For many years Fixed Partial Dentures (FPDs or Fixed Bridges) were the high-end standard of care to replace a missing tooth. With the advent of dental implants, that perception has shifted. Why? Because an FPD essentially takes a 1 tooth problem (a missing tooth) and makes it into a 3 tooth problem.
To do an FPD, the teeth on either side of your missing tooth must be ground down to create space for a crown. Sometimes another type of connector to the adjacent teeth is used, but a crown is the most common. The teeth on either side of the missing tooth are called abutment teeth. 80% of abutment teeth have only small or no fillings or other dental restorations before they become the abutment teeth for your FPD—this means we are often taking away healthy tooth structure in order to replace your missing tooth. (You can learn more about FPDs here: Crowns & Bridgework)
The way an FPD is made, the crowns and replacement tooth are all connected together. (If you’ve never seen an FPD, ask your dentist to show you an example of one.) You can brush these FPDs or Fixed Bridges as you normally do, but because they are connected, you cannot floss them like you floss your natural teeth. Flossing them is possible, and your dentist or dental hygienist can show you how to do so. But we know that most people don’t take the time to floss their natural teeth—so are they really going to go through the more time-consuming process to floss their Fixed Bridge or FPD?
The two most common reasons that we need to recommend replacement of a Fixed Bridge or FPD are (1) decay on one of the abutment teeth or (2) periodontal disease (gum disease) around one of the abutment teeth.
So why does the title say “Making a 1 Tooth Problem Into a 3 Tooth Problem”? Because most FPDs will fail after 5-10 years and once the FPD fails, even if the decay or periodontal disease is only on one of the two abutment teeth, you’re looking at dealing with 3 teeth in order to fix it not just one. A problem that greatly increases the cost of fixing it.
Think it won’t happen to you? Studies show that 8-12% of abutment teeth are lost in the first 10 years and 30% are lost after 15 years! Compare that to dental implants which have a success rate of 98% and don’t require you to grind down adjacent teeth. Though dental implants cost more at the beginning, studies show they cost less over time. (By 5-7 years out the dental implants starts earning you money when you don’t have to pay out to replace your failing FPD). One graph I’ve seen shows that at approximately the 7 year mark the expense lines cross and the FPD starts being more expensive than a dental implant. You can learn more about dental implants here: Top Reasons to Choose Dental Implants and Dental Implants FAQs
Of course, the FPD or Fixed Bridge still has a place. There are times when a dental implant cannot be placed or the condition of the adjacent teeth may mean they’d require crowns anyway (though that still doesn’t negate the possibility of it becoming a 3 tooth problem down the road if the abutment teeth fail.)
If you do find that you need to make a decision about replacing a missing tooth, talk with your dentist about your options and don’t be afraid to ask questions about dental implants, FPDs, or removable options—and be sure you understand the pros and cons of each choice.
**Note: The information in this article is not meant to replace the clinical judgement of your healthcare professionals.
Jennifer G. Robb, DMD is a general dentist who sees both adults and children.