Missing teeth not only create a hole in your mouth – they create a hole in your life as well. Empty gaps affect your ability to speak and chew properly, and they can disturb an even bite pattern and shift your jaws out of alignment. If you have missing teeth in the front of your mouth, you may feel self-conscious smiling and laughing in public and for pictures. Two standard options for tooth replacement are dental bridges and dental implants.

The Basics

• Bridges literally “bridge” the gap created by a missing or newly extracted tooth. Ideally, a missing tooth will have remaining teeth on either side of the gap – these neighboring teeth are called abutments, and they provide support for a false tooth to be placed in between them. The neighboring teeth are stripped of enamel, shaved down, and fitted with crowns that hold up the false tooth (called a pontic) in the middle. Pontics are made of golds, alloys, or porcelain material and can be crafted to match your surrounding teeth. Another bridge option is a Maryland bridge: instead of crowns, a porcelain or metal framework is fitted to the backs of two abutment teeth and support the pontic in the middle.

• You are still able to get a bridge even if you have only one adjacent tooth to a gap; however, these structures – called cantilever bridges – place even more strain and pressure on the surrounding tooth, since there is only the one abutment to support the false tooth.

• Implants are literally “implanted” into the jawbone and act as artificial tooth roots. A metal cylinder made of titanium is placed in the jawbone under the empty tooth space, and over several months fuses naturally with the bone in a process called osseointegration. A connector is fitted on top of the implant and holds the fake tooth in place. Each artificial crown is custom-made to match the surrounding natural teeth.

Pros and Cons

Bridges are a good restoration solution under the following conditions:

• If the adjacent teeth have large fillings and/or will need to be crowned or capped in the future;
• If the missing tooth was removed several years ago and the underlying gum and bone have receded; and
• If there are multiple missing teeth that need to be replaced.

The principal disadvantage of bridges is the stress they place on surrounding teeth. In order to construct a bridge the neighboring teeth must undergo enamel removal, which could permanently damage otherwise healthy teeth. And once a bridge is placed, the supporting teeth will remain under constant stress to hold it up. Additionally, while pontics are placed in the bed of the gap, they do not extend down into the gumline nor address gradual bone loss that occurs when the gum is left exposed from a missing tooth. Although bridges provide a superficial solution to tooth loss, underlying bone and gum recession will continue and could potentially lead to additional oral problems in the future.

On the other hand, implants are the only restoration solution on the market that not only preserve natural bone but stimulate continued bone growth under the false tooth. Implants are strong, durable, and replace missing teeth without affecting the surrounding, healthy teeth. And because implants protect bone health, they prevent future jaw issues that are caused by receding bone. But implants too have their drawbacks: they require an adequate supply of strong, healthy bone to fuse adequately into the jawline. If bone under or above the tooth gap is too short, too weak, or too thin, additional surgery from a bone graft may be required. For top teeth, if the sinuses are too close to the jawbone, a sinus lift may be necessary. Bone grafts and sinus lifts involve several months of recovery post-surgery, which further procrastinates setting of an implant.

The Costs

• Bridges are a less costly form of tooth replacement and the procedure is at least partially covered by most types of insurances. However, bridge placement now will lead to additional costs in the future – the average life span of a bridge is ten years and it will need to be replaced once the structure erodes with regular wear and tear.

• Implants are more expensive than bridges and may not be covered by insurance. But unlike bridges, implants are a more permanent solution for tooth restoration – with proper care, an implant will last for forty plus years. However, implants may not be the best solution if you require replacement of multiple teeth, due to the higher financial burden.

• In terms of time, implants are again more costly than bridges. While bridges are constructed and placed within a few weeks, the implant process takes several months before the full procedure is complete. Once an implant is placed, it will need a few months’ worth of time for the titanium post to fuse with the jawbone. And if a bone graft is needed pre-placement, the implant procedure will be delayed even further.

Tooth restoration is a daunting – and often financially heavy – challenge to face. Don’t be afraid to speak with your dentist in depth before making a decision. He or she will walk you through your best option, as well as the pros and cons of bridges and implants. If you choose to get a bridge, most major insurance types will cover at least a portion of the procedure. And while implants may not be included on all insurance plans, the placement process takes several months and gives you time to set up a payment plan or save money.

Here at Boyett Family Dentistry, we hope you never feel self-conscious about smiling. If you are missing one or several teeth, call our office today at 863-294-9200 to discuss restoration options with Dr. Boyett.