Sometimes dental implants are not the best option! I know this sounds strange coming from a dental implant specialist but for the last 20 years of my career, there are some cases that are best off not having implants. There are disadvantages to dental implants. There are also disadvantages to bridges as well.
Sometimes the best advice given to you by a dental implant specialist is not to have implants but rather to have a bridge made over natural teeth. There are times where the dental implants will look worse than having a bridge!
There are many factors that go into my judgment… In no particular order:
- Some people genetically have a poor “bio type. ” This means that there gums and bone are genetically thin. They are prone to losing bone and gum around the implants over time.
- Front teeth with vertical bone loss with a high smile. This can lead to a very aesthetic appearance of the implants with open black triangles and long horse like teeth.
- Previous failed implants
- Missing bone on the interproximal (side) of a critical tooth in the front of the mouth
- Cases where bone grafting would not yield a cosmetic result and in fact may worsen an already bad situation
- Medical conditions or lifestyle choices such as heavy smoking, severe osteoporosis, that would make bone grafting high risk or unpredictable.
- Type of temporary teeth patient could have during bone grafting healing. Sometimes people need removable temporaries and they do not want to take them out at night to that the gums rest.
- Periodontal (gum) condition of the other teeth in the mouth
- Unstable bite especially lack of back teeth.
- Are you (the patient) willing to go through what it takes to do it right?
Here is an example of a patient that had two existing implants for his front teeth. (picture above) When I first met this patient he came to me for a second opinion while in the midst of having treatment done. I did not place these implants.
The front teeth look very long like piano keys. The lack shape and character. The two center teeth are implants while the two side teeth are crowns. One of the side natural teeth has bone loss a cavity on the interproximal side of it. This causes vertical bone loss and a very exaggerated elongated smile. One of the implants is losing bone via peri-implantitis. The abutment is also showing.
It is ‘possible’ to correct this type of deficiency with a block graft, GBR and or titanium mesh bone graft but this patient did not want to go through this again and was unhappy with the final result. He came back to me a few years later to see what could be done.
In his situation you cannot graft bone and gum onto the existing implants. You have to remove the implants and start all over or go with a bridge option.
In his case, I removed the implants and we decided that it would be best for him to have a bridge. I sedated him under IV sedation, removed both implants, did some basic socket preservation bone grafts, extracted one of the bad natural teeth and made a 6 unit bridge going from tooth 6 through 11.
I agree that these teeth are not perfect! But I do think he looks much better than before!
They are not supposed to be perfect. He wanted to have teeth that looked more natural. In order to accomplish this I purposely made the teeth kind of crooked, added some yellow/brown stain near the neck and a little bit of pink just in case he smiles really high.
This treatment was completed in 2-3 visits. In reality if this patient came to see me the first time I would have steered him in the direction of having a bridge if he did not want to go through complex vertical bone grafting that may take 1-2 years to complete.
I have no doubt that this bridge will last 20 years as long as the patient takes care of it (diet and lifestyle are a huge part of bridge longevity) . The big disadvantage here was that I had to grind down to more teeth. The canine teeth numbers 6 and 11 are the largest roots in the mouth. Because there was no root canals on these teeth , they are very strong even when ground down
I hope this post allows you to appreciate the complexity of diagnosis and treatment planning in implant dentistry. Please keep in mind that dental bridges last much longer in the front of the mouth than they do in the back of the mouth.
My goal is always to have patients have treatment done right the first time. Complications can and do happen. Proper planning and experience can reduce the chance significantly.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry