A patient recently asked the following question–”My front teeth are severely decayed and I’ve had so many dental problems in my lifetime–Should I save my teeth?”

If your front teeth are severely decayed, many people will want to “give up” and have them extracted and have implants.  My philosophy is that the best implant is still your natural teeth.  As our experience of implants has evolved though, we now will resort to the implant option  earlier depending on a variety of factors:

1)   First, what is the condition of your gums and the bone around the teeth?  Crowns and fillings require sufficient bone for stability and to hold the restoration.  Implants also need bone support.

2)  You need to be realistic about your commitment to home care and diet—there are reasons for the extent of your dental decay.  Will you floss, brush, use home fluoride, quit smoking, and restrict sugar in the future?

3)    Even though dental implants will not decay, you will still need commitment to home care as implants need to be immaculately cleaned daily to preserve the health around them.

4)  What is the condition of your posterior teeth?  If you do not have sufficient support from back teeth, the front simply will not survive long term without support from the back teeth.

5)    You bite is also important.  Restored teeth are inherently weaker and you may need a nightguard if there is grinding or clenching (both implants and crowns).  Your bite will collapse and spaces will open up between your front teeth if there are not enough support from the back teeth!

6)    How much of the teeth actually show when you smile is critical (what we call your smile-line).  If there was associated periodontal disease and bone loss, the teeth may be longer, and spaces may have opened up between the teeth along the gum line (we call that embrasures).  If you show your gums when smiling these embrasures may be unsightly, or even catch food.  Embrasures may be controlled with either conventional crowns or implants, but technical and biologic factors may limit our success.

8)    What is your budget and desire for long term success?  Dental implants are going to more expensive than crowns and conventional bridges short term.  Due to great their greater longevity though, dental implant therapy can actually be less expensive long term.

9)    Avoid conventional dental bridges and extractions if at all possible.  The bone that used to support to extract teeth will resorb over time and be unsightly or catch food over time.  Implants replacement is definitely the choice in this case as you will lose 40-60% of the bone that used to surround the tooth roots within one year!

10)  If you have avoided dental care for financial reasons, dental financing is available that can make dental care affordable.

11)  If you have dental care for reasons of embarrassment or pain, dental sedation or advanced anesthetics are now available to make your care comfortable!

There is no short answer for you question.  In general, don’t give up on your teeth—although necessarily go too far in saving what will not last.  All these mitigating factors must be considered and the individual alternatives, risks, and relative benefits must be discussed and evaluated

• Posterior Bite Collapse–Spaces Open Up in Smile from Insufficent Support from Back Teeth
• Dental Implants Vs. Dental Bridges–Pro & Cons of Dental Implants
• Health Hazards of Tooth Loss and Long-Term Denture Use
• All on Four, Teeth in a Day, & Teeth in a Hour–Uses and Abusess
• Dental Implants & Dental Bridges-Cosmetic Comfortable Choices