Hello
This is Dr.Sherif El-leithy , well you would certainly have to close
the gap , this is because in case you don't teeth behind the gap will
migrate forward and teeth on the upper jaw ( opposing teeth ) will
supra-erupt causing a problem of mal-occlussion , you won't be able to
chew food , talk , swallow like before ,
The idea is , implants are mostly preferred and they are the treatment
of choice because they are biocompatible ( tissue-friendly ) and the
most conservative treatment , but unfortuantely the would cost more
than a simple bridge , the success rate of implants is now said to be
more than 15 - 20 years , while the success rate of bridges won't last
that period without problems I gurantee you that , In order for you to
have a bridge you have to reduce the tooth behind and the tooth
infront of the gap so u can make a 3 unit bridge containing the tooth
you lost in the middle , this is a less conservative treatment as you
have to cut into sound and normal tooth structure , do u get what I
mean !???
If you can afford implants , go for it with no hesitation
Take care
Best regards
bye

Part of the treatment option presentation should always include the
risks/benefits/alternatives and possible consequence of each option, to
include the NO TREATMENT option. If you make an informed decision to
leave the premolar space open, then you must bear the possible negative
consequences of drifting and resultant malocclusion. That being said,
your upper tooth may super-erupt and the adjacent lower teeth may
collapse/drift, in from 6 months to possibly never. No treatment is a
chance you take. I don't recall any study that prospectively evaluated
bite collapse after a tooth was extracted and not replaced, therefore
there is no time frame in which we can say collapse will occur, or if it
will occur at all. So dentists tend to go by what they actually see on a
daily basis and the consequences of what they see. My wife lost a lower
2nd molar and by the time we got around to replacing it with an implant,
only 6 months later, the upper 2nd molar had drifted downward a good
3mm, requiring me to also have to do gum surgery and a crown on that
upper tooth in order to have room to place and restore the lower implant.

For the scenario that you present, a single implant is the treatment of
choice that most dentists would want for themselves or their loved ones,
because it actually is a more tooth-conservative procedure than a
bridge, which irreversibly affects space adjacent tooth structure. Up
until the early '90s, a 3 unit bridge would have been the treatment of
choice/standard of care. Today, implant therapy has to be part of the
treatment recommendation.

Since the baby tooth had no roots, you are probably ready to have the
implant placed right now. Go for it.

    Very good question.  It's quite likely your teeth adjacent to your
spaces are in stable occlusion.  As you say, it's been that way for years.
    When a tooth that has previously been in occlusion is lost, the
surrounding teeth may drift.  This is not a uniform phenomenon though--I
have seen teeth drift quickly, I've seen them drift not a bit.  And my
predictive abilities here are very limited--unless the tooth (teeth)
being lost are already surrounded by gaps, which decreases the chances
that teeth will move.  But even then...

Steve

Exactly, does the ADA openly advertize that keeping your teeth close
together actually promotes tooth decay?

I agree, where is the science showing that all heck will break lose if
you don't get an implant. I had 4 teeth removed
7 years ago due to jaw infection, caused by that leaky filling, no
implant, no bridge, and no "drifting" or "tmj" spasms.
As an engineer I could understand the potential for teeth to drift and
bite pressures to change, but what surprises
me is the chorous of dentist voices that popped up in this thread,
warning, no-implant and your teeth will slide all over
the place! Where is one scientifc study supporting this?