The Implant Dentistry Blog

I have two congenitally missing lateral incisors. I am 25 years old, and nothing is wrong with my teeth besides this. What is the least invasive way to fix this?

One additional problem is that there isn’t enough space to fit replacement teeth in those spaces.

- Sun from Australia

Sun,
The “least invasive” way isn’t going to be the easiest, the least expensive, or the fastest way. But I can see where, if there is nothing wrong with your other teeth, that you would want to not alter those teeth if at all possible.

The first step would be to separate your other teeth to allow more space for the lateral incisors. This would require orthodontics. Be careful with this – you may end up with a general dentist who wants to move these teeth with Invisalign invisible braces. This is tempting, because it doesn’t require any metal brackets and it’s faster. But Invisalign doesn’t work well for a situation like this, because it would tend to tip the teeth. You need to have the roots well separated in order to fit an appropriate dental implant into each space.

Then, have dental implants placed in those spaces, allow those to heal, and then have crowns placed on those teeth.

The other good alternative, which is quite invasive, would be to do zirconium bridges replacing these front teeth. We have a case like this displayed on our website, where there were impacted canine teeth (see Jennifer’s zirconium bridge story). The adjacent teeth would be crowned, and they could be shaped so that the sizes of the teeth would be harmonious without requiring any orthodontics.

For more information, you may want to read our pages about the advantages of a dental implant vs a dental bridge.

I hope this is helpful.

I am 60 years old and have never needed much dental work, but a couple of years ago I had two teeth removed on my right side. This has left one tooth standing by itself with a space on either side. Should I get a bridge, (because the gum is starting to recede around this lone tooth). I’ve read that implants will cause bone erosion.
- Yvette from Indiana

Yvette,
Implants actually prevent bone erosion, or I would call it bone resorption. Yes, the gum will recede after a tooth has been missing for a couple of years, and your body will take the minerals from that bone and use them elsewhere in your body. But if a dental implant is used to replace that tooth, your body senses the presence of the implant and will not dissolve that bone away.

Having said that, that doesn’t necessarily mean that an implant is the best option for you for a tooth replacement. That depends on other factors, how much bone is left, where nerves or sinuses are, and other issues. That would have to come from a good examination by a dentist who has expertise in implant dentistry. If you don’t get implants to replace the teeth, then a bridge would probably work fine.

Links:
Read about the pros and cons of a bridge vs. a dental implant.
Read about facial collapse that occurs when you have lost all your teeth, unless they are replaced with implants.

Tooth #29 had a root canal and crown; now it is loose and I was told it has broken below the crown and needs to be extracted. The teeth on either side of it are also crowned. I think my choice is to have a t! ooth implant after this tooth is extracted and healed after a bone graft done. Will that be okay even though the teeth on either side are crowns? Thank you for your time.
- Becky from Oregon

Becky,
A dental implant is certainly an excellent option whenever you have a missing tooth.

The main advantage to having a tooth replaced with an implant instead of a dental bridge is that you don’t have to grind down perfectly good adjacent teeth in order to replace the missing tooth. If those teeth need crowns anyway, then it tends to make sense to add the replacement tooth between them. It’s simpler. But if those teeth already have crowns and those crowns are working well, then having the implant avoids having to replace those crowns.

Related link:
Click here for more information about the pros and cons of dental implants.

I am losing tooth #24. Two periodontists suggest removal of 4 lower teeth to allow 2 implants and two false teeth. 1 periodontist suggests 1 implant. 3 dentists suggest a bridge with, another 2 dentists suggesting a Maryland bridge. I am totally confused. Please help. I can provide radiographs of my mouth indicating issues with teeth.
- Linda from New York

Dear Linda,
I’m not going to be able to tell, from a distance, even with radiographs, what would be the best for you. But maybe I can help you sort all this information out.

There are often a number of acceptable ways to treat a dental problem, as you are finding out. To go to half a dozen different dentists wanting a consensus, especially with a missing teeth issue like this, is a recipe for confusion. It sounds like you have discovered that on your own. I would suggest choosing one of these dentists that you most feel you can trust and then relying on their input. There is no way you’re going to be able to sort everything out yourself without going to dental school yourself. You’re just going to have to trust one of these dentists, so pick which one you want to trust.

In our office, we present our patients all of the various options, with the advantages and disadvantages of each so that you can make an informed choice.

One way I can help here is to help you weigh what these different dentists are saying. Does the fact that you are seeing periodontists mean that you have significant gum disease? If so, I would give more weight to what the periodontists are saying. A disadvantage of a dental bridge is that you put extra stress on the teeth that are supporting the bridge, which can complicate gum disease. But as to whether you need one implant or two, I can’t tell from this distance, and it could well be that either way would work and you will have to weigh the pros and cons yourself with a dentist you trust.

Related links:
Read about a comparison of dental implants vs. bridges

P.S. Can you include what I can do and the price? My mom doesn’t have any kind of insurance.

Kelsey in Florida

Kelsey,
There are three basic choices for how to replace your missing front tooth.

You can have a removable appliance, such as you have. A flipper is the least expensive removable appliance. It is rather flimsy and is usually used as just a temporary replacement. There are other more sturdy removable partial dentures that you could have, but they are all somewhat annoying and uncomfortable.

Another option is a fixed dental bridge. To give you a bridge, your dentist would need to grind down the two teeth next to the missing tooth and place crowns on them, and then a false tooth would be suspended between the crowns. But with you being still in your teens, there are extra risks that those otherwise healthy teeth could become infected if they are ground down the way they would have to be in order to get a dental bridge.

And the third option is a dental implant. This consists of a root form that is implanted in the jaw in the place of the missing tooth and then a porcelain crown is placed over that.

For you, a dental implant would have several distinct advantages, especially since you are fairly young. You wouldn’t need to have healthy teeth ground down. Plus, when a tooth is missing, the bone that used to support that tooth gets dissolved away by the body, creating an unsightly bony defect. A dental implant prevents that bone collapse from happening.

The cost of having a single tooth replaced could vary from $2500 to $5000. That would be the combined cost of the root form implant plus the crown that goes on top of it.

Related links:
Read more about the choices of a dental implant vs bridge
Read our page about the cost of dental implants
See our main web site for lots of additional information about dental implants

Hello Doctor,
When doing an implant, second tooth, right up front, is there any chance to damage two adjacent teeth to the implant, the first and the eye tooth as people call it.

If yes, please tell me why and if not please tell me why.

Thank you,
Naomi in New York

Naomi,
Anytime a dentist puts powered instruments in your mouth there is always at least a possibility that teeth could be damaged. But there is nothing in the placing of a single implant that I would really call risky as far as possibly damaging the teeth next to the space where the tooth is missing. There is just no reason the dentist needs to touch those teeth.

In fact, this is one of the chief advantages of a dental implant when a single tooth is missing. For a bridge to be placed, the adjacent teeth have to be ground down for crowns. For a dental implant, you don’t have to touch those teeth. So if those teeth are healthy and without any significant dental work, I would strongly recommend a dental implant over a bridge.

Related links:
Click here to ask an implant dentistry question.
Click here for more information about dental implants.
Read more about the issue of a dental implant vs bridge.
Read about dental implant failure – the causes and how to avoid it.
Beware of cheap dental implants.

I am inquiring with Dr. Chal as I am looking specifically for a seasoned cosmetic dentist.

Please help me to know the cost comparison of the two procedures and any other pros and cons you could share.

Thank you in advance for your time.
Bob

Bob,
The dental implant would likely be about 2/3 of the cost of the three-unit bridge to replace one tooth. But there are a number of variables here, and please don’t hold us to that. An examination could disclose any number of factors that would change that figure.

We do have a page on the site that gives some dollar figures for dental implant cost. You may want to check that out.

As far as the bridge option, Dr. Chal has been using the new zirconium ceramic for crown and bridge work. It is extremely strong, can be worked to precise tolerances, and would be more than adequate for a three-unit bridge such as yours. With no metal, there is no dark line at the gumline and no opaque materials to wrestle with.

Related links:
Teeth in an hour cost
Tooth replacement options discussed by Dr. Chal
Read more about dental implants