There is a famous quote that says, "Everyone is entitled to have their own opinions, but not their own facts". Modern age dentistry is a practice of evidence based treatments, that are based upon facts, provided by years of research that in turn provides t reatment to the patient with higher predictability. Now whenever the discussion of evidence based dentistry or predictability comes to light, all patients and dentists have some reluctance in deciding some controversial areas of certain treatments in order to obtain the best possible outcome. One such scenario is the case of missing teeth and to treat them with either FPD or Implants. This blog aims to provide sufficient and evidence so that you, as a patient, can decide which treatment option to choose. information Earlier, there were a few alternatives for the replacement of missing tooth, the best of which was a cemented three unit fixed partial denture (FPD). However, the proven success of dental implants during the last few years has made the decision regarding how to replace one missing tooth confusing for both dentists and patients. Sometimes the best treatment is an FPD; sometimes it is an implant supported crown. There are numerous factors to consider when deciding whether to place a dental implant that will replace the missing tooth, or whether to prepare the teeth adjacent to the missing tooth and place an FPD. Lets compare both these procedures. Comparison for Implants vs FPD: 1. The implants are the closest way to replace your missing teeth so that they resemble your natural teeth. In implants, a screw made out of titanium is placed in the site of the missing tooth within the bone. The screw acts as the root portion of your previous natural tooth. Then on top of the implant the crown is placed which replaces the crown portion of the missing tooth. 2. Because your tooth is missing the bone in that area degenerates and is lost along with the gums. This cause various problems like food lodgement, drifting of adjacent teeth, increased occlusal force on the adjacent tooth. Placing an implant in that region stimulates the bone naturally and prevents bone degeneration and also prevent loss of gums. 3. Implants can bear more load on chewing than FPD's, hence they provide better chewing efficiency. 4. Th e survival and success of implants is much longer than FPD's. This means that once placed they function for more longer period of time. 5. Aesthetically implants are slightly better than FPD's because they maintain the bone and gum health. 6. Implants are less invasive than FPD's because for FPD we have to cut the adjacent natural healthy teeth and during that process the enamel is lost which does not regenerate back. Also due to this in long run many patients present with sensitivity. For implants no such s cutting is done so the adjacent teeth are maintained. Only some minor drilling is done in the bone which regenerates as the implant heals, so no tissue is lost here. 7. The FPD that replaces the missing tooth is done by support of the adjacent teeth so th e site where the crown(cap) comes to replace the missing teeth is only on the support of the adjacent teeth from the sides but without support from below. So as said earlier the gums and bone degenerate and then a gap forms between the crown and the tissue s and food gets stuck here which irritates the gums further and the cycle continues. The patient also experiences discomfort. 8. Open margins are also a big problem with the FPD. However, if the FPD is done properly then this problem does not arise. Also t he food lodgement stated earlier can be managed by the patient with excellent oral hygiene maintenance , but it demands a lot of discipline from the patients.
9. Most of these above mentioned problems with FPD arises usually after 5 to 10 years of function so FPD's are also not a bad option, but they are not the ideal option in today era for replacing missing tooth. 10. In some cases where the patient reports too late after removal of the tooth, the bone and gums are already lost so first we need to regenera te these tissues and then place the implants. This delays the process of replacement while in FPD the replacement is done faster in such cases. 11. The various surgeries done for implant are not painful and do not cause much discomfort if the patient follo ws all instructions. However it depends on the type of case. 12. In FPD, no surgery is usually advised so patients phobic to surgery need not cost of the procedure needs to be taken into account. Implants are usually costlier than FPD, but are long lasting. worry. The Implants more FPDFixed Partial Denture
Lets look into the overall factors to consider before deciding either of the treatment option: 1. All the above discussed points should be considered. The health of the bone and gums, number of missing teeth, time period of missing teeth, time frame required to replace the teeth, oral hygiene maintenance , number of procedures required and appointments needed to replace the teeth all need to be considered with an open mind. 2. Cost needs to be co is because sometimes nsidered, however the health should be given the first priority over cost. This initially certain treatments the cost may be high but they are better for long term solutions, while some treatments cost may be less but they do not provi de long term solutions and affect our health and then again expenditure is required for retreatment which further only increases the cost. 3. Other factors like smoking, poor oral hygiene history, physical activities, such as potentially traumatic athletic activity, mobile and periodontally treated teeth, bruxism, clenching, and any other medical history present needs to be considered Thus, in the end I will only say that consider all these factors before deciding the treatment option. Both are good treatm ent options, however selection is done based on the case. However, the research indicates that Implants are better option for replacing missing teeth than FPD.
