So, you’ve lost a tooth, and your dentist suggested a dental implant. Or, maybe you wear dentures, and your dentist recommended implants to keep your denture from floating around in your mouth like a loose hockey puck. Or, perhaps you have a family member who is looking into dental implants and you want to be able to support them on their implant journey. Whatever the reason, you found your way here, so I will do my best to explain what dental implants are and how you or your loved one can benefit from this cutting-edge technology.
As dentists, we strive to save teeth whenever possible. Despite the incredible advancements of modern dentistry, there is still no replacement that can match a natural tooth. But, some people are missing some or all of their adult teeth. Still, others are born with teeth that aren’t all that great to begin with. For everyone else, well, stuff happens, and teeth can be lost for a wide variety of reasons.
If you are going to lose a tooth, or you didn’t have one to begin with, nothing beats an implant in most cases. Dental implants offer a lasting and esthetic tooth replacement option that is simply unrivaled. To be sure, there are other options though, so I will briefly describe them all and summarize the differences below.
Tooth Replacement Options
| Replacement Option | Description | Removable | Picture |
|---|---|---|---|
| Dental Implant | Dental implants are placed directly into bone and may be fitted with either a crown or an attachment that affixes dentures. | No |  |
| Bridge | Bridges require the teeth adjacent to the missing tooth be crowned for support. | No |  |
| Removal Partial Denture (RPD) | Removable Partial Dentures must be taken out at night, and may be difficult to chew with. | Yes |  |
| Complete Dentures | Dentures replace all of the teeth in an entire arch. Implants may sometimes be used to help anchor dentures. | Yes |  |
Implants and bridges are both permanent and non-removable. Dentures on the other hand are removable. In fact, dentures must be removed nightly to avoid developing a fungal infection of the mouth called Denture Stomatitis. Many people hate the idea of wearing something they have to take in and out to eat and sleep. Because of this, bridges and implants are popular tooth replacement options, but what makes one preferable to another?
I don’t typically recommend bridges to patients unless a dental implant won’t work, or in rare cases where a bridge will work better. In most cases, the dental implant is the better option. When replacing a single tooth, the cost of a bridge and an implant are typically comparable up front. However, bridges have a much higher rate of failure, and in the long run the implant will likely end up costing loss. Also, because a bridge involves the adjacent teeth, there is always the risk that failure of the bridge means loss of additional teeth.
Dental Implants
Dental implants typically involve three separate parts. The first is the implant itself, which is like a screw that is buried in the jaw bone. The second part is the abutment, this piece joins the implant to the crown. Finally, there is the crown.
When implants retain and support dentures, there are different components depending on the type of fixation. In any case, implants involve more components than just the dental implant itself.
There are a couple of different methods for placing implants which affect how long the process will take. To understand the differences between these methods, see my other article that explains one-stage and two-stage implant procedures.
It is important to ask if the price includes the cost of the dental implant and all of the components that will attach to it. For example, the dental implant may cost $1,000, but the abutment and crown will cost thousands more on top of that. In total, a dental implant may cost anywhere between $2,000 and $5,000 depending on who places it.
Implants Advantages and Disadvantages
| Advantages | Disadvantages |
|---|---|
| Highest success rate | Most expensive up-front costs under most circumstances |
| Fixed in place / non-removable | Sometimes requires months to complete |
| Maintains surrounding bone | May sometimes require additional surgeries |
| Does not involve additional teeth | Limited by bone volume and density, as well as nearby anatomic structures |
| Failure of the implant doesn’t jeopardize adjacent teeth | Not recommended for patients with certain health conditions |
| Looks and feels like a natural tooth | Expense increases with the number of teeth to be replaced |
| Relatively easy to maintain / clean | |
| Can support / retain dentures | |
| Sometimes allows for immediate tooth replacement | |
| May generally be used to replace any tooth in the mouth | |
| Allow patients to eat without restrictions |
Bridge
Bridges can span any number of teeth, but the more teeth are involved, the higher the likelihood that the bridge will fail. Also, the more teeth we replace, the more teeth must anchor the bridge. In cases where a single tooth is lost, usually the two adjacent teeth are used to anchor the bridge, these teeth are called abutment teeth. When two teeth are missing, the bridge will often require three or more abutment teeth.
Implants can also support bridges. I do not recommend bridging from a natural tooth to an implant due to the fact that natural teeth move, and implants do not. Imagine for a moment if your car had suspension on the front wheels, but not on the back wheels. Not only would that make for an uncomfortable ride, it would cause the components of your car to wear out faster. Similarly, the increased stresses on a dental bridge spanning from a natural tooth to an implant will lead to a higher likelihood of failure over time.
Bridge Advantages and Disadvantages
| Advantages | Disadvantages |
|---|---|
| Fixed in place / non-removable | Although good, the success rate is significantly worse than dental implants |
| Looks and feels like a natural tooth | Requires modification of additional teeth |
| Can usually be placed within weeks and sometimes the same day | Failure of any part of the bridge requires replacement of the entire prosthesis on all involved teeth |
| May be placed in areas where dental implants are impossible | Does not maintain underlying bone |
| Allow patients to eat without restrictions | More difficult to maintain / clean |
| Expense increases with the number of teeth to be replaced | |
| Not recommended for replacing lost second molars | |
| Although they are typically less expensive than dental implants, bridges are still relatively expensive |
Dentures
There are two widely used types of denture. First, there are complete dentures, which replace all of the teeth on the upper or lower jaw. Second, there are Removable Partial Dentures (RPDs) which replace only some of the teeth on one arch. RPDs themselves offer a couple of options, from a flexible gum-colored base to a metal framework. It is important to discuss with your dentist which option is best for you.
In cases where I suspect a patient may lose more teeth in the future, I always advise the metal framework, because we can add teeth to that in the future. For patients with a gummy smile and a desire for improved esthetics, I often advise the flexible RPD, especially if they are at low risk for losing more teeth in the future.
Denture Advantages and Disadvantages
| Advantages | Disadvantages |
|---|---|
| May generally be used to replace any tooth in the mouth | Removable |
| Can be used to replace multiple teeth anywhere in the same arch | Difficult to eat many, if not most foods |
| Relatively inexpensive | Due to constant bone remodeling, dentures must be adjusted and replaced periodically |
| Failure of the denture does no harm to the supporting teeth | Must be taken out and cleaned every night |
| May be used to replace teeth when dental implants or bridges are not possible | Does not maintain underlying bone, years of denture use and bone remodeling can lead to a sunken facial appearance |
| Expense does not increase in proportion with the number of teeth to be replaced | Involves modification or use of additional teeth for support |
| Take multiple appointments and weeks or months to complete | |
| Easily lost / damaged | |
| Less esthetically pleasing | |
| Don’t feel like natural teeth | |
| May lead to bouts of Denture Stomatits or Angular Cheilitis | |
| Generally the most difficult prosthesis to fit properly | |
| Lower dentures, under most circumstances and with most patients, will never fit properly without dental implants | |
| Loss of any supporting teeth may require a new denture | |
| Many patients will never be happy with the fit of their dentures |
What’s Right For You?
Hopefully the tables above have given you an idea of the advantages of disadvantages of each tooth replacement option. When trying to help my own patients decide what option is right for them, I try to get an idea of what their goals are. The five categories I ask patients to consider are as follows:
- Esthetics
- Function
- Durability
- Price
- Ease
My patients tend to care about one of these five categories more than the others. When replacing teeth, you want to ask yourself what is important to you. Are you looking for something that looks just like a real tooth? Do you want something that just works and you don’t have to think about? Are you looking for something durable that will last a lifetime? Is price your main consideration? Or, do you want something that is easy to use?
Esthetics
If you care more about the look of the tooth replacement, then you will want to consider an implant above all other options. In cases where an implant won’t work, a bridge would be the next best option. Implants are usually impossible to distinguish from a natural tooth.
Implant > Bridge > Dentures
Function
Some people don’t care as much how things look, they just want something reliable and easy to maintain. Again, implants take the crown here (pun intended). They are relatively easy to maintain, and they function the same as a natural tooth. Most patients can’t tell the difference between their implants and their natural teeth.
Implant > Bridge > Dentures
Durability
Durability is dependent upon several factors. In most cases, there is nothing more durable than a dental implant. However, implants can be susceptible to gum disease. Bridges are not bulletproof either, as they are susceptible to cavities where the crowns meet the tooth. Both implants and bridges can break if you have a habit of grinding or clenching your teeth. Either way, your dentist will probably recommend that you wear a night guard to protect your investment.
Dentures can be susceptible to breakage in patients who clench. Dentures are also susceptible to losing teeth in patients who grind. Also, because dentures are difficult to fit properly, they are often susceptible to breakage just from daily use.
Implants, bridges, and dentures all have their relative strengths and weaknesses. The solution that will be most durable in your mouth depends entirely upon your circumstances, which is why it is important to discuss with your dentist.
Price
A single implant is typically comparable to the price of a 3-unit bridge. However, bridges are much more likely than an implant to fail over time. Because of this, implants will often end up costing less for most patients when projected over many years.
Dentures become more economical the more teeth you are replacing. In general, when patients are missing large numbers of teeth, dentures are less expensive than implants or bridges. However, it is important to understand what dentures require. First, you are usually buying two sets of dentures. The first set are “temporary” dentures, the second set are “final” dentures. After we remove teeth, the surrounding bone tends to change over time. The biggest changes occur in the first few months. Because of this, the first set of dentures you are given likely won’t 6-12 months later. We can only reline dentures so many times before we have to make new ones.
When replacing a single tooth, implants offer the most economical solution over the long-term. When replacing more than a couple of teeth, dentures may become more cost effective than dental implants or bridges.
Ease
For sake of clarity, I will consider ease from the perspective of the patient only. In general, dental implants are the easiest tooth replacement to maintain. They require the same basic care as a natural tooth. Bridges require floss threaders, which some older patients may find difficult to use. Dentures require careful daily cleaning to prevent oral fungal infections.
Implant > Bridge > Denture
Who Should Place My Dental Implants?
Okay, you’ve decided dental implants are right for you. But you’re wondering, who should you trust to do the best job?
I recommend any patient in need of dental implants try to find a dental professional who has experience placing and restoring dental implants. There are a number of credentialing organizations that list implantologists in your area. Some of these organizations include the International Congress of Oral Implantologists (ICOI), American Association of Implant Dentists (AAID), and the American Board of Oral Implantologists (ABOI).
Don’t be afraid to shop around. Dentists aren’t just tooth mechanics, we are oral health professionals, and we take our responsibility to educate our patients very seriously. If you don’t feel like your dentist is acting in your best interests, or offering you sensible advice, don’t hesitate to get a second opinion. You should never feel guilty for hearing what another dentist has to say. Don’t be surprised if they offer different advice, the practice of dentistry is as much art as it is science. Every dentist has a different risk/benefit philosophy and different ways of handling the same problems.
Should I See a Dental Specialist?
The question of specialist care in dental implantology is both controversial and complicated. Some traditional specialties consider themselves implant specialists, such as oral surgeons, prosthodontists, and periodontists. Lately, endodontists have been getting in on the action as well. Historically, the first dental implants were actually placed by general dentists. Once upon a time, dental implants were considered medical malpractice. It was a few enterprising and brave general dentists who developed the technology in the face of enormous professional pressures not to do so.
There are dentists who have limited their practice entirely to the placement and/or restoration of dental implants. These dentists typically refer to themselves as dental implantologists. Usually, they are general dentists who have decided to specialize in implant placement, but some are specialists such as oral surgeons, or periodontists.
What About Implantologists?
Do you need an implantologist to place your dental implant? Probably not. More important than professional titles is how much experience your dentist / dental specialist has placing implants. In one retrospective study at The Louisiana State University Health Sciences Center School of Dentistry, there was a correlation between the experience of the practitioner and the long-term survival of the implant. Residents with one year of experience had a success rate of 88.6% while those placed by residents with three years of experience were 94.2%. In this study the overall implant survival rate was 92.6% which is a bit lower than the 95% we typically tell patients.
Because this study was done at a dental school where specialists place dental implants, there was no cohort comparing general dentists. I was able to find one study that looked at implant outcomes in general dental practices. In that study, the equivalent failure rate was determined to be about 7%, which is roughly equivalent to the failure rate from the previous study. Other long-term retrospective studies have shown long-term success rates to be between 92% and 99%.
Ultimately, it’s less important if the dental professional who places your implant is an oral surgeon or an implantologist. What matters more is how many implants they have placed, and what their overall success rate is. Because no one is likely to be truthful about their success rates, it is best to ask to see some of their work, and ask them how many implants they have placed. A highly experienced implantologist will have placed over 1,000 implants. Any dental professional who has placed more than 50 implants will probably be capable of doing a great job.
What Happens After?
Many patients ask me if dental implants hurt a lot. I tell them that in most cases, dental implants hurt less than extracting a tooth. In fact, many of my patients have stopped taking any pain medications just two days after surgery. It is impossible to predict how you will feel after your implant surgery, because everyone handles pain differently. But, in general, dental implants are nowhere near the top of the list of most painful dental procedures.
You can expect to take some medications as prescribed by your dentist. Every dentist has a different approach to medications, but NSAIDs and antibiotics are commonly prescribed. In some cases you may be given a steroid. It is important to let your dental team know if you are experiencing any excessive pain or bleeding after surgery.
After three or four days, most patients are feeling almost completely better. If your dentist placed stitches, they may need to be removed at a later date, or in some cases they will fall out on their own. If you are experiencing pain, bleeding, bad breath, or a metallic taste in your mouth days after surgery, you should contact your dental team.
Final Thoughts
There are a number of things to consider before getting dental implants. First, you need to find the right dental professional. It is important that you trust whomever will be placing the implants. Start by searching the implant specialist websites I shared earlier, and research which dentist seems like the right fit for you. Remember, personality matters. They could be great at placing implants, but if they have poor bedside manner, are difficult to get a hold of, or they don’t pay attention to your needs and concerns, you may be better off seeing someone else.
Second, you should be sure that dental implants are necessary and the best option for you. It is important to seek a second opinion if you are unsure of why you need dental implants. Never consent to treatment you don’t understand the need for.
Lastly, you will want to do your research on what to expect. I hope this article has informed you about what dental implants are, why they make a great tooth replacement option, and how to find the right dental professional to place yours. If you happen to live near Scottsdale, Arizona, I would love to meet with you and answer your implant questions. Just visit my dental implants page and fill out the form.
If you have any comments, questions, or concerns, please leave a comment below!