Bridges, Crowns and Implants: Pros and Cons

Modern technology and varying treatment options may seem like a double-edged sword. We have many enticing alternatives available for dental care that were not feasible as recently as a decade ago. Of course, restorative choices may occasionally present both challenges and complex decisions for both patient and treating dentist. One thing is certain: "One size fits all" does not apply.

Suppose a patient is missing lateral incisors, a not uncommon congenital anomaly. These are the teeth between the central incisors, or front teeth and the canines, also known as eye teeth.

Historically, orthodontists have attempted remedies to accommodate the spaces by moving other teeth into the position of the missing lateral incisors, often requiring years of dental braces. The options were based on limited restorative dentistry options. We now have other treatment modalities to consider.

Keep in mind that what I am about to offer are my personal and professional opinions, but the key word here is "opinion." As with many things in life, there are many ways to solve a problem: you just have to find the one that best suits you. Each person and each situation is unique.

Below are four common solutions to restore the missing teeth, after stabilization of the orthodontic treatment. There are variations for each approach, complicating the options. Most important is to make an informed decision -- the treatment that best suits your individual needs and desires. To accomplish this, an open two-way dialogue between patient and dentist is essential. The list below will offer a start on what to consider.

 Pros:

• Restores gaps reliably and predictably.
• Might be most economical approach if the adjacent teeth already need fillings and dental crowns.
• Durable and least likely to pop-off or fracture.

Cons:

• Requires removal of significant tooth structure on adjacent teeth, which is undesirable if the supporting teeth are free of tooth decay.
• Complicates use of dental floss with a potential for periodontal disease.
• Least aesthetically pleasing.
• Decay or damage may require replacement of the entire bridge.

Pros:  

• All porcelain restoration yields ideal aesthetics.
• Less invasive than conventional dental bridge.
• Dentist needs to roughen or remove minimal tooth structure on the adjacent teeth for bonding.  
• Less likely to develop periodontal disease with proper oral hygiene.

Cons:

• Costs comparable to a conventional bridge.
• Can sometimes snap off if the bridge is torqued at the wrong angle.
• Susceptible to fracture.
• Like any fixed stationary bridge, flossing is difficult and will typically require the use of floss-threaders.
• Decay or damage may require replacement of the entire bridge.
• Requires an ideal bite relationship.

Pros:

• Excellent aesthetics.
• More durable than Maryland Bridges, but not as predictably sound as porcelain fused to metal bridges.
• Requires more tooth reduction than Maryland Bridge, but less than conventional bridge.
• Like the Maryland bridge less likely to cause periodontal disease with proper hygiene.

Cons:

• Costs generally higher than either conventional or Maryland bridges.
• Susceptible to fracture. 
• Like any fixed stationary bridge, flossing is difficult and will typically require the use of floss-threaders.
• Decay or damage may require replacement of the entire bridge. 
• Requires an ideal bite relationship.

Pros:

• Single restoration using no involvement of the adjacent teeth.
• Easy to floss between the teeth. 
• Can be very aesthetic, assuming a proper shade match and characterization by the lab.
• Lasts for many years. 
• Should something happen to the dental crown or if decay develops on adjacent teeth -- the implant tooth isn't affected.
• Least likely to cause periodontal disease with proper hygiene.

Cons:

• Expensive and time consuming. 
• Most insurance won't cover any of the cost.
• Has a very low, but still possible chance of failure, which usually occurs within the first year of placement. 
• Does not address the condition of the adjacent teeth.

In most cases, dental implants should be the first choice for ideal aesthetics, predictability, ease of maintenance and longevity. In all cases, a healthy periodontal condition and a stable bite relationship are prerequisites to success. Other mitigating factors such as parafunctional habits, like teeth grinding at night or teeth clenching, susceptibility to decay, periodontal status, esthetics and financial considerations will affect the decision-making process. Once again, an informed patient will make the best choice. Ask questions before treatment rather than encounter surprises later.

I encourage you, as I do all my patients, to take the information I've presented and schedule an office visit to thoroughly explore the many options. As with any decision, evaluate the benefits and weigh the costs and risks of each treatment. Decide what's best for you.

It's never too late to improve your dental health. Call us at 1-866-970-0441 to find the right dentist for you!