Your dentist will have several dental implant treatment options available. Finding the ‘best’ approach is unique for every person and will need to take your budget, condition, as well as your dentist’s capability into account.
Continue reading to discover:
Replacing a single tooth
There are many different treatment options for replacing a single tooth, all with their own set of specifications. To get an overview, see below two of the main categories:
Implant-Crown
This is a very aesthetically pleasing, functional (good for chewing and pronunciation) and durable solution. It requires surgery and the full treatment takes between three and nine months. Depending on the implant system and the patient’s condition, it may be possible to leave the practice on the day of the surgery with a fixed tooth.
Moreover, dental implants stimulate and preserve natural bone growth, which helps prevent bone loss [3]. Unlike a 3-unit bridge, an implant also stands on its own support without putting pressure on other teeth and therefore preserves them.
3-Unit Bridge
This is a very cost-effective prosthesis compared to the implant-crown and it can be done in one day. However, over years its cost is higher than an implant-based solution[22]. A bridge is also, not as aesthetically pleasing as an implant-crown and requires the healthy adjacent teeth to be worn down in order to accommodate it. Over time, the under-stimulation of bone leads to further bone loss and potentially additional tooth losses.
| Implant | Bridge | |
| Long-Term Performance | Lasting 15+ years Limited bone loss [1] [2] | Lasting 5-10 years Foreseeable bone resorption Higher risk of caries[3] |
| Comfort | High Adapted brush & floss | Acceptable Oral hygiene can be complicated |
| Appearance | Best possible aesthetics | Functional more than aesthetic (partly due to adjacent teeth preparation)[4] [5] |
| Procedure Duration | 3-6 months | Few weeks |
| Cost | Long term cost-effective[6] [7] Rarely covered by insurance | Short term cost-effective Frequently covered by insurance |
Replacing several teeth
There are many different treatment options for replacing several missing teeth, all with their own set of specifications. To get an overview, see below four of the main categories:
An Implant-Retained Bridge
This is when a prosthesis (bridge) is screwed onto implants. This solution is aesthetically pleasing, improves speech capacity, feels comfortable, and is very durable. Naturally, implant treatments require surgery, which affects the cost and takes some time until healing can be complete (approximately three to nine months).
One efficient solution to treat fully edentulous patients is to use the All-on-4 technique which uses four (or more) implants per arch with a screwed bridge. The success of this solution lies in tilting the posterior implants. This allows patients to leave the practice the day of surgery with a fixed provisional implant-retained bridge.
Removable Partial or Full Denture
This is the most cost-effective option. A denture requires time to get used to, in particular when it’s on the lower jaw (mandibula). It does not stimulate the bone, but rather accelerates bone loss, especially when poorly fitted[18] It is greatly accentuated during the first year and continues over a 25-year period of time [19][20]. Drifting and loss of teeth affect the remaining teeth and facial symmetry. Comfort, function, speech, esthetics, self-image, and dental health are not as good as with an implant-based solution[21].
Tooth-Based or Fixed Bridge
The cost of this solution lies somewhere between an implant-based and a removable denture system. However, over years its cost is higher than an implant-based solution[22]. This option is more comfortable than a removable solution, but not as long-lasting as an implant-based prosthesis. The bridge does not stimulate bone and leads to further bone resorption.
Fixed-Removable Overdenture
Systems, such as ball- or locator-attached dentures, can be used for lower missing teeth and are based on a minimum of two implants having snap-able anchors for the denture. They offer better chewing and speech qualities than removable dentures, although some gum soreness can occur in the areas without anchors. This option is not as functional as an implant-retained bridge, as food can be trapped between the denture and the gum, which can cause discomfort. However, the patient can easily brush and clean the denture by removing it.
| Implant Fixed Bridge | Implant-Supported Overdenture | Tooth-Based Bridge | Removable Denture | |
| Long-Term Performance | Lasts 15+ years Good speech quality Limited bone loss [8] | Risk of accelerated bone resorption[9] [10] | Lasts 5-10 years Foreseeable bone resorption Higher risk of caries[3] | Lasts 3-6 years Continuous bone loss impacting facial structure (ageing) [11] |
| Comfort | Comfort like natural teeth Adapted brush & floss | Medium[12] [13] due to frequent maintenance Adaptation time required Possible impact on speech Remove for cleaning (for some solutions) Food limitation | Acceptable Oral hygiene can be complicated | Low due to poor retention and stability [14] [15] Adaptation time required Remove for cleaning Variable speech quality[16] No surgery required Food limitation |
| Appearance | Best possible aesthetics | Acceptable aesthetics of prosthesis | Functional more than aesthetic (partly due to adjacent teeth preparation)[4] [5] | Acceptable aesthetics of prosthesis Risk of poor stability |
| Procedure Duration | 3-6 months | 3 – 6 months | Few weeks | Few weeks |
| Cost | Long term cost-effective [17] due to bone volume preservation Rarely covered by insurance | Intermediate | Short term cost-effective Frequently covered by insurance | Low cost |
Your expectations and satisfaction
The most important goal of any dental implant treatment is for you to be satisfied with the outcome. There are numerous studies [23][24][25][26] that show a significantly higher satisfaction level when choosing a dental implant treatment over other types of tooth replacement treatments (removable partial dentures and fixed partial dentures) [27]. These studies found a high level of satisfaction to mainly be dependent on (1) a positive clinical outcome and (2) meeting the patient’s expectations.
While the clinical outcome depends mostly on your dentist’s skills, developing realistic expectations in terms of outcome is essential for your satisfaction. This exercise is done together with your dentist by understanding the level of difficulty in addressing your indications. For example, the challenge might be so high that the treatment will require more time than you expected. To better frame your expectations, click here for some inspiration on useful questions to ask yourself and your dentist.
Some expectations may not be feasible and others may significantly influence the price. For example, if you want to get an outcome giving you the best appearance and quality level, this will hardly be possible within the shortest period of time.
[4] Shillingburg HT, Grace CS. Thickness of enamel and dentin. J South Calif Dent Assoc 1973;41:33-52.
