Fixed prosthetics refers the treatment of people who are missing all of their teeth (totally edentulous) or are missing some of their teeth (partially edentulous) with a prosthesis that stays in the mouth.
If a patient is missing a tooth (or more than one tooth), it can be replaced in some cases with a bridge or in some cases with an implant (or implants). Bridges are fixed prostheses that span between natural teeth. This requires the dentist to crown the teeth adjacent to the edentulous area. Implants restore edentulous areas without having to use the adjacent natural teeth.
Whether to use implants or bridges depend upon many factors. Here are some of our considerations:
- What is the cost to the patient? In the short run, implants can be more expensive than bridges. In the long run though implants may be more cost effective. Implants are the only restorations dentist place that we can guarantee will never redecay.
- Are there teeth on either side of the missing teeth? If no, then I would never recommend a bridge. Likewise, I would never recommend a bridge if the bridge span was too long or if the bridge was required to curve around the dental arch. In these cases, the only way to get a fixed prosthesis would be using implants (or you go to a removable solution).
- What is the condition of the teeth adjacent to the edentulous area? If these teeth are healthy without any restorations, it would be a shame to have to cut them down in height and circumference to place a bridge. Conversely, if the teeth adjacent to the edentulous area must be treated with crowns anyway, practicality might lead the dentist and patient to use a fixed bridge.
- How quickly does the patient want the treatment completed? Implants need to be stable in the bone before placing restorations. Some large cases can be restored with implants immediately using cross-arch stabilization but in general, we like a healing period after implant placement for osseointegration (when the implant becomes rigid with the bone). Also, sometimes bone grafting is required in order to have enough bone to accept an implant.
These are just some of the considerations. Every patient is different. It is important to take time and consider carefully.