Missing Tooth: Should I choose an Implant or Bridge?


Once in awhile patients need to have a tooth removed, usually due to decay or fracture. It is usually a good idea to replace that tooth. One of the biggest reasons is that missing a tooth causes the other teeth to shift into that space. Over time, that will change the way your upper and lower teeth meet together, which we call "the bite". Changes to your bite cause premature wear and tear on your remaining teeth. Replacing a missing tooth usually can be done in one of three ways: 1) dental implant; 2) fixed bridge; 3) removable bridge (partial denture). For the purposes of this discussion, I will primarily focus on replacement with a fixed bride or dental implant, but will briefly discuss reasons to replace a tooth with a removable bridge.

Defining Implants and Bridges
Let's first review what each of these are. A dental implant is a titanium post which is surgically placed into the bone of either the upper or lower jaw. This must integrate into the existing bone structure on a microscopic level. An abutment attaches to the implant which comes up out of the gums, and a crown is placed on top of the abutment. For all intents and purposes, an implant is the closest thing that you can get to replacing your original tooth.

A fixed bridge is similar to a dental crown, except that it involves three teeth: the missing tooth and the teeth on either side of the missing tooth. The missing tooth is called the pontic. These adjacent teeth are reduced in size during preparation. The bridge is made by a dental lab and cemented over these teeth. For more information on a fixed bridge, visit https://pvdentistry.com/services/bridges.html

A removable bridge, or partial denture, is something that a patient will take out every night and put back in, in the morning. Typically there are clasps to help it attach to the adjacent teeth. It is made of acrylic and blend of chromium and cobalt and typically spans the entire mouth. On the top, sometimes it must cover the palate of the mouth.

Cost considerations
There are pros and cons to both implants and bridges. An implant tends to be the most expensive option, start to finish. Several years ago, I saw a billboard advertising implants for $800. What this billboard didn't tell you, is that placing the implant is just the first aspect of the procedure. (Furthermore, I question the quality of the implant if it is that inexpensive.) Beware, because these ads only tell you the cost of the implant placement, not the implant restoration. Implant restoration is where the dentist puts a tooth (abutment and crown) onto the implant. Some insurance plans will cover implant placement and restoration.

Bridges are usually a bit less expense, but not overwhelmingly so. More insurance plans will cover a fixed bridge than will cover implants. This often makes the fixed bridge a more affordable option for some patients.

Bridges typically are a bit more effort to keep clean. With implants, you can still floss in between the adjacent teeth, but with a bridge, you need to thread something underneath the pontic (middle part of the bridge that replaces the missing tooth). Implants are more convenient to keep clean because the adjacent teeth are left untouched.

Written by: Harold Henderson, DDS November 6, 2019

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