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Batsheva, a dental implant patient from New York, asks us:
I am in my late 40’s, and am missing tooth #13, #14 is a root canal, and #12 is a healthy tooth. I look terrible with the missing tooth, but am very afraid of doing a dental implant.
I recently went to a top dentist in New York and asked him to make me a bridge. He told me that in this day and age it as absolutely ridiculous to have a bridge, and to shave down a healthy tooth when one can have a dental implant. However, I worry about the long term health ramifications of implants, i.e. the metal in the body, complications, etc.
Granted that for some people dental implants changed their lives for the better, and it all depends on the circumstances, but what is so wrong with a bridge in my situation? Is there truly such a huge benefit for dental implants over a bridge? Thank you for your response.
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78 Responses to “ Bridge or Implant? ”
Dear Batsheva:Did your dentist
advise you of risks? Well, if not, I will. You should know that if that implant fails due to improper placement, nerve injury, peri-implantis, bone loss, etc. it might need to be extracted. When it is extracted you may lose a good portion of bone and healthy teeth in the near-by area. This can happen once the implant integrates with the bone. Problems can develop even years after implant placement. Why the dental profession is placing implants knowing they will cause damage if removed is beyond me. If more people were aware of the risks, you can be sure there would be less money made on implants.
They can remove a pace-maker but can’t develop the science to safely remove a dental implant. Good luck! I’d go for the bridge.
Dear dental implant patient,
I totally disagree with the above statements that implants actually do damage when removed.
Little history on implants, currently over 60 companies produce dental implants, and most are in their 4th or 5th generation of manufacturing. The success rates are 92-98% depending on who you read in the literature. The first implant placed was about 30 years ago, and still in use today.
Now to address your fear of implants, it natural to fear something that is foreign or unknown, hopefully after reading this and having a consultation with an experienced surgeon you will be better informed to make a decision between a bridge and implant.
FEAR OF IMPLANTS AND LONG TERM IMPLICATIONS
Titanium is the major component of implants, depending on the manufacturer, it can range from 96% to 100% titanium. There are different alloys added for properties that are superior to “pure” titanium. This the driving point,
THERE HAS BEEN NO DOCUMENTED CASE OF AN ADVERSE REACTION TO IMPLANTED TITANIUM.
In medical literature, titanium has now replaced stainless steel when repairing bony fractures due to the fact that titanium and bone are very compatible. Bone will actually grow over titanium hardware implanted to repair lets say a jaw fracture. Therefore I high doubt that you will have any long term complications from implanted metal, especially titanium.
Your dentist is absolutely right about his opinion of bridge versus implant treatment options. Implants are here to stay in the modern era of dentistry and will become the gold standard if not already for single tooth replacement.
To the above comments of potential bone destruction. With any inflammatory (ie, abscess, periodontal disease, root fracture, peri-implantitis) reponse you will get adjacent bone loss. Hopefully with regular dental visits, you would catch wind of these processes before they cause extensive bone destruction. These process also cause symptoms, mainly pain, discomfort and occasional swelling and difficulty chewing. With implants, the symptoms maybe absent, so it is imperative that frequent check ups are followed. The old say of an ounce of prevention is worth a pound of cure is applicable to dental implants. Being proactive rather than reactive will allow you to make better choices, not just with dentistry but your overall health.
In brief, I will list ADVANTAGES and DISADVANTAGES of IMPLANTS.
ADV:
1) It does not rely on other teeth for support, therefore not “damaging” pristine tooth structure.
2) It is a reversible procedure. If for whatever reason you decided that you dont want the implant anymore and a bridge instead, you can take the implant out and the bone will regenerate. Whereas if you went with a bridge first and then an implant, the “prepped” teeth would still require crowns.
3) Long term viability is very good to excellent.
4) Finances, the implant restoration will cost less versus a bridge over a few decades. Imagine if one of your anchor teeth was damaged to the point where the bridge is failing, you would have to pay for a new bridge. Depending on the bridge and the stability of the adjacent teeth, you may look at a few replacements in a lifetime assuming you live to 79 years of age (mean life expectancy).
Again this is off the top of my head, so this list is by no means all inclusive, I’m sure there are other ADV that I am not thinking of right now.
DISADVANTAGES
1) Time, it takes a long process when compared to a bridge from start to completion. From extraction to healing to implant placement and osseointegration, it can be as long as 8-9 months before you get a functional crown.
2) Surgery, everyone that I’ve met dislikes the idea of surgery.
3) Higher maintenance, because of the intricate pieces and parts, close observation is needed. Sometimes parts and pieces do malfunction. I believe that your choices of a dentist are limited to those who are more experienced with implants. Implants are not a be-all end all type of restoration. In good hands, it will be the best treatment option for a single missing tooth.
4) Cost, initially the cost of an implant will be higher than of a fixed bridge. If this is your only deciding factor, I would consider visiting a few offices to get a sense of what is a nominal fee and what is excessive. Remember each office is different in what they offer, so strictly calling and shopping around is something I discourage.
MY TWO CENTS
As dentists, we are opinionated by what we experience. Because every dentist has their unique insight and experience, you will get very different opinions about this topic. Some will say a bridge is equally effective as an implant, others will agree with your dentist, like myself. However, this decision is ultimately up to you. Now consider the profession of dentistry as an institute of TRUST. You did not go to dental school, (nor did you want to), therefore you are “TRUSTING” your dentist, what they would do considering all the factors that go into a decision. The more honest and forthcoming you are about what concerns you will allow your dentist to make the best recommendation for you. You obviously know that we can not explain every intricate physiological process of a certain condition in a consultation appointment for 30 minutes when we all went to school for 4 years with many more years of clinical experience. Hopefully you have gained something from reading this and will be encouraged to explore the option of dental implants further.
I thank you for your time.
I too disagree with the first posted response. I would like the poster to explain what type of nerve injury one might expect when placing an implant fixture in the area formerly occupied by tooth #13?!?
Batsheva,
Ultimately the choice is yours to make and when you have done some research you will be able to give your “informed consent” to treatment. Prior to the early 1980’s implants were not a readily available option and the bridge would have been state of the art dentistry. Things have changed since the 1980s but what hasn’t changed is the concept that it is your body and your decision to make. From a dentists point of view it seems a shame to cut down a healthy, never restored tooth to help support a bridge when an implant will likely be quite successful. On the other hand, the other end of your bridge is on a tooth that has had root canal therapy and should ideally have a full coverage restoration. Perhaps the middle ground is to have your bridge, configured with a full crown on #14, a pontic at #13 and a conservative inlay at #12. This would have been the choice of many quality practitioners prior to about 1990 and is still a very acceptable, quality restoration today. If your dentist won’t provide this service to you and insists on an implant, perhaps it is time to seek out a new dentist who listens to all your needs and is open to all quality options.
Batsheva,
I can tell you both from being and individual working in the implant industry and an implant patient myself (I got my implant when I was 35) I would never go for a bridge only if there was a medical reason for it (systemic contraindication)! My implant is replacing tooth No. 13, the abutment and temporary was placed after 6 weeks, the final crown went on 2 weeks later and I am totally happy with it. It treat the implant like a regular tooth - brushing, flossing, cleaning everything is the same. The surgery was not an issue at all. I have talked to so many people who have not had the option of chosing an implant over a bridge and ALL of them told me that they would have gone for an implant if they had only known about their existance and advantages. Those advantages are mentioned in comment #2 and there are many more, such as reduced boneloss due to the fact that the tooth root is replaced, which helps stimulating the surrounding bone.
If there is no medical contraindication for you, get the implant restoration it is your best choice!
Batsheva: Happy to see professional responses to your query. I am not a professional; just someone who did a lot of research prior to opting against dental implants. Post #4 inquired as to what type of injury one might expect from placing an implant in #13.
Nerve injuries most often occur in the mandible area (lower jaw). You are considering an implant in #l3 which I believe is maxillary area (upper jaw). Sinus punture is a risk when placing maxillary implants.
This type of injury is quite painful and irreversible. I suggest you visit a website entitled “Nerve Injuries from Dental Implants” prior to making a decision. Also, check the credentials of the professional who will be performing the surgery. You want a good placement since placing an implant too close to a vital structure (an adjacent health tooth) You may also lose that tooth if something goes wrong with the implant. Good luck! I still recommend the bridge.
Batsheva, Sorry that my last two sentences contained some gramatical error. I was attempting to emphasize the importance of not placing an implant too close to a vital structure such as a healthy adjacent tooth. If something should cause the implant to fail and necessitate extraction, the healthy tooth will be lost along with the implant. Again, good luck!
Bridge will most likely need to be re-done at least one time. This will be more more costly from both finances and tooth structure lost. I would choose the implant in my own mouth.
Why would you have to have a bridge redone? What are the most common reasons for bridge failures?
I had 2 dental implants in place for only 7 years that got infected and were removed. I didn’t lose my adjacent teeth, but I ended up with some bone loss. I am currently contemplating either going with a bridge or the process of building up the bone and gum tissue to try implants again. I really don’t want to grind adjacent teeth for a bridge and I’m afraid of bridge failure and the possibility of losing more teeth (is this very common?) I’m concerned with the possibility of abutment tooth decay, etc… Any thoughts would be appreciated.
My understanding of this issue is based on statistics gathered by others rather than personal experience. They tell me that the average bridge lasts about 15 years. They are estimating that the average implant supported crown will last about 45 years. This estimate is based on and extrapolated from early failure rate data; obviously, implants have not been in use long enough to observe the failure rate at 45 years. The issue of relative longevity makes the decision a virtual no brainer for my money.
The idea of taking a one tooth problem and turning it into a three tooth problem also bothers me. It has been pointed out that things can get ugly when implants fail. Granted. Things can get ugly when bridges fail, too. When the bridge fails, what are the chances of the teeth needing root canals or needing to be removed? We have statistics on these things, and they are a bit on the ugly side. What are the chances of bad things happening to the adajacent teeth if they are left untouched rather than incorporated into a bridge? This statistic turns out to be a happy one! All these questions need to be given thought before a decision is made. I have just made the switch from the pro-bridge position to the pro-implant position on this issue based on these data.. I hope this helps.
Bob Koons
www.mastershanddental.com
I also had to have an implant extracted after just a year.
My OS placed the implant too cloae to the next-door tooth and the implant also broke through the aveolar ridge. I ended up losing the implant, next-door tooth, and a great deal of bone. It was so hard to find a doctor who was willing to remove the implant and help me. My OS was in such a hurry to put it in but didn’t want to help me get it out even though I was in pain. My insurance would not pay for the surgery because they don’t cover implants. This is something I never thought could happen. Now I am out money. You have lots of information here. Poster number two is right. You must arm yourself with information. It is important to know the pros and cons. After all, you will live with whatever you decide. Please also bare in mind, that just because this happened to me, does not mean it will happen to you.
Bridges are re-done because of:
recurrent decay around supporting teeth, root canal treatment needed on supporting teeth, porcelain fracture and breakage, root fracture.
Mr. Batsheva - Don’t let your dentist pressure you into a dental implant. If you want a bridge then go for it. Dental implant sounds more
risky. My mother had a bridge for many years and never had a problem. Before you have the implant find out if your insurance company will cover the surgery and God forbid any complications after. You don’t want to end up like the poor soul who previously posted. The guy or gal couldn’t find a dentist willing to help him,
lost an implant, a good tooth, bone, a broken jaw and money. I’m not even sure that the ADA recognizes dental implants. That’s probably why some insurance companies won’t cover them. If it were me, I’d have the bridge. It sounds safe and to me it sounds like you really want it. Don’t let anyone pressure you. Stay well.
I’m a dental assistant and have seen an uprise in injuries resulting from dental surgery. Most involve root canals and dental implants. This prevalance may be due to the large number of patients our surgeons try to treat on a daily basis. Many procedures require a great deal of time on the surgeon’s part. I love my work and feel awful when I see people in pain. They trust us and we must help them. As far as
Batsheva is concerned, he must ask questions and make sure he is given the utmost care.
Whoah, what a nightmare. Forget the implant and stick with a bridge. Safest choice.
Health is more important.
Every person is unique, as well as their maxillofacial anatomy. Do not compare results without looking at the fine detail and pertinent factors and variables of each particular case. All implants are not created equal.
Again, its obvious that experienced dentists/surgeons place better implants than dentists/surgeons without training or experience. Not all dentists/surgeons are created equal.
It is so sad to read the opionions of some dentists opposing implants (I can clearly see they have basic dental education and tons of weekend courses). Unfortunately, if they placed implants, they would have a different opinion about them.
The opinion of nerve damage in area of # 13 is not correct (poor anatomy knoledge). What about sinus perforation causing a very painful and irreversible damage (obviosly, this person does not know about implant surgical techniques and sinus? Or damaging the tooth next to the area where the implant was placed? you have to be taking pills.
All these problems can be avoided by going to specialists or experts general dentists with experience in surgery. If you go to the local dentists who advertise in the supermarkets or offer you a coupon for a free whitening, you most likely experiece all the above problems.
Surgery can not be learned in three weekend courses. You learn from watching, operating with other doctors and of course studying. This is one of the reasons why specialists have more knowledge about surgery.
In America, the new trend is “do everything yourself” or if you don’t know how or could not learned at the LVI, just do not recommend it because you will not make money”.
Ignoring dental implants with 40 years of human and animal research is not only returning to the 1900’s dentistry but it is irresponsible and may have legal implications in the informed patient.
One of reasons why the newest techniques in dentistry are developed abroad is because of the respect of health providers for education (Germany, Switzerland, Italy and even Brasil.
It is time to respect knowledge and research and put aside office expenses and personal desires.
I strongly recommend this patient to go to dental schools and ask for referral to reputable practitioners in the community. Most likely, they do not adverse in local magazines and drive Mercedes Benz.
I had an implant placed for my left front tooth 10 years ago. 5 years afterwords, the screw “backed out” and the dentist I went to used some type of glue to resecure the implant. Now I it appears that I have bone loss but the implant hasn’t “failed”. My new OS wants to go ahead and remove the implant and do a bone graft. Since my implant hasn’t technically failed, should I go ahead and have it cut out or get as much use out of it as possible and let the implant come out naturally? I am also up in the air about whether to go through the 1yr-2yrs for a bone graft and reimplant or just opting for the bridge. While I understand the implan is best if everything works out fine, if it doesn’t work out, a huge problem is trying to find someone to fix your problem. Two dentists wouldn’t even touch it and I had to wait forever to see an OS. Likely to not have that problem with a bridge, but at 27, I’m looking at having to have the bridge redone 3-5 times throughout my life! Ahh, decisions, decisions.
My god I had recently got three implants for two missing molars and stitches are yet to be removed. before getting it done I had came accross only the success stories but such severe failures, now I am in doubt what will happen with me , as I am already feeling my adjoining tooth to be a lttle tight after the implants are placed.
Dear Harsh, Same thing with me. Prior to implants all I read or heard was how great dental implants were. Well for some I guess that’s true but for me it was not. My problem is similar to the poster who encountered pain some time after implant was placed. For me, I lost more than one tooth, I lost two, a lot of bone and I’m still in pain after having two implants removed. In fact, I can no longer smile because my front teeth which were implants are gone. Now I will have to wait to graft and possibly have a denture.
Harsh, I wish you luck.
Logical Solution: a) Root
Canal with crown - least invasive b) - Root Canal with crown and bridge or crown w/bridge - least invasive c) -Dental Implant - Invasive. Why not go for a or b and if not satified you can always go for c. However, if you go for c you, in all likelihood, will not be able to go for a or b. Simple and sensible.
At the very least your dental insurance will cover a and/or
b but not c.
How in the world can dental professionals refuse to treat an implant patient who is having problems? Isn’t it their job to help people? There must be an organization that can look into doctors who refuse to treat patients. Perhaps a major news network would be interested in your stories.
Interesting to note that all the posts by “dentists” against implant use are unsigned.
Implants are rapidly becomming (if not already considered) the “standard of care”. In the hands of experienced, ETHICAL practitioners, they are the treatment of choice. I have 2 and my wife also has 2. The benefits far outweigh the alternatives.
Dr. Moskowitz, Interesting indeed! How would you feel if your wife was injured?
Do you have any idea what nerve pain feels like? Would you enjoy waking every day knowing you will be in agony 24/7. Also, imagine being on medication with horrendous side effects indefinitely. Think about the potential for organ damage as the result of medication (kidney or liver failure). Although I admit there is much to be gained monetarily, there is also a risk of a person’s quality of life being destroyed. Also, why do you think most insurance companies refuse to cover dental implants?
Dear Dr. Moskowitz: Kindly
refer to “Numbness After Implant Placement” in August
Blog. Note that the responder in the last post is a dental professional who appears intelligent and objective. Sincerely, JM
Dr. Moskowitz: If dental implants are the “standard of care” as you say, why is it that the ADA does not recognize them. Also, why is it that most insurance companies will not cover expenses for dental implants?????
There is always the top and bottom half of the dental class. I see both ARE out and commenting on this one.
As a health care professional after careful diagnostic assessment of the patient I develope a rational set of treatment stratagies that best suit this patient using best available EBD for this particular patient at this particular time.
In simple terms the outcome assessments are discussed and I listen to the patient. I try too remain as unbiased as possible and allow the patient to make a decision.
In the above matter relating to the left side of this patients mouth using an FPD from 12-14 is an option for the 70″s, but in a healthy person is clearly the wrong choice. ONCE YOU CUT DOWN A TOOTH IT IS WEAKENED FOR EVER.IT IS STULTIFING TO SEE THAT ADA APPROVAL AND INSURANCE APPROVAL IS EVEN MENTIONED . DO WE HAVE SUCH A LOW VALUE FOR TOOTH SUBSTANCE? Once we start with a 3 unit fpd we are starting the cycle of dentistry for the rest of this patients life. We have all seen this. We see a large alloy and there is an overhang and its been symptom free for years. The next step is to push for full coverage. Then in a couple of years the Endo and the post core which after GCL now further weakens the tooth and it later gets a fracture from the load transfer from the post. The tooth is now lost. Origionally it was OK. Sometimes the enemy of good is better! With the wise use of a STR much of this DEMOLITION DENTISTRY can be avoided. Please accept the fact that we understand the risk/benefit ratio with any mode of care.
As far as the ADA is concerned it is now a requirement that students in most schools do and offer 2 implants with the FLD case presentation. I assume the schools are ADA approved programs.
I trust that the above comments will be accepted as my feelings regarding diagnosis and treatment vs. outcome assessment. Then allowing the patient to develope their concept and be party to the decisions making.I feel deeply regarding the products of my mind and how these thoughts are construed in the good sense of the words only.
Are root canals safe? It seems that there is something wrong with every option! I have read so many scary things about root canals too…I am in my early 30’s and have a few molars that need root canals or implants-maybe I should just go for a partial denture as it seems every option can cause serious problems?
My mother had 3 root canals done at one appoinment. She was 53 when she had them done. She is fine now.
A bridge sounded safer. I have also heard about shaving down the abutment teeth for supports of bridges. I have know some people who have bridges for over 20 years. The key is to maintain good oral hygien such as; brush, floss, mouth wash and see your dentist 3-4 times per year so that they can spot any problems before all the decay causes you to lose the abutment teeth. This is the same with whether your teeth are natural, crowed or veneered. Oral hygien and regular check up by the dentist will prevent the issues. KEEP IT CLEAN.
I am a bit conservative over implant is because it is too invasive (surgically). Also, there is no long-term study on the effects…as some of you might agreed with me that back then when implants are done, they are done on senior generation. Today it is much more popular for younger generation…this might give us enough data and years to see the long-term effects. Also, if you read blogs on this website about “Cement vs. Screw Retetion”, Don Callin did mention about the bacteria which will be gathered under the abutment of the implants…an area where it is hard to clean…and haven to gather bacteria, pathogens because it has food, air and water.
I am currently considering the same choice. I am chosing a bridge since one of the adjoining teeth is chipped and the other is not quite symetrical with its opposite neighbor. A bridge would seem to correct all three teeth and be far less expensive, let alone the potential risk of implant problems. I am 62 years old and I am not too worried that the bridge won’t last 45 years. Even if I get 15 years, I’ll be thrilled.
In Summary,
all patients are different
all dentists are different
Some patients will be better with an implant whilest others may be better off with a bridge or denture or having a gap.
You need to be seen by an informed dentist or even a specialst. They will assess your individual case. You need to ask the dentist for both the positive and negative aspects.
No procedure is without risks, ask them for their back up plan, at least this will give you an indication of how well they think things through.
Ultimately it is the patient’s decision after being correctly informed. The severe risks mentioned above would be very rare in competent hands and you can ask the dentist for a referral to a specialist if you are concerned.
In 1966 at 14 yoa, a month before I would get braces, I became ill, fainted, fell on my face (literally) and lost 8, 9, 10, 11. I wore a temporary partial (plastic thing) until age 24 when the AF provided me with a metal bridge. This I am still wearing (31 years later). I talked to my dentist about replacement when 2 of the 3 clasps broke. We talked implants. Probably 3 with a smaller bridge for the 4th tooth. During implant surgery last Thursday, I developed excessive bleeding and could not continue. My dentist stitched me up, now I’m recovering for about 3 months while the bone and tissue heal. He will refer me to an OS and I’ll determine to continue with another 8 months of dental work or go back to the bridge. I may not have enough bone to support the 3 implants.I’ll keep you posted on my recovery and decisions. I want the implants and have been saving for a year. Yes it was/is painful and uncomfortable, but I prefer to think of long term benefits.
I just spent the entire day between my dentist’s office and the referred oral surgeon’s office after finding out that I had 2 teeth fractured (#6 and #18). Never had a problem with my teeth and probably have caused the fractures by biting on some nuts. My dilemma is now choosing between a partial bridge and dental implants. I stumbled over this site by chance. I am definitely going to do some more research before I make my decision, although I’m leaning toward the partial bridge from what I’ve heard so far.
I’m in need of either a bridge or an implant on both the upper left and upper right side and have spent the last few days investigating on the web to be able to ask intelligent questions of my DDS.
Some points to make here: First off, I’m skeptical of any “dentist” posting above who has 4 to 8 years of college education and can’t spell or write correct grammar. One instance above is to, two, too, which I believe we all learned in the fourth grade.
As far as insurance goes and what they will pay for, I don’t believe this has any bearing at all as far as what is best for us as a patient. We all know that insurance is big business that is interested in collecting premiums and paying out the least amount of money possible.
There are also horror stories from any type of procedure be it a tune up on your car, something as simple as a wart removal, corrective eye surgery or an implant. I had been contemplating eye surgery for years to correct my -6.50 vision while my eye doctor said wait. He changed his opinion when LASIK became established and I had this done six years ago. I still see 20/15 out of both eyes and am extremely satisfied but am glad I waited a couple more years and I made sure I went to a competent doctor who had a lot of experience in the field.
Everything else aside, I see two outstanding issues with bridge vs. implant. Done correctly, an implant will maintain healthy bone structure while a bridge will not. A bridge will definitely need to be reworked if you plan on living more than 15 years. Whether you take care of your teeth and still have problems with them or you have problems because you don’t take care of them, you will still have issue in the future that need to be dealt with unless the tooth fairy comes by and magically makes your teeth impervious to decay. (I for one brush at least twice a day and floss a few times a week and still am helping put my dentist’s kids through college.) Eliminating an injury, and most of the time tooth loss is not due to injury, if you get a bridge, you’re going to eventually have problems with the support teeth and need to have them redone at which time you will need a new bridge built. I for one have a few crowns and already one has needed to be reworked. Waiting until then and deciding the implant was best may now require much more surgury due to bone loss around the missing teeth.
While the implant may be a newer procedure, it seems to be better in the long run. The key would be that it is performed by someone competent rather than the dentist that advertises on the back of a Cracker Jack box.
This was just a few observations on my part. I have in no way decided on which is best for me yet, but will continue to do more research along with getting a couple different opinions once I have my x-rays in hand.
Hey all, back to the implant vs bridge discussion…
I’m 25, and have a failed root canal on my back lower molar (last before the wisdom tooth) due to infection. The tooth will need to be removed (as redoing the root canal or attempting an Apisectomy will not work as the infection is too serious). I now have the choice of a bridge or implant. A highly regarded oral surgeon in Germany (who is conveniently also one of my best friend’s dad)has said that he would like to do a bridge rather than an implant. Do you always need to crown the adjacent teeth for a bridge? In my case, they are both healthy Also, the back adjacent tooth is a wisdom tooth that is only about a quarter out. Is there any reason to do a bridge in this case rather than an implant? In fairness, he hasn’t actually seen my teeth yet, I only sent him the X rays. I was just surprised that he suggested a bridge rather than an implant, which would seem to leave the other teeth untouched. I’ve read the posts above and there appears to be a majority of people leaning towards the implant. Any thoughts or comments would be much appreciated.
Dear Marco
A bridge of 3 PFM units needs 2 abutments teeth: first lower molar and the wisdom who seems semi-impacted and maybe tilted mesialy so short life-time due to periodontal envolvment and the preparation of a full PFM crown on your 1st molar would maybe induce a RCT treatment.
Go for the exo of the 2nd molar and after a healing period of 2 months ask for 1 implant of a minimum of L=10mm in the extracted site. It can be done in 1 or 2 surgical steps, it depends on your implantologist and the trade mark of the implant. Strauman ITI standard-plus Swiss implant allow 1 surg step
feel ease to call me back.Good luck
Dr Elie Victor Warde
elievictor.warde@gmail.com
What a discussion on OSSEONEWS. Im still concerned about the anonymous posters who think implants arent the treatment of choice. Statistically, they survive longer, there is no decay, there is no root canal, they love bone and they function statistically longer than any orthopedist would give you on a knee replacement. Look up the stats on Pubmed. They sould not be painful because bone has no pain fibers in it. if there is pain, let someone diagnose it. dentistry is a science and an art, and there are sound biological principles that apply.Nothing is 100% in medicine or dentistry, there are benefits and risks for any procedure, even a conservative restoration - Implants as well. In today’s dentistry, it makes no sense to cut down healthy teeth and risk more treatment for those teeth later. Implants are less invasive in my opinion. If you are looking for a cheap way out, then nothing better will ever suffice for the naysayers. People have different values. Less cost does NOT equal high quality in everything - be it health care or toilet paper. Over a 10 year period, an implant/crown costs about $1.00 a day.
Bill
In the hands of the “right” dentist or team of dentists, there is no question the implant is the better choice. However not all cases are appropriate for implants so the dentist not only has to have excellent surgical skills but must also be able to diagnose a treatment plan well in the first place. I agree with the comments by Dr. Bill.
if 2 adjacent teeth are missing and abutment tooth are there on both sides there is a need to replace with implants.what will be the rx option
1.to give 2 implants
2.to give an implant at 1 missing tooth and give a implant-tooth supported bridge
3.if thr rx option is any of theabove2,any difference in rx option b/w anterior and posterior areas
drakbar
implants are definitely better. If you choose your patient well and you are well trained, you should not experience any problem. Let those who still want to ride donkies to work enjoy their ride.
I have read through most of the above postings and can’t believe some of these notes. I am someone who has now 3 implants. 2 due to an accident and one due to a failed root canal. 25 years ago, people had no alternative but to employ a fixed bridge or removable denture to restore their ability to eat, speak clearly and smile. Fixed bridges and removables have there own big problems. They may slip or cause clicking sounds while eating or speaking. Greater concern, fixed bridges often affect adjacent healthy teeth, and removable dentures may lead to bone loss in the area where the tooth or teeth are missing. Recurrent decay, periodontal (gum) disease & other factors often doom fixed bridges to early failure. Insurance company’s will pay for a new bridge every 5 years. What’s that tell you? They expect them to fail after about 5 years. Dental implants really are the state-of-the-art solution to missing teeth or tooth. The small little titanium fixtures fuse with the jawbone. They end up being stronger than the natural tooth in many cases. So with implants, no more embarrassing noises like false teeth, never decay like the anchoring fixed bridges, and bone lose is generally not a problem. They are much more comfortable and I can eat whatever I want.
30 years ago I broke a tooth (upper back molar). When I went to the dentist, they did an x ray and discovered an abscess on the tooth in front of it (#3). The dentist suggested and performed a root canal on the abscessed tooth, reshapped the broken tooth and put a double crown covering both teeth. About 3 years ago I had problem with the root canal tooth and had a retreatment done (different doctor this time and endodontist). That retreatment lasted until the past week. ( I had another abscess) My regular dentist sent me to an endodontist (same one who did the root canal 3 years ago) and he believed the root canal tooth had a fracture and needed to be extracted. I have had the tooth extracted by an oral surgeon, and am now considering a bridge or implant for the extracted tooth (#3)
Considering my situation, can someone offer some insight on to the advantages or disadvantages of either.
Thank you in advance
PS I am not really sure about bone loss etc, and understand that would play an issue
Jeff,
This discussion may interest you:
http://www.osseonews.com/implants-impacting-endodontics/
Hi I’m in need of 6 implants in my upper frot teeth. However, at a recent consult the dentist told me I’m a bad candidate for implants and I told him I can’t wear a denture for the rest of my life. He told me to go with a 11 tooth bridge because I have periodontal disease and he’s concerned about the bone loss. He just finished doing something called perio lase on my bottom teeth and will do the same for what’s left on my upper teeth. He quoted me $10,900 for the 11 tooth bridge. Is there any hope for me. Expense is an issue but I want to have the best success rate. The last dentist I consulted with told me that he could put state of the art implants in and they’d last forever. I didn’t get it done with him because he wanted $24,000 upfront and was chargin $1,500 just for the implant crown (in addition to the price of implant which wasn’t that bad only $2,000)
Any advice, I feel awkward with this denture and am afraid to do an 11 tooth bridge but I have significant bone loss
Angela,
If you ask 10 dentists you’ll get ten different answers. My advice and experience is that an 11 tooth bridge is not the standard of care, especially on teeth with periodontal disease. Laser treatment is questionable at best according to published, peer-reviewed articles but some clinicians swear by it.
I have never seen a patient that had no hope. If I can’t treat the patient I will refer it to someone who can. With such a large investment and if you have any doubts, get a second opinion. Nothing wrong with that.
I don’t know anything from the case but with implant therapy, usually, there are options. For instance, an implant retained overdenture MAY be possible. This would drastically reduce the total cost of the therapy you were quoted. You will end up with a horseshoe denture that is fixed onto implants instead of individual crowns on top of implants. Again, you may need bone grafting procedures or other things that I don’t know about, which increases the total cost.
I did want to point something out as well. Either treatment will be expensive and will take much of your time. Just make sure you go with a plan you feel comfortable with and a surgeon/dentist you trust.
I hope this helps.
Dear Batsheva,
I have been restoring implants for some 23 years now. The Oral Surgeon I use to place the implants learned from Dr. Branemark himself (he flew to Sweden to train). The lab I use also flew to Sweden for training when osseointegrated implants were first being released. I have yet to record my first failure! I have yet to record any adverse physiological effects of any sort! This includes many complete arch, smaller bridges and single teeth and denture retained. I cannot make these same claims for any other restorative procedure. Only four times have I incurred a broken abutment screw a couple of years into the life of an implant restoration, and on each occaision the bridge was removed the screw replaced and the bridge attached again that same afternoon. Indeed, I have had my own implant for missing tooth #20 for 4 years now and cannot discern where or which tooth it is so I speak from a restorative as well as a patient aspect. As many dentists will tell you, implant placement is a technically demanding procedure as well as the restorative if success is to be high. You need to do a little internet research into osseointegration so you will understand that the implants are so physiologically tolerable that the bone actually heals to the implant. It is not like your body encapsulating a foreign body so much as accepting and healing to it. I am also a little disturbed by some of the comments made by your first responder. Most of the comments were extremely ambiguous, false or uninformed and seemed to me to be intentionally inflammatory. It is very easy to scare the heck out of someone but multiple times harder to get them to rationally evaluate it afterwards.
Thank you so much Stan. I just had a tooth pulled by mistake, and am feeling very down about it. I started at the top of this blog and was going down fast as I read thru the comments. And thankfully yours was there at the end to bring some sanity and hope to the question of losing a tooth.
I have 3 dental implants and I love the. Yes they are expensive…but compared to bridges that get loose and yoiu have to have fixed and refixed. There is always that feeling like this might be the day it falls out and I look like an atrosity…The only problem that I had was one of them the placement was a little off and I had a pain for several days that I knew wasnt right, so I went to see my Denist and she repositioned it and now its great Ive had the for 5 years and I will ghet them anytime
I visited dentist this week to have bridge of one of the moral, the procedures is three morals to connect to fill the space that is missing. He told me it’s save although it cost a lot here in (Boston) but I decided to go for it. Can you please give advise how long will it stay for bridges and is it save or will it stay longer. Please give me an advise because my next appointment will coming Thursday 11/08/07.
Thanks,
i want to know if theres a minimum teeth in bridge.i lost 9 teeth.i dont want to use dentures forever.pls i need the answer.
I broke my #14 tooth (upper left, second from the back). I’m interested in getting an implant, but my dentist says to go with a bridge because #14 is so close to the sinuses and the potential interference is too risky. I’ve read through all of these posts and don’t see any information suggesting that certain teeth positions are poor candidates for implants because of their proximity to the sinuses. Any thoughts on this? I’ve never had any sinus problems.
Hi Bea. I also lost tooth #14 after a crown broke and the major of three roots removed (this crown was done three years ago). My dentist recommended an implant and i went to the implant specialist who quoted me a price. The stopping point for me was the extra cost of the sinus floor elevation which he would decide on doing if needed during the procedure. That additional cost of $2500 is making me look at a bridge. The implant gets close to the sinus cavity and if too close they do a Sinus floor elevation. So my total cost for the tooth would be around $8000 without insurance coverage. If he found he did not need to do the floor elevation it is still around $6000. A bridge will cost me out of pocket $1400 since insurance will cover half. Nobody can see #14 anyway so I think I will go with a bridge and take my chances. If the bridge lasts 15 years I will be happy. If it were any front or very visible teeth I would definetly go with the implant. I appreciate any comments.
Hi John and Bea. Same situation as you two, #14 tooth pulled and sinus too low and not enough bone so need a bone graft. Cant decide between bridge or implant, have spoken to about half a dozen dentist instuctors at the university over the past year (work is half price there by students supervised by instructors, already in middle of another front tooth implant i got there–going good so far, getting the crown tomorrow) and they all say both bridge or implant are equally suitable for the #14, and its my decision. But the surgeon who specializes in implants there, whom I spoke to just last week, stressed there is a one week period after the bone graft, you’re all swollen and out of commission. He said its doable, but i got the feeling he was trying to discourage me from an implant, which before i was sure i was going to go with. Also my two abutting teeth both need crowns, maybe thats why no one is saying implant outright.
paying $8000 is a bit too expensive, if you come to india here we would charge something close to $1000 for the same work, and you can also enjoy your vacations. do give it a thought, nowadays we have many patients from usa & uk coming to india for medical & dental tourism.
Dear Betsheva,
I hope you have made your decision.
After going through all the above comments I think it will confused you more. It surely did that to me.
I am from Malaysia and hope that this story told to me will help you in any way.
There was this guy whose young daughter age 8yrs old whos lower jaw is way ahead of the upper jaw,that is called a severe pronagthic lower jaw, not nice for a girl to be with. I asked him how does this happened?.Are there anyone in the family that has this type of jaw pattern and the answer is NO. Well he said the reason could be that when his wife was delivering the girl in the labour
room there was another lady delivering her baby in the next bed nearby. This lady in the next bed has
a large lower jaw and she was staring at his wife, and that was the reason he felt must be the cause of this to his daughter. Well I told him will it be possible the next time if his wife is delivering and a white lady stared at her will the baby becomes a white person.His answer is definitely not possible. By the way we Malaysian
are brown, yellow and black predominantly.
So you see how many people think whether they are in New York or in Malaysia and if I may guess they will be not be different if they come from Timbaktu.
If I may ask of you, will you drive a car knowing that the number of people killed in motor vehicle accidents everyday outnumbered those killed by cancers ?.
Look for honest and professional dentist and that will be your best area to seek advice.
A friend from Malaysia.
I love implants, but conservative bridges have been a mainstay of dentistry for many years. Especially if the adjacent teeth need crowns anyway there is really no downside in my opinion, plus it is nearly instantaneous compared to an implant, especially if sinus grafting is required. If you don’t mind the appearance of some gold, an old-fashioned dentist can construct a bridge with a partial coverage gold abutment on tooth #13, an all gold or porcelain bonded to gold pontic on #14, and whatever you want on #15. Many of us older dentists have done exactly that through the years because gold fits better, lasts longer, and doesn’t break. Very biocompatible also. Not exactly the answer you may want to hear on this web site, but I would consider it carefully before committing to surgery.
I’ve pretty well decided on an implant instead of bridge for following reasons:
The dentists were all saying a bridge lasts only 10 to 15 years, with a mean of 12. No one mentioned anything about gold ones lasting longer, however I didnt know enough a few days ago to ask about it. I know porcelain chips and falls apart, that happened to one of my independent crowns, and i replaced it with a gold one for that reason, but a bridge can still see-saw and break the bond and get cavities i heard and i think you have to be more careful about eating hard stuff.
I dont floss everyday and you have to under a bridge as stuff accumulates there, and you get decay, and if its on just one tooth the whole bridge has to go
True, the university can do a bridge in a few weeks, and will take nearly two years for the sinus lift and implant, with summer holidays and all.
Will only cost $1900 though with no insurance, $500 for the sinus lift bone graft and $1400 for the implant (a Canadian university in a big city) so a lot less than the $8000 quoted above, but a bit more than India. Bridge is half the cost of an implant, but one would need to replace a bridge at least once in a lifetime, depending how old you are, and every replacement hurts the teeth more I’m hearing, possibly needing a root canal at some point. I’m hearing that independent crowns tend to last longer than bridge crowns just because there’s less teeth involved.
THIS IS IN RESPONSE TO SEAMENTUM COMMENTS ABOUT IMPLANTS. HE MENTIONS THAT A implant retained overdenture MAY be possible FOR THIS WOMEN SEEKING ADVICE ON IMPLANTS. SEAMENTUM SAYS THAT THE WOMEN WOULD SAVE ALOT OF MONEY IF SHE DID THE IMPLANT RETAINED OVERDENTURE RATHER THAN HAVING INDIVIDUAL IMPLANTS . I RECENTLY HAD 10 IMPLANTS AND NOW I AM WAITING ON THE CROWNS. THE DENTIST TOLD ME THAT HE WAS USING A FULL DENTURE WITH A TOTAL OF 14 TEETH ON THE DENTURE. HE SAID THIS DENTURE WOULD SNAP ONTO THE 10 IMPLANTS THAT I HAVE AND THEN CEMENTED IN. THIS IS FOR MY UPPER TEETH. MY RECEIPT FROM THE DENTIST SHOWS ME PAYING FOR 14 TEETH, BUT ALL INDIVIDUALLY. A TOTAL OF 14,000. THIS IS JUST FOR THE CROWNS. CAN SOMEONE TELL ME IF I AM GETTING OVERCHARGED. OVERDENTURE VERSES INDIVIDUAL IMPLANT
Dear Angela,
If u have plan to come to india u can plan to get all the necessary no. of implant placed with real good quality job and at 30% of the price u’r dentist had asked for.
Dr.Chakrabarty,what you are suggesting to Angela
is anethical at best.I work in London(UK)and over the past 3-4 years seen a huge rise in dental tourism to eastern Europe and far east with all the assosiated problems.Inflamation around implants,lost crowns and abuttments,perforated sinuses etc.Angela tretment is extensive and complex,what would you like her to do?move to India for 12 months?or fligh back and forth?or do you have a colleque who is going to look after her
in the US?
I HAD 6 IMPLANTS INSERTED IN THE UPPER PART OF MY MOUTH. I LOST 5 OUT OF 6 OF THEM. I WOULD OF LOST THE REMAINING ONE BUT THE NEW DENTIST DECIDED NOT TO PULL IT OUT BECAUSE HE SAID IT WOULD CAUSE MORE DAMAGE TO TAKE IT OUT RATHER THAN LEAVE IT IN. ALSO,AFTER THE IMPLANT SURGERY, MY FACE DOUBLED IN SIZE AND I HAD TWO BLACK EYES. I LOST MY FIRST IMPLANT 1 WEEK AFTER SURGERY FROM A PAINFUL INFECTION. IN FACT I WAS IN PAIN THROUGHOUT THE WHOLE HEALING TIME. THE SECOND TIME I HAD THE SAME IMPLANT SURGERY BUT WITH A NEW DENTIST AND HE DID 10 IMPLANTS INSTEAD OF 6. THESE WERE ALL UPPER IMPLANTS WHICH LATER WOULD SUPPORT A PERMANENT BRIDGE. I HAD NO BRUISING OR BLACK EYES , IN FACT YOU WOULD NEVER KNOW THAT I HAD ANY KIND OF ORAL SURGERY DONE AT ALL. THIS NEW DENTIST ALSO DID A BI-LATERAL SINUS LIFT AND BONE GRAFTING TO REPAIR THE DAMAGE FROM THE FIRST LUMBERJACK IMPLANTS INSERTED BY THE FIRST DENTIST. EVERYTHING IS GOING WONDERFUL,THANK GOD, BECAUSE THE NEW DENTIST TOLD ME HE DIDN’T THINK HE COULD HELP ME WHEN I ORIGINALLY WENT TO SEE HIM. I WANTED TO SHARE MY EXPERIENCE WITH YOU ALL AND HOPE THIS DOSEN’T HAPPEN TO ANYONE ELSE. DENTISTS’ DO MAKE WRONG CHOICES, SO DO YOUR HOMEWORK BEFORE CHOOSING A DENTIST.
Dr. Leo
I didn’t understand what is unethical about it.I have never told angela to come to india to get her implant job done here.I have suggested from the point of view of “sugesstion” only . I hope she is going to decide on her own wish.By the way I have seen 3 cases of failed implants done in uk and we have “looked after them”.I never encourage the stupid concept of “Dental Tourism”.But don’t opine in the way that all we asians are doing are bogus.
sorry for fingerslip I meant “suggestion ‘.
Dear Dr.Chakrabarty,
1.you did suggest to Angela to travel to india
2.I never said anything about “asians doing bogus”
3.some of the best british dentists are asian eg.
Ashok Sethi.
4.eastern europe is not asia as far as i know.
Dear Dr.Leo ,
1.I asked Angela whether she had any plans to come to India ? Again I am emphasizing no attempt to create any decision on her behalf.
2.As far as I know “Far East” is in Asia.
Dear Dr.Chakrabarty,
I think I understood your point.So I would like to
put it strait:I never intended to offend any collegue in eastern europe,far east,or anywhere else.Ofcourse if Angela would move to India permanently it would save her a lot of monney on her dental treatment,but also on food and rent.
She might even get her treatment absolutly free since
some implant companies have dental centres in India,where they experiment on homeless and underprivelleged.
I have been practicing in the West Indies for more than 15 years doing Implant and Cosmetic Dentistry
I have serviced many patients from through out the region and the US and UK and far beyond
Patients are aware of the nature of the treatment and the time constraints involved
I have done the full gammut of treatments from all grafting procedures and crown and bridge etc etc
I have a world class facility.. far better than most in the US and Europe
What exactly is your problem with Medical/Dental tourism ?
Why is this unethical?
Is it unethical for an Indian or German to come for treatment in the US..or do you have your predictable double standard on this .. ?
Just because you are in the US does not mean you will get the best treatment possible..life is not so easy ..read these forums to see the variety of standards and oppinions for a single implant placement…
You have total novices in the US doing work they have no clue about(Usually after a weekend coarse) asking the most basic questions and charging fees that are several months salary for many people even in the US
What guaranteed standards can the US boast ?
you buy foreign cars and use foreign services
America and Europe uses the rest of the world to define every part of their existence and now having services done over seas is wrong…?
It makes no sense
True other countries may have different standards and codes of practice ..that does not mean that the practitioners promoting themselves to the world market have lessor standards
At the end of the day the patient needs to research and decide
I am certain of my credentials and any patient can check these out …
There is a tremendous arrogance in the US that they are the best at everything ..just look at where your products and people and technology who pioneer your acheivements are from
It is incorrect to suggest that all treatment in the US is good I think you know very well that the US can produce absolute trash dentistry as well..ask your countless lawyers .
The US has the best AND the worst of everything
Incidentally none of my full mouth implant cases have moved here permanently for treatment
Dont pre judge a concept you know nothing about
You will be more than surprised at the extraordinary high level of service (in every sense) of treatment around the world in the emerging market of Medical tourism
Dr SS
The above applies as much to Europe as the US
DrSS
Dear Dr.Leo & DR.SS
If my previous post to Angela had instigated any sort of controversy I apologise for that .I assume we would use this fantastic blog site more as an implant-knowledge exchange platform rather than a place of confrontation.
With regards,
Dr. Himadri Chakrabarty
Dr Chakrabarty
I appreciate your diplomacy
..however it is this very controversy that makes these forums what they are
Otherwise we all tell each other what we already know
Your comments inspire a discussion in advanced dentistry that illuminated what many clearly do not know about (you must never apologize for that)
Many of us are very experienced practitioners from around the world, who take our work very seriously and passionately and care deeply about our patients These forums allow us to share our experiences and knowledge
Learning is not always comfortable
I had root canal treatment in my upper molar and the dentist broke his instrument in my root canal during the procedure. I was referred to a specialist who could not remove it , but instead fractured my tooth in the process. I am now booked to have this upper molar removed and an implant inserted at the same time. This is all to be done under local anaesthetic. Both teeth on either side of the molar are filled and one has had a root canal treatment, so they are already compromised. After reading your comments I am not sure if I should go ahead with this procedure. I apparently have good bones. With my luck, the implant may go horribly wrong. Any suggestions?
Implant Dentistry is statistically the most sucessful of the two options. If you have a 1mm overhang on a filling you fail but a 10mm pontic is good???, Posts fracture etc
Sure there can be issues but these are in the 1-2% range
Today I had a consult with an OS on tooth #7 (next to the front incisor). My general dentist had thought that an implant was best and could probably be done at the same time the old root was removed.
The OS found the bone in front to be too thin and said a bone graft was the way to go first.
My brother had a very bad experience with a graft.
#6 is my only remaining natural tooth. # 8 is already crowned. With the new information about the graft, I am thinking the bridge is the way to go.
Any suggestions would be appreciated.
great blog and I am glad I found this. It certainly helps in decision making for somebody who has no idea like myself. I am in the later 40s and I have bad teeth (and I mean really bad teeth). I blame part of this to growing up in a rural part of Germany where taking care of teeth was low on the list at home or at schools (and a big part to myself). I have a bridge for lower molars, a couple crowns and a few root canal treated teeth. There are only a few healthy teeth I have left. Just today #10 which was root canal treated broke off right at the base at the gum line. #9 has a crown which just came off half a year ago. This crown is probably 20yrs old. My dentist told me that I need to look into a bridge or an implant for this one because the base is very weak and will likely break off soon. So, one option was to use #10 for the bridge. That’s not an option anymore after today of course. He says a bridge from 8-11 is still one option but he would recommend implants for 9 and 10 instead. He knows my concerns about the price (he mentioned 6k for two implants) but explained that a bridge may only last 5-10 yrs in my case because I apparently grind my teeth at night and will likely cause premature failure of the bridge (which he estimates to be around 3k). He also mentioned sth about a guard to work against my teeth grinding in case I choose to go with a bridge (never heard of that before).
From reading all the comments and advice in this blog I take it that the most sensible thing to do is choosing implants, pay more upfront, but knowing it will pay itself off longer term compared to a bridge. Of course some of the posts here addressing implants are concerning to say the least. I am still wrestling with myself to come to a conclusion. I will get an appointment with the local surgeon to get a better idea and estimate of what’s ahead of me if I choose implants.
any comments are welcome
thanks for the great blog
I just came across this blog, even though I see it began in 2006. I had #20 extracted after an absess and failed root canal. My dentist is promoting the implant for obvious reasons. My hesitation is purely due to finances. I have dental insurance, which means the bridge would only cost at most $500, probably less. My insurance, like most, does not cover implants. I was told the implant, after all is said and done, will cost about $4,500. The difference is significant. Even if I had to replace the bridge in twenty years, my total payout would be $1,000. My dentist has emphasized “it’s only money” and “we are talking about your health.” $4,500 really is a huge stretch for me right now. If money were not object, I see the benefits of the implant. Assuming cost is a factor, medically speaking is a bridge really that terrible an option? Any advice would be greatly appreciated!
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