Implant dentistry has become the standard of care in the 21st Century. So, when should you remove a tooth and replace it with an implant? This is certainly one of the biggest dilemmas a patient and their dentist can face.
As a periodontist who is trained to save teeth, I still believe there is nothing better than your own natural tooth. It is connected to and retained in the jaw bone by a ligament called the periodontal ligament. As long as the health of this ligament is maintained with good oral hygiene and regular professional care, it allows the tooth to withstand the forces of chewing and biting.
An implant does not have this ligament. It is bonded directly to the bone by the bone cells through a process named osseointegration. Both the periodontal ligament and the bond between the bone and implant can be damaged by oral bacteria (plaque), so both implants and teeth require frequent, meticulous cleaning.
One advantage that implants have over teeth is that implants will not decay. If you are prone to decay, an implant can be a good choice. Also, in adults who often have recession (where part of the root of the tooth is exposed), cavities develop more quickly in the root than in the natural, enamel covered crown. These root cavities are often more difficult for the dentist to reach, clean out and successfully place a filling.
When the enamel of the natural tooth is damaged by decay or fracture, it can require a filling or, if the damage is too extensive, a crown (cap). If the natural enamel of the tooth becomes unattractive, it can often be corrected by bonding or veneers or whitening. Implants always require a crown(cap), fillings or cosmetic veneers or whitening are not possible.
With a natural tooth, if sufficient tooth structure remains, a crown(cap) can be placed without a post. That saves additional expense, and the tooth is actually stronger without the post. An implant always requires an abutment which is the implant equivalent of the post (note: patients often refer to an implant as a “post,” but dentists use the term post to describe the part that connects the crown or cap to the underlying root of the natural tooth).
More thoughts about this next time.