Dr. Mark J. Weingarden

By Jane Brody, Published November 16, 2009 

If I have one serious regret about my age, it is that my permanent teeth developed before New York, my hometown, got fluoridated water.  I first lost a permanent molar to decay in my early 20’s, and the resulting bridge has had to be replaced several times in subsequent decades, ultimately as a four-part apparatus. 

Now that has to go as well.  Because I could not floss and clean properly under the bridge and between the supporting crowns, I developed a severe periodontal infection. 

Dr. Michael Zidele, the young periodontist I consulted, took one look at my mouth and said: “This is not how we do restorations nowadays. A bridge is not a permanent solution and makes it too hard for most people to keep their gums and underlying bone healthy.  Now we do implants and individual crowns where needed.” 

More out of curiosity than distrust – and before I invested thousands of dollars and countless hours on new teeth – I did my own homework and got a second opinion.  Dr. Zidile, I learned, is correct.  In an overwhelming majority of cases, implants to replace lost teeth are by far the best long-term solution for maintaining a healthy mouth.  Also, because they rarely need to be replaced, in the long run they are more economical than bridges. 

Implants for replacing lost teeth have come a long way in the 25 years since I last wrote about them in this column.  Better materials, procedures and professional experience result in far fewer problems than occurred in the early years of implants.

Critical to their success, however, is proper selection of both patients and practitioners – and, after the implants, a commitment to good oral hygiene.  Dental implants must be treated like natural teeth: kept clean and free of plaque through proper brushing, flossing and periodic professional cleanings. 

“Bridges are not the standard of care anymore,” Dr. Lawrence J. Kessler, a periodontist and associate professor of surgery at the University of Miami School of Medicine, told me in an interview. “For most people who lose teeth, implants are the treatment of choice”.

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