If you’ve had a tooth extraction, you may be faced with the decision of how to replace that tooth for optimal esthetics and function. Depending on your particular circumstance, you may have some options for that.
Increasingly, patients are choosing an implant to fill that gap. Traditionally the only material choice for implants was titanium. Titanium was chosen because it was believed to be a non-toxic, non-allergenic and inert material. Because of these qualities, many dentists still believe titanium implants made of commercially pure titanium or titanium alloys are the best choice.
But, implant placement has a relatively short track record of 40-years. In that time frame there has been an increasing tendency that dentists recommend and, patients choose, an implant. Because of increased numbers of implants placed, we’ve amassed a body of knowledge on the pros and cons of implanted titanium. It turns out drawbacks have been documented in both medical and dental scientific literature. According to a recent review in the Archives of CraniOroFacial Sciences,
- High concentrations of titanium have been detected in tissue surrounding dental implants mostly as a result of wear or corrosion of the titanium implant surface.
- An animal study showed that nine months after titanium implantation, titanium particles had spread and were found in adjacent lymph nodes.
- There are indications that phagocytes, a type of cell that engulfs and absorbs bacteria and other small cells and particles, could transport titanium particles to the lymph nodes without any initial or immediate inflammatory response and potentially cause later immunologic reactions.
- Implants are not as inert as believed. They have been shown to corrode once exposed to body fluids such as saliva. In addition, they appear to develop electrical activity when they are coupled with prosthetic components made of other metal alloys.
- Titanium implants as they corrode are known to release metal ions which create low level electrical currents through the body but also weakens the structural integrity of the implants.
For these reasons, the 40-year track record for titanium dental implants have been a bit of a hit and miss for people.
But that doesn’t mean you should necessarily rule implants out completely. Recent advances in implanted biomaterials research and technology has seen more success with bio-ceramics such as zirconia. According to this review,
- Zirconia is the crystal form of the material zirconium which is a transitional metal. After mining and processing of zirconium silicate, zirconium is isolated and further processed under high temperature and pressure. Zirconium then undergoes an oxidation and crystallization process which allows it to transition into a structurally stable and inert crystal. This bio-ceramic crystal is called… zirconium dioxide.
This transformation means zirconium dioxide is not a metal. It also means zirconia has exceptional physical and biological properties. It can sustain an extreme load capacity, features a very long service life, and presents no conductivity or interference in the body’s meridian systems; it is the most hygienic, non- electrical conducting and stable material available for dental implants. Zirconia implants pose no danger of corrosion. In addition, zirconia, compared to titanium, has a low affinity for plaque, a vital attribute, since poor gingival health can compromise the longevity of any implant.
All of this means when deciding whether an implant is the right option for your missing tooth, it is critical to understand what biomaterials are available. Right now, Zirconia implants look like the best material for those looking for the most biocompatible option. In addition, zirconia’s esthetics qualities exceed those of titanium implants. Its translucency and all white color eliminates the dark shadow often experienced with titanium.
While ceramic implants are an amazingly natural looking and functioning option they may not be right for everyone. Truth is, what’s best depends on your particular circumstance. How many missing teeth do you have? What opposes your missing tooth? Do you have immune system challenges? Material sensitivities? These answers to these questions help you and your dentist to decide which option might be the best for you.
In addition to implants there are other options you might consider. You could choose to do nothing after the extraction. This may be an acceptable option if your extracted tooth is not between two other teeth. But it could also mean, if there are teeth on either side of the missing tooth’s space, over time, your permanent teeth may drift into the space where your tooth used to be. Also, if there is a tooth opposing the space, it may supra-erupt and fill the space because there is nothing to stop it. These shifting teeth may eventually compromise your bite resulting in both poor function, poor esthetics and costly repair.
If you have more than one missing tooth in your arch, you may be to consider a removable partial denture. While this is designed to replace several teeth at one time, it’s not always ideal because it’s typically casted with metal. The metal rests on gum tissue, not naturally designed to be covered. If you’ve worked hard to get the metal out of your mouth for reasons of biocompatibility, you may struggle with the idea of adding metal to your mouth again.
You may also consider a fixed bridge for a single missing tooth. A fixed bridge links two teeth on either side of the missing tooth to a false tooth. The downside is, those teeth will need to be prepared for a crown that the pontic, or false tooth will be joined with. Your teeth, which naturally move when independent from each other, will have restricted movement. In addition, flossing under the pontic and along the adjoined crowns will require a bit more attention to ensure the longest lifespan of the bridge and teeth.
Finally, know this, no matter what you chose to do to replace a missing tooth, there is a bigger picture—the best choice will fit with your health goals, your finances, and the esthetics that best restore your smile.