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 http://pvdentistry.com/fixed-bridges/
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.
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.
A bridge is the quickest way to replace a missing tooth. Start to finish, it takes 3 weeks to a couple of months.
This is a two to three appointment procedure depending on when the tooth was removed. There are two main scenarios. The first is where you start the bridge at the same appointment in which you extract the affected tooth. We prepare the adjacent teeth and place a temporary bridge and allow the extraction site to heal. The second appointment happens after at least 6 weeks of healing. We take an impression for the lab to create the permanent bridge. Three weeks later is the third appointment, where we cement the permanent bridge. That entire time the patient has a temporary bridge to replace the missing tooth, until the permanent bridge is placed. This scenario takes at least two months.
In the second scenario the tooth was removed long ago and the site has fully healed. Since no additional healing needs to take place, so we only need two appointments. At the first appointment, we prepare the adjacent teeth, take an impression and place a temporary bridge. Three weeks later we cement the lab fabricated bridge.
There is some variation in the number of appointments that an implant takes. Sometimes the implant can be placed when the tooth has been removed, and sometimes it is best that healing occurs prior to the implant placement. The healing process from the initial tooth extraction can be a few months. After the implant is placed it must be allowed to integrate for a few months prior to restoration of the implant. This largely depends on a number of factors, but usually is 3-6 months. There are some cases where the implant can be restored on the same day that it was placed with a temporary crown. These scenarios are limited, however.
There are a number of factors that lower the success rate of implants, which should be considered when making that choice. Habits, such as smoking, will significantly lower the success rate of implant placement. Also chronic diseases, such as diabetes, hypertension, other factors and diseases which compromise the immune system all lower the success rate of implants or slow down the healing process. Radiation or chemotherapy due to cancer is also a mitigating factor, but modern treatment makes this less likely to be an absolute contraindication. Finally, diseases of bone formation, like osteoporosis are a consideration, especially if you have been on a bisphosphonate like Fosamax (alendronate). It is important to have a complete health picture prior to choosing to pursue dental implants.
Bridges have less health restrictions on them and are only contraindicated in a few cases.
Sometimes One or the Other Won’t Work
Some situations don’t allow the placement of a fixed bridge. For example, if you were to lose the tooth which was the furthest in the back of your mouth, you couldn’t put in a fixed bridge because there is not a tooth on either side to attach it to. In this case, you could place an implant.
Some situations don’t allow for implant placement, and usually it has to do with either amount or quality of bone. If you have been missing a tooth for a long time, the body will sometimes resorb the bone, which means that the jaw bone slowly becomes smaller over time. If it has been years, or if the extracted tooth has decayed extensively or abscessed, sometimes there is a destruction of bone that must be grafted prior to placing an implant. This adds additional cost and time, not to mention the graft must hold in place, so the implant placement depends on the success of the graft.
If considering aesthetics, this largely depends on your individual situation. Usually either choice can be done to the highest aesthetic standard, but it depends on if there are any compromising factors.
Because an implant is a surgical procedure, it does sometimes contribute to post-operative pain requiring the use of pain medication. A fixed bridge does not have this requirement. The removal of a tooth is also a surgical procedure that sometimes requires pain medication, and usually implant placement is not worse than this procedure in terms of post-operative pain.
Because a bridge involves more than one tooth, it does put additional strain on the other teeth. An implant leaves those teeth alone.
Removable Bridge AKA Partial Denture
Finally, a word about removable bridges. There are a number of different types and styles. Because these attach to other teeth also, this can also cause some strain and wear and tear on your remaining teeth. If you are replacing just one tooth and it is in the back of your mouth, then I find that patients are not motivated to wear it daily. For multiple teeth, this is the most affordable option. Whereas a fixed bridge costs per tooth, a removable bridge is the same price whether you replace one tooth or many teeth. There are some scenarios where neither a fixed bridge or implant will work, and a removable option is the only choice.
My favorite of these options in most cases and for most people is dental implant. Both bridges and implants have a 90 to 95% success rate on average. Both have their risks as well. Because a fixed bridge compromises the adjacent teeth, not to mention the ability to still be able to floss with an implant is why I usually prefer implants. All are good ways to replace a missing tooth. Please come visit us at PV Dentistry to talk about your specific situation.
Dr. Hal Henderson
Contact us at (928) 772-8175.