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Tooth Replacement Options

“Can I get a permanent tooth replacement for a lost tooth?”

Tooth replacement options are now more accessible than ever. By “permanent tooth replacement,” I assume you mean a non-removable restoration. Some of your choices include dental implants, permanent fixed bridges, acid-etched bridges (Maryland splints), and chairside bonded bridges.

Of course, there are advantages and disadvantages to each of these options. It is very important that you see a quality dentist to go over your options based upon the amount of bone you have, the number of healthy adjacent teeth, your overall medical health, your age, and your financial capabilities.

Dental implants have been around since the mid-1980s and are usually the primary choice for replacing a missing tooth. These implants are made of pure titanium, but don’t worry — they won’t set off any alarms at the airport, nor will they stop you from having an MRI without problems. In order to be a candidate for a dental implant, one needs to have enough bone and soft tissue to hold the implant. Initially, a screw is implanted in the jaw bone at the site of your missing tooth. This screw is specially made with a surface material that helps promote bone adherence, allowing it to become the anchor in your bone. Approximately three months after healing, a cap or crown is attached. Dental implants have a 95 percent success rate and seem to last a very long time. You can floss your implant in a normal fashion, since the missing tooth is not joined to any other teeth. The only negative to this option is that if you do not have enough bone for an implant, it is necessary to undergo procedures to restore the bone. Also, it takes time for biologic healing to occur before the crown can be put in place.

Fixed bridges, the second choice, have been around for over 50 years. A fixed bridge is also a permanent restoration achieved by drilling the enamel of the adjacent teeth, taking impressions, and making a permanent bridge across the area where the tooth is missing. It is a very predictable procedure that used to be a dentist’s first choice in treating missing teeth, before implants came along. This procedure is still performed often because there are clear indications for it. If a patient has very little bone, then a fixed bridge is a good option. In addition, fixed bridges are sometimes preferred for patients who have loose adjacent teeth, because the bridge joins all these teeth together and provides greater strength. The cost of such a procedure is similar to getting an implant, but since the teeth are joined you must learn how to floss above the joining of the teeth. The advantage to getting a fixed bridge is that it can be performed faster, and treatment is completed in a shorter amount of time than a dental implant. There are also no surgical procedures involved in this process.

The third and fourth choices, acid-etched bridges or bonded bridges at chairside, are ways to temporarily (over a one to three-year period) provide permanent restorations on a less costly basis. Acid-etched bridges may last anywhere from one to 10 years; many fall out over the course of five years, though I am sure some individuals have had such bridges last longer than 10 years. This method provides a missing tooth restoration without cutting down the adjacent teeth. A permanent acid-etched bridge is made at a laboratory after an impression is taken at the dental office. The bridge is bonded on from the lingual or palatal side of the teeth, which is the inner side that touches the palate or tongue. In many cases, over time these bonded bridges de-bond and have to be replaced or rebonded.

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