Thursday, April 14, 2011

Implants Vs. Bridge

The topic today everyone is implants vs. bridge.  When you lose a tooth or teeth and are going to have it/them replaced how does a dentist pick the best treatment? Well, first are the teeth on either side virgin (untouched)  then implant is a good way to go, simply because cutting the teeth on either side of the space to place a bridge is like destroying the village to save the village. A good rule of thumb is- what a dentist can do is not better than what you were born with. Cutting down untouched tooth to support a missing fake tooth usually does not make a whole lot of sense.  If the teeth adjacent to the space have boneloss then implant again. Alright what if the teeth next to the space have large fillings and lots of bone support?  Well then you have to think, will they need crowns in the future?  Then a bridge is not such a bad option. You can cover the teeth with crowns and use those crowns to support the fake tooth(pontic)  The bridge doesn't require surgery, or waiting for integration- an implant has a waiting period of 3-6 months to allow the bone to attach to the implant called integration, so it takes a while to finish up the case. The work around for getting implant teeth faster is- immediate load implants which mean that the implants are placed and a provisional (temporary) crown is placed on the same day but not placed in the bite. Nice, walk in with a gap and walk out with a tooth then wait for the bone to heal and get the permanent crown cemented.  In this situation it is important to pick your cases carefully or else the the bone won't grow properly and the whole implant will come out. A permanent bridge goes from start to finish in weeks not months. As in everything else there are downsides to a bridge.  I think the biggest problem is the spot where a tooth was taken out.  When a tooth is pulled there is no tension on the bone so the bone starts to resorb(shrink) unfortunately the bridge tooth stays the same creating a gap  between the fake tooth (pontic) and gum.This is where food will get caught which brings me to the possibility of cavities because the fates of the teeth are now intertwined lose one supporting tooth(retainer) and the whole bridge might be lost.