Should you get a dental implant instead of a dental tooth bridge?

Dr. Robert Heller of Oral Implants & Reconstructive Dentistry places a dental implant on a patient as his staff assists. (Photo courtesy of Midwest Implant Institute)

Dr. Robert Heller of Oral Implants & Reconstructive Dentistry places a dental implant on a patient as his staff assists. (Photo courtesy of Midwest Implant Institute)

A guide to dental implants

Oral surgeons have seen in increase in dental implant procedures in recent years, but is this procedure right for you?

Just a few years ago, if you lost a front tooth, your dentist would recommend grinding the two adjacent teeth down to nubs and using them as anchors for a three-tooth bridge, thereby sacrificing two healthy teeth to replace one. Nowadays, you have an alternative that involves much less collateral damage: a single-tooth implant.

According to the American Academy of Implant Dentistry, about 3 million people receive 5.5 million implants each year in the United States, which is growing by an additional 500,000 more patients each year.

Dental implants are similar to traditional crowns, in which the root of a damaged tooth is capped. But when there's not enough left of the natural tooth to support a crown, an artificial root can be implanted to anchor the crown.

Inserting implants requires teamwork in an assembly that comprises three parts. The implant itself is a titanium post that the oral surgeon screws into the jaw. After insertion, tissues in the jawbone grow onto the post, affixing themselves like barnacles in a process called osseointegration. This creates a more stable and secure anchor for the crown.

The crown attaches to the abutment which has either an external or internal hex to hold it in place.
Read more about dental implant surgery.

Next, either the dentist or oral surgeon places an abutment over the top of the implant. The abutment juts out from the gum line as tissue grows over it. Finally, a prosthodontist creates a permanent crown that the dentist attaches to the abutment. 

“The amount of implants I’ve done over the past five years has increased significantly,” reports highly rated Dr. Paul Tiernan, who opened his private practice in Santa Rosa, California, in 1991. “In the first 15 years of my practice, I hated implants because the product was terrible, but they’ve since come out with a much better structural integrity on the implant.”

According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), “Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.”

Risks of implant surgery

The AAOMS touts the procedures as having “an overall success rate of about 95% and almost 50 years of clinical research to back them up.” Even so, because dental implants require surgery, you always run some risk of complications. You might get an infection at the site of the implant, suffer damage to the surrounding teeth or blood vessels or experience nerve damage that can numb your mouth.

Sinus problems could result from implants placed the upper portion of your mouth, but “the old way of thinking where you’re not going to put the implant in the posture of the maxilla (upper jaw) is pretty much gone," says Dr. Tiernan. "The limiting factor of your lower jaw is your nerve.” While an oral surgeon can reposition that nerve — Dr. Tiernan says he has done that only once in his 21 years of private practice — most people will opt out at this point because of the risk of a numb chin and an extra four or so hours of surgery (with resulting higher costs).

In other cases, the bone doesn’t fuse to the titanium implant, which requires removal, cleanup, replacement and a few more months of healing. Other implant procedures that can prove tricky involve large bone grafts that can be unpredictable and can fail.

These risks are relatively rare, but the two factors that most affect the decision are time and money.

An implant procedure often takes two or three times longer than a bridge, though in a perfect scenario the time investment may be more comparable. Dr. Tiernan calls this a “slam dunk” and says, “The implant takes me less than 20 minutes to put in. You drill the hole, you screw it in and you put a healing cap on it. Two weeks after you do that, they’re chewing on it like it’s their own teeth.”

However, most take longer. For example, if the original tooth still needs to be removed, expect about two months of healing before you proceed to the implant. If you need a bone graft, tack on another three to nine months before the transplanted bone can support the implant. By comparison, traditional bridgework can be completed in two or three weeks.

Cost of a dental bridge vs. a dental implant

In addition to the time spent, cost can be a big factor. Dr. Tiernan estimates that a single implant, a clean abutment and a reasonably priced crown will cost about $4,000, and the patient should expect to pay all or most of this. Unlike more traditional dental procedures, dental implants may not be covered by your insurance or may be covered at a lower percentage.

The most expensive part of the whole procedure is not the implant itself, but the crown, and it’s often the part that gives patients sticker shock. Whether you're having the crown applied to an implant or to the root of a natural tooth, the procedure and price is substantially the same. However, some insurance policies may not cover crowns that are applied to implants, so check with your insurance provider before deciding what to do.

A traditional three-unit bridge includes a false tooth, flanked by dental crowns. (Photo by Jay Madden)

Whether it's a crown or some other expensive medical procedure, you can find out how much it should cost in the Heathcare Blue Book. This is a free online guide that calculates the "fair price" based on surveys of what most health care providers have accepted from insurance companies as the full payment of a particular procedure. According to the Blue Book, the national fair price for just the crown is $861. If your dentist quotes you a substantially higher price, you can use the Blue Book estimate to negotiate for a lower amount, or you may decide to look for another dentist to do your crown. 

If you choose a traditional three-unit bridge to replace one missing tooth, the cost of a dental bridge can range between $2,100 to $4,500, according to Costhelper.com. A four-unit bridge can cost between $2,000 and $12,000.

Are you a good candidate for implants?

For a successful dental implant procedure, age doesn’t necessarily play as important a factor as much as health does. Because this procedure requires healing to work effectively, candidates who aren’t ideal include smokers, patients with weakened immune systems or patients with diabetes. You probably shouldn’t get an implant if you grind your teeth while sleeping. Also, oral surgeons generally rule out children because their jawbones have not yet matured.

The best patients are those with a healthy upper or lower jawbone capable of supporting the implant. “I’d say 99 percent of the success of your implants is in your workup,” says Dr. Tiernan. That workup includes examining the adjacent teeth, how they’re fitting together (the occlusion) and how the present condition of your mouth may affect the implant. 

He also weighs his patients’ current state and history of oral hygiene. “I determine whether to do implants from what the patient looks like now and what he’s going to look like ten years from now," he says. “If somebody hasn’t been taking care of his teeth very well and you pump in a couple of implants, how long do you think those implants are going to last?”

Dr. Tiernan recommends an implant instead of a bridge for broken or infected front teeth with healthy surrounding teeth. But if your adjacent teeth have had a root canal, have crowns or are missing, you may want to consider a bridge instead.

If you have extensive bone loss, your oral surgeon will have to place a bone graft to support the area. For Dr. Tiernan, one thing is more important than good bone. “If you have good soft tissue around an implant, you’re going to have a successful implant for a very long time.”

Editor's note: This is an updated version of a story that originally posted January 21, 2013.


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The crown attaches to the abutment which has either an external or internal hex to hold it in place.
The crown attaches to the abutment which has either an external or internal hex to hold it in place.

Depending on the condition of your jaw, teeth and gums, a dental implant procedure can take as little as a few weeks or as long as nine months as your dentist, oral surgeon and prosthodontist restore your smile.

Comments

With tooth bridging, grinding down our healthy teeth just anchoring up a replaced one and that’s also with a risk of damaging an adjoining structure - An awful event, certainly it was or we can say unfortunately somewhat today too. An advent of Dental Implants is definitely not less than a blessing; only replacing the tooth or teeth that do require operating, not interfering adjacent parts. Apart, dental implants proven to be with the long-life are tremendously awesome. Diminished tooth root when required to support the crown, implants are favored; being set up with a crown or a bridge or a denture on top fixable or non-fixable; great invention of dentistry!

I had a crown fall out which is next to one of my 2 front teeth. The crown broke off most of the post. I was told I need either a bridge (3 teeth) or one implant and that either requires surgery to remove the root of the tooth where the crown fell off. Is that true? The two teeth on each side of the crown which fell out have crowns on them. Is there a way to build a post other than having an implant and what are the downfalls of a bridge other than not being able to floss? What kind of dentist/professional do I need to help me with this. I already saw a dentist, but he doesn't do any surgery, etc. Thanks

I am having pain in a root-canaled crowned tooth that was done 8 years back and now I am in Europe with this problem and don't know how to go about this. The dentist says there is bone loss and the tooth should come out eventually and he can bridge it also there is a crowned tooth next to it, and they are both on the bottom left at the end, I guess I want this as painless as possible, could I go for a bridge and consider an implant in the future as is it a must to have to grind down a good tooth next to it? I got 2 teeth that I would be happy if they bridged them together but I don't like what I am reading about having to grind down a good tooth in also. Please give me a reply, the dentist isn't a great communicator and I don't want them to talk me into expensive procedures.

In Dr. Tiernan's article , why is it not advisable to have an implant if one of the adjacent tooth have had a root canal and is a crown? I have an infection on my root canal done a long time ago, and the #9 tooth now needs to come out because a fracture is discovered. I'm sixty and in good health. According to the surgeon, the tooth bone is strong, but the tooth beside it has had root canal done and is a crown, so would you advice #9 for an implant procedure? Also, if under the best hygiene care, what is the wear and tear for implants and how long do they normally last. What about bridges? Thank you for your time and your advice.

Thank you for answering all of my concerns! I will consult my dentist. Currently a bridge partial with two adult front teeth. The bridge broke as I was eating subway. My worst nightmare came true today!

Correct, an earlier time has largely witnessed the patients with lost tooth facing the problems of unnecessary crushing of other adjacent teeth around the damage tooth to have the surgery done. Fortunately, dentistry has invented a meaningful method called Dental Implant just to have the tooth replaced, the only tooth that requires the reconstruction, not damaging adjoining teeth or teeth structures. Numbers of successful dental implant patients are seen, recovering well with better integration to tooth bone and having the most appealing teeth look.

How much does bridges cost I have 4missing teeth in front on bottom middle I have partials but I'm not comfortable with them I don't go outside and I just want to fix the problem to get my confidence back thank you

I am planning to have 4 lower front teeth implants. What are pros and cons, please? I am 67 years old.

i was told that people over 60 cannot have implants done in the lower jaw easily....?

I am beginning to have problems with my molars. I have a three tooth bridge placed between teeth 2 and 4. The bridge was placed on May 6 this year. In my opinion the bridge was not properly designed and placed . There is a gap where the middle tooth (3) was, creating a food trap. . In making the bridge, shouldn't the crown be designed to plug the cavity where the middles tooth (3) was. Would an implant be a better option?

The comment that you sacrifice two healthy teeth for a bridge is a gross exaggeration. Also, an implant requires several xrays. A bridge requires none. this is a consideration for me, since I have had radiation, and to anyone to whom this is a consideration. finally, a bridge is much simpler so costs less. I have one of each. If you have problems, a bridge is much easier to fix; there isn't a hole in your bone. Next time, I'd go for a bridge.

Sir i have two implants in lower jaw, its temporary denture, but i hate this because it make difficult to eat food ,speak and i feel miserable. i want fix permanent teeth in lower jaw, can you tell how much implants is required , and what will be cost.

Thanks you for this excellent article. It answers all my concerns.

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