Implant vs. Conventional Solution in Replacing First molar?

A mandibular first molar was missing for years and resulted in bone deficiency. The deficiency had a typical dip like profile of about 5mm in the deepest area. The ridge in that area ends in a knife edge. Should one consider grafting the missing tooth area to provide a condition suitable for an implant placement or should one restore the missing tooth with a conventional bridge considering that such option exists?

11 thoughts on “Implant vs. Conventional Solution in Replacing First molar?

  1. Reg O'Neill says:

    Too many variables. Does the tooth missing for years require replacement? If it involves adjacent crowns on healthy teeth then they can be expected to fail and the gap becomes two, three etc. Its back to basic treatment planning with diagnostics, records, age, occlusal stability, etc. and weighing up the cost benefit/risks to all involved. Post more specific details please. The practitioners on this forum are very keen to help and you may get some interesting differences of opinion.

  2. Ed Dergosits says:

    I personally would place a fixed bridge. 3 unit fixed bridges will service for 25 years or more if done well. Marginal fit is only one factor. Minimally tapered abutments is another. Cementation appointment are often viewed as “justa” cement appointment and this is the cause of early failure. Abutments should be thoroughly cleaned with pumice and ultrasonic. An antibacterial agent should be applied after the cleansing. Retraction cord should be placed if the margins are sub gingival. The site needs to be kept completely isolated from saliva while the bridge is seated and while the cement is setting. If this is done one can expect and observe more than 25 years of caries free service. The statistics of 3 unit bridge failures demonstrates how these things are generally not done.

    • Jim Dandy says:

      ” 3 unit fixed bridges will service for 25 years or more if done well.”

      I could not disagree more. A 3 unit FPD should last forever if done well, however the patient has to take care of it. If they have poor hygiene, dry mouth, rampant decay, etc, the FPD will not last a year. No matter how good your work is, the patient determines the longevity of the restoration.

      Why did this patient lose the tooth in the first place? Are they asking for replacement because they need the function or just that it would be a nice thing to consider and now they have insurance that will pay for it?

      If the abutment teeth are healthy, then don’t cut them. Graft and implant.

  3. bridgeVSimplant says:

    I have done thousands of both over thirty years, and seen thousands more from others. The failure rates (not mine, national statistics) on 3-unit bridges are 1/10th that of implants. Implants have many advantages, but the failure rate is not one of them, particularly early failure rates. I’ll stand by for comments with my flame retardant suit on.

  4. Robert Moxom says:

    I generally recommend a bridge if the abutment teeth are fairly heavily restored such that crowning may be indicated in the future anyway.Too heavily restored or virgin teeth and the implant becomes the best option.
    From what you tell us of this case the implant would require bone augmentation possibly at an additional visit making this option far more involved than bridge preparation.

    • James Bond says:

      “Robert Moxom says:

      I generally recommend a bridge if the abutment teeth are fairly heavily restored such that crowning may be indicated in the future anyway.”

      I agree with this wholeheartedly.

  5. Raad Shahaltough says:

    Although with the progression that has been achieved in the implants field in the last decade, and the increased acceptance of it as an alternative modality of treatment for missing teeth both by the practitioners and the patients, reaching a point that I used to say to my patients that”3 unit bridge” is nowadays became obsolete when compared to the benefits and less destructive effects of the dental implants.
    But after coming across a few cases especially those that needed vertical bone augmentation- even though I try to avoid it by using the CB CT accompanied accompanied by computer-guided surgery which given me the advantage of being able to avoid vital structures like the inferior Dental nerve for example by tilting the implants just certain degrees so I wouldn’t need the bone augmentation- I couldn’t but seem to mention other factors that are somehow don’t extend uncontrollable or skills control and should be assessed before the treatment option is selected like the General Health of the patient age medications that he might be taking like bisphosphonates also the oral hygiene of the patient the factors also mentioned by by the esteemed colleagues above.
    another important factor that should be considered is the financial capabilities of the patient also until those countries there is the problem of getting the the bridge that is acceptable by the standards of dental treatments which sometimes causes concern and problems
    So just say the last I think that dental implants or the bridge choice depends highly on the on the patient himself his financial status General Health and dental hygiene capabilities of the dental lab technician and the quality of the bone at the implant sites in addition to the overall dental and General Health of the patient.

    there’s this way that I use whenever i need to make a decision regarding the best tretment in the some of the cases that could be treated in one or other alternatives and using it I got to get satisfying results for both the patients and my self , giving the best treatment I can.
    just by imagining that, if I had the same exact condition of this patient what would be my treatment choice? and then what I would think is right and acceptable for myself, my family,it is the treatment adviced .

    • Dr.Tito says:

      “So just say the last I think that dental implants or the bridge choice depends highly on the on the patient himself his financial status General Health and dental hygiene capabilities of the dental lab technician and the quality of the bone at the implant sites in addition to the overall dental and General Health of the patient.”

      Well said!

  6. Ed Dergosits says:

    Why do so many dentists not have confidence in a simple 3 unit bridge? It seems that the “inevitable” failure of a bridge is very frequently used as a reason not to place one. No doubt I place an implant if the site does not need augmentation. In my practice the cost of an implant, custom abutment, and crown is the same as the 3 unit bridge option.

  7. Dr. Gerald Rudick says:

    It is difficult to give a proper opinion of how to treat this situation, when no xrays or photographs have been supplied.
    That being said, a lot of valuable information has been given above….i.e…. if the teeth on either side of the missing teeth have been heavily restored, and need crowns…… then sure go for a bridge.
    I have long standing patients who have been in my practice more than 40 years, and it is sad to see, that the teeth that were prepared as retainers for the bridge, have suffered some gingival recession, margins were exposed, and decay set in under the crowns……
    There is no guarantee that an implant crown will survive 30 years without developing peri-implantitis, hence shortening the left of the implant…….
    The best thing to offer your patients is to insist on good oral hygiene and diet, and try to get them to keep their teeth, and not require either a bridge or an implant.

  8. Yaron Miller says:

    In a situation like this I would explain to the patient the benefits and disadvantages of each option. One of the key factors I consider is the patient’s age and condition of adjacent teeth. In my office I tend to see older patients so if this is a 75 year old person with potential medical issues and crowns on adjacent teeth, it’s a 3 unit bridge every time.

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