Dental Implant vs Bridge: Single Tooth Replacement

For most patients missing a single tooth, a fixed (non removable) and natural looking replacement is the number one priority. Historically, dental bridges offered these results by crowning the teeth adjacent to the missing space and "bridging" it with a false tooth. However, the rise of dental implants has created new opportunities to restore missing teeth without needing to modify the neighboring dentition. The best choice for your mouth depends on a number of biological and cosmetic factors. Take a look!

Dental bridges are an excellent way to restore missing teeth without requiring surgery or implant placement. The most obvious drawback is that the adjacent teeth need to be modified to receive crowns to support the bridging tooth. However, if both teeth already have crowns or large fillings, a bridge can seem like a more attractive option. The biggest hesitation towards placing a bridge is when one of the neighboring teeth is completely healthy and free of any previous dental work. From a oral hygiene standpoint, bridging two teeth creates a potential food trap and an area that is difficult to floss. You will probably need to use floss threaders to clean under and around this area. Cosmetics are difficult to judge on bridges. The height of remaining soft tissue, space to be covered by the false tooth and angulation of adjacent teeth will all influence the final outcome. 

Likewise, implants allow dentists to restore missing teeth independently of neighboring teeth. In fact, an implant does not even need a tooth on both sides of it to be placed. This is why implants are the first choice for replacement when the last teeth in the dental arch are lost. Since an implant is placed surgically, cosmetics can be managed via bone remodeling and gum grafting. A well placed implant is indistinguishable from natural teeth. However, implants have a long healing time, typically requiring 6+ months from insertion to final crown placement. In the meantime, patients are provided with a temporary denture called a flipper if cosmetics are a concern. Another consideration with implants is bone height and health. There needs to be ample space and width for the implant to be placed without damaging nerves, blood vessels or sinuses. Not every patient will qualify for implant surgery. 

Deciding between an implant or a bridge is ultimately your choice. However, an exam and conversation with your dentist can alleviate concerns and help guide you towards the option that suits your needs best. If you would like to schedule an exam or consultation, please give our office a call today!

Dentures

One of the greatest aspects of modern dentistry is our ability to replace missing or extracted teeth. Today, patients typically seek out implant crowns and bridges as quick and safe methods of restoring their smiles. But what about dentures? The name alone might conjure up pictures of older relatives and seltzer tabs, but they are still an excellent way to fix a gap in your dentition. At Thousand Oaks Family Dentistry, we offer a number of denture options for patients needing everything from temporary single tooth replacement to permanent appliances for entire arches. No matter what your needs, there is likely a denture solution to fit it!

Patients who still have some existing teeth are typically eligible for partial dentures. These appliances bridge one or more empty spaces between teeth to recreate a natural smile. They usually require healthy molars or premolars to snap on to and give them rigidity. Some partial dentures are made entirely out of acrylic. These are commonly referred to as “flippers” and typically serve as temporary solutions until an implant can be placed or a permanent denture can be made. Because they are plastic, they need to be made thick for rigidity. Likewise, flippers can feel bulky and uncomfortable and are prone to becoming brittle. Still, they are an excellent interim esthetic solution for patients missing teeth.

a full acrylic partial denture or "flipper"

Partial dentures can also be made using a combination of acrylic and cast metal. These devices are stronger, thinner and typically more comfortable than flippers. When you smile or open your mouth, pink and enamel colored acrylic hide the metal framework beneath and the appliance looks like natural tissues. Rigid metal partial dentures are appropriate for long term use and are often the most comfortable option. If you have enough teeth to anchor the device, they can fit snugly and comfortably in your mouth.

A partial denture with metal framework

If you are missing all teeth on an entire arch, you are likely eligible for full dentures. Full dentures are made out of acrylic and stay in your mouth using the suction created between your gums and the denture base. Since they rest on your gum tissue, full dentures can take some time to get used to. Many patients will feel sore spots or an uneven “rocking” sensation until they become accustomed to the feeling of the appliance. Our office can make small adjustments to dentures to better accommodate your mouth, but they will never feel as natural as something anchored to your teeth. Still, they are a great alternative to smiling, chewing and speaking with no teeth.

a full upper and lower full denture

A final subset of dentures are implant supported dentures. Here, an acrylic appliance is mounted to 2 or more implants (depending on the number of teeth replaced) through rubber snaps. These are typically the most comfortable denture style for replacing whole arches of teeth. However, this treatment option is both costly and time consuming; Implant placement can take up to six months to become healed and sturdy enough to support a denture. Still, many patients are extremely satisfied with the resulting product, as the implants keep the appliance rigid and out of contact with gum tissue.

A diagram of how implant supported dentures are mounted

No matter what type of denture we are making, our office needs three types of impressions: one impression of the teeth (or gums) on which the dentures will be made, one of the opposing teeth and one of how the teeth come together when you bite down. Once we take these impressions, we send them off to a lab along with instructions on tooth color, transparency and brightness. From there, the lab will either fashion your permanent denture, make a wax try-in (a soft, denture lookalike used by our office to ensure fit and esthetics), or send us custom trays. Custom trays are impression trays that precisely fit the dimensions of your mouth. These instruments insure a perfect impression (and a better fit) for the final denture. Once we are ready to deliver your appliance, you will return to our office for a short fitting appointment where we can make minor adjustments.

The true scope of dentures extends into many different devices, materials and mounting styles. We like to have a lengthy discussion with every patient prior to taking impressions, to make sure they will satisfied with the final product. Only a consultation between you and Dr. Hong can show us what kind of denture is appropriate for your specific needs. If you would like to know more about dentures or any other type of appliance offered at our office, please give us a call. We are always happy to walk you through any and every procedure!

Dental Implants Thousand Oaks

Lost teeth can be replaced by a number of different dental treatments, including implants, removable dentures, and bridges.  Implants are the most technologically advanced treatment option and act the most like natural teeth.  Dental implants are bio-compatible titanium alloy cylinders that act as a root replacement for a missing tooth.   In their current form, dental implants have been around since the late 1970s when a Swedish orthopedist named Dr. Branemark developed them for dentistry. 

Today dental implants are the preferred course of treatment for replacing a single missing tooth.  They are similar in cost to doing a bridge and far more comfortable than wearing a removable appliance such as a partial denture.  In addition, unlike a bridge, dental implants do not require disturbing the tooth structure of surrounding teeth. 

According to the Academy of Osseointegration website, the long term success rate of implants remaining stabile in the bone is 90%.  A study published in Clinical Oral Implants Research (July 2010) showed a 16 year survival rate of 83%.  In either case, implants have an amazing long term success rate, that makes them a predictable option to replace a missing tooth. 

Implants have become a billion dollar industry.  Two of the leading implant manufacturers, Nobel Biocare and Straumann each reported yearly revenue in 2013 and 2012 respectively of over 780 million US dollars.  In my office I have been placing dental implants since 2007.  I have chosen to place Straumann implants, because they are an industry leading company that has been developing implants in Switzerland since 1974.  They produce a high quality and consistent product, including the implant and all of the parts that connect to the implant that allow us to restore the implant with a prosthetic tooth. 

As a general dentist, I enjoy placing implants in my office because I know where the ideal placement is so that I can restore the implant with an ideally fitting and functioning crown.  The actual surgery of placing the implant isn’t much different than drilling an ideal hole in a tooth to fix a cavity.  Implants are placed by surgically making a small incision in the tissue, followed by drilling a hole similar in size to the implant, and then using a torque wrench to screw the implant in place.  The entire procedure is done with local anesthesia in under an hour.  Patients have told me that having an implant placed is less traumatic than having a tooth removed, and the recovery isn’t much different than having a filling placed. 

After a tooth is lost, it is ideal to wait four months for the bone to heal before placing the implant.  It takes an additional four months once an implant is placed for it to osseointegrate in the bone and for the permanent crown to be placed.  So from the initial tooth loss it takes eight months for the procedure to be completed.

In restoring the implant, there are a couple of steps.  We take an impression of the location of the implant.  Then my lab fabricates a custom abutment, which replicates the missing part of the tooth that sticks above the gum tissue.  These abutments are made of either a high noble metal, titanium or zirconia and they are screwed onto the implant.  Finally a traditional crown is made to attach to the abutment.

Patients frequently ask about the cost and timeline for dental implants.  To restore a single missing tooth with a dental implant, abutment, and crown, the cost is approximately $3500.  Implants are most predictable in their long term success when they are given the proper amount of time for the bone to integrate and heal to the implant.  When advertisements are made for implants that cost less or take less time, it generally involves using less quality implants and connecting parts.  I believe in using industry leading parts, custom abutments, and quality local labs to complete all of my implant cases.

Kari Ann Hong, DDS
1000 Newbury Rd. #190
Thousand Oaks, CA 91320
www.thousandoaksfamilydentistry.com