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Dentistry/Bridge vs. Implant

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QUESTION: I need to have a tooth extracted and have been told by my dentist that I have the option of either a bridge or an implant.  Although it would be nice to pay less, I can afford either procedure; therefore, cost is not a factor in my decision.

However, I have two friends that have both: a bridge and one, or more, implants and they insist that they are much happier with the bridge than the implants (not sure why).

Part of me feels that it is foolish to file down good teeth to obtain a bridge, yet the comments I'm hearing are disconcerting.  Any advice on the pros and cons of the two procedure would be greatly appreciated.

ANSWER: Rob -  I will try to help you, but I first need to know which tooth is to removed and the reason for that.  I also need to know if the other teeth in your mouth are healthy and you have a good bite.

I am asking these questions to help decide the best approach.  I may need to ask you more questions, but those above should give me the assistance I need.  Also an xray of the area is important to see if any vital anatomical structures might be invaded by the placement of the implant.  

So get back to me and I will try to help you arrive at the most appropriate treatment.

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QUESTION: I don't know the number of the tooth but it is the middle molar (my wisdom teeth were pulled) on the lower left side.  You inquired about my bite. My teeth are not straight, but my bite seems to "work okay for me."  My other teeth seem to be good.

The history of the tooth being extracted is this: I had a root canal on it 29 years ago; which failed within a couple of years.  They redid the root canal and it failed within a few years.  In 1992 I was sent to an oral surgeon that performed a procedure (retrofill?) that was supposed to last "forever."  It has cracked and I am getting infections in my gum.  The dentist said it has to go!

Hope this information helps.  I appreciate your time and any advice you can provide.

ANSWER: Rob - It sounds like the tooth is the first molar.  Assuming that is the tooth, I would suggest that after the extraction, a bridge would be better.  Sure the teeth on either side of the extraction site will need to be cut down for an evaluation for a crown.  It sounds like the bridge would be the best treatment to replace the tooth that needs extraction.

---------- FOLLOW-UP ----------

QUESTION: Just a quick follow-up. Would you mind telling me why you feel a bridge is a better option for me than the implant?  I'm not unhappy with your answer because the bridge means I can have a tooth there quickly with little recovery time.  I'm just curious as to the reason.

Thanks again!

Answer
Rob -  Of course, without examining you I cannot be 100% sure, but you would need to find a skilled surgeon to do the implant.  Many doctors have problems with them.  The overall cost is higher.  Chances of secondary problems, such as nerve injury, is much higher.  

Look - implants are a good procedure, but having seen a significant number of failures, it is a procedure that is less predictable than a bridge.  Just my opinion.  Some implants are great, especially towards the front of the mouth where the anatomic complications are minimal compared to back teeth.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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