The first choice of most dentists would be to place dental implants to replace missing teeth. The decision is based on dental implants having a higher success rate, lasting longer and often times looking better than ceramic bridges.
Dental implants have a very high success rate to replace missing teeth. Once the dental implant is placed and integrated into the bone, an abutment and crown are screwed into the implant finishing the restoration. The implant replaces the root of the tooth and the abutment and crown make up the part of the implant that you see. The implant itself has a very high success rate and the abutment and crown can be changed out as necessary without disturbing the implant.
Bridges replace teeth by connecting the missing tooth area to other teeth that are still in the mouth. Usually, a missing tooth is connected to two other teeth, one on either side, making up the bridge. The missing tooth is called a pontic. The bridge success rate is much lower than an implant and the success rates go down as the natural teeth anchoring the pontic have large fillings or root canal treatments. Sometimes pontics are “Cantilevered” off of one or two teeth and not connected on both sides. This situation will be successful replacing the small lateral incisors or sometimes a central incisor, but introduces very high risk in the back of the mouth. When teeth are missing in the back, with no natural teeth behind them to support a bridge, then a dental implant is usually the best or only fixed option.
These cantilevered lateral bridges are replacing teeth that the patient was born missing. The lateral incisors are the pontics and they are attached to the canine teeth. This keeps the connected area toward the back of the mouth and less apparent when the patient is smiling.
The aesthetic of both options can look good or bad depending on the dentist, surgeon and technicians creating the restorations. The downfall of bridges is in the connectors, the parts of the bridge that connect the pontic to the existing natural teeth. The connectors can make the teeth look less natural as there is no embrasure space in the contact area like natural teeth. Implants do not have connectors, because they can stand alone. Implants also have crowns that look like they are growing out of the gums like natural teeth, this can also be created with pontics of bridges, however the longevity of this look is compromised by the slowly resorbing gum and bone around the missing tooth. It may look good when it is completed, but chances are that it will look less natural over the life of the bridge.
Implants help to maintain the gum and bone around where a tooth was missing. Once a tooth is lost, the gums and bone around the missing tooth start to resorb, or shrink. This creates a pink deficiency in the smile that needs to be recreated with artificial pink or gum and bone grafting. Implants help to prevent the gums and bone from shrinking, while bridges do not.
This patient has an implant crown on the right central incisor and porcelain veneers on the other teeth. Creating an implant crown that looks like it is growing out of the gums takes time and skill. It is important to work with talented surgeons and a dentists who understands the perio/restorative interface.
Bridges have another negative. If a problem occurs with one of the teeth, either under the bridge or a fault in the porcelain on top, the whole bridge needs to be replace. Some bridges are only three teeth connected, but some can be much longer. If an implant crown chips, then only the implant crown needs to be replaced.
In the end, the patient makes the decision. Some implant placements are simple and some require multiple bone grafts and other surgeries to be placed. Today with CT scanning and guided surgeries, implant placement is getting more and more predictable. Some patients may want to avoid the surgeries all together, while others are not comfortable with the additional costs of implants, or the waiting period after implants are placed and crowns and abutments can be screwed onto the implant, which can be up to a year in some cases. Our job as Smile Stylists is to present what we feel is the best option, then work with our clients to come up with what they feel is their best solution.