Dental implants and tooth replacement

Why replacing teeth is about more than closing a gap

Every tooth supports its neighbours and keeps the row of teeth stable. If a gap stays open for a long time, this balance starts to shift. The neighbouring teeth can tip or drift into the gap. And the tooth opposite is left without a partner and can grow out of the row of teeth. Little by little, this shifts your bite (occlusion). The jawbone in the area of the gap also shrinks. That makes the later restoration more involved. A gap is not an emergency. As a rule, though, it makes sense to close it within the first year. We will discuss the right time with you.

No replacement is as good as your own tooth. That is why we always first try to save a tooth that is still there. If a tooth does have to be replaced, an implant comes closest to your own tooth. It is an artificial tooth root made of titanium or of metal-free ceramic (zirconia) that fuses firmly with the jawbone. Almost all fixed solutions build on this foundation: the single crown, the implant-supported bridge and the replacement of whole rows of teeth. The prospects are good: around 95 out of 100 implants are still firmly in place after ten years. Good care and regular check-ups improve these prospects.

One tooth is missing

If a single tooth is missing, an implant with a crown is usually the best choice today. The big advantage: the healthy neighbouring teeth are preserved completely. A conventional bridge, by contrast, uses the neighbouring teeth as abutments, which means we have to crown them as well.

In some cases a bridge is still a sensible solution. For instance when the neighbouring teeth need crowns anyway, or when there are medical reasons against an implant. These can include poorly controlled diabetes, certain medicines that affect the bone and radiotherapy in the jaw area. We always assess this case by case.

Several teeth are missing

If several teeth are missing side by side, we often replace them with individual implants. Each implant then stands on its own and can be cleaned like a natural tooth. Depending on the bone available and the position of the gap, an implant bridge can be the better choice: two implants act as abutments and carry three crowns. In narrow gaps, a single implant can also carry two joined crowns. If the teeth at the end of the row are missing, there is no rear abutment that could carry a conventional bridge. Here, as a rule, implants are the only way to a fixed restoration.

All or almost all teeth are missing

A jaw without teeth no longer automatically means a denture that simply rests on the gums. As few as four to six implants can carry a fixed restoration for the whole jaw, known as All-on-6 or All-on-4. It is screwed firmly in place and stays in the mouth permanently.

If you prefer a removable solution, a telescopic denture gives you a firm hold without visible clasps. It sits on precisely fitting double crowns and can simply be taken out for cleaning. It can be anchored on your own teeth as well as on implants.

A third option is a denture that is attached to implants. In the lower jaw, two implants already give it a secure hold, and in the upper jaw it is usually four.

Good to know

Titanium implants are the international standard: proven over decades. Alongside them we offer ceramic implants made of zirconia. These are a good option if a metal-free restoration matters to you. In studies they show convincing results over a period of five years. Their scientific track record is, however, shorter than that of titanium implants.

An implant cannot decay. Even so, it is not maintenance-free. If plaque is left behind, the gum and the bone around the implant can become inflamed. This inflammation is called peri-implantitis and affects around one in five implant patients. Detected early, it can usually be treated well. Preventing it is simple: daily cleaning that includes the spaces between the teeth, and regular professional dental cleaning. Patients who keep their check-up appointments lose their implants considerably less often.

In all honesty: no restoration lasts forever and none comes with a guarantee of success. Smoking roughly doubles the risk that an implant will not fuse with the bone. Poorly controlled diabetes or untreated periodontitis increases the risk of inflammation later on. That is why we make sure the mouth is healthy before every implant placement.

Do you live outside Barcelona? Enquiries reach us from all over the world, particularly for extensive restorations. With a recent panoramic X-ray (OPG) we can give you an informed initial assessment and information on costs in a video call. The final planning and the treatment then take place here at the practice.