Dental Implant or Bridge: Which Is Better for One Missing Tooth?

What is the difference between an implant and a bridge?

An implant replaces the root as well as the tooth. A titanium post goes into the jawbone where the root used to be, the bone fuses to it over a few months, and a crown is fixed on top. The teeth on either side are not touched.

A traditional bridge replaces only the part of the tooth you can see. The two teeth next to the gap are reshaped and fitted with crowns, a false tooth is joined between them, and the three pieces are cemented in place as one unit. Those two neighbors then carry the chewing load for the missing tooth.

Two lighter designs exist: the cantilever bridge, anchored on one neighbor only, and the Maryland bridge, which bonds thin wings behind the neighbors instead of crowning them. Both spare the neighbors some drilling, but both are less sturdy than a traditional bridge, so they are usually kept for smaller teeth or lighter chewing forces.

Which lasts longer, an implant or a bridge?

Over the first 10 years, the two do about the same. A review that compared them using the same methods found about 89 in 100 traditional bridges and about 89 in 100 single crowns on implants still in place after 10 years (Pjetursson and colleagues, 2007). The implant post under the crown does a little better: a 2019 review of 18 studies found about 93 to 96 in 100 still in place after 10 years, a little lower in people 65 and older (Howe and colleagues, 2019).

Repairs are common with both: implant crowns more often need fixes such as a loose screw or chipped porcelain, while bridges more often run into decay or an anchor tooth needing a root canal (Pjetursson and colleagues, 2007).

Over the longer run, both need upkeep. The implant post itself often stays in place for many years, though none can be guaranteed, while the crown on top can chip, loosen or wear and may need replacing, much as a bridge does. Cleveland Clinic puts the average life of a bridge at about 5 to 15 years, and some last longer with good care (Cleveland Clinic).

When a bridge fails, it is rarely the false tooth. More often the bridge comes loose, decay starts under an anchor crown, or an anchor tooth needs a root canal or cracks (Tan and colleagues, 2004). Because the pieces are joined, a problem with one anchor usually means replacing the whole bridge.

What does each option do to the teeth next to the gap?

This is the question I would weigh most if I were the patient. A bridge needs the two neighbors reshaped, which means removing healthy enamel that does not grow back. If those teeth are already crowned or heavily filled, you give up much less, since they would likely need crowns anyway. If they are healthy and untouched, you are committing two good teeth to a lifetime of crowns to fix one gap.

An implant leaves the neighbors alone, and when they are perfect, that alone tips most of my patients toward an implant.

What happens to the jawbone?

Bone needs a job to stay put. When a tooth and its root are gone, the bone that held it starts to shrink, most of it in the first months and more slowly after that (Tan and colleagues, 2012). A bridge rests on the gum and does not stimulate the bone underneath, so over the years the gum under the false tooth can sink and a dark gap or a visible edge can appear.

An implant puts a root back in the bone and stimulates the bone around it, which helps protect the bone that remains, though it cannot rebuild bone that is already gone. If a tooth has been missing for years and the bone has already shrunk, a graft may be needed before an implant can go in, which adds healing time. We check this with a 3D scan before recommending anything.

How long does each one take?

A bridge is the faster route: usually two visits a couple of weeks apart, with a temporary bridge in between. An implant takes months, because the bone has to grow onto the post before a crown can be loaded on it. A simple case is often three to six months, longer if a tooth must come out or a graft is needed first. Our implant timeline guide walks through every stage. Those months do not have to mean a gap in your smile: for a visible tooth we can usually give you a temporary tooth while the implant heals.

Who should not get an implant?

An implant is minor surgery, so what counts most is your general health rather than your age. Smoking roughly doubles the chance that an implant fails (Chen and colleagues, 2013), diabetes should be well controlled, and gum disease needs to be under control before an implant goes in. Radiation to the head or neck, and some bone medicines such as those for osteoporosis, need careful planning, so tell us about every medicine you take. Teenagers whose jaws are still growing wait. None of these is an automatic no, but each is a reason we might suggest a bridge for now, or treat something first and place the implant later.

When is a bridge the better choice?

In more cases than you might expect to hear from an implant practice. A bridge makes good sense when:

• The teeth on both sides already have large fillings or crowns, so there is no healthy enamel to give up.
• Surgery is not advisable for you, or you would rather avoid it.
• You need the gap closed quickly, for a wedding, a new job or your own peace of mind.
• Your bone would need a lot of grafting and you do not want the extra steps.

Dental plans differ on whether and how they cover implants and bridges, so bring your card and we will check your benefits before you decide. We do not push one answer. We show you both, with the trade-offs, and you decide.

What if I am missing more than one tooth?

The same thinking applies, with more options: a longer bridge anchored on natural teeth, a bridge carried on two implants, or, when most of an arch is gone, a full set of fixed teeth on a few implants. Our All-on-X and All-on-4 page explains the full-arch route. If the failing tooth is still in your mouth, we plan the extraction with the replacement in mind, since in some cases the implant can be placed in the same visit, depending on the bone.

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