Gone is the era where extraction and leaving the space alone was the number 1 choice, or dentures were the first thing that came to mind. Patients these days are often asking for a more permanent and comfortable replacement option and many have found that dental implants are able to provide what is desired.
In 2012, Academy of Medicine, Singapore (AMS) and Ministry Of Health (MOH) published a Clinical Practice Guideline on Dental Implants which explained why dental implants are the preferred choice within the limits of the right conditions. Quoting from the Guideline, “The workgroup researched the success/survival rates of alternative treatment modality such as teeth-supported fixed dental prostheses and found that they were comparable to that of endosseous implant-supported dental prostheses. As such, the advantage of not requiring the preparation of sound adjacent teeth renders implant-supported prostheses the teeth replacement option of choice.” Now that we understand why dental implants are, for many reasons, often better than dental bridges and dentures, let’s examine what other factors might hold one back from replacing a tooth with an implant.
From a lay person’s perspective, it is not uncommon to feel phobic about the idea of placing a metal object into the human body, causing some to reject the idea of getting a dental implant right from the start. The term surgery elicits a knee-jerk reaction in some, too. To demystify the experience of dental implant placement, one need to understand the difference between dental implant placement in a fully healed and well-sized ridge (stage II as shown in diagram) versus a collapsed, or lack of bone height or width area (stage III & IV).
Placing an implant in a fully healed and well-sized ridge (II) is very much like the reversal of extracting a tooth as both are anchored in good sound bone. The only difference is in the placement vs removal. Thus, most of my patients have found that implant placement in these situations are surprisingly comfortable, the discomfort being mostly limited to the day of the surgery itself (just like the extraction experience). I can attest to this as I have cracked 2 teeth over the years due to bruxism (night-time grinding) and have had 2 implants placed, under different conditions, i.e. with and without bone grafting. Thus, it is not hard to imagine that I have literally been through “heaven” (II) and the contrary (III).
My advice to anyone with a compromised tooth needing extraction would be to check with your dentist on the bone quality and suitability of an implant as a replacement sooner rather than later (to avoid waiting till the bone has receded away). In this way, we no longer have to experience the downside of leaving an empty gap such as poor smile aesthetics, decreased biting ability, and unwanted tooth movement, which can lead to increased food traps and higher risk of decay. Nor are we left with the often uncomfortable denture option.