Teeth Severely Decayed: Will Implants Help?

Hi Christine,

There is no short answer for your question.

If your front teeth are severely decayed, many people will want you to "give up", have them extracted and put in implants. My philosophy is that the best implants are your natural teeth.

So, in general, don't give up on your teeth, although don't necessarily go too far in saving what will not last. I should note though, that as our experience of implants has evolved though, we now will resort to the implant option earlier depending on a variety of factors. Here they are, please consider these carefully:

1. First, what is the condition of your gums and the bone around the teeth? Crowns and fillings require sufficient bone 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 the back teeth, the front will not survive long term without support from the back teeth.

5. Your bite is also important. Restored teeth are inherently weaker and you may need a night guard if there is grinding or clenching (both implants and crowns).

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.

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

8. Avoid conventional bridges and extractions if at all possible. The bone that is used to support extracted teeth will resorb and will be unsightly or catch food over time. Implant replacement is definitely the choice in this case.

All of the above mitigating factors must be considered and the individual alternatives, risks and relative benefits must be discussed and evaluated.

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