Bridge or Implant - How to Replace One Missing Tooth
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By Dr. David Leader
You Can't Do It Yourself
When children lose a tooth, there is celebration and joy. When adults lose a tooth, there is usually concern and dismay. Children replace their own tooth by growing one anew. Adults require assistance from their family dentist. The first job of the dentist is to assist their patient with the decision of how to replace that tooth.
There are many options available to replace teeth. When a front tooth is lost in an accident, such as when playing a sport or in a car, time can be a major concern. Dentists can replace a tooth very quickly by fabricating a single tooth denture often called a flipper. A flipper is much like an orthodontic retainer with one or two teeth; it may have a couple of wire clips that hold it onto other teeth. Flippers are easy to wear and care for, and they repair the patient’s appearance. Most people are not happy with their ability to chew with the flipper in place, so they remove it when eating. Some have trouble talking with the flipper at first, but speech improves with practice. This is the least expensive way to replace a tooth. Some patients will live with a flipper for years before replacing it with a more permanent false tooth or another flipper.
A newer technique to rapidly replace a missing tooth is by bonding a denture tooth or the avulsed or lost tooth to the teeth on either side. The supporting teeth are the abutments and the false tooth is the pontic. This procedure will last from months to a few years depending on how the dentist attaches the replacement tooth. Usually, this procedure will cost more than a flipper, perhaps two to four times more.
Lately, the state of the art technique to replace a single tooth involves the use of a titanium metal, dental implant. A dentist places the implant into a hole that they drill into the bone where the tooth should be. The bone knits to the implant and supports a crown that will look and feel just like the missing tooth. Replacing a tooth with a dental implant is usually very predictable and long lasting. This is may be the most expensive way to replace a missing tooth. This is the replacement technique with the highest level of comfort and satisfaction.
For many years, the fixed bridge was the gold standard when replacing a single tooth. It remains an important tooth replacement technique. To make a bridge, the dentist must reshape the abutment teeth(adjacent) so that crowns may be made to cover them. A dental lab makes two crowns and a pontic in one piece. The dentist cements or bonds the bridge to the abutment teeth. The bridge is made of porcelain alone or lined with metal. Fixed bridges are durable and long lasting. The advantages are that the bridge will not normally come out, and it will look and feel much like the original tooth. The disadvantage is that if anything happens to one of the abutments the entire bridge may be lost. Also, reshaping a tooth to make it a bridge abutment makes it more likely to require root canal treatment. Replacing a single tooth with a fixed bridge may cost about the same using a dental implant.
Some people may remember the “Maryland Bridge” that was very popular in the 1980’s. This type of bridge attaches a porcelain tooth using metal wings that cover the backs of the abutment teeth. The advantage of this design is that the dentist only makes small changes to the shape of the abutment teeth. The procedure is relatively quick and far less expensive than a traditional bridge. Additionally, there is very little likelihood of causing one of the abutment teeth to require root canal treatment by inadvertently damaging the pulp or nerve of the tooth. The disadvantages are that the metal wings cause a shadow in the abutment teeth making them appear darker or somewhat gray, and that Maryland Bridges tend to debond or come undone every few years.
A new bridge that is similar to the Maryland Bridge does not have metal. Instead, the dental lab forms the entire bridge of plastic and glass composite or porcelain / ceramic material. Since the wings are made of a tooth colored material, the dentist may decide to put the wings on the front of the abutment teeth to improve their appearance. Unfortunately, bridges like this are not as strong as traditional bridges. Many dentists will not consider this type of bridge or offer it as an option. The longevity of this kind of bridge is highly variable. The cost is similar to a traditional bridge.
Finally, some patients in search of an inexpensive replacement for a single back tooth leave their dentist’s office with a single tooth, removable partial denture called a “Nesbit”. The Nesbit is a denture tooth with plastic or metal clips that encircle the abutment teeth. Most people eat and speak well with Nesbit partials. They will never look or feel like the natural tooth they replace, but they seem to be very comfortable and easy to use. The major advantage of Nesbit partial dentures is their low cost. The disadvantage is that /pages/ swallowing a Nesbit with metal or sharp plastic clasps might cause serious internal injury.
Missing teeth cause cosmetic and functional problems. It may be more difficult to eat or speak correctly. Other teeth will move into the space left by the missing tooth. There are many choices to replace a single missing tooth. To determine your best option, speak with your dentist
Dr. David Leader is the Chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs.