During a recent session at the EAO Digital Days, experts gathered to debate a critical topic in dental restoration: the best approach for replacing a single tooth in the maxillary anterior region. The focus was on whether to opt for a dental implant or a bonded bridge, with discussions led by Irina Saylor, Professor of Fixed Prosthodontics at the University of Geneva and EAO board member.
The Clinical Challenge The patient case discussed involved a woman concerned about the aesthetics of her upper right central incisor, which required replacement due to significant soft and hard tissue loss. Adjacent to this tooth was a lateral incisor with an aesthetically displeasing crown, adding complexity to the restoration challenge.
Treatment Options Debated Two esteemed experts, Alexis Ioannidis from Switzerland and Shaquille Shahdad from the United Kingdom, presented their preferred treatment strategies. Ioannidis advocated for minimally invasive approaches, favoring bonded bridges, while Shahdad argued for the long-term benefits and aesthetic potential of dental implants.
Dental Implants Shaquille Shahdad emphasized that proper treatment planning and risk assessment are crucial for successful implant outcomes. He highlighted the importance of prosthetically driven implant placement combined with simultaneous augmentation to achieve optimal aesthetic results. Through various case examples, Shahdad demonstrated how implants could address even high-risk aesthetic cases effectively, citing a less than 2% requirement for aesthetic replacements over five years.
Bonded Bridges Alexis Ioannidis countered by presenting the resin bonded bridge as a less invasive and equally effective alternative for single tooth replacement in the anterior region. He showcased a case where a resin bonded bridge was used following the extraction of a fractured tooth, achieving excellent aesthetic results with minimal treatment sessions. Ioannidis stressed the advantages of resin bonded bridges, including lower cost, shorter treatment duration, and reduced patient morbidity compared to implants.
Interactive Audience Participation The session included real-time voting, where attendees could express their preference for either implants or bonded bridges based on the information presented. Initially, the majority favored implants, reflecting common practice at dental implant conferences. However, as the debate unfolded and more details about the advantages of bonded bridges were discussed, the audience's opinions began to shift slightly, showing increased support for the bonded bridge option.
Expert Recommendations Both experts agreed that patient-specific factors, such as aesthetic demands, tissue health, and the presence of adjacent restorations, should guide the choice of treatment. While implants offer a long-term solution with proven success, bonded bridges provide a viable, cost-effective, and less invasive alternative that can yield equally satisfactory aesthetic outcomes.
Conclusion The debate highlighted that both implants and bonded bridges are valid options for the replacement of a single tooth in the maxillary anterior region, with the choice largely depending on specific case characteristics and patient preferences. The detailed presentations and discussions provided attendees with a comprehensive understanding of the potential benefits and drawbacks of each approach, enabling them to make more informed decisions in their clinical practice.