Should implants always be used for tooth replacement?

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Gum disease affects the teeth of four out of five patients to various degrees. All gum disease is a result of accumulated bacteria that have not been kept under control.

The mildest form is gingivitis. This is characterized by tissue inflammation with bleeding and no bone destruction. The most severe form is advanced gum disease with severe bone destruction.

Often, this range of conditions can come with no symptoms apparent to the patient.

Prior to any consideration of tooth replacement with implants, the tissue health of the patient must be evaluated. Although dental implants are not subject to tooth decay, they can fail due to gum disease.

Oftentimes, even with their gum disease under control, patients would be best served by fixed bridges instead of implants, depending on the health of the adjacent teeth.

Having gum disease does not automatically eliminate a patient from being a good candidate for implants.

Of particular interest are the lower front incisor teeth between the "fang" teeth. It is always a challenge when considering replacement of a single tooth in this area. For example, a single center tooth that might have had a previous root canal and has broken off to the gum line must be extracted.

The problem is that the teeth in this area are small and the bone in this area is going to be minimal. What is the best solution?

Even a mini-dental implant does not work well here due to the minimal bone. The small size of adjacent teeth is an issue, because making them smaller for a fixed bridge doesn't work.

A good solution would be a "bonded" bridge. The adjacent teeth are minimally prepared as in a porcelain veneer, and the missing tooth is suspended in between the two adjacent teeth.

This three-unit replacement is bonded into place. A fixed permanent solution is accomplished that is strong, healthy for the gums and provides the best esthetics. All situations vary so it is important to have such an area evaluated thoroughly prior to treatment.

James G. Jenkins, D.M.D. is the owner of Bluffton Dental Care in Bluffton.

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