Dr. Sam, a few months ago I had a root-canal done on tooth #3.  The dentist applied a temporary filling and said I should come back for a crown. I did not understand how important this was and the tooth cracked down into the roots. I just had it removed. What do I do now? As both adjacent teeth need crowns, my dentist recommends a bridge. The oral surgeon that removed my tooth said I should definitely get an implant. How do I decide?

Answer:

The key factors in deciding on a dental implant or dental bridge are the following:

Amount of Jaw Bone Remaining After the Extraction – Dental implants require healthy jawbone in order to last.  The bone has to adapt to the implant and the more bone available the better.  Patients that have jaw bone that is wide and deep and are physically healthy are good candidates for dental implants.

Esthetic Zone – Where is the dental implant going to be placed?  Is it a front tooth or a back tooth?  Front teeth require thick gum and papilla between the teeth to look natural.  Otherwise, the metal implant may show through the gums and look very unsightly.  Sometimes the papilla, (the tiny triangular piece of gum that fits between the teeth) is missing leaving a hole between the teeth.  Dental implants may not be the best choice if the papilla are missing or the gum is thin. 

Neighboring Teeth – The teeth next to the extracted site may already have big fillings or crowns.  In that case, the neighboring teeth can be treated and the missing tooth replaced in one procedure.  Dental bridges work very well and last for many years.  I have patients that have had dental bridges for over 30 years and forgot that they were even in their mouth because they were so comfortable. 

Cost – Generally, dental implants cost more than a dental bridge.  A bridge can be completed in just a couple of weeks but a dental implant can take months to heal in order to be serviceable.  For patients on a budget, dental bridges may be their only choice.

Engineering – Dental implants are a great choice because the missing tooth is effectively being replaced with another tooth.  All of the teeth are working.  A dental bridge requires two teeth to do the work of three teeth, which makes the engineering or foundation of a dental implant superior to a dental bridge.

Dental Bridges and Dental Implants both stay in the mouth are and not removable by the patient.

Time – For patients that have limited time, dental bridges can be completed quicker in most cases unless the patient has very strong jaw bone.  In that case, the implant can be placed and the crown can be placed immediately.  “Implants in an Hour” can be very tricky.  The patients want fast results but if the biology is violated, the patient can be in for many months of surgery and discomfort. 

Decay – Dental implants do not decay and are not hot or cold sensitive.  A dental bridge that is completed by a talented dentist will not decay nor be hot or cold sensitive either.  However, both dental implants and dental bridges fail for a variety of reasons.  The bite can be bad, the patient’s dental hygiene could be poor or the work was not completed by a highly talented and skilled dentist.

Dental Hygiene – Dental implants and dental bridges both require consistant maintenance (brushing, flossing and water pik) at home and cleaning in a dental office.  The patient can have a gum infection around the dental implant and can loose the entire implant if it is not treated early.  Gum infections around implants are generally painless, so the patient is unaware of the problem until it is too late. 

Conclusion – There are a variety of reasons why a dental bridge would be superior to a dental implant and there are also a variety of reasons why a dental implant would be superior to a dental bridge.  These reasons and particular to each individual patient and the condition of the jawbone, neighboring teeth, esthetics and dental health are the most important.  My suggestion, is to seek the advice of a third dentist, take your x-rays and get the opinion of a experienced dentist to give you the best possible choices and recommend the best dental care for you.