Missing a tooth complicates replacement decisions due to the invasiveness, time commitment, and expense of a dental implant. Implants are a surgical solution that replaces the tooth root, but many patients seek non-surgical alternatives due to concerns about the procedure or the overall cost. Fortunately, several established dental prosthetics offer fixed or removable options for restoring function without the need for jawbone surgery. Understanding the mechanics and long-term implications of these choices is the first step toward finding the right replacement.
Fixed Dental Bridges
Fixed dental bridges are a non-removable option that bridges the gap created by one or more missing teeth. This restoration relies on the adjacent teeth, known as abutment teeth, for support. The replacement tooth, called a pontic, is fused between crowns that are cemented onto these abutment teeth.
The procedure requires the healthy abutment teeth to be prepared, or filed down, to create space for the crowns. This preparation is irreversible, as it involves altering sound tooth structure to anchor the bridge. Once cemented, a traditional bridge is a highly stable and durable solution that can last well over a decade. The success of the bridge depends on the health and stability of the supporting abutment teeth.
Removable Partial and Complete Dentures
Dentures offer the most accessible and often the most budget-friendly alternative for replacing missing teeth. They are removable prosthetics that restore both the missing teeth and the surrounding gum tissue.
Partial dentures are utilized when a patient still retains some natural teeth in the arch, using metal clasps or precision attachments to secure the appliance to the remaining teeth. They typically consist of replacement teeth attached to a gum-colored plastic base, often reinforced by a stabilizing metal framework. Complete dentures are used when all teeth in an arch are missing, relying solely on the suction and natural contours of the gums and jawbone for retention.
Because dentures rest directly on the gum tissue, they do not provide the necessary stimulation to the underlying bone. Over time, this lack of stimulation can lead to gradual bone resorption, which causes the jawbone to shrink. As the bone changes shape, complete dentures will require periodic adjustments or relining to maintain a proper fit. Both partial and complete dentures demand daily removal for thorough cleaning to maintain oral health.
Resin-Bonded Bridges
The resin-bonded bridge, commonly known as a Maryland bridge, is a minimally invasive type of fixed restoration. Unlike a traditional bridge, it does not require significant preparation of the adjacent abutment teeth. Instead, the replacement tooth (pontic) has metal or porcelain “wings” that are bonded with strong adhesive resin to the back surface of the neighboring teeth.
This approach avoids the irreversible cutting down of healthy enamel and is considered a more conservative treatment option. Resin-bonded bridges are most commonly used to replace a single missing tooth, particularly in the anterior (front) part of the mouth. They are generally not recommended for back teeth due to the higher bite forces, which can compromise the adhesive bond. The primary limitation of this bridge type is its dependence on the strength of the bond and the risk of debonding over time.
Comparative Factors for Selection
The decision among fixed bridges, removable dentures, and resin-bonded bridges involves weighing several practical and biological trade-offs. The overall cost often places dentures as the least expensive option, followed by resin-bonded bridges, with traditional fixed bridges being the most significant investment.
Durability and longevity are major considerations; a traditional fixed bridge can last for ten years or more, while dentures typically require replacement every five to eight years. Resin-bonded bridges have a high survival rate at five years, but their long-term retention can be less predictable than a traditional bridge.
In terms of invasiveness, a traditional bridge is the most destructive to the adjacent teeth, requiring irreversible reduction of tooth structure. The resin-bonded bridge is the least invasive, often requiring only minimal enamel recontouring or none at all. Dentures are non-invasive to the teeth but require consistent maintenance and adjustment.
Neither dentures nor bridges prevent the bone loss that occurs after a tooth root is removed. Only the natural tooth root or an implant provides the necessary stimulation to maintain the density and height of the alveolar bone. Choosing a bridge or denture means accepting the potential for continued bone resorption in the missing tooth area.