Replacing four front missing teeth.

I had a car accident when I was in college and lost four of my teeth. They are the front two teeth and then two teeth to one side. I got a partial plate to replace them at the time, and I am kind of tired of it. My dentist says she can use a bridge to replace them, and it’s going to cost about $10,000. Before I spend that much money, I want to know if this is the right thing to do? How can I tell if this is the best way to fix this?
- Chad in Montana

Chad,
If you’re missing a tooth, there are two good ways to replace it and another way that is not as good. One is with a fixed bridge. A bridge involves placing crowns on the two adjacent teeth and suspending a false tooth between them. It is cemented as one solid unit, and it can last for years.

Another good way is with a dental implant. A root form is implanted in your jawbone, allowed to heal, and a false tooth is placed on this root form. This most nearly simulates a real tooth because it has both a root and a crown. It also helps keep the bone from sinking in. When a tooth is extracted, the bone that was supporting that tooth gradually resorbs and your body uses those minerals elsewhere.

Another method that isn’t as good but is usually quite a bit less expensive is with a removable partial denture. It clips onto the other teeth and it can be taken out to clean your teeth and at night. It is not as comfortable and can be annoying.

If you’re missing just one tooth, it’s kind of an even call, as far as which method is better – a dental implant or a fixed dental bridge. When you add more teeth, it tips the scales in favor of the dental implant. The more teeth that are missing, the more strain it puts on the adjacent teeth. If you are missing four teeth in a row, to be done properly the bridge should rest on four good teeth. So you are ending up with an eight-unit bridge. This is complicated to engineer, and if anything ever goes wrong with any one of the four teeth it rests on, you will likely need to replace the entire restoration. It addition, the way your missing teeth are configured, they go around a curve at the side of your mouth. The canine tooth, which when present is in the middle of that curve, is the tooth in your mouth with the longest root. The reason for that is that, because of its position, it has to take a lot of sideways stress. With a bridge, that tremendous stress will be taken by the teeth the bridge rests on, which could shorten their lives.

The ideal treatment for you would be to have the teeth replaced with dental implants. There may be reasons that your dentist hasn’t suggested that. She may not be that proficient with dental implants. Doing them well usually requires continuing education after graduating from dental school. It is only in the past few years that some dental schools have begun to include regular training in placing and restoring dental implants, so older dentists and even many young dentists may not be adequately trained in this area. And, if these teeth have been missing for some time, the bone could have shrunk where the teeth were. Some bone grafting may be required to provide enough bone support for the implant root forms.

This blog sponsored by California implant dentist Dr. Robert Thein.

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