Whether to have conventional dentistry, or an implant supported option, depends entirely on the individual. All dental problems can be treated conventionally, implants however offer a number of distinct advantages which are best explained by looking at different restorative problems :

• Missing Single Tooth
• Replacing all the teeth in an arch

Note: The options described are in principle only, different situations may require different approaches e.g. a reduction in the amount of bone available, a compromised opposing dentition, a night time tooth grinding habit.

Missing Single Tooth

Options:

1. Partial denture
   A removable prosthesis that can be made of all plastic or metal reinforced. It does not involve damaging the teeth either side of the space and hence is very conservative. This is the cheapest option but needs to be removed at least 3 times per day for cleaning, and replaced approximately every 3-5 years.
   
   
   
   
   
2. Adhesive bridge
   A fixed prosthesis that is glued to the tooth, or teeth, either side of the gap. Only minimal preparation of the teeth is required. It is only suitable when the teeth either side have no existing restorations. These bridges can be very aesthetic, but as the glue used is brittle it can come unstuck over its lifetime. (If this is a front tooth it could present as an aesthetic emergency.) After 2 or 3 debonds these bridges may need to be remade and the preparations on the teeth extended.
   
   
   

   Before Treatment

   View from behind completed bridge

   Finished case

   
   
   
3. Fixed (conventional) bridge
   This is the technique most associated with fixed replacement of teeth. The teeth either side of the gap are shaped to support a restoration, which is designed & shaped to look like the missing tooth and supporting teeth (conventionally constructed out of porcelain and gold).
   
   This type of restoration is generally the least conservative, as it involves removing a considerable amount of tooth structure to create enough space.
   
   A fixed bridge will function like real teeth and provide a very aesthetic result that should last up to 15 years A restoration like this is often the ideal option when the supporting teeth would benefit from full coverage restoration in their own right. Unfortunately approximately 10-15% of teeth cut down as bridge supports will require root canal treatment.
   
   
   

   Missing left lateral incisor and badly damaged abutment teeth prior to conventional fixed bridgework.

   Completed fixed bridgework.

   
   
4. Implant supported crown
   The missing tooth root is replaced with a titanium implant and after a period of healing a replacement tooth is fabricated that is screwed or cemented on to the top of the implant.
   
   This is perhaps the most ideal restoration when the teeth either side are unrestored. It is the smallest restoration, provides function as good as a real tooth and has the longest survival rate of all the options. The techniques exist to control the shape of the gum tissue where the crown joins the implant such that the appearance is almost undetectable from a real tooth.
   
   

   Restoration with a single implant supported crown
   Before	After

   
   

   Replacement of lost fractured tooth with an implant supported crown
   Before	After	After

   
   
   
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Replacing all the teeth in an arch

1. Complete denture
   The simplest and easiest option to replace all the teeth missing in an arch is a complete all acrylic/plastic denture. The denture relies on suction and muscle control to hold it in position. The appearance can be excellent, it is the function which is rarely ideal. All the biting forces are supported by the gums, which can lead to ulcers from rubbing and a compromise in eating habits because of denture movement. Long-term denture wear results in loss of the supporting bone necessitating relines or fabrication of a new denture. The maximum biting force possible with complete dentures is about 1/10 that possible with natural teeth.
   
   

   Complete upper and lower dentures

   
   
   
2. An implant supported complete denture (overdenture)
   The minimum number of implants (2 in the lower jaw, 4 in the upper) can be used to hold a complete denture firmly in place. The dentures are still primarily supported on the gums but the implants prevent any excessive movement such that social embarrassments are reduced and eating becomes much easier. The easiest way to use implants like this is to incorporate ball and socket joints, the ball on the head of the implant and the socket within the denture. Relines are needed much less as the implants help to maintain the bone around them.
   
   

   Two implants with ball attachments ready to receive complete lower denture

   Complete dentures in place

   
   
   
3. A removable bridge
   If the number of implants is increased (a minimum of 4 in the lower, 6 in the upper) then all the biting forces can be placed on the implants and the size of the restoration correspondingly reduced. There is no need to cover the palate and the plastic is limited to replacing the missing teeth and gum tissue only. This restoration provides an excellent aesthetic result with superb function, it is however still necessary to remove it for cleaning.
   
   There is generally no further bone loss and the integrity of the facial structures is maintained.
   
   
   

   Before treatment	Implants in place
   Removable bridge in place (palate uncovered)	Finished case (see case histories for further detail)

   
   
   
4. Fixed full arch bridgework
   Again when sufficient implants are employed, a restoration can be fabricated which is either screwed or cemented on to the implants. These bridges are generally made of porcelain, or acrylic and gold, on a gold substructure and are as close to replacing your natural teeth as possible. Your maximum biting force is almost the same as having natural teeth and all foodstuffs can be eaten without compromise. Obviously all cleaning has to be carried out with the bridge in place, it is however removable for maintenance in the surgery if required.
   
   
   

   Upper and lower arches prior to treatment
   Upper and lower porcelain and gold full arch bridges in place	Completed case

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