Question

I (female, 55) had to extract a molar in my lower right jaw due to severe toothache. Now I have to decide between a bridge or an implant. What do you recommend? R. B. in E. 

Short answer

A missing tooth usually has to be replaced if an opposing tooth is also present. There are two basic options for replacing a tooth, namely with a removable partial denture (often incorrectly referred to as a "Brüggli" in common parlance) or with a fixed, non-removable solution.

Whenever a tooth has to be removed, the question arises as to whether it needs to be replaced at all in order to ensure normal function and aesthetics of the dentition and pronunciation in the long term. A missing tooth at your age and in this position (1st molar) usually needs to be replaced if an opposing tooth is also present. 

Removable or fixed 

There are two basic options for replacing a tooth, namely with a removable partial denture (often incorrectly referred to as a "Brüggli" in common parlance) or with a fixed, non-removable solution. In your case, the second option is under discussion: a tooth can be replaced by a fixed bridge (crown on the neighboring teeth and a fixed tooth in between) or by an implant with a crown.

Bridge or implant with crown

The following criteria speak in favor of the bridge:

- The adjacent teeth are stable but damaged or have large fillings: the crowns would improve this situation at the same time.

- The amount or quality of bone below the gap is insufficient to place an implant. Bone augmentation is not possible or is associated with risks.

- Aesthetic needs can often be met more easily than with an implant.

Speaking in favor of the implant:

- The neighboring teeth are healthy or only have small fillings. It would therefore be a shame to grind them down to wear a bridge.

- The roots of the neighboring teeth are too weak to help support a bridge. The risk of the bridge coming loose again quickly is too great in such a case.

- There is sufficient bone in the gap, or it can simply be built up.

- The risk of a problem occurring later is lowest, as the solution is only sought at the point (namely in the gap) where action is actually required. Any unnecessary treatment of neighboring teeth is avoided.

- If a later problem is expected, this can be solved locally, tooth by tooth, and an entire bridge does not have to be repaired. The cost issue plays a minor role, as the price for both solutions is roughly the same.

Author: Dr. med. dent. Jürg Eppenberger
Published in: Neue Luzerner Zeitung on February 27, 2008