When a patient loses a tooth and needs to have it replaced, they have a choice to make. There are four basic options in this situation.
First, they can do nothing. The upside to this is that it doesn’t cost anything. But the downside of this can be significant. The worst being that teeth can move into the missing space and tip bad enough to make them useless as far as chewing food goes. Also, if the tooth is in the aesthetic zone, it will affect the patient’s self-esteem. Depending on where the tooth is, this is unacceptable to most patients.
Second, they can have a removable prosthesis made. This is also known as a partial denture. It’s a fake tooth connected to some kind of framework that attaches to the other teeth around the missing tooth. The upside to this option is that it’s relatively cheap. The downsides of this option are that its bulky, food will get caught in it, and it doesn’t look very natural. It also limits the ability to chew and is uncomfortable to wear. For most people, this isn’t a good option.
The third option is a fixed bridge. A fixed bridge is a fake tooth connected to one or more crowns that attach to the teeth adjacent to the missing tooth. This option is much better than the first two as it solves some of the issues they have. It will adequately and permanently replace a missing tooth so that the patient can chew food and it will usually provide a nice aesthetic result. It does cost more than a removable prosthesis, but it’s initially not as expensive as an implant. However, if a more detailed cost analysis is done it usually turns out to be more expensive than an implant over the long term. This is because of tooth decay and the longevity of the bridge. A bridge will statistically only get 15 years of use before it will need to be replaced. Some bridges may last up to thirty years, but others may only last five years. If a bridge is only replaced one time, it will end up being more expensive than an implant. Also, the chance of decay along a margin of a bridge increases with age which means that it’s longevity will go down.
The fourth option, which is usually the best one, is an implant supported crown. The upside to this is that it’s the most functional and natural way to replace a tooth. It works exactly like the original tooth in that it’s connected to the bone instead of the teeth around it. This means that it also doesn’t compromise other teeth the way a bridge does. It doesn’t get food caught under it like a partial denture or even a bridge can and it feels more natural while chewing food. Another huge benefit is longevity.
Dental implants are biologically compatible replacements for missing teeth. The difference between an implant and other restorative dental procedures is that implants replace the root of the tooth and are integrated directly into the bone of the jaw. Other restorations only replace part of the tooth where an implant will replace the entire tooth. What this means is that implants are not subject to tooth decay.
This can’t be said for a crown or a bridge on a natural tooth because there is always an interface between the restoration and the natural tooth. It may be below the gum line, but it’s still there. And while the material that makes up the crown or bridge can’t decay, the natural tooth under it still can. This is why the life expectancy of a bridge is less than fifteen years. Also, the margin between the crown and the natural tooth has a much higher chance of developing tooth decay than the tooth would if it didn’t have a crown.
As I mentioned, the chance of developing decay along the margin of a bridge increases with age. This is due to the fact that as we get older, we produce less saliva. This is significant because saliva is the main defense that we have against tooth decay. We even produce saliva at the gum line, which prevents tooth decay from forming in this critical area. So because tooth decay is much more likely to occur at the margin of a crown or bridge, without a healthy production of saliva, the chances of having tooth decay under a crown or bridge goes up even further and lowers the life expectancy even more of that restoration.
Replacing a bridge due to root decay will compromise the natural abutment teeth even further. This may mean that they will need root canals or even need to be extracted. All this means that the ultimate cost to benefit analysis of an implant over a bridge makes the implant much more affordable over the life of the patient.
I use the analogy of buying a new roof for your house whenever I explain this to someone. If you were going to live in a house for thirty, forty, fifty or even sixty years, would you buy a fifteen-year roof if the cost was a little less than a lifetime roof? Because you can’t move out of your body and into a new one, this analogy becomes even more relevant. Over a lifetime, implants are much more cost effective, even for people who are older.
The only real downside to implants is the surgery and time involved in having them placed.
It has taken decades to perfect the process of placing stable and predictable dental implants. Today the success rate of dental implants is well over 90%. The story of dental implants goes back to a Swedish physician researcher by the name of Per Invar Branemark. In 1952, Dr. Branemark was studying how blood flow affects the healing of bone in rabbits. As part of his experiment, he placed titanium optic cylinders in the bones of rabbits. When he was finished with his experiment, he found that he was unable to simply remove these cylinders because the bone had fused to them. He called this phenomenon “osteointegration” and quickly realized that it could be applied to dental implants.
Because bone is living tissue, it is constantly regenerating itself. This is how broken bones are able to heal and the reason that osteointegration takes place. But it takes time for an implant to become osteointegrated. The process of placing an implant involves drilling a small hole in the bone and then placing the titanium implant cylinder. If the cylinder doesn’t move, the bone will grow around it in about three to four months.
An implant that has successfully osteointegrated is very strong but one that hasn’t is not and so great care needs to be taken during the first three months to not allow the implant to move. So-called “same day” implant procedures need to provide a way to stabilize the implant to prevent movement during the healing phase of treatment. Connecting four implants together with a denture framework is one way to accomplish this.
Complications of implant surgery include but are not limited to infections, bleeding, nerve damage and sinus issues. Today we have the ability to image the patient in three dimensions with a machine called a Cone-Beam CT machine. With the images of this machine, we can greatly reduce the complications with implant surgery. We can see where the nerves and sinuses are and accurately place the implants in solid bone making the surgery safer than ever before. We use this information to make a surgical guide that allows the exact placement of the implant so that the surgery will avoid complications and the implant will function more effectively with the planned restoration, be it a crown, bridge or denture.
Dental implants can be used a number of ways. For patients who wear complete dentures and have no teeth, two implants can be used to significantly stabilize the dentures. This will keep them from moving or falling out. If four implants are placed, the denture can be permanently attached to them. This procedure has greatly improved the lives of those who wear dentures.
As I mentioned earlier, implants don’t decay. But they’re still susceptible to gum disease. This is called peri-implantitis and can cause the loss of implants. This is why patients who have implants still need to keep them clean. Smoking is another risk factor and can cause peri-implantitis.
Of all of the ways to restore teeth, dental implants have been the most exciting due to their predictability, durability, and capability. There is almost no reason today for a person to suffer without the use of their teeth.