Question

I (m, 52) had to have the first molar in my lower left jaw extracted at the beginning of January due to severe toothache. I now have to decide whether I want a bridge or an implant. What is recommended and what are the decision criteria?

Short answer

Neighboring teeth that are stable but damaged or have large fillings are an argument for a bridge, as the crowns also improve this situation. Completely healthy neighboring teeth are an argument for an implant, as these would have to be ground down to fit a bridge, which would be a shame. An implant is also indicated if the neighboring teeth are too weak to support a bridge. If a tooth has to be removed, a decision must be made as to whether it needs to be replaced at all in order to ensure normal function, appealing aesthetics and perfect pronunciation. A missing first molar is usually replaced at your age if an opposing tooth is available. 

Two possibilities

If a tooth gap has already developed, there are two basic options for replacing the missing tooth: on the one hand with a removable partial denture (this is often incorrectly referred to as a "Brüggli"), and on the other hand 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 with a firmly attached tooth in between) or by an implant (artificial tooth root) with an attached crown.

What are the advantages of the bridge?

Neighboring teeth that are stable but damaged or have large fillings speak in favour of the bridge. The crowns would improve this situation at the same time. The same applies if the amount or quality of bone below the gap is insufficient for an implant and bone augmentation is not possible or involves risks. It is also often easier to meet esthetic requirements with a bridge. As a rule, a definitive solution can be realized in fewer sessions. If a fixed restoration is required immediately after tooth extraction, this can be easily achieved with a temporary bridge.

What are the advantages of the implant?

Neighboring teeth that are healthy or only have small fillings speak in favour of an implant. It would be a shame to grind them down to fit a bridge, and implants should also be preferred if the neighboring teeth are too weak to support a bridge. The risk of the bridge coming loose too quickly or the supporting teeth not being able to withstand the load is then too great. Implants are also more likely to be chosen if there is sufficient bone in the gap or if it can be easily built up. The risk of a long-term problem is lowest if the solution is only carried out at the point (i.e. in the gap) where action is actually required. This avoids any unnecessary treatment of the neighboring teeth. Any problem that may occur later can be solved locally, tooth by tooth, and it is not necessary to replace an entire bridge. The cost issue plays a minor role, as the price of a single implant with crown and that of a three-part bridge are roughly the same.

Dr. med. dent. Jürg Eppenberger
Neue Luzerner Zeitung on February 18, 2013