In the past, people would get gold or silver teeth replaced after losing them. Nowadays, people say they're getting a new tooth implanted. While dental implants are a relatively new method of tooth replacement, they've actually been available in Hong Kong for decades. Dental implants, bridges , and removable dentures are the three most common ways to address missing teeth. This time, we've invited Dr. Chan Sze-yan, Medical Executive Director of a dental centre, to compare the advantages and disadvantages of each method to help you make the wisest choice.
Do you know the principles behind these three methods of filling missing teeth?
Dental implants
If surgery is involved, the dentist will drill a hole in the alveolar bone and insert a screw-like implant (artificial tooth root). After the wound heals and the implant stabilizes, a porcelain crown will be fitted.
Diagram: The screw-shaped implant (artificial tooth root) is fixed to the alveolar bone, and then a white porcelain crown (dental implant) is attached.
Dental bridge (fixed prosthesis )
This procedure does not involve surgery. Healthy teeth are used as abutments to support the dental bridge. The adjacent teeth on either side of the missing tooth are ground down, and three prostheses are attached to the teeth on either side, then fixed with adhesive. It is only suitable for cases where one or two teeth are missing in the middle.
Diagram: A set of three dentures (a dental bridge) is attached to the teeth on both sides and then fixed with adhesive.
Removable dentures (Denture)
No surgery is involved. The removable dentures are installed inside the mouth, with healthy natural teeth acting as abutments to support the entire set. The dentures are custom-made to fit the individual's oral condition, and then secured to the natural teeth using metal hooks or magnets to fill in any missing teeth. Chewing and biting forces are primarily borne by the soft tissue of the gums, and the dentures must be removed and cleaned after each use to maintain oral hygiene. Due to their relatively low price, they are very popular with the elderly.
Diagram: Removable dentures (removable dentures) that use metal hooks to hold natural teeth.
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Dental Implants, Bridges, and Removable Dentures: A Comparison
The following chart briefly compares the advantages and disadvantages of the three treatment methods. For a detailed analysis, please see below.
Round 1 : Healing Time — Removable dentures are the fastest
- Removable dentures: After the dentist's assessment, an initial impression will be taken, analyzed, and custom-made. Once the dentures are made, polished, and adjusted, they can be used. The entire treatment usually takes about 3 to 4 weeks, allowing patients to quickly regain their chewing function.
- Dental bridge: This method is similar to custom-made crowns, except that the denture is placed between two crowns. The production time is fast, and it can usually be completed in a month from the start of treatment to the fitting of the denture.
- Dental implants: After the dentist places the implant into the alveolar bone, it takes 4 to 12 weeks for the implant to integrate and stabilize with the bone before the next step can be performed. A single implant takes approximately 3 to 6 months, while multiple implant procedures can take 6 months to a year. This long treatment time is the biggest drawback of dental implants. If the implant requires bone grafting, tissue grafting, and surgical placement of the implant, the entire treatment can take 6 months to a year, which is undoubtedly a burden for the elderly.
Round 2 : Comfort – Bridges and implants feel just like real teeth.
- Removable dentures: They are placed directly on the gums when in use, which can feel like a foreign object and requires a long period of getting used to and breaking in.
- Dental bridge: Like a crown, it is fixed to the tooth and feels just like a natural tooth when in use.
- Dental implants: When porcelain crowns are fitted, the implants have already integrated with the alveolar bone, and the overall experience is similar to that of natural teeth.
Round 3 : Chewing Force – Optimal Bite Force for Implants
- Removable dentures: The chewing force is borne by the soft tissue of the gums, which makes it easier to eat. They may feel loose, wobbly, or even fall out when eating.
- Dental bridge: The biting force is distributed on both sides of the healthy teeth that serve as support, and the biting and chewing force is generally acceptable.
- Dental implants: The implant is fixed in the alveolar bone, and the biting force is distributed into the bone, resulting in optimal biting and chewing force.
Round 4 : Oral Health — Dental Implants Can Replace Lost Tooth Roots
- Removable dentures: After teeth are lost, the alveolar bone loses the stimulation of chewing, leading to gradual bone loss and gum recession. Removable dentures do not have artificial tooth roots and cannot provide chewing stimulation. Moreover, dentures may exert pressure on the supporting jawbone, accelerating gum recession.
- Dental bridges: Dental bridges require grinding down the healthy teeth on both sides to form a bridge, sacrificing the health of two natural teeth to support the prosthesis, which is quite a pity. Like removable dentures, dental bridges do not have artificial tooth roots, and the gums will eventually recede.
- Dental implants: Implants (artificial tooth roots) inserted into the alveolar bone can fully integrate with the bone, stimulating the bone just like a real tooth root, reversing the fate of tooth root loss and gum recession after tooth loss.
Round 5 : Cleaning Method — Implant Cleaning is No Different from Natural Teeth
- Removable dentures: They need to be removed and cleaned after each use. You can use a toothbrush and toothpaste to clean the dentures carefully or soak them in denture cleaning tablets. Finally, rinse them with clean water. They are relatively inconvenient.
- Dental bridges: The lack of tooth roots in dental bridges leads to continuous irritation of the alveolar bone, causing gum recession and gradual separation between the bridge and gums. This makes it easier for food particles to accumulate, increasing the risk of periodontal disease and cavities. Unlike natural teeth, dental bridges are connected to the gums, making it impossible to clean the connection between the bridge and gums with dental floss. Instead, a fine interdental brush or similar device must be used to clean the gaps.
- Dental implants: Cleaning is relatively convenient and simple, just like brushing your teeth normally, but you still need to go to the dental center regularly for cleaning and check-up of the implants.
Illustrated guide: Proper use of dental floss is essential for cleaning implants. First, slowly slide the floss into the gap between your teeth, keeping it close to the adjacent surface of one side of the teeth. Wrap it around the implant in a C-shape, and gently pull it left and right, up and down to clean and remove any remaining plaque and food.
Round 6 : Duration — Dental implants are more durable
- Removable dentures: These need to be adjusted according to oral conditions and typically need to be replaced after 5 years or more. If oral conditions change and the gums and removable dentures can no longer fit tightly together, then new removable dentures will need to be made.
- Dental bridges: The lifespan of a dental bridge is affected by individual usage and maintenance. It can generally last 10 to 15 years, and with proper care, it can last up to 20 years. However, as gums gradually recede over time, after 10 to 15 years, the gums and the dental bridge can no longer fit tightly together, requiring the dental bridge to be remade.
- Dental implants: Generally have a long lifespan, and with proper maintenance, can last for more than 20 years. Depending on the use and care habits of the teeth, it is a long-term and high-quality treatment option.
Round 7 : Aesthetics — Dental implants produce results that most closely resemble natural teeth.
- Removable dentures: Removable dentures must be cleaned after eating and before sleeping, making them unable to maintain their aesthetic appeal continuously. Sometimes the metal clasps of the dentures may become exposed, which is unsightly. Furthermore, dentures may fall out if you laugh too loudly.
- Dental bridges typically use full zirconium crowns, which are harder than natural teeth, wear-resistant, bite-resistant, and aesthetically pleasing. The color is close to that of natural teeth but is rather dead white.
- Dental implants: Generally, all-ceramic crowns are used. The translucency, texture, color, and warmth of the teeth are almost indistinguishable from those of natural teeth. The hardness is also comparable to enamel, and it is not easily damaged by normal use, making it the most realistic.
Before and after dental implant comparison
Overall assessment : There is no best, only the most suitable; it depends on individual financial capabilities and needs.
Overall, removable dentures are the most affordable option, requiring no surgery, and people who have lost all their teeth can eat using full removable dentures, but they are also the least convenient to use.
Dental bridges are relatively affordable, do not require surgery, and generally offer decent results.
Dental implants do not affect adjacent teeth and are beneficial to oral health in the long run. However, they require surgery, and suitability depends on one's physical condition. Furthermore, dental implant treatment is lengthy and expensive, making it unaffordable for many.
Each type of missing tooth has its own advantages and disadvantages. A dentist can provide professional advice and discuss the issue with you to help you make the wisest choice. If you have any questions, please consult your trusted family dentist.
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