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Dental Implants vs. Fixed Bridges

By Joseph Preziosi Jr., DMD

Osseointegated implants are rapidly becoming the standard of care for replacing missing teeth, thus relegating all other treatment options to some type of compromise. As a quick overview an implant has three major components.

Advantages Of Implants Vs Fixed Bridges

The first component is the fixture that is surgically placed in the jaw and osseointegrates with the jawbone to produce a stable replacement for the root of the tooth. The component is the abutment that is screw retained to the fixture and allows for a sufficient super gingival (above the gum line) platform for the prosthesis to be fabricated to and retained to either by a screw or cement. The final component is the prosthesis itself whether it’s a single crown or an abutment for a fixed restoration.

The advantages of osseointegrated implants compared to conventional fixed bridges are many. First and for most implants preserve the underlying jawbone and therefore preserve the overlying facial structures, preventing them from collapsing. Once a tooth is lost and the jawbone is no longer stimulated by the pressure from chewing the body resorbs that area of jawbone.

Thus implants are more aesthetic both in retaining the patient’s natural appearance within their mouth and also their overall facial structure. Implants are more conservative than fixed bridges since the teeth on either side of the space do not have to be prepared (cut down) as abutments. Implants are also more flexible than fixed bridges since they do not require an existing tooth to be present on both sides of a space and several of them can be used to fill a space that is simple to long for a fixed bridge.

Implants make it easier for patients to maintain their periodontal health than fixed bridges because homecare is facilitated by being able to floss between the implants, therefore avoiding the floss threaders that are required for fixed bridges. Implants are also impervious to many of the problems and diseases that plague natural teeth such as caries (decay), fractures and pulpal (nerve) disease. Since there is no pulpal disease associate with implants there is never a need for endodontic treatment, more commonly known as root canal therapy.

Implants are more cost effective over time because although they have a higher initial cost their life expectancy, retrievability, immunity to disease processes and independence on other teeth make their long-term maintenance less expensive than conventional fixed bridges.

Several cost comparison studies have fond that the after seven years implants are cheaper to maintain than fixed bridges. The most common reason for fixed bridge replacement is caries, or decay of the underlying tooth structure, which implants cannot develop since they are made of metal and porcelain. Once either abutment tooth of a bridge develops caries (decay) the entire bridge, which is at least three crowns, must be replaced. Often the abutment tooth will also need more treatment such as a pulp cap, core build up, crown lengthening or root canal therapy.

All this additional treatment is avoided wit implants. When the prosthetic crown on an implant brakes it is removed and just that single crown has to be redone. In more rare cases the abutment may also have to be replaced, but the fixture almost never has to be replaced once it is restored.

Fixed bridges have a mean life expectancy of 10 years causing 15% of them to be replaced by then while over 33% of them need to be redone by 15 years. Implant fixtures have an osseointegration success rate of 98.5% and of the 1.5% that fail to osseointegrate 95% of those will fail prior to any prosthetic restoration being placed.

This means that implant fixtures almost never have to be replace thereby eliminating the need for patients to have additional surgical treatment procedures and limiting fractured prosthetic crowns to be replaced as individual units. This evaluation clearly demonstrates that implants are the more economical choice for almost everyone under the age of 65 years old and for certain healthy patients even through their seventies.