Implants are one of the best ways to replace missing teeth. There are some prerequisite conditions that should be present for implant placement. They include presence of proper amount of bone in the implant site, non-contributory medical condition, healthy mouth, teeth and gums and patient compliance.

ADVANTAGES:

The main advantage of an implant is that it will replace the missing tooth and restore function without damaging the adjacent teeth. It will not interfere with proper oral hygiene as related to the natural teeth. Restoration can be done most of the time with a pleasing outcome (with no metal or dark shadow showing at the crown margin). Implants are also the treatment of choice where teeth juxtaposed an edentulous space have less than ideal bone support. In such cases other options will compromise the future of these teeth.

DISADVANTAGES:

Implants require careful planning and case analysis. It takes a considerable amount of time from the initial stage to completion. There is a mandatory waiting period from the time the implant is placed until its restoration. This is needed for proper healing and osseo-integration between implant and jaw bone.

BRIDGE

A bridge is the most common prosthesis replacing a missing tooth. The prerequisites include presence of teeth with proper bone support in the immediate vicinity of the empty space, healthy mouth, teeth and gum, and patient compliance. In this technique the supporting teeth or abutments are prepared by cutting them down. There must be teeth in front and back of the missing tooth for the bridge.

ADVANTAGES:

Most dentists are trained relatively well in the fabrication of a bridge. Provided the other conditions are met, a bridge can be made fairly rapidly with often pleasing results.

DISADVANTAGES:

It is mandatory to cut down the adjacent teeth to make a bridge. At times it might become necessary to utilize additional teeth for this purpose. In general the more missing teeth the more number of abutments required to support a bridge. In some cases to assure longevity of a bridge one or a few teeth with compromised prognosis next to an edentulous spot need to be extracted. This is done in order to reach the next available tooth/teeth with better bone support.
Another disadvantage of a bridge is that the dark metal margin of the bridge around the abutment teeth sometimes becomes visible. This not only affects the patients smile but also can trap food and plaque which will result in decay. In addition, it is often difficult to clean under a bridge with routine oral hygiene aids.

PARTIAL DENTURE

A partial is another common prosthesis replacing missing tooth/teeth. It is a removable appliance utilizing metal brackets to obtain support and retention. The prerequisites are the same as before, however it is not necessary for teeth to be present at both ends of an edentulous space.

ADVANTAGES:

A partial denture is the most inexpensive of the above options. It can be done in a relatively reasonable amount of time with a fairly acceptable outcome.

DISADVANTAGES:

Most of the time it is necessary to modify the abutment teeth in order to properly fabricate a partial denture. These modifications include: removing part of the enamel of the tooth to eliminate undercuts, drilling a ditch over the occlusal surface to receive a rest or placing a crown to reshape a tooth or to restore a broken down abutment tooth. Partial denture often has extra bars and plates extending from one part of the mouth to another. There are also rests, retentive and reciprocating arms for support. Many times these extensions will show even without a smile.

Partial denture changes the ecology of the mouth and promotes plaque formation. There is an increase of recurrent caries and inflammation associated with a partial denture. It is also not uncommon for the patients to misplace or loose their partials.

NO REPLACEMENT

In some occasions no replacement is certainly an option. It includes extraction of third molars, loss of teeth not having a significant functional role, e.g. 2nd molars where there are no opposing teeth. However, this is not an acceptable option for the majority of the cases. Missing a tooth results in shifting of the adjacent teeth, supraeruption of the opposing teeth, and changes in the forces of occlusion. This may lead to loss of support, periodontal disease, broken teeth due to excessive para-axial forces, decay, TMJ dysfunction, poor mastication, changes in speech pattern etc.

Based on the above report it is quite clear that an implant is a proven alternative and in many respects superior replacement for missing teeth. One of its draw backs is time involvement and cost. It seems only fair to consider benefits for implant at some levels. To minimize abuses and casual decisions about implant it might be logical to assess a copay for implant procedures. This will show commitment and recognition on the part of the patient before deciding to proceed with implant treatment.