Bridge or implant?

Esel

Hoping for some advice here. I appreciate the limitations of giving such advice without seeing x-rays etc. I will try to give as complete a description as I can.

I recently had my UL incisor extracted. It was badly decayed, dead/hollow root, so not suitable for restoration. The tooth had been troublesome for many years, including recurring abscesses that would normally clear up without treatment/medication. I am a smoker, but would be prepared to switch to e-cigarettes if necessary, as I understand that smoking can adversely affect the prognosis for an implant.

I have to make up my mind between a bridge (lava is being recommended) or an implant and crown. My concerns are as follows:

Bridge:

1. How will the gumline over the middle 'tooth' of the bridge look into the future? i.e. Is it likely that recession of the gum would lead to an obvious gap?

2. How difficult is it to keep this area clean without 'widening' any gap?

3. Life expectancy of the bridge. Is 15-20 years too much to expect with good hygiene and regular check-ups?

Implant:

1. What is the likelihood of the implant not integrating with the bone? I ask because of the history of infections in this area and the possibility of the bone being compromised as a result.

2. Again, life expectancy. Longer than a bridge?

3. Appearance - again v. the bridge and my gumline question above.


I know the implant will be more expensive, so this is not an issue.

Dianthus

Please consider discussing all these questions with your own dentist, who is familiar with the specifics of your case (condition& quantity of your gums/bone/adjacent teeth, your bite, the amount of tooth you display on smiling, the longterm prognosis for the rest of your teeth...).
However, if cost is not an issue but confidence is, consider seeing a periodontist &/prosthodontist for consultation. They specialise in these areas of dentistry.
Briefly:
**Post-extraction, the majority of gum shrinkage occurs in the first 3-6months.
**For BOTH options:
-Cleaning(daily flossing, regular hygienist visits, ect)& regular 6 monthly dental visits for maintenance are absolutely vital. And won't exacerbate gum shrinkage- if anything, it will keep it to a minimum
-You may require a bone graft.
-Complete, longterm, smoking cessation will maximise your chances of success& overall lifespan.

Esel

Thanks for the advice.

I would appreciate the input of some of the other professionals on the forum.

btkm8unsl0w5r4

Esel wrote: »

I have to make up my mind between a bridge (lava is being recommended) or an implant and crown. My concerns are as follows:

I would be very carefully about Zirconia (lava is a type of zirconia) bridges, the aesthetics in my experience leave a lot to be desired as the connectors are very thick and the separation between the teeth is poor, also there can be some strength issues. Often used more as a selling tool than actual clinical necessity.

Esel wrote: »

Bridge:

1. How will the gumline over the middle 'tooth' of the bridge look into the future? i.e. Is it likely that recession of the gum would lead to an obvious gap?

Usually if the dentist leaves it a suitably long time before the final bridge is done the recession is finished, usually about 8 weeks. The teeth either side hold the gum in position. You do get shrinkage in width and height over time and this can become an issue. A good dentist is use pontic forming techniques and ovate pontics in these areas to get a better result, this takes more time and hence money.

Esel wrote: »

2. How difficult is it to keep this area clean without 'widening' any gap?

Use of superfloss or TePe brushes is essential to remove plaque from under the bridge pontic (the false tooth). It wont widen the gap under the bridge doing this.

Esel wrote: »

3. Life expectancy of the bridge. Is 15-20 years too much to expect with good hygiene and regular check-ups?

The longevity of the bridge will depend on the condition of the abutment (holding) teeth and accidents like trauma are hard to predict. The literature would say on average (from 100,000's of bridges) that it will last between 10-15 years but in your specific case its hard to predict. Bridges last very well indeed, however when they do fail its usually because one of the supporting teeth failed so re treatment is more complex.

Esel wrote: »

Implant:

1. What is the likelihood of the implant not integrating with the bone? I ask because of the history of infections in this area and the possibility of the bone being compromised as a result.

Implants will integrate about 95% of the time by experienced operators using good implants in good bone. Infections in the area usually cause loss of bone on the lip side and this often requires bone grafting for a good long term result but it will depend on your case. The implants need to be encased in bone all over so infections tend to create a swiss cheese effect in the bone that needs to be repaired.

Success is an interesting topic, as a implant can be placed at a funny angle into the available bone which will fuse to the bone but the angle make the final tooth look funny and cause gum recession, is this successful?

Esel wrote: »

2. Again, life expectancy. Longer than a bridge?

The implant itself ( the screw portion of the titanium screw) if it integrates will probably last your entire life with good cleaning and maintenance. The crown on the implant is like the tyre of your car its in your mouth and will require periodic replacement every 15-20 years similar to a bridge however retreatment is simple.

Esel wrote: »

3. Appearance - again v. the bridge and my gumline question above.

A good bridge willl look good, a good implant will look good, a bad bridge will look bad and a bad implant will look bad. It depends on who does it and their attention to details. A implant is actually difficult to make look really good and take a lot of time with temporaries to shape the gum, this bridge is simpler, at the end of the day the implant does come out of the gum so its more realistic to your tongue and you can floss between your teeth also. Long term an implant is a better options in most cases but not all. Like all dentistry is not what you do its the way that you do it


Good questions, I hope this a help.

Esel

Thank you so much for the very detailed reply. I genuinely appreciate it.

Jillian Worried Source wrote: »

I would be very carefully about Zirconia (lava is a type of zirconia) bridges, the aesthetics in my experience leave a lot to be desired as the connectors are very thick and the separation between the teeth is poor, also there can be some strength issues. Often used more as a selling tool than actual clinical necessity.

I also have the option (actually cheaper!) of a metal-based bridge. Can I take it that this type would not have the issues you mention above?

Bridges last very well indeed, however when they do fail its usually because one of the supporting teeth failed so re treatment is more complex.

This is one of the things I am concerned about. Both supporting teeth have restorations (they have been renewed during my current treatment).

Implants will integrate about 95% of the time by experienced operators using good implants in good bone. Infections in the area usually cause loss of bone on the lip side and this often requires bone grafting for a good long term result but it will depend on your case. The implants need to be encased in bone all over so infections tend to create a swiss cheese effect in the bone that needs to be repaired.

My dentist has told me I might need bone graft(s) if I opt for an implant. Yesterday, I could feel something hard protuding from the gumline of the empty socket, and when I probed it (gently) with a toothpick soaked in alcohol (hand-sterilisation type) I found that it was a small loose piece of bone about 2x3x1mm in size. It came out very easily. If it was bone (rather than a root fragment, which I think is unlikely, as I actually have the removed root/stump) I suppose this would be a contra-indicator as regards getting an implant? I definitely do not want to get an implant which is hugely complex to place or which might not prove 100% successful.

An implant is actually difficult to make look really good and take a lot of time with temporaries to shape the gum, this bridge is simpler, at the end of the day the implant does come out of the gum so its more realistic to your tongue and you can floss between your teeth also. Long term an implant is a better option in most cases but not all. Like all dentistry is not what you do its the way that you do it.

Good questions, I hope this a help.

I am now leaning towards a non-lava bridge, as, knowing the probable state of the bone, and given the reservations expressed by my dentist (although he is leaving the decision up to me), I feel that a bridge would be more suitable/successful than an implant.

Again, Jillian Worried Source, I am really grateful for your detailed reply.

Oral Surgeon

Hi Esel,

I'd agree with Fitzgeme...

In addition;
Most clinicians nearly always do a simultaneous bone graft with implant placement in the anterior aesthetic zone these days anyway as we don't want screw threads exposed and not in-cased in bone during healing but also we want to bulk out the soft tissue (gum) so that when the crown is made- it will look like it emerges from the gum like a natural tooth does. The graft can be a bone graft or in some cases, a gum graft depending...

Bridges, done correctly, can look very well... Most important factors are your lip line during smiling (at a big smile can you see upper gum or not) and allowing the bone level to stabilize before making the bridge...
If you can see a lot of gum at a big smile- a bridge may look unnatural with time as the gum may shrink away from it...

All depends on the particular case though...

Good luck,
OS

Esel

Thanks for that OS, much appreciated.

Regarding bone/gum graft before implant - is this normally included in the 'standard' implant price? If not, by how much percentage-wise would it increase the cost? Ball-park, of course. (I know I can ask my dentist this, and I will, but would be interested to know the score.)

Oral Surgeon wrote: »

Most important factors are your lip line during smiling (at a big smile can you see upper gum or not) and allowing the bone level to stabilize before making the bridge...
If you can see a lot of gum at a big smile- a bridge may look unnatural with time as the gum may shrink away from it...

Just checked there - the top of my two front incisors is masked by my upper lip when I 'big smile'

Also, in a bridge, by how much would the bridged tooth normally insert into the gumline? I ask this from the point of view of knowing how much the gum would have to recede before the gap might be visible.

Finally, do you share fitzgeme's reservations about the lava bridge?

Oral Surgeon

Hi Esel,
Usually the graft fee is not included in the headline price. I'd charge about €400 on a single tooth implant (graft materials are expensive...) but I know most charge more...

A low-lip line is a bonus and will make your particular case easier... The "pontic/fake" tooth usually comes to meet the gum but not tightly as you will need to be able to floss under it. Fitzgeme???

To be honest- I know nothing about lava or any of these materials as I don't do any bridges, crowns, veneers etc.... I'd trust Fitz's opinion on this though.

OS

Esel

Thanks again, OS.