Question
How important is the tooth from a structural point of view, does it need to be preserved or replaced and what is its general state of health?
Short answer
Consider all possible treatments and alternatives, seek advice and decide for yourself.
When treatment is required on a patient's own tooth, the question always arises as to which treatment is the most suitable and whether it is worth carrying out. This requires an examination of the tooth and its surroundings and an appropriate assessment. The criteria are complex and include the following questions:
How much of the healthy tooth is still there - how much has broken away or been destroyed by caries?
Is the tooth nerve still alive or has it died? If it is dead, would a good quality root canal treatment be feasible?
What about the surrounding gums and the tooth-supporting bone - are they diseased and partially melted away (periodontitis)?
Where is the tooth located in the jaw, in a clearly visible front position or very far back, and is there an opposing tooth to chew on?
What about daily oral hygiene? What other measures and treatments would also be necessary?
How important is the tooth from a structural point of view, does it need to be preserved or replaced and, finally, what is the general state of health?
As a result, the treatment options and alternatives must be set in relation to the patient's personal needs, risks, durability and costs. With this necessary information, the patient will be able to make an informed decision: Either the tooth is restored with the necessary dental artistry or it is removed and replaced if necessary.
If there is a gap between teeth, 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. A fixed tooth can be replaced by a bridge (crown or partial crown on one or both neighboring teeth and a fixed tooth in between) or by an implant with a crown.
Bridge or implant with crown?
Neighboring teeth are stable but damaged or have large fillings: crowns would improve this situation at the same time. The same applies if the amount or quality of bone below the gap is insufficient to place an implant and bone augmentation is not possible or involves risks.
It is also often easier to meet esthetic requirements (in the front in the visible area) with a bridge than with an implant.
On the other hand, neighboring teeth that are healthy or only have small fillings speak in favor of the implant. It would therefore be a shame to grind them down in order to wear a bridge. Implants are also preferable if the roots of the neighboring teeth are too weak to support a bridge and there is sufficient bone in the gap or it can be easily built up.
This minimizes the risk of a problem occurring later, as the solution is only sought at the point (i.e. in the gap) where action is actually required. A later problem 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.
Are people more likely to use pliers today than in the past? Have people's own teeth become obsolete?
This is an obvious assumption, if you believe the many advertisements and reports that are also finding their way into dentistry today. Unfortunately, stories about failures are piling up, as implants are often placed and loaded far too quickly and without waiting for healing times, without precise clarification and comprehensive advice and with insufficient competence.
What is necessary for implant treatment to be a success?
It is essential for the dentist to have sound training and experience commensurate with the degree of difficulty of the implantation. A serious examination and assessment of the existing problem, thorough information and explanation of the risks and alternatives to the patient and scientifically sound planning are absolutely essential. Furthermore, the implant must be carefully inserted and a professionally competent restoration with an artificial tooth is required. The patient should be fully informed, maintain good oral hygiene over the years and have regular follow-up care with the dentist or dental hygienist.
Difficult starting positions for implants are, on the one hand, positions at the front in the esthetically important, highly visible area, especially if several teeth are missing and, on the other hand, if there is not enough bone to anchor the implant, making bone augmentation necessary beforehand. All fixed restorations in the edentulous upper jaw are also difficult
Published in the Tages Anzeiger on April 26, 2010