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Case Study Bridge or Implant?
In a case in which more than one mode of treatment is possible, the patient should be informed about all the possibilities rather than have one treatment proposed on a "take it or leave it" basis. Some dentists prefer to do implant cases over bridge cases. Still, the procedure should not be overused and/or oversold.
Why Not a Bridge?
In the top drawing to the left, the patient has two good natural teeth on either side of the missing tooth space. The space can be filled by using either a three-unit bridge (left) or a one tooth implant (right). The patient has (should be given )a choice: a fixed bridge or an implant.
Bridge Pros: Implant surgery (and the involvement with a surgeon/periodontist) is not needed and surgical risks are avoided. A simple bridge like the one above can often be done in 3-4 visits at the general dental office. The bridge is permanently cementer and does not come out like a denture. It is tooth-like in appearance). A well-done bridge on solid teeth is a valid alternative. Your dentist or surgeon may prefer to do an implant but it is your decision.
Bridge Cons: Both teeth on either side of the space must be crowned and their enamel removed in the bridge preparation. This is a consideration where the patient has perfect, unfilled teeth, even though patients are usually quite happy with bridges Shaving off enamel for a bridge preparation may not seem as invasive as having an implant placed in your jawbone so this aspect of "saving enamel" may be over emphasized. If the teeth are already crowned or weak from fillings, they may need to be crowned anyway, so the "saving tooth structure" argument may not apply.
Where there is No Tooth On Which To Attach a Bridge
Note that, had the patient been missing the rear anchor tooth (or where the anchor tooth is not solidly in bone), an implant would have been the only possibility for avoiding a removable partial denture.
You can see that, while I certainly think implants have their place, I also believe the good old reliable bridge option is being dismissed too readily by some dentists. Implants come in kits filled with the implants, drills, other tools needed, proprietary "systems" that are expensive and patented. Much may be invested in implant courses. The point here is not that dentists are putting finances above the patient's needs (most are not, or not consciously); my point is that the patient has a right to know all modes of possible treatment and all risks and benefits of each and to decide for him or her self. If you feel coerced or feel that a certain treatment is being "sold" to you, do a little research and get another opinion. Ask questions and do not start treatment until you understand what is being proposed and why.
Copyright© 2005-2010 Lynne Heckert, DDS, JD All rights reserved. No portion of this or any DentalSmarts.com site may be used without express written permission.
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