Dentures: implant or bridge?

Dental implants are an established but expensive method. But the operation is not always without risk. In some cases, bridges are a better alternative.

Every tooth has its function in the dentition. All teeth together enable chewing and speaking. If even one tooth is missing, the bite can shift and cause pain in the temporomandibular joint. Doctors often recommend dental implants.

Tooth gap instead of a crown, bridge, or implant?
First of all, it should be clarified whether a lost tooth needs to be replaced at all. A tooth gap can remain if it does not cause any functional problems and does not interfere visually. Advantages of the tooth gap: It causes neither pain nor costs, oral care is possible without any problems.

A dental implant is a surgical procedure
Oral surgery is required to insert a dental implant. In order to prevent bacteria from entering during the operation, the attending physician must examine the teeth and gums very carefully beforehand. This means: diseases in the oral cavity should definitely be treated first before the implant is placed.

During the procedure for the implant, the dentist first cuts open the gums and drills a hole in the jawbone.

The implant, a kind of screw, is inserted into the hole – practically an artificial tooth root. This implant then holds the dental prosthesis, which is later mounted on top. It has to be tight so that it can grow together with the jawbone.

Often jaw augmentation with the body’s own bone is necessary
If the existing bone substance and the mucous membrane are not sufficient for secure anchoring, the oral surgeon must first carry out a complex and often painful bone augmentation with the body’s own bone fragments from the hip or bone substitute material. The body’s own bone is best suited because it is most similar to the jawbone.

Dental implants are usually made of titanium or ceramic
After the bone has been built up, the material for the implant is selected. Titanium has been used for decades and has proven itself well. The newer ceramic implants are still rarely used. Once the implant is in place, the jawbone grows very slowly towards the implant over a period of weeks. During this time, the implant must not be heavily stressed by eating nuts or the like.

Risks: Injury to the mandibular nerve and inflammation
Important when implanting: Under no circumstances should implant damage the mandibular nerve, this provides the lip with feeling, among other things.

Once the denture is anchored on the implant, it needs very good dental care for life and professional teeth cleaning twice a year to keep it in place. The big danger is peri-implantitis, the inflammation of the tissue around the implant. The result: the bone retreats. In the worst case, peri-implantitis can mean that an implant has to be removed again.

Rely on specialists when choosing a doctor
When it comes to implants, experience, and a sure instinct are crucial – so choosing a good doctor is important. In principle, every dentist in Germany is allowed to implant. Oral surgeons or oral and maxillofacial surgeons who specialize in operations on the jawbone are most likely competent. Competence is also reflected in the number of implants and the number of patients who are treated with implants.

For which patients are dental implants suitable?
Good doctors are characterized by the fact that they inform patients when an implant is not recommended – and what advantages and disadvantages the dentures have.

Advantages of the implant:

1: 1 replacement of individual teeth
no supports required
fixed anchoring
long durability
Disadvantages of the implant:

Drill hole in the jawbone
Risk of nerve injuries
Risk of sinus injuries
Risk of inflammation and adhesions
Shorter shelf life with poor oral hygiene
Implants are not suitable for:

Immunodeficiency (due to illness or medication)
blood cancer
Diabetics with poorly controlled blood sugar levels
Taking bisphosphonates
The basic bridge is the standard denture
In the case of a missing tooth, the so-called basic bridge is the standard restoration as a fixed dental prosthesis. The two adjacent teeth, which have to be ground for this, serve as pillars for the bridge made by the dental technician.

Advantages of the bridge:

long durability
lower cost
ideal solution if neighboring teeth have tooth decay
Disadvantages of the bridge:

healthy neighboring teeth have to be ground down, risk of grinding trauma
maintenance is more difficult due to the bridge construction
Telescopic bridges are placed on the abutment teeth
Telescopic bridges are not firmly cemented in place, but rather placed on the abutment teeth. They are mainly used when there are only a few teeth left and the abutment teeth of a fixed bridge might not be able to withstand the chewing load in the long term.

As a removable dental bridge, it is more expensive than most other types of bridges due to the more complex manufacturing process. The affected person can decide for himself whether the bridge should remain in the mouth permanently or whether it can be removed for daily oral care like a denture.

Advantages of the telescopic bridge:

optimal care of a tooth gap
The patient can decide whether the bridge is fixed or removable
easier oral care
Disadvantages of the telescopic bridge:

complex construction
more expensive than classic bridges
Adhesive bridges are glued to neighboring teeth
Adhesive bridges, also called adhesive bridges, are glued to healthy neighboring teeth. They are an alternative in suitable places in the mouth if extensive bone formation would be necessary for an implant and the neighboring teeth in the area of ​​the adhesive surfaces are healthy. A so-called adhesive slide is more stable. The construction is almost invisible from the outside.

The prerequisite for an adhesive bridge is healthy neighboring teeth with intact enamel, to which the wings are glued like door hinges.

Advantages of the adhesive bridge:

low cost (around half of an implant)
good durability
no grinding of healthy teeth
particularly suitable in the anterior region
Disadvantages of the adhesive bridge:

Neighboring teeth must not have caries
not ideal in the molar area because of the high load
The adhesive connection can be loosened but can be repaired
Health insurance companies pay a fixed allowance
Since 2005, the statutory health insurance companies have been working with a subsidy system that is based solely on the dentist’s findings and no longer on the type of dental prosthesis. Since then, those affected have been able to choose freely which type of dentures they prefer and receive a fixed allowance for it. What is decisive is the so-called standard pension, for which certain fixed subsidies are paid. Those affected can also use the subsidies for more expensive restoration, for example, an implant. However, he then has to pay a higher share, which the dentist bills privately.

Compare offers from dentists
In general, the cost of a denture depends on several factors: material, laboratory costs, and dentist’s fees. There is often scope here, which is why you should get a second opinion before treatment. There are auction portals on the Internet where you can post the dentist’s offer and compare it with other dentists. Everyone has to decide for themselves whether the price difference justifies the change of dentist.