When a person loses a tooth, if they want to replace the missing tooth, he or she is faced with several options. As long as there is a tooth on either side of the missing tooth, placing a bridge is an option. A bridge supports a false tooth. Another option is an implant. The third option is a removable partial denture.
There are several advantages and disadvantages to the three options above.
The advantage of a partial denture is that the cost is significantly less than the other options.
Partial dentures, however, have the problem of food collecting under the denture; also, you cannot exert a lot of “biting” pressure on the denture. Partial dentures tend to have some movement, which some people find annoying.
The advantage of an implant is that it functions like a real tooth and you can exert full biting pressure. Another implant advantage is that you do not have to do anything with the tooth on either side of the missing space. Implants are the best option if you do not have a tooth on one side of the missing tooth on which to anchor a bridge.
There are two types of implants: one is titanium, the other is zirconia, which is an inert ceramic material. The disadvantage of the titanium implant is that titanium is metal and thus creates electrical currents. In my experience, the electrical currents can interfere with proper brain function. Also, titanium can migrate to all your cells. Another potential disadvantage to an implant, whether it be titanium or ceramic, is that placement of the implant is into an acupuncture meridian, and we don’t know all the implications of such a procedure. Due to the electrical aspects of the titanium implant, this would tend to have more of a chance to cause a detrimental effect on an acupuncture meridian than a ceramic implant, which creates no electrical currents. Ceramic implants are also very biocompatible, and the material is inert. Ceramic implants have been used in Europe for many years but are relatively new to this country. Thus, it is more difficult to find a practitioner willing or able to place a ceramic implant.
There are two types of dental bridges – conventional and inlay. Today, both types of bridges can be fabricated from zirconia, thus eliminating the electrical currents that were present when they were metal based.
Conventional bridges have several disadvantages. You need to place a crown on the tooth on either side of the missing tooth. Creating a crown means that these teeth need to be “cut down,” hence, mutilating the teeth. Such mutilation of the teeth increases the odds that a root canal may become necessary in the future. Root canals may have deleterious systemic effects. Another disadvantage is that you will need to have temporary restorations in the process of creating a conventional or inlay bridge. These temporary restorations can become loose and need re-cementing.
I am not fond of conventional bridges unless the supporting teeth are so broken down that there is no other way to restore them except with a crown.
The advantage of an inlay bridge is that it is a much more conservative type of bridge. Yes, the supporting teeth need to be “prepped”; however, these preparations are usually smaller than if a filling were placed in these teeth.
Because the tooth preparations are small, the problem typically experienced with the inlay bridge is retention. The preparations in each supporting tooth must be eyeballed by the dentist who is trying to make them as parallel as possible to each other to have adequate retention (doesn't come uncemented or become loose). The concept is like having a box inside another box that fits tightly; it would subsequently be hard to "tease" or remove one box outside of the other box – the more parallel each tooth preparation is to the other, the better the retention.
I have had training in a new type of bridge, called First FitTM . FirstFit is a unique patented technology. This bridge requires minimal preparations in the teeth that support the missing tooth. The FirstFit bridge, made out of zirconia, is very biocompatible and has no electrical component.
This problem of parallelism in inlay bridges is solved ingeniously with the FirstFit Bridge. The conventional method of making a bridge is to prepare the teeth, and then take an impression of the prepared teeth. A model of the teeth is made from the impression. The bridge is then fabricated on the model. With the FirstFit bridge, there is no initial preparation of the tooth. An impression is taken of the unprepared teeth, preferably with a digital scanner. This digital impression is sent to a specialized dental laboratory. Special software will enable the lab technician to make tiny preparations in the supporting teeth that are parallel to each other. A bridge is then constructed and returned to the dentist along with a special jig or preparation guide. This preparation guide is placed over the supporting teeth. The dentist uses a custom dental handpiece which fits into the guide like a lock and key; this allows duplication of the computer-assisted preparations of the teeth that were made in the dental lab. Thus, the dentist is not attempting visual "eyeballing" to create parallel preparations. Having such exacting preparations solves the retention problems that can accompany traditional inlay bridges.
FirstFit Bridges are long-lasting and a safe solution that is minimally invasive. I find that FirstFit is an excellent alternative to implants. Naturally, each case is different, and the decision on what to do has to be made in concert with the patient.
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