Picture this-you’re eating your favorite dessert with your family on a Sunday afternoon. As you take a bite into that perfect, crunchy dish, you hear a different type of crack and your tooth starts hurting. A lot. Oh no!
If you’re like most people, your first thought is dread at needing to see the dentist. Then you worry about what will happen to your tooth. Let’s start talking about what happens when your tooth needs to come out.
Your dentist will first take a radiograph, or an X-ray, to see the damage to the tooth. He will probably tap on the tooth and use some ice to see what the damage is like. If it needs to come out, he will start talking about replacement options. Generally, there are three options for replacing your tooth: an implant, a bridge, or a denture. I’ll talk about each of these and their pros and cons here.
Implant
This is considered the best option for most people and is state of the art. An implant is actually three things-a titanium or ceramic implant screw that sits in the bone, a connector (called an abutment) that connects the tooth to the implant, and the crown that you see. We dentists know that you don’t want an implant, you want a tooth. We usually just call the whole thing an implant.
Pros:
This is the only option that avoids using any other teeth to support the replacement tooth. It preserves the most of your natural tissues without having to damage adjacent teeth. This is also the replacement option with the longest expected life-span when done correctly, typically lasting more than 20 years.
Cons:
An implant will take the longest of any option to get the tooth replaced. Implants rely on bone strength and health to survive, and bone takes a long time to heal. Because of this, you will be missing the tooth for 3-6 months while everything heals post-placement. Your dentist will have one of several options to temporarily replace the tooth in the meantime.
Implants are also the most expensive option to replace a tooth. After the extraction, the doctor will need to do a ridge preservation bone graft to help your body heal with enough bone to support the implant. Sometimes, even after this type of bone graft, an additional graft will be necessary to build enough bone to support the implant.
Implants may not be the right option for you in certain cases. There may be insufficient bone even with grafting, or you may have certain medical conditions (diabetes, osteoporosis treatments, or periodontal disease to name a few) or have lifestyle choices (tobacco, alcohol, or drug use, for example) that will make implants a much riskier, or even impossible, option.
Bridge
A bridge is the historical choice for replacing a missing tooth over the last 50 years. The teeth in front of and behind the missing tooth are prepared for dental crowns (some people call them caps). One piece of porcelain is fabricated into a bridge that connects the front and back teeth with a fake tooth, called a pontic, in the middle.
Pros:
This is a quick restorative solution. Generally, this is done in two appointments and you wear a temporary bridge for 1-2 weeks while a trusted lab makes the final bridge. Sometimes, the dentist will leave the bridge as a temporary to allow the gums to heal before placing the final bridge.
Cons:
A bridge requires at least two teeth to be damaged in order to replace the tooth. The numbers are not in favor of bridges as one or both of those teeth will likely need a root canal treatment in the next 10 years. It’s also likely that one or both of these supporting teeth will have decay or damage in the future that requires the entire bridge be redone. This is when it can become really expensive because now you are paying for at least THREE teeth to have work done instead of at most one.
Because it requires a tooth on either side, the back-most tooth in your mouth isn’t an option to use a bridge for. Sometimes a dentist will use a CANTILEVER bridge that uses two teeth in front of the missing tooth and a hanging tooth off the back. This is not considered a good option, but sometimes is the only option available. I call it a springboard bridge because it looks like the springboard of the pool I grew up swimming in.
If you are replacing more than 2 teeth, a bridge is not usually a good option as it puts significantly more stress on the supporting teeth and this increases the risk of future damage to those teeth. If one of those teeth are damaged, you are possibly looking at replacing 5 or more teeth.
Cost for a bridge is in the middle. It is more expensive than a denture, but less expensive than an implant restoration. If replacing more than 2 teeth, it is more expensive than implants with more risk.
Denture
Also called a Partial or Partial Denture, this is the only way that we have had to replace teeth for much of our history. After your dentist removes an affected tooth, they will make grooves and dimples in the other teeth of your mouth. These are for clasps and hooks to grab onto and hold the denture in place. You take the denture out each night and after each meal to clean.
It will take at least three appointments and as many as five to make the denture and can take up to 6 weeks because of all the time it takes to go to the lab. These are extremely complex restorations, so fewer and fewer dentists are making them, choosing to refer dentures of any type to specialized dentists who only do dentures.
Pros:
The least expensive; most often it costs the same to replace 1 or 8 teeth as the fee is for an arch, either the upper or lower jaw.
Partials can be paired with implants for larger areas of missing teeth. This combines the security of an implant with the cost-effectiveness of a partial denture.
Cons:
The partial denture can only replace so many teeth and in only certain configurations. If you have less than 6 teeth or your teeth are in a poor condition or configuration, you may not be able to have a partial denture made and your dentist may recommend a complete denture.
Multiple teeth must be cut into to make a denture work. Even when done perfectly, partial dentures still come out several times a day and may fall out when eating certain foods or when speaking. Very few people choose a partial denture anymore because the other options are more appealing.