It has been a while since I last posted a blog so here it goes:
Recently I have had quite a few patients wrestle with having to choose between a fixed (non-removable) bridge or an implant to replace a missing tooth or teeth. Both choices can look and feel great and are not removable by the patient. They but both require consistent maintenance (brushing, flossing, water pik) at home and regular cleaning at our office. Both are great solutions to the problem of missing teeth and your choice will be dependant upon many factors. Typically I will review all the factors and help you make the most appropriate choice for you as an individual.
Factor 1: Amount of bone available to support an implant: One of the huge advantages of implants is that after an extraction an implant will slow the disappearance of the bone in the extraction site since the implant stimulates the body to maintain the bone levels locally. However if your teeth have been missing for a while so there is little bone left or the quantity or quality of bone is lacking then we must do a bone graft (surgery to add bone) before placing the implant. In addition, if the implant will be too close to your sinus or nerve canal then grafts need to be considered or a fixed bridge which doesn’t have the same bone requirements is indicated. Healthy patients with jaw bone which is wide and deep are great candidates for dental implants.
Factor 2: Quality of the neighboring teeth: A fixed bridge requires that the neighboring teeth support the replacement teeth. If the teeth on either side of the space are not strong enough to support a bridge (due to loss of bone from gum disease) then implants make more sense. However, if the neighboring teeth are sound enough but they have big fillings or existing crowns, then a bridge is a logical choice since the tooth (or teeth) can be replaced and the neighboring teeth re-restored in one step
Factor 3: Location of the missing teeth: Is the implant replacing a front or a back tooth? In the front of the mouth, sometimes gums are thin and the metal implant may show through the gums. If the papilla (the tiny triangular piece of gum that is in between the teeth) is missing then implants may leave a “dark triangle” between the teeth. Back teeth are much more forgiving esthetically when considering implants.
Factor 4: Cost: Typically you will spend more for implants than for a bridge. Replacing one tooth with a bridge can run $2700 to $3500 whereas implant replacement of a single tooth (includes the implant, abutment and crown) is closer to $4000. This difference in cost becomes more exaggerated the more teeth that are replaced (i.e., replacing 2 teeth with a bridge runs $3600 to $4800 whereas 2 implants (implants, abutments and crowns can approach $8000). Patients on a budget may need to choose a bridge.
Factor 5: Time considerations: Implants generally take 3-4 months after placement before teeth can be attached to them. If bone grafts are needed, this can add an additional 3-6 months. For certain patients and special situations, implants can be loaded immediately, but this doesn’t work most of the time. Bridges can be done immediately after extraction (typically we place a “provisional bridge” the day of the extraction to replace the tooth, then wait 3 months for healing before making the “final” bridge). If you are in a hurry, bridges are a better choice.
Factor 6: Personal preferences: Many patients have a strong aversion to surgery (even though is extremely straightforward and quick) and so are uncomfortable with implants. Other patients have a strong aversion to prepping adjacent teeth for crowns (especially teeth that have no previous restorations or fillings) and so are uncomfortable with bridges. Neither is “right” or “wrong”, it simply depends on individual choice and preference.
Summary: Many factors will weigh in when choosing between a bridge or an implant. These factors will usually determine the logical choice that is the superior option for that particular patient and the particular circumstances. There are no rules, but I encourage you to discuss your dental situation with me. I am experienced in both treatments and am always available to help you make the best possible choices for your best dental health.
That’s all for now, wishing you a joyous and healthy holiday season!
Mark W Langberg, DDS, MAGD