Should I have a bridge or an implant to fill the gap where my tooth was?
image credit Canva
The first thing to mention is that not every gap needs filling! Some people are not concerned with the aesthetics of a missing tooth and very often people can also chew without problems as well. You may find that the thought of having a gap is often worse than the gap itself.
One thing to bear in mind though, if and when you lose a tooth, if you do choose to leave a gap, then the teeth opposite the gap in the opposing jaw and those either side of the gap (in the same jaw) can drift and move over time. Sometimes this can cause problems with food trapping and because of this, it can increase the risk of decay. We see this more often when the tooth in the opposite jaw drifts. The decay can commonly be on the root surface of the tooth which can be difficult to fill and can lead to a poor prognosis and risk of losing another tooth.
So, if you’ve made the decision that you don’t want a gap and that you want to fill the space, then now you’d like to know what your options are….On a basic level, there are three options! A bridge, a denture or an implant. I am going to focus only on fixed options in this article, the implant or a bridge but always remember that sometimes removable false teeth (a denture) can be a good, lower cost and simple solution to replacing missing teeth, especially if you have more than one missing tooth to replace.
There are lots of different options for bridgework but I am going to keep it very simple today and talk only about fixed-fixed bridgework as this is the most common bridgework solution for replacing back teeth. There are other types of bridgework such as adhesive bridgework that are more conservative but these are often unsuitable for replacing back teeth.
Fixed Bridgework Vs Implants.
First and foremost, what is a bridge and what is an implant?
Bridges
A bridge is a ceramic or metal (or more often than not, a combination of both) prosthetic tooth replacement which is attached to the teeth either side of the gap and is cemented into place. In order to do this, the teeth either side of the space have to be altered in size sufficiently to accommodate the bridge material (porcelain and metal). Have a look at the little animation attached to help explain what I mean by this.
This is by no means a conservative option, as approximately two millimetres of tooth tissue have to be removed from the full outer layer of the tooth. Due to the destructive nature of this procedure, it would never be my first choice for tooth replacement if the teeth either side of the gap are otherwise untouched. Often however, teeth may be heavily filled or crowned, already and a lot of what needs be removed, may be filling material. This might sway a decision. Due to the process of preparing teeth for bridgework (and potentially because a lot of teeth undergoing this procedure have already been heavily filled due to fracture or decay earlier in life), a proportion of teeth involved in crown and bridgework will go on to lose their vitality and the nerve will die off. This is true, no matter how carefully or how well the procedure is carried out, even though steps can be taken to minimise this risk. There is more chance of this in a younger patient. This is because throughout our lives, the pulp chamber in our teeth (where the nerves live) gradually gets smaller and protective dentine thickens as we get older. In a younger person, the pulps in teeth are larger and as a result more likely to be affected by the procedure of preparing the teeth for a bridge. If a tooth loses vitality and dies, then this can cause severe toothache and subsequently an infection in the form of an abscess.
Either of these conditions would need to be treated with root canal treatment or an extraction! Ultimately this could mean a two tooth gap, where you only had a one tooth gap before!
The benefit to having a bridge is that it tends to be a cheaper alternative to an implant and is often quicker. A provisional bridge can be placed immediately after extraction of a tooth and a permanent bridge can be placed three months after extraction of a tooth.
A three tooth bridge (one space and two teeth either side) currently costs approximately £1500 at Wollaton Dental Care. Each case is different and an accurate treatment plan would be provided before embarking on treatment, so that exact costs can be given to you.
Implants.
I like to think of an implant being a false tooth root which is placed directly into the bone where the tooth is missing. A crown is then placed on the top of the false root. The benefit of the implant is that it is a fixed replacement for your tooth without having to cause any damage to adjacent teeth. Sometimes an implant can be placed immediately following the extraction of a tooth, other times, a healing period is needed.
Have a watch of the animation below to understand what an implant is.
Animation credit CanvaThe disadvantage of an implant is that it is a surgical procedure and tends to be more expensive than a bridge due to the materials, surgery time and expertise needed in order to place implants. There are also risks associated with implants in the same way as there are with our own teeth. Although implants can’t decay, gum disease can still occur around implants and a high level of oral hygiene is advised in order to maintain your implants well. We advise regular hygienist appointments in order to make sure you are looking after your implants appropriately. Otherwise we would liken it to buying a high performance car and never having it serviced!
It is important to make sure implants are placed appropriately. Not all patients or mouths are suitable for implants! Some medical conditions can preclude implant placement or certainly make it more risky. There needs to be sufficient bone available to place implants and sometimes, for upper teeth, a procedure needs to be carried out on the sinus to ensure that there is enough space to place the implant.
We believe it is important that high quality dental implants are placed with a history of good quality research into the product. When we think back to the PIP breast implant scandal, it is a good example of a cheaper product being placed without the appropriate clinical trials to back up their use. For this reason, we place Straumann implants. These are not a cheap product and thus our prices, are also not the cheapest, but we feel confident that we would be happy having them placed in our own mouths and that there is a support system in place should complications occur.
To train to be able to place implants competently and confidently is also a lengthy and costly experience for any clinician who wishes to work to high level. Of course, any dentist can quickly begin placing implants but case selection is everything as is preparation, training and cross infection/surgical set up. This takes time to train properly and keep standards high with excellent attention to the small detail. Certain cases are more complex than others. We work closely with local specialist practice The Campbell Clinic in order to ensure mentoring is utilised if needed or referral on for complex cases is ensured where necessary. We believe that The Campbell Clinic is the best in the business for complex implant dentistry and we are more than happy to recommend and liaise with them in order to offer this service to our patients. You can be sure that we will always be honest and open with all of our discussions with you and if we think you would benefit from being seen elsewhere then this will be discussed. At Wollaton Dental Care, both principal dentist Simon Lawson and our associate David Bell can competently and confidently take on straight forward implant cases and we are delighted to now be able to offer this for our patients in house.
A single tooth implant placement at Wollaton Dental Care costs approximately £3000. Every case is different, some take longer, some are quicker. Some need other associated procedures, others do not. Therefore an exact cost is only possible once your own personal case has been assessed. You will then be provided with an accurate treatment plan including exact costs..
image credit Canva
Our reception team still get asked every day by patients if they still need to wear a mask when attending their appointments. We get it-people are keen to know what is asked of them.
It hasn’t been mandatory in England to wear masks in health care settings for many months now. For a while at Wollaton Dental Care, we continued to politely ask our patients if they would mind still wearing a mask when attending their appointments with us whilst in our waiting areas. This was after careful consideration, in order to protect our vulnerable patients particularly when there were increases in COVID cases in Nottingham.
We decided to remove this request around Autumn of last year. This was both for our patients and for our team members (when not treating patients). We are acutely aware that face masks are very much a barrier to effective communication for all patients but particularly for those who may not hear well or those patients who are deaf. Many people find them hard to breath normally in and some people get claustrophobic. Masks can also add to problems with their vision for some people as they struggle to clear the mist from their glasses caused by wearing a mask inside when coming in from the cooler weather outside! It is also harder to read nonverbal communication cues such as facial expressions and to a certain extent body language too. We want to see if you are smiling!
Prior to COVID, our clinicians would have felt it was highly inappropriate to speak to a patient whilst wearing their mask as it is a known barrier to communication and we remember that! You may still see the odd one of us floating around in a mask. This might be someone not in a face to face role at that time or just their personal preference. We also ask team members with any symptoms of a respiratory virus (such as a cold) to wear a mask.
If you feel more comfortable continuing to wear a mask, then please of course do so but for all of the above reasons, we no longer request that our patients wear a mask when visiting our practice.
Can I do work experience at the dentist?
Over the years we have been approached many times to consider students for work experience placements. Sometimes it is local schools doing the asking on behalf of young people and other times it is the students themselves or even their parents. We have become quite picky in our selection due to many years of offering this experience for (predominantly) young people and learning as we go! We always prefer people to approach us directly and in this era of everything being done online, we also prefer a phone call at some point in the process! Dentistry is a profession of communication and you need to be able to be a good communicator to get the best out of our work experience.
We have had multiple work experience students who have gone on to study dentistry and others who have decided it is not for them after all. We have also had students who clearly are not interested in our work (often those who have had the placement suggested for them and not those who have approached us directly) which is difficult as no one wants a disinterested teenager sitting in on their treatment!! On the other hand, the majority of students we have accommodated have been a joy to meet and have really thrived. There is no such thing as a stupid question and we think the people who have asked lots of questions to the team have enjoyed their time the most and got the most out of it.
Essential traits of students who hope to go on to be a good dentist:
Excellent communication
Kindness
Inquisitive and interested in the small stuff.
Good manual dexterity and a willingness to practise.
An artistic eye and pay attention to detail
An ability to work as part of a close knit team.
Academic enough to get accepted on the course and understand and pass it!!
We recently had one such student with us, Will. He was fabulous to have at the practice, a great communicator and clearly enjoys being around people (another must for a good dentist!). Whether he decides to study dentistry or not is by the by, but either way, we send him best wishes for his future which is sure to be bright. We asked Will for a short report about his experience with us and here’s what he had to say.
“Hi my name is Will and I did a week of work experience at Wollaton Dental Care and I can honestly say it was one of the most informative weeks of my life. The information they provided me with was invaluable, which has massively influenced my decisions going forward.
The staff were welcoming and friendly, settling me in and explaining how I would be spending my time with the whole team. I was able to see the ins and outs of how a general practice works, which was more than I expected. Although I was only there for 4 hours each day, every day was different and provided me with new experiences, which I loved and demonstrated the different aspects of the job.
It’s not very hands on work experience for obvious reasons but that did not matter to me as every time a patient had a problem Simon, Anna and Gemma explained to me how and why procedures were done which gave me a broader knowledge and understanding of what was going on. I am extremely grateful for the opportunity given to me.”
Did you know that dental teams really know their anatomy? From your orbicularis oris to your lateral pterygoid, we know our stuff! We see many patients (& their mouths) every day. We know what’s normal & what’s not! Our clinical team carry out routine screening for oral cancer at every examination but if you are ever concerned about anything that you think is unusual in your mouth, always get it checked out. We would always rather see you than leave it to chance. It is almost always nothing to worry about, but in the unlikely event that it is cancer, then early detection vastly improves the prognosis for patients.