Two options for replacing lost teeth

Missing teeth can lead to additional dental woes, but implants and bridges can restore your smile and improve your dental—and overall—health.

Few of us will make it through life with a full set of 32 teeth. By age 50, the average American has lost 12 permanent teeth to decay, gum disease, or injury. Losing teeth not only affects your smile, but can also alter your bite and weaken your jawbone as well.

There is little reason to let that happen. Advances in prosthetic dentistry have made it possible to fill the spaces with bridges and implants that are more functional and attractive than the teeth they have replaced. "Your mouth is the first organ of your digestive system. Missing teeth affect not just your appearance but your overall health," says Dr. German Gallucci, executive director of the Harvard Dental Center. "We view dentistry as an integral part of comprehensive health care."

Implants

An implant is usually the preferred option for replacing a single tooth. Placing an implant requires careful preparation to assess the amount of bone where the implant will be placed to make sure that there will be adequate support for the implanted tooth.

Your dentist may take CT scans of your teeth to see the amount and shape of bone available for the implant and take impressions of your teeth. If your jawbone is adequate, your dentist may use a computer to make a models of your jaw to simulate the implant before performing the actual procedure. Doing so can improve the accuracy of placement and minimize the amount of tissue disrupted during the implant procedure.

If your jawbone won't support an implant, your dentist will augment it with bone or a bone-like material in a surgical procedure. You will need to wait several months for the bone to heal before receiving the implant.

The next step is to place a titanium screw—which serves as a replacement for a tooth root—in your jaw. The screw is fitted with a cap that looks like a small stud in your gum. During the next several weeks, your jawbone will grow around the screw to firmly anchor it in place, and your gum will heal.

In the final step, your dentist will make sure the implant is firmly in place. He or she will remove the screw cap and re-place it with a titanium abutment, or post. A porcelain crown that has been designed to match your surrounding teeth will be cemented or screwed onto the abutment.

Bridges

A bridge—which consists of artificial teeth fused to a metal frame—is a good option for replacing several teeth. The frame is cemented to supports—either implants or healthy teeth that have been covered by crowns. The more teeth being replaced, the more natural teeth or implants are needed to give the bridge the necessary support.

The Maryland bridge is a variation in which the dentist attaches the bridge by gluing thin metal or ceramic strips to the backs of nearby teeth. It is used to replace a single tooth in the front of the mouth when there isn't enough room for an implant.

Getting a bridge is a shorter process than getting an implant, but still requires several visits—one for imaging and impressions, another for preparing the supporting teeth for crowns and fitting a temporary bridge, and another for fitting the permanent bridge.

Other considerations

Your dentist can advise you on which option is best for you after considering the state of your teeth, gums, and jawbone, as well as your overall health. It's important to let your dentist know whether you have any chronic conditions like diabetes, which can affect healing, as well as all of the drugs you are taking.

Bisphosphonates, which are taken for osteoporosis, have been associated with an increased risk of jaw necrosis (bone death) following oral surgery. However, the risk is primarily associated with intravenous drugs like zoledronate (Reclast), instead of oral medications like alendronate (Fosamax).

Implants and bridges, though a wise investment, are not inexpensive. You can expect to pay up to $6,000 to replace a single tooth with either option. If you have dental insurance, check your benefits to see how much of the cost will be covered.