My opinion on Implants vs. Bridges has changed through the years. After I graduated from dental school, I spent two additional years studying implant dentistry because I thought it was the future. I learned both the surgical and prosthetic side of the procedure. I felt an implant was the closest thing we have in dentistry to restoring a missing tooth back to its original state… And, this IS probably still true. However, through the years, I realized that practical logistics, combined with the high cost of implants is a difficult sell in the real world.
First of all, the companies who fabricate implants (and accessories) seriously RIP OFF the dentist. I’m talking about $80 for a teeny screw the size of a pin head. They make everything proprietary, short expiration dates, and excessive surgical sterilization protocol, and harsh return policies. I’m sure some of this is necessary, but much of it is NOT. They’re trying to make a buck!
Ultimately, for liability and legal reasons, dentists are left with the sense that they must buy that $80 screw or they will not maintain standard of care. Implant companies jack up their fee. This causes dentists to jack up their fee. Insurance companies refuse to cover these high fees and only offer a small fraction of compensation. Dentists are locked into contractual fees with insurance companies. Dentists end up making very little profit while incurring high liability and expense.
So… Yes, I still believe implants are the closest thing we have to getting your original tooth back. And, I STILL believe that implant dentistry is the most conservative and ideal form of treatment. HOWEVER…, the patient must have adequate bone, they must be relatively healthy generally, and they must have an immune system capable of healing around an implant preventing infection. AND… at the end of the day, the dentist must have some type of profit margin to validate the liability incurred and skill level required for implant dentistry.
In my hands (surgically and prosthetically), implant success rates are probably in the 90-95% range. But, this is because (from a medical history and “expectation” standpoint), I choose my patients carefully. In addition, I have a Cone Beam (CAT SCAN) machine in my office that allows me to see exactly (in 3 dimensions) the amount of bone available. As I’ve mentioned in other sections of this website, I don’t like surprises. The CT scan eliminates all the guesswork while in surgery. Digital planning is critical for implant success.
However, in a majority of cases, a single implant replacing a single tooth can take up to 8 months MINIMUM before you can even start the fabrication of the crown. For example, before an implant can be placed, an extracted tooth requires a socket graft. This graft then must sit (marinate!!) for approximately 3-4 months (depending on bone quality) before an implant can be placed. Then, after the implant is placed, there requires another 3 1/2 to 4 months before the crown can be fabricated. And, that’s assuming bone was successful in integrating around the implant…. That’s a long time to be without a tooth!!
Please know, for many years, I used to extract the tooth and place an implant the same day. But, I stopped doing it because I had a few failures. I found that the success of an implant goes up exponentially if you wait the (above) described time. Why the rush? This is something you will have for the rest of your life. Waiting the recommended time is a small fraction of a lifetime and can prevent catastrophic failure. As I know from experience, if an implant fails, the patient ends up with less bone (quality/density/and volume) than they had before the start of the procedure. It’s one step forward two steps back. And, in many cases, the implant option is no longer viable after a failure. It’s just not worth it!!!
This leaves… THE BRIDGE.
Considering the BRIDGE option… I can extract a tooth and have the patient in a temporary bridge the SAME DAY. The immediate bridge idea is much more predictable, tried and true than an immediate implant.
Bridges accomplish the same goal as an implant. It gives you your tooth back in a functional, esthetic, and permanent way. And, at the end of the day, a bridge looks (and feels) exactly like an implant. It’s permanently fixed, stable, and strong.
In fact, in some respects, a bridge is MORE cosmetic than an implant. Since an implant has a round cross section (at its collar) and natural teeth have a rectangular or oval cross section, this presents some discrepancy between the transition from implant to crown. This creates gaps at the base of the implant crown, presents an awkward esthetic appearance (tooth is long and tapered shape to the implant), and makes hygiene difficult. Due to the basic nature of a traditional bridge design, it can better cover gaps, defects, and present a better illusion of a natural tooth replacement.
Of course, a well planned implant can also accomplish superior esthetic results. But, they are much more dependent on bone availability and patient anatomy.
Implants do, however, have the hygienic advantage of being able to floss between the teeth. Bridges, by nature, include two abutment teeth supporting a prosthetic tooth suspended above the gums. There are no spaces between the teeth. Waterpiks or Floss Threaders are critical for cleaning under a traditional bridge. However, what a lot of people don’t realize, is that waterpiks, etc are ALSO needed to clean around implants (due, again, to the circle/rectangle discrepancy mentioned above.) So, it’s an interesting dilemma….
To summarize:
The “Implant” is the Ferrari of the tooth replacement world (solid, highest quality, takes a long time and harder to attain, and the most expensive)
The “Bridge” is the Toyota of the tooth replacement world (a quality product for the money, looks pretty darn good, gets the job done functionally)
THEN, something we haven’t mentioned yet… the “Removable Partial Denture” (or RPD) is the Volkswagen (MUCH less expensive, a little uncomfortable, not as esthetic, but gets you from point A to point B.) (PLEASE SEE THE SECTION TITLED “REMOVABLE PARTIAL DENTURES”)
