First of all, it is important to mention that the purpose of both treatments is to replace the patient’s missing teeth, and in the case of the fixed bridge they would be contiguous missing teeth in the same arch. With the replacement of the missing teeth, oral rehabilitation is achieved, that is to say, correct masticatory function, facial esthetics and the general health of the oral cavity are recovered.
It also prevents the development or progression of dental malocclusions such as crowding and dental migration (along with the muscular and articular consequences that this can cause). And by improving facial esthetics, it also helps to increase the patient’s self-esteem and confidence. They are also indicated to prevent maxillary bone loss or avoid its progression.
Each rehabilitative treatment has its pros and cons, and we invite you to read on to discover them. We would like to point out that since dental bridges can be cemented on teeth as well as fixed on an implant, in this article we will contrast the differences of the dental bridge cemented on the remaining structure of a tooth versus the unit formed by the dental implant and a dental crown.
Shape and structure
The dental bridge is a set of three or four crowns that simulate the anatomy of several missing teeth. The crowns located at the ends of the bridge are cemented onto trimmed teeth that serve as abutments and support, while the central crown has the function of filling the gap left by the missing tooth.
Since abutment teeth are trimmed for life, they would always need to be covered by a bridge or crown for protection, and it is for this reason that some dentists are not inclined to this treatment as they do not see the logic of having to trim two healthy teeth as this reduces the size, volume and strength of their structure.
Implants are screw-shaped devices made of titanium. Their purpose is to simulate the root of a missing tooth and then place a crown, a fixed bridge or a complete denture on them. A surgical intervention is necessary to place them and after a couple of months they are firmly fixed to the surrounding bone. It should be noted that when an implant is placed with a prosthesis, the adjacent teeth are not affected since it is not necessary to lean on them (here the implants are the pillars).
Fixation and stability
Bridges are a type of fixed prosthesis that is cemented to the trimmed structure of an abutment tooth. As they are fixed, their stability is assured and their mobility and displacement is prevented, however, with the passage of time or due to poor adaptation, they can become misaligned, causing discomfort to the patient.
As mentioned above, implants are fixed to the bone (osseointegration), which gives them excellent adhesion and stability properties. In addition, they adjust adequately to the prosthesis located on them, preventing its mobility, which, being screwed in, gives them very good stability and provides great comfort and safety to the patient when speaking and chewing.
Cleaning
The bridge cannot be removed for cleaning at home or when the patient is going to perform tooth brushing, that is why if it is not well adapted it can favor the accumulation of food debris inside, which in turn can irritate and inflame the surrounding soft tissues causing periodontal disease and/or cavities.
The unit formed by the implant + dental crown cannot be removed because it is screwed, so it may be necessary to use devices such as an oral irrigator to clean more deeply the space between the gum and the prosthesis. If the implant/crown unit is not properly cleaned and maintained, periimplantitis can result compromising the stability of the implant.
Resistance and lifespan
Bridges are usually quite durable prostheses but depending on their fabrication material they usually have less strength and lifespan than an implant with porcelain crown. Their survival period is usually about 5 to 10 years. As they are less resistant, they are not recommended for patients who suffer from bruxism since the constant clenching can increase the risk of fracture (we emphasize once again that this depends to a great extent on their manufacturing material).
The implant + porcelain crown is the rehabilitative alternative with greater resistance, durability and useful life (longer than the bridge cemented on teeth). An implant well placed and well cared for by the patient can last a lifetime, especially if we take into account that its rate of integration with the bone is quite high (98%).
Cost
Fixed bridge on teeth is a more affordable rehabilitative option than performing an implant + dental crown. And in the case of implant-supported bridges, it is also a more economical option than implants on individual crowns.
The implant, when accompanied by individual porcelain crowns, is a more expensive option, but if we take into account its cost-benefit ratio, it is an investment that is totally worthwhile.
Aesthetics
Depending on the material the bridge is made of, it offers esthetic results more or less similar to the natural tissue of the teeth. The base of the prosthesis, being made of acrylic, is quite similar to the gingival tissue, offering an appearance quite similar to the natural one.
The implant + porcelain crown unit offers the patient excellent esthetic properties since it can reproduce quite accurately the shape, color and natural appearance of the teeth.
Considerations
As we have seen, both alternatives offer the patient various advantages as well as less favorable points, so the choice of one option or the other will be determined by the following aspects:
-The dentist’s point of view depending on the complexity of the case and the characteristics presented by the patient. For this, an exhaustive evaluation of the oral cavity and complementary examinations (imaging studies, photographs, etc.) should be carried out beforehand.
-The economic possibilities of the patient.
-The speed with which the treatment needs to be completed.
It is also important to bear in mind that, regardless of the option chosen, the patient should maintain a correct oral hygiene routine to extend the life of the bridge or implant as much as possible. It is also necessary for the patient to visit the dentist periodically to evaluate the condition of the rehabilitative device and clean it.
