My dentist has told me that I have to remove one of my grinders. He also told me that it should be replaced as soon as possible. I don’t want a denture for sure but I can’t decide whether I should go for a bridge or an implant. What do you think is the best option?

Even though the natural teeth should be preserved as far as possible, sometimes circumstances arise where a root-canal and crown to save the tooth may not be an option. In these cases you would usually need to decide between a bridge or an implant. There are some important considerations that you should keep in mind before deciding on either.

The need to replace a missing tooth are many: The adjacent teeth start to shift position putting them at risk of decay and gum disease and possibly problems in the jaw joint. The tooth opposing the lost tooth starts to move out of the socket as there is nothing to oppose it and it will eventually become loose. Moreover the jaw bone that holds the tooth starts to erode and deteriorate as it is no longer functional.

Bridges are a quick-fix option as usually you can get the bridge in a couple of days. However, bear in mind that a bridge involves grinding down the adjacent teeth and that can present a host of problems such as sensitivity and, sometimes, pain. This might necessitate a root-canal treatment on one or all the teeth that hold the bridge. This might add to the complexity and cost of the procedure. Also decay and gum disease almost always start under bridgework after a few years because of the practical difficulty of cleaning and flossing under the bridge. If one of the bridge supporting teeth is lost, then the entire bridge will fail and the whole process may need to be repeated on new teeth.

On the other hand, there are a few situations where a bridge may be a better choice. If your immunity is compromised in some way such as in uncontrolled diabetes, or you have certain bleeding disorders or are unable to heal because of certain drugs such as those taken for rheumatoid arthritis, cancers and certain anti-clotting medication, then a bridge can be advantageous. In almost every other situation, the implant is a better choice.

An implant replaces the root of the tooth and a crown is fixed on top of the implant. The advantages of the implant are that the jaw bone that holds the tooth is preserved unlike a bridge, and the adjacent teeth are untouched. Implants usually last much longer than bridges and feel more natural and are easier to clean.

Skilled dental implantologists can usually deliver implant crowns within a few days provided certain conditions are met – sometimes even on the same day. The pain involved is minimal and frequently patients need not have even a single pain killer after implant placement.

The best place to start is usually with a Dental CT scan, also called a CBCT. This would give the treating dentist a very good idea on the complexities involved. If conditions permit then we would usually recommend an implant over a bridge. Best of luck with your treatment.

Dr. Tanveer Ahmed is an implantologist, dental surgeon and medical director at New Ivory Dental and Implant Clinic, Dubai