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Do I have to have a dental implant?

So you’ve been told by your dentist that you need a dental implant, then you got told how much it’s probably going to cost and you started asking yourself, do I really need a dental implant?

The simple answer is no, you absolutely do not have to have a dental implant. There are several options for filling spaces in your mouth, each with its own pros and cons.

I’m focussing here on filling gaps between healthy teeth. Remember, it’s important to ensure that the rest of your teeth are in a good condition before undertaking any treatment to fill the spaces. You wouldn’t install a state-of-the-art kitchen in your house if the foundations were crumbling.

Broadly speaking, you have five options for any gap in your mouth.

Option 1 - Do nothing

The simplest option is always not having any further treatment. Clearly, this is the cheapest option as well. If you’ve got a gap at the front of your mouth then you may feel it’s more important to fill the space from a cosmetic perspective, but most dentists will agree with me when I say that filling spaces at the back is more important. While a missing back tooth is less obvious, the back molars are the big teeth that do the bulk of the chewing and when you lose a tooth, more pressure goes on the remaining teeth.

That said, many people can eat and chew perfectly well with one or two missing back teeth so it’s certainly not a necessity to have the space filled. If you want to leave a space at the back, you should be aware that the teeth adjacent to the gap can tilt or drift into the space. The tooth opposite (particularly an upper tooth facing a lower space) can also “over-erupt”, the tooth moves further and further out of the gum, I think of this as the tooth is trying to find something to bite on.

Option 2 - Dentures

A denture is a removable tooth or teeth on an acrylic (plastic) or chrome (metal) base. Dentures are great for filling lots of gaps quickly and relatively cheaply in the short term. If you’ve lost lots of gum and bone in an area, dentures can easily replace this with pink acrylic. Dentures can look fantastic and blend in really well with the surrounding teeth and for sure, I will often suggest that my patients at least try a denture before embarking on any more complex treatment.

Unfortunately, many people cannot tolerate or don’t want to wear a denture. The thought of having to leave them out every night (or the thought of what their partner might think) is enough to turn many people off the idea. Whilst they offer some support when eating and can help with chewing sometimes, they often rely on the other teeth to hold them in so can place extra load on the other teeth rather than supporting them. They also often get food stuck around them and should be removed for cleaning after eating.

They certainly do take up a lot more space in your mouth and they can affect your speech while you’re getting used to them, though most people adapt within a few weeks. As a general rule, the younger you are, the quicker you’ll get used to them. Dentures usually need replacing every 7-10 years.

Option 3 - A bridge

A bridge, as the name suggests, is fixed on to one or both of the teeth adjacent to a space, providing a fixed tooth replacement without the need for surgery. Historically, bridges used to involve drilling a lot of enamel away from both adjacent teeth to make the space for a shell of porcelain and metal, with an extra tooth in the middle, to be glued on. What we found a lot of the time is that these bridges would last around 10 years before breaking off and taking the supporting teeth with them, leaving you with a big three-toothed space instead of a single tooth. Occasionally, we still do these bridges, though it’s usually in very specific circumstances, such as when replacing a small tooth and a larger adjacent tooth already has a crown on it.

Nowadays, we more often provide resin bonded bridges, in which a metal or ceramic wing is glued on to the tooth next door, in many cases, without the need for much, if any, preparation to that adjacent tooth. With advances in the technology of the glues we use, these bridges are becoming more predictable and can be an ideal solution, particularly when replacing a smaller tooth. It’s important to note that whilst we’re filling the gap, we’re not supporting the adjacent tooth with a bridge, we’re actually putting extra pressure on it. This can lead to problems associated with overloading the tooth so it’s only usually an option in certain situations where you have a small gap with a larger tooth behind it.

We expect these bonded bridges to last 5-10 years which may not seem that long, but remember, if done carefully, there will be minimal damage to the supporting tooth so a new bridge can often be made or you could revisit your options.

Option 4 - Braces

We can use braces to open or close spaces in your mouth. It’s become a more and more popular choice for adults to have braces, either to straighten your teeth for the first time or correcting teeth that have moved back since having braces as a child.

Whether braces are suitable to close a gap in your mouth very much depends on which tooth you’re missing and whether you’re willing to commit to the length of time the treatment will take. If you’re missing a tooth front and centre of your mouth, it’s going to be very difficult to move other teeth into the right positions and make them look natural. Also note that closing a space in one place also often means opening a space somewhere else, though if you already suffer with a bit of crowding, this could be the perfect opportunity to straighten the teeth and close the gap in one go.

Option 5 - A dental implant

Dental implants are like artificial tooth roots on which we attach a crown, not dissimilar to a crown like you’d have on a normal tooth. They provide a fixed tooth replacement without damaging the adjacent teeth, and in fact they provide more support for the surrounding teeth. We expect dental implants to last 10 years and longer if they’re looked after well.

Dental implant treatment usually isn’t a quick fix, taking between 3-12 months from initial assessment to fitting the final crown and it does require a surgical procedure to place the implant (the root), though this is usually a single appointment with local anaesthetic like you would have for a filling. In fact, the procedure itself often takes less time than having a filling done.

As a dentist who places dental implants, I see my role as being much more than just wanting to put dental implants in every space I see, but to fill gaps in whichever way is best for each individual to enable the best chewing ability and cosmetic outcome. Not infrequently, this means patients are referred to me for dental implants, and I end up recommending something else entirely.

So, when you have a gap, is a dental implant the only option?

No, implants aren’t the right solution for everyone. They are often the gold standard in tooth replacements in the right situations but this depends on what's right for you and your mouth.

If you want to know more about dental implants and whether they’d be the right option for you, don’t hesitate to get in touch and speak to Lucy our treatment coordinator who can help you understand your options a little better.

Thank you to Straumann for providing the images for this article.

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