Updated: Feb 2019
So you’ve been told that you need a dental implant or dental implants, but you might be wondering do I really need to have them, and are there any alternatives which may be nearly as good or even better?
We’re going to look at the four options today as alternatives to dental implants. Firstly you could decide to do nothing, secondly you could decide to have a denture. We are going to talk about the different types of dentures and their advantages and disadvantages further in this article. Thirdly, you can have a bridge placed as a tooth replacement. There are different types of bridges, which we will talk about and their advantages and disadvantages. Finally you may want to consider having something called smaller diameter implants, and again why they are being increasingly used with cost and time savings, and the procedure is now a lot less complex than traditional implants.
So if you think you need a dental implant, what are the alternatives? You may have been told that, and let’s assume you haven’t lost the tooth yet. So you’ve been told that you’re going to lose a tooth, and therefore in order to replace it you need to have a dental implant. One of the options you should always consider is whether the tooth that you’re going to lose can be kept. Now it may be that for example there’s treatment in it already, and the existing root canal filling is failing or it’s got an infection. It may be possible that the old root filling can be taken out and a replacement new filling can be placed, which removes the infection and allows the tooth to heal back up again. For this you may need to see a specialist dentist, or one in the dental hospital. It’s not always worth saving a tooth but sometimes it can be done. If the worse comes to worse, it may prolong the life of that tooth; so if you think that you’re going to lose a tooth but by having some intervention now then the tooth may last a bit longer, for example another three years or four years, then it may be worth a while for you to try to salvage that tooth. Even though you know that it’s going to be lost in the long term, you may want to hang on to the tooth for a little bit longer for now.
Now let’s assume that you’ve already lost a tooth, and you’ve been told that you need a dental implant, you could always decide to have nothing or no treatment whatsoever and the most important factor here will be where the tooth is in relation to your mouth, as no one or not many people will want to walk around with a gap big gap on their middle front tooth because it will just be too noticeable. However if you have lost a back molar then nobody really is going to notice that you’ve got a tooth missing at the back, and in addition it also depends on how many other teeth you’ve lost. If you think you’re going to lose a few teeth at the back of the mouth, then this could have an impact on the way you eat and you may not want a big gap or gaps, so you may want to have a dental implant at the back. On the other hand if you know that you know you’re going to be fairly safe in hanging on to all your back teeth, and you’re just going to lose a single back tooth then you may not really want to worry about having a dental implant done.
It’s always worth considering the option of having nothing done whatsoever, and one word of advice is that when you do initially lose a tooth especially the gap will seem absolutely enormous; it will be like you a big crater left in your mouth. However, rest assured that although initially it will be discerning to have a big gap, after a period of a few weeks or months you will get used to having a gap there and if it’s not a really big problem for you at that time you may want to consider having your treatment done. The other way you can think about this is you may not want to have any treatment done, because a dental implant may involve surgery that is too complex or there are risks associated with it.
Plus also you have to think about the long-term implications of dental implants. So after some years a dental implant, or any of its components such as the abutment – the abutment screw – or the crown, or the cap that goes over it, may need replacing. These replacement cycles obviously could be inconvenient, and there is the cost factor to consider as well, as you also have to realize that the costs will generally always increase; so an implant replacement ten years from now could possibly, or will possibly most likely, cost more than what it is now – although it’s not always the case.
So the first option is to not have any dental implant done at all and sometimes it is worth sometimes just waiting and to see how much of an impact losing a tooth has actually had compared to initially.
Let’s look at the second option this is having a denture. A denture is by far the most commonly used alternative to losing a tooth and the replacement of it. Thousands upon thousands of dentures are made in the UK, so obviously it must be one type of treatment that you should consider, especially as so many people do wear dentures. There will definitely be some people within your family, friends, or colleagues who wear a denture and you are not even aware of it. So dentures can be a good alternative way to replace a tooth or teeth, and many patients wear dentures without any problems whatsoever and they have done for many years.
There are however certain problems that can arise from dentures. Not everyone can wear a denture, because they may find it difficult to get used to or they just find it intolerable in their mouth having a foreign object, because that’s what a denture essentially is, that replaces something natural that you had in your mouth. Having said that the mouth, the body as a whole in fact is an incredibly adaptive environment organism and most patients do get adapted to dentures even though initially they may struggle quite a bit with keeping the denture in the mouth, with it moving, with the speech with eating, but most people do manage to wear dentures.
In fact, even before bridgework and implant a denture was the only alternative available to patients to replace a tooth or teeth. There are problems with dentures, and you only know about them once you have it. Once you have had a denture made, I suppose the big advantage of having a denture is that once you have had a denture made, and then you find that you can’t wear one; you’re not really left with the situation any worse off than when you first started, because a denture is a removable object in your mouth.
There are different types of dentures, and one should always explore the relative merits and disadvantages of each type of denture and to really gauge which type of denture will be best in your situation. Your dentist may talk about a plastic denture, also called an acrylic denture, this is by far the most common type of denture. There is also something called cobalt chrome denture, it sounds horrible and complex but all that means is that the denture framework instead of being plastic is made out of a metal called cobalt chrome. The advantage of it is that if you can get a cobalt chrome, then you can achieve better retention in some circumstances; so it will hold in your mouth better so it will move less during talking and eating. It will also cover less area in your mouth, which obviously helps in you getting used to a foreign object in your mouth, and finally they can be made a lot thinner than a plastic type of denture – which tends to have a certain thickness otherwise a plastic can break – and this is a big advantage of a cobalt chrome denture. A cobalt chrome denture is extremely effective in the right situation and a cobalt chrome denture can last many years. Not all dentists will do a cobalt chrome denture and certainly it is unlikely to be available on the NHS so you would have to pay for it privately.
A new type of denture is a flexi denture. There are different names for them, probably the most common one is Valplast Denture. This flexi type of denture is made out of an acrylic or a plastic, but it’s not a hard stiff plastic it’s got a certain amount of give and flexibility, this allows it to be adapted to the mouth the better and it allows you to get better retention. So it grips in your mouth a lot better, meaning that it will move less and you will get used to it more quickly. Plus a denture or a flexi denture is more expensive, sometimes three or four times more expensive as a normal traditional plastic denture, and it’s not available on the NHS, and not every dentist will do flexi denture. But they can be extremely effective, and a good alternative sometimes to replacing a gap or gaps in your mouth once you’ve lost teeth.
These flexible dentures do have disadvantages, in that you cannot add any more teeth on in the future. So with a traditional acrylic plastic denture if you lose a tooth, for example in the future, six months down the line or a year down the line, a tooth can be added onto your existing denture which avoids the need for making a brand-new denture. But this can’t be done with the newer type of flexi dentures, and also it cannot be done with the second upper denture which we talked about which is the cobalt chrome type of denture. But nevertheless, if you know that you’re not going to realistically lose any further teeth in the near future, then a flexi denture is a very good alternative to a traditional denture.
The other disadvantage that flexi dentures do have, is that the plastic does stain a lot more quickly and readily than a traditional denture. The amount of staining that it picks up is related to your habits, such as smoking, and the types of food that you eat; so it may not be suitable for everyone, and the problem of the staining is that it just looks not so nice when you take the denture out to clean it because you just cannot clean the stains out but really if that does not bother you that much then it’s not a big thing to worry about.
Let’s move on to the third alternative replacement. So we’ve talked about firstly having nothing to replace missing gaps, we talked about dentures and the different types, and the third method is bridge work which are also called fixed teeth as well.
So the main difference between the denture and the bridge is that a denture must be taken out to clean and a bridge is something that is fixed in your mouth, so it does not need to be taken out. A traditional bridge however, involves modifying or trimming the adjacent teeth next to where the gap is. This means you are compromising the adjacent teeth to some extent, but this is the only way you’re going to get a fixed tooth is if the adjacent teeth next to the gap that are used to anchor the additional tooth that you want to replace in the gap.
The modification itself can have adverse effects on these adjacent teeth, so for example in a certain percentage of cases they can get damaged, and this can be as much as 20 to 30 percent. Bridge work also would not last forever so it will need replacing 10 to 15 years down the line, and when their bridge does get replaced you will compromise the adjacent teeth further. Having said that the bridge is still effective, or can be an effective alternative, to those people who do not want to wear dentures even though they do have the disadvantages.
The traditional type of bridge is just called a fixed bridge, however the newer more recent type of bridge is called an adhesive – or a Maryland bridge or a Rochette bridge there’s different names – the overall umbrella for this type of bridge is called a minimally-invasive bridge, and the advantage is that the adjacent teeth do not need to be trimmed extensively in order to anchor on the teeth that you’re replacing.
Initially these bridges were designed as just temporary bridges, but it was found that they were lasting in some patients for quite considerable time, and therefore an idea came into being that perhaps these could be used as permanent bridges in some circumstances. Certainly they can last as long as a traditional bridge, however they come off and they usually come off without warning so that’s something that you do need to consider.
So we’ve talked about having no treatment for missing teeth, dentures, bridge work, and the final thing I mentioned was something called smaller diameter implants.
So although today you know these are still in France, they’re not traditional influx, the story of smaller diameter implants came about in the USA where a dentist used them as temporary implants with a view to replacing them in the near future but what he found was that the implants had all become firm and stabilized and they lasted the patient for as good as any traditional implant. So this is where the idea came about, where this type of implant perhaps could be used as a permanent implant. The advantages are that the procedure for smaller implants is much simpler, is less traumatic, there’s less surgery most of the time, there’s no stitches involved or having to take the gum back, bone grafting is not usually needed, and the procedure is quicker and there’s potentially significant cost savings in this as well. Dentists who have been placing implants for a long time using traditional methods are quite reluctant to place smaller diameter implants, so you may need to search or look for a dentist who does believe in and does place smaller diameter implants; after all why go for something more complex and more costly when something simpler and easier will do the job just as well and sometimes even better. There are different names for smaller diameter implants and they come under different categories such as mini implants, SDI’s called also known as smaller diameter implants, MIDI implants, and there’s just lots of different types of smaller diameter implants for you to consider.