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

km 編輯部2026-08-13About 22 min read
#證據鏈#牙醫KM#台灣#植牙

本頁是〈Do I have to get an implant for a missing tooth? What if I cannot afford replacement?〉的事實單元帳：每一條主張對應的來源、證據等級、地域與期間、原文引句與限制，逐條攤開。

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

F-Units (fact ledger)

  • F1｜confidence: verified｜basis: peer_reviewed (PMID 29476794, systematic review)｜period: PROSPERO CRD42017064851, published 2018｜geo: universal｜span: 「there is currently insufficient evidence to recommend one tooth replacement strategy over another in adult patients with reduced dentitions」「Ten articles were included in this systematic review. Of these, four were analyses of different outcomes from a multicentre randomized controlled trial in Germany, whilst one study was the pilot phase for this trial.」｜caveat: Population limit: adults with shortened dental arches/reduced dentitions (the title says shortened dental arches; the conclusion says reduced dentitions), not all missing-tooth situations. 10 studies were included; the authors state that high-quality randomized controlled trials are insufficient. Same anchor as F8 of KM-DENTAL-34; summarized here, not rewritten.
  • F2｜confidence: verified｜basis: clinical_guideline (PMID 35688447, EFP S3-level clinical practice guideline)｜period: published 2022; 13 commissioned systematic reviews｜geo: universal｜span: 「which require additional interventions following completion of active periodontal therapy」「Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment」「recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care」｜caveat: The guideline applies to patients with stage IV periodontitis, not all missing-tooth patients. This card cites the structure of treatment order, not effectiveness figures for any individual procedure. On 2026-08-06, a PubMed title-field search for periodontitis and S3 level found only 1 UK implementation in the last 3 years (PMID 40555302); this article is the current version.
  • F3｜confidence: verified (status checked)｜basis: withdrawn_publication/not_evidence (PMID 31425605)｜period: marked withdrawn 2019-07-17; esummary pubtype includes Retracted Publication｜geo: universal｜span: 「WITHDRAWN: Interventions for replacing missing teeth: partially absent dentition」｜caveat: This item records only that there is no current valid Cochrane-level conclusion for this question; none of its conclusions may be used as clinical evidence. A CD003814 version-chain search found 2 records (22336794, 2012 version; 31425605, withdrawn 2019 version); the withdrawn item is the end of that chain.
  • F4｜confidence: verified｜basis: peer_reviewed (PMID 23062124, systematic review and meta-analysis)｜period: searched 2006 to 2011; published 2012; 46 studies included｜geo: universal｜span: 「survival of implants supporting SCs at 5 years amounted to 97.2% (95% CI: 96.3-97.9%), and at 10 years amounted to 95.2% (95% CI: 91.8-97.2%)」「The survival of implant-supported SCs was 96.3% (95% CI: 94.2-97.6%) after 5 years and 89.4% (95% CI: 82.8-93.6%) after 10 years」「Technical complications reached a cumulative incidence of 8.8% (95% CI: 5.1-15.0%) for screw-loosening, 4.1% (95% CI: 2.2-7.5%) for loss of retention, and 3.5% (95% CI: 2.4-5.2%) for fracture of the veneering material after 5 years」「technical, biological, and aesthetic complications were frequent」｜caveat: Survival is not success and does not equal an individual expectation. Same anchor as F16 of KM-DENTAL-34. Under the 2026-08-06 project rule, this card's span uses the source's original word order rather than the old inverted wording in #34.
  • F5｜confidence: verified｜basis: peer_reviewed (PMID 38762079, umbrella review)｜period: searched to 2023-10; PROSPERO CRD42024512408; published 2024｜geo: universal｜span: 「None of the associations were graded as convincing evidence」「Two associations, presence of periodontitis (OR = 3.84 [95 % CI 2.58,5.72]) and cigarette smoking (RR=2.07 [95 % CI 1.41,3.04]) were graded as highly suggestive」「Eight associations, diabetes mellitus, hyperglycaemia, lack of prophylaxis, history of chronic periodontal disease, ongoing or history of periodontal disease」｜caveat: 12 articles and 41 meta-analyses were included; this is a synthesis of observational studies, so association does not equal causation.
  • F6｜confidence: verified｜basis: peer_reviewed (PMID 40512526, umbrella review)｜period: published 2025-09-26｜geo: universal｜span: 「Ten relevant patient-related risk factors for peri-implantitis were identified. While some of them are modifiable (smoking, bleeding on probing, plaque control, number of sites with PPD ≥ 5 mm, recall frequency, and occlusal overload), others are not (history of periodontitis, implant location, number of teeth lost, and systemic diseases)」「or to forgo implant therapy in high-risk conditions」｜caveat: The review itself says relative influences vary considerably between systematic reviews and can be overestimated. This card cites no effect size for a single risk factor. It is newer than F5 (2024); the 2 are presented together, not as replacements.
  • F7｜confidence: verified｜basis: clinical_guideline (PMID 37271498, EFP S3-level clinical practice guideline)｜period: published 2023; 13 commissioned systematic reviews｜geo: universal｜span: 「Once the implants are loaded and in function, a supportive peri-implant care programme should be structured, including periodical assessment of peri-implant tissue health」「Prevention of peri-implant diseases should commence when dental implants are planned, surgically placed and prosthetically loaded」｜caveat: The guideline is a procedure recommendation for clinicians. This card cites only the structural fact that implants require long-term supportive care, not a treatment-effect claim.
  • F8｜confidence: verified｜basis: peer_reviewed (PMID 25935732, systematic review and meta-analysis)｜period: searched 2006 to 2013; published 2015｜geo: universal｜span: 「Forty studies reporting on 1796 metal-ceramic and 1110 all-ceramic FDPs fulfilled the inclusion criteria」「an estimated 5-year survival rate of metal-ceramic FDPs of 94.4% (95% CI: 91.2-96.5%)」「the survival rate of densely sintered zirconia FDPs was 90.4% (95% CI: 84.8-94.0%) in 5 years of function」「A significantly higher incidence of caries in abutment teeth was observed for densely sintered zirconia FDPs compared to metal-ceramic FDPs」「Significantly more framework fractures were reported for reinforced glass ceramic FDPs (8.0%) and glass-infiltrated alumina FDPs (12.9%) compared to metal-ceramic FDPs (0.6%) and densely sintered zirconia FDPs (1.9%) in 5 years in function」「The estimated survival rate of reinforced glass ceramic FDPs was 89.1% (95% CI: 80.4-94.0%), the survival rate of glass-infiltrated alumina FDPs was 86.2% (95% CI: 69.3-94.2%) and the survival rate of densely sintered zirconia FDPs was 90.4% (95% CI: 84.8-94.0%) in 5 years of function.」｜caveat: Multi-unit fixed dental prostheses; differences by material are large. Same anchor as F17 of KM-DENTAL-34.
  • F9｜confidence: verified｜basis: peer_reviewed (PMID 23062127, economic-aspects systematic review)｜period: published 2012｜geo: universal｜span: 「Initial costs for single implant crowns and FDPs on teeth were similar, but varied between tariff systems」「Failure rates reported with single implant crowns and FDPs on teeth were similar」「The utility for the patient to keep healthy adjacent teeth unprepared makes the implant crown more economic」｜caveat: Cost systems vary by country. This card cites no amount and does not convert this conclusion to Taiwan. Same anchor as F18 of KM-DENTAL-34.
  • F10｜confidence: verified｜basis: peer_reviewed (PMID 34761421, systematic review)｜period: searched 1966 to 2020; published 2022｜geo: universal｜span: 「Two retrospective studies indicated that RDPs increased the risk of tooth loss compared to FDPs in patients with a history of periodontitis」「Several studies indicated that RDP increased plaque accumulation」「There is no strong evidence that RDPs per se will cause periodontal destruction including tooth loss」｜caveat: Data were heterogeneous and not meta-analysed; population limited to patients with periodontitis. Same anchor as F15 of KM-DENTAL-34.
  • F11｜confidence: verified｜basis: peer_reviewed (PMID 26066662, systematic review)｜period: searched 2003 to 2014; published 2015｜geo: universal｜span: 「Comminution or mixing ability in subjects with (E)SDA was 28-39% lower compared to that of subjects with complete dentitions」「distal-extension RDPs could compensate this reduction partially (some 50%)」「more artificial teeth in RDPs resulted in better performance」｜caveat: SDA = 3 to 5 posterior occlusal pairs; ESDA = 0 to 2 pairs. Few studies were included. Same anchor as F14 of KM-DENTAL-34.
  • F12｜confidence: verified｜basis: peer_reviewed (PMID 17002745, literature review)｜period: searched 1966 to 2005-11; published 2006｜geo: universal｜span: 「no clinically significant differences between subjects with shortened dental arches of three to five occlusal units and complete dental arches regarding variables such as masticatory ability, signs and symptoms of temporomandibular disorders, migration of remaining teeth, periodontal support, and oral comfort」｜caveat: Narrative review, not a meta-analysis; it mainly included work from one research group. Full shortened-dental-arch discussion belongs to KM-DENTAL-34; this card only summarizes it.
  • F13｜confidence: verified｜basis: peer_reviewed (PMID 29316570, 10-year multicentre randomized controlled trial result)｜period: published 2018｜geo: universal｜span: 「The number of teeth lost was higher than expected」「The results suggest an overestimation of the influence of the prosthetic management of the bilateral SDA」「In treatment decisions, patient preferences should be considered with appropriate weight」｜caveat: 82 of 152 people reached the 10-year examination; loss to follow-up was high. Same anchor as F13 of KM-DENTAL-34.
  • F14｜confidence: verified｜basis: peer_reviewed (PMID 37001792, systematic review)｜period: searched to 2022-11-06; published 2023｜geo: universal｜span: 「No significant difference was recorded in the nutritional status of patients rehabilitated using the SDA concept compared with RPDs」「Higher costs for treatment provision and maintenance for patients in the RPD group was found when compared to SDA treatment」「SDA therapy may be considered as a feasible treatment concept in older adults especially in those with complex medical statuses and limited finances」｜caveat: Only 4 reports (from 2 studies); meta-analysis was not possible. The cost conclusion cannot be converted into a price for any locality. The source wording is “may be considered”; this card must not rewrite it as “suitable” or “recommended,” and the population is limited to older adults. Same anchor as F11 of KM-DENTAL-34.
  • F15｜confidence: verified｜basis: peer_reviewed (PMID 40552466, systematic review)｜period: PROSPERO CRD42024584113; published 2025-06-24｜geo: universal｜span: 「Out of 1,876 initial records, 12 studies met inclusion criteria: 7 cohort studies, 4 case-control studies, and 1 randomised controlled trial」「Both RCT and DIs demonstrated high survival rates, with RCT slightly outperforming DIs in terms of success」「Failure rates ranged from 0.7% to 12.0%, with no significant differences between treatments. DIs were associated with a higher frequency of postoperative interventions and complications」「The decision between treatments should consider clinical factors, patient preferences, cost, accessibility, potential complications, and patient-centred outcomes. Shared decision-making is essential for optimal patient care」｜caveat: Heterogeneity prevented meta-analysis; results are a qualitative synthesis. DIs = dental implants; RCT in this paper means root canal therapy.
  • F16｜confidence: verified｜basis: peer_reviewed (PMID 38443242, systematic review)｜period: searched to 2023-07; published 2025-03 (electronic publication 2024-03-04)｜geo: universal｜span: 「Three included studies revealed no difference in survival rate between endodontically treated teeth and implant-supported prostheses during the first 3 years, but the survival of endodontically treated teeth declined over time with a higher failure rate than implant-supported prostheses」「In contrast, the other 3 included studies reported lower survival rate for implant-supported prostheses and more complications」「Whether implant-supported prostheses or endodontically treated teeth are better in terms of survival outcome is unclear」｜caveat: 8 observational studies (3 retrospective cohorts and 5 case-control studies); no randomized controlled trials.
  • F17｜confidence: verified｜basis: clinical_guideline (PMID 32383274, EFP S3-level clinical practice guideline)｜period: published 2020; 15 commissioned systematic reviews; PubMed notes a 2021 erratum (J Clin Periodontol 2021;48:163)｜geo: universal｜span: 「pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions」「Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time」｜caveat: Population is stage I to III periodontitis. This card cites the stepwise-treatment structure, not effectiveness figures for any individual procedure.
  • F18｜confidence: verified｜basis: peer_reviewed (PMID 33648772, systematic review)｜period: published 2022｜geo: universal｜span: 「Three studies (4396 extractions in total) could be included for the risk of bias assessment and qualitative data synthesis」「caries with the proportion of all extractions ranging from 36.0% to 55.3%, periodontitis from 24.8% to 38.1%, trauma from 0.8% to 4.4%, periapical disease from 7.3% to 19.1%」｜caveat: Only 3 studies were included. The paper also notes that non-dental and non-medical motives for extraction lack reliable estimates; this card does not cite that section. Same anchor as KM-DENTAL-30.
  • F19｜confidence: verified｜basis: peer_reviewed (PMID 33053198, Cochrane systematic review CD004346.pub5)｜period: searched to 2020-01-17; published 2020-10-14｜geo: universal｜span: 「We included two studies with data from 1736 participants」「there is little to no difference between risk-based and 6-month recall intervals in the number of tooth surfaces with any caries, gingival bleeding and oral-health-related quality of life over a 4-year period (high-certainty evidence)」「The available evidence on recall intervals between dental check-ups for children and adolescents is uncertain. The two trials we included in the review did not assess adverse effects of different recall strategies」｜caveat: A CD004346 version-chain search found 4 records (15846709/17943814/24353242/33053198); pub5 is the current version, and pubtype has no withdrawal marker. Participants were regular attenders (in adult trials, at least 1 dental visit in the prior 2 years), so it cannot be extended to people not seeking care for a long time. The review did not study follow-up intervals for unreplaced missing-tooth areas; this card must not use it to support any missing-tooth follow-up frequency.
  • F20｜confidence: verified｜basis: peer_reviewed (PMID 42131949, systematic review and meta-analysis)｜period: electronic publication ahead of print 2026-05-14｜geo: universal｜span: 「Fifty articles comprising 55 population-based cohorts (287 750 participants from 37 countries) were included」「Individuals with nonfunctional dentition had approximately twice the odds of impaired OHRQoL compared with those with functional dentition [pooled adjusted odds ratio (OR) = 2.08; 95% CI 1.72-2.52; I2 = 70.6%]」「Certainty of evidence for OHRQoL outcomes was rated as moderate」｜caveat: Most included studies were cross-sectional; association does not equal causation. epubdate 2026-05-14 precedes this card's date. Same anchor as KM-DENTAL-30.
  • F21｜confidence: verified｜basis: peer_reviewed (PMID 33345687, systematic review and meta-analysis)｜period: searched 2009 to 2019; published 2022 (electronic publication 2020-12-21)｜geo: universal｜span: 「individuals who were completely edentulous or who lacked functional dentition had a 21% increased likelihood of being at risk of malnutrition or being malnourished, as compared with those who were dentulous or had functionally adequate dentition (risk ratio, 1.21; 95% CI, 1.11 to 1.32; I2 = 70%)」「Findings were limited by heterogeneity, risk of bias, and overall quality of the studies reviewed」｜caveat: Population limited to people aged 60 years or older in developed countries; 7 studies included and 6 entered meta-analysis.
  • F22｜confidence: verified｜basis: peer_reviewed (PMID 34210202, systematic review)｜period: published 2022 (electronic publication 2021-07-02)｜geo: universal｜span: 「41 studies were included in the synthesis (14 rated good quality, 20 fair, and 7 poor)」「The balance of data supported a positive impact of wearing full (5/7 studies) or partial (3/3 studies) dentures (vs. no dentures) on nutritional status, though no clear direction of effect was detected for the impact of dentures on dietary intake」「The balance of data clearly showed that objective measures of eating function were compromised in full (14/15 studies) and partial (6/7 studies) denture wearers as compared with the dentate」｜caveat: Vote-counting and narrative synthesis; no meta-analysis; included-study quality varied.
  • F23｜confidence: verified｜basis: peer_reviewed (PMID 37837498, systematic review)｜period: published 2023 (electronic publication 2023-10-14)｜geo: universal｜span: 「Of the 1517 articles identified in the initial search, 12 were selected for the final review」「a consistent pattern of improvement in nutritional status was not observed when they did not receive dietary advice」「Isolated prosthetic rehabilitation may not have the effect of exerting a change in nutritional status of edentulous elderly patients」｜caveat: Population limited to randomized clinical trials of people aged 60 years or older with at least 1 month of follow-up; conclusion limited to edentulous older adults.
  • F24｜confidence: verified｜basis: peer_reviewed (PMID 17559530)｜period: published 2007｜geo: universal｜span: 「Supraeruption was found in 92% of subjects' unopposed teeth」｜caveat: Clinical-attender study of 100 cases plus 100 controls, not a community census. This item is summarized from KM-DENTAL-34 (the canonical card for this topic); this card does not repeat its full analysis.
  • F25｜confidence: verified｜basis: peer_reviewed (PMID 22211303, systematic review)｜period: published 2012; 20 studies included｜geo: universal｜span: 「horizontal dimensional reduction (3.79 ± 0.23 mm) was more than vertical reduction (1.24 ± 0.11 mm on buccal, 0.84 ± 0.62 mm on mesial and 0.80 ± 0.71 mm on distal sites) at 6 months」｜caveat: Limited to untreated naturally healing extraction sockets. Same anchor as F24 of KM-DENTAL-34 and KM-DENTAL-28.
  • F26｜confidence: verified｜basis: peer_reviewed (PMID 42021242, qualitative study)｜period: published 2026-04-23; trial registration ISRCTN26302774｜geo: universal｜span: 「a purposive sample of 15 older partially dentate patients」「Each patient received resin-bonded bridgework (RBB) to restore them to a functional dentition of 10 occluding pairs」「the patients indicated concern that the SDA treatment provided in the clinical study would not be available to them in a primary care setting」｜caveat: Qualitative interviews, n=15; population limited to older people who had previously joined the trial, with study sites in Ireland and Northern Ireland. Their concern about access is a local context and is not extended to Taiwan.
  • F27｜confidence: verified (2026-08-06, ego-browser page load and verbatim match)｜basis: law｜period: current text (law compilation data cutoff: ROC year 115, 07-31)｜geo: TW｜span: Article 51 of Taiwan's National Health Insurance Act: “The following items are not included in the scope of insurance benefits: ... 11. Dentures, artificial eyes, eyeglasses, hearing aids, wheelchairs, crutches, and other appliances not for active treatment.”｜caveat: Individual coverage follows the National Health Insurance Administration's current notice; this card makes no coverage determination. Same anchor as VERIFIED-FACTS.
  • F28｜confidence: verified (2026-08-06, ego-browser page load and verbatim match)｜basis: law｜period: current text｜geo: TW｜span: Article 81 of Taiwan's Medical Care Act: “When a medical care institution diagnoses or treats a patient, it shall 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.”｜caveat: Statutory quotation, not legal advice.
  • F29｜confidence: verified (2026-08-06, ego-browser page load and verbatim match)｜basis: law｜period: current text｜geo: TW｜span: Article 87 of Taiwan's Medical Care Act: “The publication of medical knowledge or research reports, patient health education, or academic publications that do not solicit medical business shall not be deemed medical advertisements.”｜caveat: Statutory quotation, not legal advice.
  • F30｜confidence: verified (2026-08-06, ego-browser page load; page title and 4-file list read verbatim)｜basis: official_statement｜period: page-listed effective date 115.07.01; updated 115.06.24｜geo: TW｜span: National Health Insurance Administration, Ministry of Health and Welfare, notice page “National Health Insurance Medical Service Payment Items and Payment Standards,” listing 4 items including a compressed payment-standard file｜caveat: This card did not download and compare files item by item. It is only a verification channel and does not determine coverage for any item.　[On the official page the label appears in Chinese only: 「全民健康保險醫療服務給付項目及支付標準」]
  • F31｜confidence: verified (2026-08-06, ego-browser page load and verbatim reading)｜basis: official_statement｜period: metadata updated 2026-07-13｜geo: TW｜span: Government Open Data Platform dataset “Taipei City Medical Fee Standards,” provider: Taipei City Department of Health; update frequency: irregular｜caveat: One-city example; before scaling, pages for other cities and counties must be verified one by one.　[On the official page the label appears in Chinese only: 「臺北市醫療收費標準」]
  • F32｜confidence: verified (2026-08-06, ego-browser page load and verbatim reading; page says data updated 115-05-29)｜basis: official_statement｜period: current page status｜geo: TW｜span: Taipei City Department of Social Welfare “Denture Subsidy for Low- and Middle-income Older Adults”: assistance forms include removable dentures, fixed dentures, and removable-denture repair; eligible groups include registered city residents in low-income, low-to-middle-income, older-adult living-allowance, institutional-placement allowance, and disability living-allowance categories, with age thresholds of 55 years or 65 years depending on category. Notes state “more than 3 consecutive missing teeth (inclusive) in the posterior region are eligible only for removable dentures” and “for removable and fixed denture-device subsidies, the same tooth position may not be applied for again within 5 years (calculated from completion of fitting)”; required documents are announced annually.｜caveat 1: This site does not reproduce any subsidy amount. Caveat 2: This is only a Taipei City example; rules differ elsewhere and this card did not verify them one by one. Caveat 3: “More than 3 consecutive missing posterior teeth are eligible only for removable dentures” is an administrative subsidy-approval rule, not a clinical indication criterion. Caveat 4: This card did not verify a similarly named central-government programme and therefore does not cite one. Same anchor as KM-DENTAL-13.
  • F33｜confidence: verified｜basis: internal_dataset｜period: 2025-03 to 2026-08 GSC｜geo: TW｜span: Backlog #35: the 6 queries “缺牙沒錢補,” “拔牙後一定要植牙嗎,” “缺牙一定要植牙嗎,” “沒有牙根一定要植牙嗎,” “牙齒掉了一定要植牙嗎,” and “一定要植牙嗎” had total impressions of 103,429 across 2 sites,｜caveat: Impressions are an asset-level figure, not deduplicated traffic. The listed clinics follow queue-page #35; do not add or remove. This is internal data and must not appear in the visible layer of the publication transform.
  • F34｜confidence: structural synthesis (editorial framework, not external factual claim)｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: The “two-question separation” and “six-condition list” are this site's communication framework synthesized from F1 to F26｜caveat: Not clinical criteria or a diagnostic tool; does not replace a dentist's assessment.
  • F35｜confidence: verified (2026-08-05, OP personally verified with ego-browser; neither full text of the two tracks contains the character 牙)｜basis: official_statement｜period: current entry status｜geo: TW｜span: The National Health Insurance Administration “Medical Device Price Comparison” site's 2 search tracks (12 categories for co-payment-difference device comparison and 8 categories for device-fee comparison) both exclude dental items｜caveat: From the site's cross-card verified-facts file (VERIFIED-FACTS.md); not retested in this card. It is used to prevent readers making a wasted trip, not as a channel for verifying dental fees.　[On the official page the label appears in Chinese only: 「醫材比價網」]

Sources

Access date for all items: 2026-08-06. PubMed records were checked against abstract wording acquired with E-utilities efetch, and pubtype was checked one by one with esummary (all except item 3 had no withdrawal marker). Taiwan official and legal pages were loaded in ego-browser and their innerText checked verbatim.

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  2. Herrera D, et al. Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol. 2022. PMID 35688447
  3. WITHDRAWN: Interventions for replacing missing teeth: partially absent dentition. Cochrane Database Syst Rev. 2019. PMID 31425605 (**withdrawn; marked non-evidence in this card**)
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  22. Moynihan P, Varghese R. Impact of Wearing Dentures on Dietary Intake, Nutritional Status, and Eating: A Systematic Review. JDR Clin Trans Res. 2022. PMID 34210202
  23. Brígido JA, et al. The effect of prosthetic rehabilitation with or without dietary advice on nutritional status in elderly patients: a systematic review. Aging Clin Exp Res. 2023. PMID 37837498
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  25. Tan WL, et al. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res. 2012. PMID 22211303
  26. Meaney S, et al. Patient perceptions of prosthodontic management options for partially dentate older adults: a qualitative study. BMC Oral Health. 2026. PMID 42021242
  27. Taiwan National Health Insurance Act, Article 51 (Laws & Regulations Database of the Republic of China)
  28. Taiwan Medical Care Act, Article 81 (Laws & Regulations Database of the Republic of China)
  29. Taiwan Medical Care Act, Article 87 (Laws & Regulations Database of the Republic of China)
  30. National Health Insurance Administration, Ministry of Health and Welfare: “National Health Insurance Medical Service Payment Items and Payment Standards” notice page
  31. Government Open Data Platform: Taipei City Medical Fee Standards (provider: Taipei City Department of Health)
  32. Taipei City Department of Social Welfare: “Denture Subsidy for Low- and Middle-income Older Adults”
  33. Internal data: appendix to #35 in `analysis/reports/km-dental-backlog.md` (query × site × impression records auditable individually)
  34. Editorial framework: this site's “two-question” separation and “six-condition” list (no external source; marked structural synthesis)
  35. Cross-card verified fact: `km-compliance/VERIFIED-FACTS.md`, “Medical Device Price Comparison excludes dentistry” (verified 2026-08-05)

Internal citation chain

  • What may change when a missing tooth is not replaced, and the full shortened-dental-arch discussion (canonical card for this question; not repeated here): Can a molar be left unreplaced after extraction? What happens? (KM-DENTAL-34)
  • Cost components, maintenance, and local-subsidy details for removable dentures: How much does a removable denture cost? (KM-DENTAL-13)
  • Cost components and how to read an estimate for fixed prostheses (bridges and crowns): How much does one fixed prosthesis cost? (KM-DENTAL-03)
  • Components and variables of implant cost: How much does one implant really cost? (KM-DENTAL-09)
  • What a resin-bonded (Maryland) bridge is and who it may suit: What is a resin-bonded (Maryland) bridge? Who may it suit? (KM-DENTAL-22)
  • How to ask about costs for multiple missing teeth or full-mouth reconstruction: How should I ask about the cost of full-mouth reconstruction? (KM-DENTAL-32)
Publication-gate reminder: this card is a draft. It may not enter km_entries until zh-Hans/en/ja all exist. F3 is withdrawn literature and must never be rewritten as clinical evidence. No F32 subsidy amount may be restored to the visible layer. F35 follows a cross-card verified conclusion and must be synchronized if VERIFIED-FACTS changes.

FAQ

If I am missing one tooth, do I definitely need an implant?
**Not necessarily.** A systematic review of adults with shortened dental arches/reduced dentitions says current evidence is insufficient to recommend any replacement strategy over another [F1]. The Cochrane review covering the broader population with partial tooth loss has been withdrawn, leaving no current valid conclusion [F3]. Meta-analysis reported 5-year implant survival of 97.2% [F4], but the same review recorded frequent technical, biological, and aesthetic complications [F4]. Periodontitis and smoking are highly suggestive peri-implantitis risk factors [F5], and structured supportive care is needed after loading [F7]. Bridges, removable dentures, and—in specified circumstances—not replacing posterior molars are all approaches discussed in the literature [F8][F10][F12]. A dentist must assess which suits you.
1 本欠損したら、必ずインプラントが必要ですか？ — **必ずしもそうではありません。** 短縮歯列・歯列縮減の成人を扱った系統的レビューは、どの補綴戦略をほかより推奨するにも現時点のエビデンスが不十分としています [F1]。より広い部分欠損歯の集団を扱う Cochrane レビューは撤回され、現在有効な結論はありません [F3]。メタ解析はインプラントの 5 年生存率を 97.2% と報告しましたが [F4]、同レビューは技術的、生物学的、審美的合併症も頻繁と記録しました [F4]。歯周炎と喫煙はインプラント周囲炎の高度に示唆的なリスク因子で [F5]、荷重後には構造化された支持的ケアが必要です [F7]。ブリッジ、可撤式義歯、そして一定の条件では後方大臼歯を補わないことも、文献で扱われる方法です [F8][F10][F12]。どれが合うかは歯科医師の評価が必要です。
If I am missing one tooth, do I definitely need an implant? — **Not necessarily.** A systematic review of adults with shortened dental arches/reduced dentitions says current evidence is insufficient to recommend any replacement strategy over another [F1]. The Cochrane review covering the broader population with partial tooth loss has been withdrawn, leaving no current valid conclusion [F3]. Meta-analysis reported 5-year implant survival of 97.2% [F4], but the same review recorded frequent technical, biological, and aesthetic complications [F4]. Periodontitis and smoking are highly suggestive peri-implantitis risk factors [F5], and structured supportive care is needed after loading [F7]. Bridges, removable dentures, and—in specified circumstances—not replacing posterior molars are all approaches discussed in the literature [F8][F10][F12]. A dentist must assess which suits you.
I truly have no money. Is my only option to leave it alone for now?
**“Leave it alone” and “defer it with a plan” are different.** In the literature, caries account for 36.0% to 55.3% of extraction indications and periodontitis for 24.8% to 38.1% [F18]. These are commonly what can lead to another missing tooth, so with a limited budget, controlling them comes before replacing the missing site. Periodontal treatment itself has a stepwise structure [F17], and guidelines place reconstruction for functional consequences after active periodontal treatment is completed [F2]. A systematic review in older adults says, cautiously, that shortened dental arch treatment “may be considered” as a feasible concept, especially for people with complex medical status and limited finances [F14]. This is a guarded, study-level statement; the population is older adults and the review included only 4 reports. A dentist must decide whether it applies to your oral condition.
本当に費用がありません。当面は放っておくしかないですか？ — **「放っておく」と「計画して延期する」は異なります。** 文献では、抜歯適応のうち、う蝕は 36.0% 〜 55.3%、歯周炎は 24.8% 〜 38.1% を占めます [F18]。これらは次の歯を失う原因になり得るため、予算が限られるなら欠損部を補う前にコントロールします。歯周治療自体に段階構造があり [F17]、指針は活動性歯周治療の完了後に機能的な結果の再建を置いています [F2]。高齢者の系統的レビューは、短縮歯列治療が、複雑な医学的状態や限られた経済的余裕がある人で実行可能な概念として「考慮され得る」と慎重に記しています [F14]。これは慎重な研究レベルの表現で、対象は高齢者、組み入れ報告は 4 件だけです。口腔内の条件に当てはまるかは歯科医師が判断します。
I truly have no money. Is my only option to leave it alone for now? — **“Leave it alone” and “defer it with a plan” are different.** In the literature, caries account for 36.0% to 55.3% of extraction indications and periodontitis for 24.8% to 38.1% [F18]. These are commonly what can lead to another missing tooth, so with a limited budget, controlling them comes before replacing the missing site. Periodontal treatment itself has a stepwise structure [F17], and guidelines place reconstruction for functional consequences after active periodontal treatment is completed [F2]. A systematic review in older adults says, cautiously, that shortened dental arch treatment “may be considered” as a feasible concept, especially for people with complex medical status and limited finances [F14]. This is a guarded, study-level statement; the population is older adults and the review included only 4 reports. A dentist must decide whether it applies to your oral condition.
If there is no root, is an implant the only path left?
**First distinguish which situation you have.** If the root remains and the tooth is severely damaged, first discuss the trade-off between retention after treatment and reconstruction after extraction. A 2025 systematic review reported failure rates of 0.7% to 12.0%, no significant difference, more frequent postoperative interventions and complications with implants, and the need to consider clinical factors, preferences, cost, and accessibility [F15]. Another 2025 systematic review said which gives better survival remains unclear [F16]. If the root truly is absent, implants, bridges, and removable dentures are all literature-discussed options [F4][F8][F10], not a single remaining path.
歯根がなければ、残る道はインプラントだけですか？ — **まず、どの状況かを分けてください。** 歯根が残り歯が大きく損なわれているなら、まず治療後の保存と抜歯後の再建の負担を相談してください。 2025 年の系統的レビューは、失敗率 0.7% 〜 12.0%、有意差なし、インプラントでより頻繁な術後介入・合併症、臨床因子・選好・費用・利用可能性を考える必要を報告しました [F15]。別の 2025 年の系統的レビューは、生存でどちらがよいかは不明確としました [F16]。歯根が本当にない場合も、インプラント、ブリッジ、可撤式義歯はいずれも文献で扱われる選択肢であり [F4][F8][F10]、残る道が一つだけということではありません。
If there is no root, is an implant the only path left? — **First distinguish which situation you have.** If the root remains and the tooth is severely damaged, first discuss the trade-off between retention after treatment and reconstruction after extraction. A 2025 systematic review reported failure rates of 0.7% to 12.0%, no significant difference, more frequent postoperative interventions and complications with implants, and the need to consider clinical factors, preferences, cost, and accessibility [F15]. Another 2025 systematic review said which gives better survival remains unclear [F16]. If the root truly is absent, implants, bridges, and removable dentures are all literature-discussed options [F4][F8][F10], not a single remaining path.

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km 編輯部・《Do I have to get an implant for a missing tooth? What if I cannot afford replacement?｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/reports/dental-missing-tooth-options-evidence

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更新 2026-08-13T14:17:27.371Z · server-rendered · four-language · IDAEO 知識庫