of the four paths below has its own evidence, indications, and trade-offs. The choice depends on conditions in your mouth and your priorities ¹¹³¹⁵.

2. The conditions and trade-offs of four paths (no prices)

This section discusses survival, complications, and indications in the literature. It gives no prices. Cost components and how to read an estimate are covered by this site's cost cards in the internal citation chain.

Implant (an implant-supported single crown)

• A systematic review and meta-analysis of 46 studies reported 5-year survival of implants supporting single crowns at 97.2% (95% confidence interval 96.3 to 97.9), and 10-year survival at 95.2% (91.8 to 97.2); 5-year survival of implant-supported single crowns was 96.3% and 10-year survival 89.4% ⁴.
• The same review recorded 5-year cumulative technical complications: screw loosening 8.8% (95% confidence interval 5.1 to 15.0), loss of retention 4.1%, and veneer-material fracture 3.5%. Its conclusion says technical, biological, and aesthetic complications occurred frequently ⁴.
• Some people already belong to higher-risk groups. An umbrella review of 12 articles and 41 meta-analyses found no association graded as convincing evidence. The two graded “highly suggestive” were presence of periodontitis (odds ratio 3.84, 95% confidence interval 2.58 to 5.72) and smoking (risk ratio 2.07, 95% confidence interval 1.41 to 3.04); diabetes, hyperglycaemia, lack of preventive care, history of chronic periodontal disease, and 8 other associations were graded “suggestive” ⁵.
• A 2025 umbrella review listed 10 patient-related risk factors. Modifiable factors include smoking, bleeding on probing, plaque control, the number of sites with probing depth of 5 mm or more, recall frequency, and occlusal overload. Non-modifiable factors include history of periodontitis, implant location, number of missing teeth, and systemic diseases. Its objective states that this information can support lifestyle change or avoiding implant treatment in high-risk conditions ⁶.
• An implant is not finished when it is placed. The European Federation of Periodontology S3 clinical guideline states that, after implants are loaded and functioning, a structured supportive peri-implant care programme including regular assessment of peri-implant tissue health should be established ⁷. Long-term maintenance is therefore part of the choice.

Bridge (a fixed dental prosthesis supported by adjacent teeth)

• A systematic review of 40 studies, covering 1796 metal-ceramic and 1110 all-ceramic fixed dental prostheses, reported 5-year survival of 94.4% for metal-ceramic multi-unit fixed prostheses (95% confidence interval 91.2 to 96.5), 90.4% for densely sintered zirconia, 89.1% for reinforced glass ceramic, and 86.2% for glass-infiltrated alumina ⁸.
• The same review recorded a significantly higher incidence of caries in abutment teeth with densely sintered zirconia fixed prostheses than with metal-ceramic prostheses. Framework-fracture rates were significantly higher for reinforced glass ceramic (8.0%) and glass-infiltrated alumina (12.9%) than for metal-ceramic (0.6%) and zirconia (1.9%) ⁸.
• A bridge requires preparation of neighbouring teeth. A systematic review of economic aspects reported similar initial costs, but variation between tariff systems, and similar failure rates for single implant crowns and tooth-supported fixed prostheses. The authors wrote that the benefit of retaining healthy adjacent teeth without preparation makes the implant crown more economical in that respect ⁹. This is a study-level comparison; it cannot replace an individual assessment or be converted into a price in any location.

Removable denture (removable partial denture)

• A systematic review found that 2 retrospective studies indicated a higher tooth-loss risk with removable dentures than with fixed prostheses among patients with a history of periodontitis. Several studies indicated increased plaque accumulation. However, the same review concluded that there is no strong evidence that removable dentures themselves cause periodontal destruction including tooth loss ¹⁰.
• For chewing, a systematic review's synthesis found that people with shortened or extremely shortened dental arches had comminution or mixing ability 28% to 39% lower than people with complete dentitions. A distal-extension removable partial denture could partially restore that gap (about half), and performance improved as the number of artificial teeth increased ¹¹.
• In practical terms, removable dentures need regular cleaning and review adjustments; maintenance capacity and the condition of remaining teeth are closely related ¹⁰.

Temporary non-replacement (discussion of the shortened dental arch concept)

• International literature does contain a concept of retaining anterior and premolar occlusion without replacing posterior molars. One literature review reported that people with 3 to 5 occlusal units in a shortened dental arch generally had no clinically significant difference from people with complete dental arches in chewing ability, signs and symptoms of temporomandibular disorders, movement of remaining teeth, periodontal support, and oral comfort ¹².
• The 10-year result of a multicentre randomized controlled trial reported more tooth loss than expected. The authors considered that the influence of prosthetic management of bilateral shortened dental arches may previously have been overestimated, and wrote that patient preferences should receive appropriate weight in treatment decisions ¹³.
• A systematic review in older adults found no recorded significant difference in nutritional status between shortened-dental-arch and conventional removable-denture reconstruction, while treatment and maintenance costs were higher in the removable-denture group. Its clinical-implications wording is cautious: shortened dental arch treatment “may be considered” as a feasible treatment concept in older adults, especially those with complex medical status and limited finances ¹⁴. This is one of the few evidence items here that directly touches money, but it is a study-level cost comparison, not personal advice.
• This path does not mean “do nothing,” and it is not suitable for everyone. The conditions for and against it, and oral changes after non-replacement, are covered fully in KM-DENTAL-34 and are not repeated here.

Another often missed path: first find out whether the tooth can still be saved

Some people searching “if there is no root, do I have to get an implant?” actually still have a root: the tooth may be deeply decayed, broken, or described as not salvageable. The question then is not “which replacement?”, but “can this tooth be kept after treatment?”

• A systematic review of 12 studies (7 cohort studies, 4 case-control studies, and 1 randomized controlled trial) found that root canal treatment and dental implants both showed high survival, with root canal treatment slightly better in success; failure rates ranged from 0.7% to 12.0%, with no significant difference between treatments. Dental implants were associated with more frequent postoperative interventions and complications. The authors stated that decisions should consider clinical factors, patient preferences, cost, accessibility, potential complications, and patient-centred outcomes, and emphasized shared decision-making ¹⁵.
• Another systematic review of 8 observational studies showed disagreement: 3 found no survival difference in the first 3 years but declining survival of root-canal-treated teeth over time; another 3 reported lower survival and more complications for implant-supported prostheses. Its conclusion says it is unclear which is better for survival ¹⁶.
• The honest reading is that these two recent systematic reviews do not identify the same winner—one records slightly higher root-canal-treatment success, the other judges the answer unclear ¹⁵¹⁶. “Extract and implant” is not automatically better than “keep and treat.” Your tooth's actual condition and a clinician's assessment decide this question.

3. The answer is determined by six of your conditions, not a price list

The following is this site's list of conditions synthesized from the literature above (an editorial framework, not clinical criteria) ³⁴. It is for asking better questions in the clinic, not for reaching your own diagnosis.

1. Periodontal status: Presence of periodontitis is a highly suggestive peri-implantitis risk factor (odds ratio 3.84) ⁵. Among people with a history of periodontitis, removable dentures versus fixed prostheses raise the tooth-loss-risk issue ¹⁰.
2. Smoking: Smoking is also graded a highly suggestive risk factor (risk ratio 2.07) ⁵ and is listed among modifiable risk factors ⁶.
3. Ability to clean and attend review: Plaque control and recall frequency are modifiable risk factors ⁶. A structured supportive care programme is needed after implant loading ⁷, and removable dentures increase plaque accumulation ¹⁰.
4. Site of the missing tooth and remaining pairs of opposing teeth: The fewer remaining posterior occlusal pairs, the more chewing performance falls (28% to 39% lower) ¹¹.
5. Condition of adjacent teeth and bone: A bridge requires preparation of neighbouring teeth ⁹. After extraction, the alveolar ridge changes; a systematic review of 20 studies found horizontal bone-dimension reduction greater than vertical reduction at 6 months ²⁵.
6. Your own priorities: Trial authors say patient preference should carry appropriate weight in treatment decisions ¹³. Systematic-review authors list cost and accessibility among factors to consider ¹⁵. A qualitative study of 15 partially dentate older adults—who had previously taken part in a randomized trial of replacement options and received resin-bonded bridges restoring 10 occluding pairs under the shortened-dental-arch principle—recorded high satisfaction but also concern that this treatment might not be available in primary care ²⁶.

4. What can be done first when money is tight?

This section uses Taiwan's system, geo: TW. Readers elsewhere should use the system where they live. It gives no prices and does not determine any subsidy eligibility.

“I cannot afford replacement” is a real situation, not procrastination. The shared logic of the following four directions is: spend first on losses that are still getting worse, then on functional reconstruction.

Direction 1: stop disease that is still progressing first

• A systematic review of 3 studies and 4396 extracted teeth found that caries accounted for 36.0% to 55.3% of all extractions, periodontitis 24.8% to 38.1%, periapical disease 7.3% to 19.1%, and trauma 0.8% to 4.4%. It concluded that caries and periodontitis are common indications for extraction ¹⁸.
• This is a study-level distribution of reasons for extraction, not a determination of why you personally lost a tooth—a dentist must diagnose why you might lose another ¹⁸. It can nevertheless support a clinic question when the budget is limited: should still-progressing caries or periodontal disease be treated before replacing the missing space? The order depends on an individual diagnosis. This is this site's question prompt, not treatment instruction ³⁴.
• Periodontal treatment has a clear staged structure. The European Federation of Periodontology S3 guideline for stage I to III periodontitis uses a pre-established stepwise treatment approach, progressively adding behavioural change, supragingival biofilm, gingival inflammation and risk-factor control; supra- and subgingival instrumentation; periodontal surgery; and supportive periodontal care to maintain benefits ¹⁷.

Direction 2: phase treatment; do not assume it must all happen at once

• The S3 guideline for stage IV periodontitis says stage IV includes anatomical and functional consequences of tooth and periodontal attachment loss (tooth flaring and migration, occlusal collapse, and so on) that require additional interventions after active periodontal therapy is completed ².
• The same guideline says that definitive, comprehensive diagnosis and case evaluation; relevant patient information; and frequent re-evaluation during and after treatment are critically important before planning. The interventions it covers include orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses, and supportive periodontal care ².
• In plain language: the guideline already places “reconstruction” after “getting disease under control,” with re-evaluation in between. “Do part now and part later” is not merely a compromise; it is an established treatment structure. A dentist must plan the phases and their contents for your condition.

Direction 3: temporary non-replacement needs a follow-up plan; it is not doing nothing

• With a missing tooth, the mouth continues to change. One study recorded supraeruption in 92% of participants' unopposed teeth; at 6 months after extraction, horizontal bone-dimension reduction exceeded vertical reduction ²⁴²⁵. These are summaries from KM-DENTAL-34; that card gives the complete discussion and applicable conditions.
• How should review intervals be set? A Cochrane review of 2 studies and 1736 participants found that, for adults having dental check-ups in primary care, risk-based and 6-month recall intervals made little to no difference over a 4-year period in the number of tooth surfaces with caries, gingival bleeding, or oral-health-related quality of life (high-certainty evidence) ¹⁹. It also says that recall-interval evidence for children and adolescents is uncertain and that neither trial assessed adverse effects of different recall strategies ¹⁹.
• The boundary of this evidence matters. Adult-trial participants were “regular attenders,” defined as having seen a dentist at least once in the preceding 2 years. It cannot be extended to people who have not sought care for a long time. The 2 trials assessed caries, gingival bleeding, and quality of life; they did not study how often an unreplaced missing-tooth area should be followed ¹⁹. This does not tell you to attend less often to save money or to stop seeing a clinician. It only shows that review intervals can be discussed with a clinician by risk, rather than stopped by yourself. Ask in the clinic what needs monitoring and how often during a period of non-replacement.

Direction 4: verification channels (this article gives no prices)

• The boundary of National Health Insurance coverage is written in law. Article 51 of Taiwan's National Health Insurance Act excludes “dentures, artificial eyes, eyeglasses, hearing aids, wheelchairs, crutches, and other appliances not for active treatment” from insurance coverage ²⁷. In other words, the denture appliance itself is out-of-pocket. Whether an individual diagnostic or treatment procedure is covered, and under what conditions, is determined by the National Health Insurance Administration's current “National Health Insurance Medical Service Payment Items and Payment Standards” notice ³⁰. This article makes no coverage determination.
• Fees for out-of-pocket items have authority-approved schedules that can be checked. One example is the Government Open Data Platform dataset “Taipei City Medical Fee Standards,” supplied by the Taipei City Department of Health ³¹. For an out-of-pocket item, ask the provider for a written itemized cost statement.
• A reminder to avoid a wasted trip: neither category of the National Health Insurance Administration's “Medical Device Price Comparison” search includes dentistry, so dental out-of-pocket items cannot be verified there ³⁵.
• A local government may have a denture subsidy for specified people. The example verified by this site is the Taipei City Department of Social Welfare notice “Denture Subsidy for Low- and Middle-income Older Adults” ³². It lists 3 forms of assistance—removable dentures, fixed dentures, and removable-denture repair—and specified registered city residents in low-income, low-to-middle-income, older-adult living-allowance, institutional-placement allowance, or disability living-allowance categories, with age thresholds of 55 years or 65 years depending on category. Its notes state that more than 3 consecutive missing teeth (inclusive) in the posterior region are eligible only for removable dentures, and that a removable or fixed denture device may not be applied for again at the same tooth position within 5 years from completion of fitting; required documents are announced annually ³².
• This site does not reproduce any subsidy amount. Use the competent authority's announcement for the current year ³².
• Honest limitation: this article verified only Taipei City's notice in this review ³². It did not verify whether other cities or counties have a similar subsidy, their eligibility, or their categories. Check the current notice of the authority in the city or county where your household registration is located. This article also cites no central-government programme name that this site has not verified.
• “More than 3 consecutive missing teeth (inclusive) in the posterior region are eligible only for removable dentures” is an administrative subsidy-approval rule, not a clinical indication criterion ³². A dentist must still assess individual circumstances.
• You may ask for an explanation. Under Article 81 of Taiwan's Medical Care Act, medical care institutions treating a patient must inform the patient or the patient's legal representative, spouse, relative, or related person of the condition, treatment plan, disposition, medication, prognosis, and possible adverse reactions ²⁸. When your budget is limited, state it and ask the dentist to explain a feasible treatment sequence; that is a legitimate request under this provision.

5. Risk factors and limitations

Costs of non-replacement (summarized from KM-DENTAL-34 and 2 missing-tooth reviews; this article does not repeat their full analyses)

• A systematic review and meta-analysis of 50 articles, 55 population-based cohorts, and 287 750 participants from 37 countries found that people with nonfunctional dentition had about twice the odds of impaired oral-health-related quality of life compared with people with functional dentition (pooled adjusted odds ratio 2.08, 95% confidence interval 1.72 to 2.52, I2 = 70.6%). Certainty was rated moderate ²⁰.
• A systematic review of 7 studies, 6 of which entered the meta-analysis, found that people completely without teeth or lacking a functional dentition had a 21% increased likelihood of being at risk of malnutrition or being malnourished (risk ratio 1.21, 95% confidence interval 1.11 to 1.32, I2 = 70%); the review also states that heterogeneity, risk of bias, and overall study quality limit the result ²¹.

But “replacing it” does not automatically solve everything; that half also matters

• A systematic review of 41 studies found that overall data support a positive effect of wearing full or partial dentures, versus no dentures, on nutritional status, but the direction of effect on dietary intake was unclear. It also clearly found that objective eating-function measures in removable-denture wearers were impaired compared with people with natural teeth ²².
• A systematic review of 12 randomized clinical trials concluded that prosthetic rehabilitation alone may not change nutritional status in edentulous older patients; combining dietary advice with denture treatment may generally improve dietary habits ²³.
• The honest synthesis is: missing teeth are associated with poorer quality of life and a higher malnutrition risk ²⁰²¹; replacement has a positive direction for nutritional status and enjoyment of eating ²²; but it is not a switch that automatically makes things better ²³. These are population-level associations and cannot predict an individual result.

Risks of each option itself

• Implant: technical, biological, and aesthetic complications occur frequently ⁴; periodontitis and smoking are highly suggestive peri-implantitis risk factors ⁵; long-term supportive care is required ⁷.
• Bridge: adjacent teeth need preparation ⁹; framework-fracture rates and abutment-tooth-caries incidence differ by material ⁸.
• Removable denture: increased plaque accumulation and the tooth-loss-risk issue in people with a periodontitis history ¹⁰; limited chewing compensation ¹¹.
• Temporary non-replacement: reduced chewing performance ¹¹; continuing oral changes ²⁴²⁵; and the current systematic review considers evidence insufficient to recommend a single strategy ¹.
• Shared premise: all figures above are population-level research data and cannot predict an individual result. Missing-tooth reconstruction has risks and contraindications. The actual treatment and its effects vary by person and require a dentist's assessment.

6. Checklist before your appointment (8 questions)

1. For this missing-tooth site, which replacement options are clinically feasible, and what are the limits of each?
2. If the root remains (or a root remnant remains), can this tooth possibly be retained after treatment? What are the considerations for retention and extraction ¹⁵¹⁶?
3. What is my periodontal status? Before any reconstruction, which periodontal or caries treatments must be completed ²¹⁷?
4. I smoke / have diabetes / cannot clean easily—would these conditions change the options you recommend ⁵⁶?
5. My budget is limited. Can treatment be phased? Which part must be done now, which can wait, and what needs re-evaluation in between ²?
6. If I temporarily do not replace the tooth, how often should I return for follow-up and what changes should be monitored ¹⁹²⁴?
7. What items are included in this treatment plan's cost? Could there be additional items? Can I receive a written itemization? (Under Article 81 of Taiwan's Medical Care Act, medical care institutions must explain the treatment plan and disposition.) ²⁸
8. Do I meet the denture-subsidy eligibility of the city or county where my household registration is located? Must it be applied for before treatment, or can treatment come first? What documents are required ³²?

How to find a clinic that provides this service

This site lists no clinics and does not recommend, rate or compare any medical institution.

To find a clinic that provides this service, use the following official lookup channels yourself —

they are maintained by the competent authorities and are more current than any list:

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- The Ministry of Health and Welfare's medical-institution lookup: search by city or county,

township and specialty (dentistry) for institutions that have completed practice registration.

The results show the institution's name, address and registered specialty. This is the first place

to confirm whether a clinic is lawfully registered.

- The National Health Insurance Administration's contracted-institution lookup: check whether a

clinic is under contract with National Health Insurance. This determines which items are covered

and which are self-paid, and therefore what kind of fee explanation you will be given.

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Both systems are on the respective authorities' official websites; searching for the

medical-institution lookup or the contracted-institution lookup will find them. This site does not

reproduce the URLs, because they change; use whichever entry point the authority currently publishes.

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In an emergency, do not spend time looking up lists. If your breathing, swallowing or speech is

affected, or swelling is spreading, go to the nearest emergency department.

Chinese labels to look for on the official pages

These official systems, datasets and files are published in Chinese only. The English names above are this site's renderings; on the page itself you will see the following strings, so search for these:

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- 「醫事機構查詢」

- 「特約醫事機構查詢」

- 「特約院所查詢」

- 「醫材比價網不含牙科」

Compliance note

This is health education information under Article 87 of Taiwan's Medical Care Act ²⁹. It is not a medical advertisement, does not recommend a particular clinic, and gives no amount or price range. Missing-tooth reconstruction, including implants, bridges, and removable dentures, has risks and contraindications; actual treatment and effects vary by person and require a dentist's assessment. Survival figures, complication proportions, and association strengths cited here are population-level research figures. They cannot predict an individual result or replace clinical diagnosis. This article provides no insurance-claim or legal opinion; insurance questions depend on the policy terms. Eligibility and amounts in local-government subsidy rules are subject to the current announcement of the competent authority; this site does not determine eligibility.

Every clinical statement in this article is mapped line by line to its cited source (see the sources and evidence chain below). It has not been clinically reviewed by a licensed practitioner. This is health information, not individual advice; assessment by a clinician is required.