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Save a Tooth or Get an Implant?

Things to consider when making this important dental decision

By Dr. Scott D. Ganz & Dr. Martin Trope

This article is endorsed by the
International Congress of Oral Implantology.
This article is endorsed by the
American Association of Endodontics.


Dental Implants — Other Considerations

Dental implants are widely considered to be among dentistry’s greatest modern advances and the most successful tooth replacement systems. Dental implants have become an increasingly popular option because they:

  • Are highly predictable
  • Often last for many decades
  • Result in aesthetic and functional tooth replacements
  • Can replace single or multiple teeth, or even all of the teeth in the upper or lower jaws
  • Can allow for either fixed or removable replacement teeth for those who are missing single or multiple teeth.
  • Are the only tooth replacement option that maintains the jawbone and hence facial contours
  • Do not require adjacent teeth to be used for support
  • Are not subject to tooth decay

Yet implants, as remarkable as they are, aren’t right for every situation, as there needs to be sufficient bone for implants to be placed. This may mean additional bone grafting procedures to help enhance the chances of success. The cost of dental implants may sometimes be significantly higher than other treatments — although, if performed successfully, their greater longevity will likely make them more economical in the long term.

Researchers have recently pointed out that the criteria for judging the success of implants vs. the success of endodontic treatment aren’t based on the same metrics — making it difficult to compare the two systems directly. When modern advances in saving teeth are taken into account, the real “success” rate of both procedures could turn out to be roughly comparable.

The Success Of Dental Implants

A dental implant replaces the root part of the tooth. Made of titanium, it is inserted into the jawbone during a surgical procedure. The new “root” will then integrate with the surrounding bone and provide support for a new crown (to replace one missing tooth) or set of prosthetic (false) teeth. Success of dental implants rests primarily on the special surface characteristics of titanium that allow bone to integrate with it, and with technological improvements over the years that have reduced healing time.

Dental implants step by step.

When weighing treatment decisions, the involvement of multiple teeth afflicted by periodontal disease is another factor to consider. Replacing teeth with dental implants may sometimes be falsely considered a “cure” for gum disease or periodontitis, since the condition can’t exist without teeth. But peri-implantitis, an inflammatory/infective process, can destroy the integration of a dental implant to the bone, leading to potential complications — including loss of the implant. However, with routine follow-up dental care including x-ray examination and hygiene maintenance, these complications can be treated, minimized, or avoided completely.

The Truth, The Whole Truth…

In some circumstances, there may be a clear reason to replace compromised teeth with dental implants rather than attempt to restore them via RCT, periodontal therapies, or other procedures. For example, a series of failed treatments in the past, a doubtful prognosis, or the likelihood that multiple procedures will be necessary could argue in favor of implants. If that’s not the decisive factor, then perhaps there is another crucial question to answer: Just how important is it to you to keep your natural teeth? All other things being equal, the whole truth may come down to quality of life, and value.

It’s true that dental implants can look (and function) more like natural teeth than any other tooth replacement system. But the subjective value you place on keeping your “own” teeth is something that can’t be measured by any instrument. In the final analysis it will be helpful to sit down with your dentist; he or she can explain your options, listen to your concerns, and help you make the best decision.