New bridge? Or implant?
February 16, 2012 10:50 AM   Subscribe

Can you help me choose between a dental implant and replacing my bridge?

Lost a front tooth when I was 11, had a bridge put in when I was about 25. It lasted until I did something stupid at 39. It's time to either replace it with a more modern bridge or have a dental implant.

My dentist recommends the implant, saying it'll look better and that if there's an issue with one of the two remaining teeth, it'll be simpler to address it if there's no need to pull a three-tooth bridge off. Fair points. But I'm generally OK with how my current bridge looks, and figure a new one will look even better. And I just can't get past having 'needless' surgery; why let someone drill into bone and wait 4-5 months for it to heal if I can just have another bridge popped on there that should last even longer than the last one, especially if I don't do something stupid again? I'm being told cost is roughly the same.

Looking for advice, especially from anyone who's had either of the two procedures in the last several years.
posted by troywestfield to Health & Fitness (11 answers total) 1 user marked this as a favorite
 
i had an implant put in 13 years ago and it's been maintenance-free issue-free since day 1. implants are the shizzle. if you don't want one, it's not like it's wrong not to get one, but they're a lot closer to "do it and forget about it" than a bridge. of course, you might have surgical complications, etc., etc.. There's no way to be 100% sure in advance.
posted by facetious at 11:07 AM on February 16, 2012


I have both bridges and implants - bridges on the top, implants on the bottom. (I was born without multiple adult teeth.) I haven't had issues with either. Unfortunately, neither of them are as cosmetically appealing as I would like. The bridges are a bit obvious because the "teeth" do not go directly up into the gum. The implants would be great except that they miscalculated how much the swelling on the gums would go down, so they look like they're receding.

If you have the option, though, I'd definitely got with the implants as they'll last forever. My stepmother has slowly been getting all of her bridges changed over to implants for this reason.
posted by anotheraccount at 11:16 AM on February 16, 2012


I have both a bridge (right up front like you do) and some implants (in the back), and I much prefer the implants. They're easier to clean around and care for, and I'm less worried about them breaking/falling out/whatevs. If my bone could support an implant in the bridge zone, I would get one without a second thought.
posted by elizardbits at 11:22 AM on February 16, 2012


Here are a couple of factors worth considering:

A dental implant in the aesthetic zone (your front teeth) is considered a success if the 'emergence profile' (which is the way the tooth appears to come out of the gums) can be managed in such a way that no one can tell it's not your own tooth. this would be the advantage of an implant over a bridge.


The implant and crown for the tooth being replaced is comparable in price to an new bridge, but if the teeth that held the old bridge in place need to be crowned as well then the price for those should be factored in.

My advice to patients usually hinges on these two factors, all else being equal in terms of the overall health of the rest of your mouth.

Feel free to memail me if you have specific questions.
posted by OHenryPacey at 11:26 AM on February 16, 2012


I have one bridge near the front. If the bridge was damaged, wouldn't there be three teeth to deal with instead of just the one in the center? For mine, they ground down the teeth on either side so the cost should figure in those teeth also. If I had been able to afford the implant, I would have done it at the time, but I think the situation is different since you had teeth prepared for the bridge?

On preview what OHenryPacey said.
posted by Glinn at 11:28 AM on February 16, 2012


I have two implants replacing a bridge. It was well worth it.
posted by francesca too at 11:31 AM on February 16, 2012


I have three implants that have been in there successfully for 25 years! Prior to that, I had bridges. The difference was night and day. After having missing teeth (in back) for most of my childhood, adolescence, and up to my late thirties due to poor/no dentistry as a kid, to have something fixed in my mouth that felt like real teeth was a revelation. My implants are not in front, so maybe someone else can speak to that, but I recommend the implants if you have the money.

I dreaded the surgery, but a Valium ahead of time helped me to relax. (At that time, the surgeon used a sterile sheet over my face with just an opening at the mouth. That could've been claustrophobic, but the Valium helped me deal rather nicely as I recall.) My husband picked me up afterwards, the healing went well, and I've been totally satisfied with the implants ever since.
posted by Elsie at 12:03 PM on February 16, 2012


I have an implant on a front upper tooth and it feels solid as a rock. That said, it was a long and (sometimes) painful process which included some complications. There were times I wished I'd just gotten a bridge...

First I had to have bone grafting into the space to provide support for the implant--this took several months. During that time I wore a "flipper" which drove me utterly nuts. I eventually convinced my dentist to temporarily bond a fake plastic tooth into the space so that I wouldn't have to deal with the bulky, ever-shifting flipper against my palate. I could barely eat the flipper in, and had trouble pronouncing many words. So you should find out whether you'll need any bone grafting and whether or not you'll need to wear a flipper at any point (I'm guessing you'll still be able to use your bridge throughout the process, which would be ideal).

My oral surgeon then recommended I get a bit of gum grafting to help "plump up" the area--I'd originally lost the tooth in a stupid accident which definitely played a part in this. In any case, you may not even need gum grafting. That was an additional three-month long, painful process involving bloody stitched up gums for a good week.

Having the implant placed was not pleasant. It definitely felt like a surgery to me. I was in pretty bad pain for a good 24 hours, after which I was fine. But...more blood, stitches, etc. One of my nostrils/upper lip felt a bit numb for a good month after the surgery--this eventually went away.

When it was finally ready to have the crown placed on the implant, my otherwise totally competent dentist managed to use too much cement (or to in some way use it incorrectly). In cementing the crown to the implant/implant abutment, a small amount oozed out under my gum unbeknownst to anyone. Unlike relatively "biocompatible" titanium and porcelain, this cement was extremely irritating to my gum and also led to an infection under the gumline--this lead to a pus-filled boil on my gum (which my dentist incorrectly diagnosed as a loose "tiny bone chip" for a couple of months, treating me with antibiotics). Eventually I showed up at my oral surgeon's office and he gave me hell me for not coming in sooner (even though my dentist had seemed to know what he was doing). He had to perform a flap surgery--cutting open the gum near the implant and scraping away the excess cement. This was painful, bloody, and took a long time to recover from. It also led to a bit of gum recession around the implant AND it turned out there was a bit of bone loss around the implant itself.

Eventually, everything settled down and my implant feels mostly pretty good, and really solid, and looks fine (the porcelain crown looks amazing/nearly indistinguishable from natural teeth; stay away from blacklights).

tl;dr
The procedure will take time and probably more than one specialist. It might be relatively painless, but it might be somewhat gory and painful too--it's really hard to say. Complications are possible and can be kind of scary--especially in the aesthetic zone. After all that, I'm still pretty happy with the implant and would do it again. You should ask about whether or not bone and/or gum grafting will be necessary. Also ask about the current health of the two teeth that have been supporting your current bridge. If they're in excellent health, then it makes sense to crown them and get an implant. If they're in bad shape, maybe hold off and keep the bridge set-up, with the idea in mind that you'll one day need to get an implant-supported bridge for all three teeth.
posted by bennett being thrown at 12:16 PM on February 16, 2012


I had an implant in lieu of a bridge for a molar I lost for reasons similar to those mentioned above. It looks better, it's easier to clean, it feels more solid than any of my regular crowns, and that series of teeth is not in an 'all for one and one for all' state.
posted by A Terrible Llama at 3:20 PM on February 16, 2012


Implant here too - it's right in my smile line and you honestly cannot tell it apart from my real teeth.

Only downsides to the implant I can think of are:

- was that I couldn't chew on that side of my mouth while the implant healed - this was a 6 week process from memory.

- an implant in your smile line will be more expensive because it's a 2 stage crown process: 1 temporary crown while the impant heals, and 1 permanent crown that's coloured to look like your other teeth. The temporary crown is very white and looks a bit out of place

- I remember spitting up a fair bit of bloody from the dental surgery the day of. Ick.
posted by Cattaby at 5:13 PM on February 16, 2012


I had a baby tooth (eye tooth) that stayed in place for 37 years- no adult tooth came in. It finally wore out and I went with an implant. Wearing the flipper wasn't bad (my dentist was great and it fit fine). Because I waited so long to fix it, I did have some bone loss and required a bone graph, also not a big deal.
It is painful but the doctor will give you pain meds to make it better. I am so thankful that I went with the implant. No one knows (well, they do now) that I'm missing a tooth.
My dentist insisted on the implant because the location of the tooth would have meant too much wear on the teeth holding the bridge.
posted by myselfasme at 9:11 PM on February 16, 2012


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