Bridge or Implant? Advantages and Disadvantages
Bridge or Implant?
Which to Choose and When
The two options most often discussed for replacing a missing tooth are a dental bridge and an implant. Both are fixed solutions that look natural and allow good chewing. However, they differ in how they work, the procedures they require and the problems that may arise in the long term.
There is no single “best” option; the right decision depends on the condition of the neighbouring teeth, the bone, your general health and your expectations. This article is a decision guide. You can find the long-term results and risks in our article on the long-term results of implants and bridges, and the differences in everyday use and care in our article on caring for implants and bridges.
The Two Methods at a Glance: How Do They Work?
With a dental bridge, the teeth on both sides of the gap are reduced and prepared for crowns, and a one-piece prosthesis is cemented onto them: it is supported by these teeth and carries an artificial tooth (pontic) in the middle that takes the place of the missing tooth. The treatment does not require surgery and is usually completed in a short time.
With an implant, an artificial root is placed in the jawbone in place of the missing tooth’s root; once it has fused with the bone, a crown is fitted on top. The neighbouring teeth are not touched, but a minor surgical procedure and a healing period are needed. For details of each step, see our article on the implant stages.
Situations That Favour an Implant
- If the neighbouring teeth are healthy: A bridge requires healthy teeth to be prepared for crowns. A laboratory study on front teeth showed that full crown preparations require removal of approximately 63-72% of the tooth’s crown (Edelhoff and Sorensen, 2002). If the neighbouring teeth have no fillings or crowns, an implant leaves these teeth intact.
- If there is no supporting tooth behind the gap: When the missing tooth is at the end of the row, a bridge can only be made as a one-sided (cantilever) design; the 10-year survival of this design is lower than that of conventional bridges (80.3%) (Pjetursson et al., 2007).
- If the gap is long: When several teeth are missing, implant-supported solutions are considered instead of long bridges.
- If there is enough bone, or it can be augmented, and your general health allows surgery.
Situations That Favour a Bridge
- If the neighbouring teeth already have large fillings or crowns: Crowning these teeth can benefit them too; a bridge meets both needs at once.
- If surgery is not wanted or not suitable: Some uncontrolled systemic diseases or a history of radiotherapy to the head and neck region increase the risk of implant treatment; in one meta-analysis, a history of radiotherapy increased the risk of implant failure approximately 2.3-fold (Chen et al., 2013).
- If the bone is insufficient and bone augmentation is not wanted: A bridge can close the gap without the need for a bone graft.
- If finishing quickly matters: A bridge can be made without waiting for the bone to heal.
A Minimally Invasive Option: The Resin-Bonded (Maryland) Bridge
Particularly for single missing teeth at the front of the mouth, resin-bonded bridges can be used; they are held in place by wings bonded only to the back surfaces of the neighbouring teeth. Very little or no tissue is removed from the neighbouring teeth.
In a systematic review, the survival of resin-bonded bridges was 91.4% at 5 years and 82.9% at 10 years. Debonding and minor fractures are common; designs with a zirconia framework and a single wing gave the best results (Thoma et al., 2017). For this reason, a resin-bonded bridge can be considered as a temporary or permanent option in suitable cases.
The Criteria Assessed When Deciding
- Condition of the neighbouring teeth: Are they healthy, or do they have fillings or crowns?
- Bone and gums: Bone height and width, gum health and, if necessary, bone augmentation.
- General health: Diabetes control, smoking, medications taken and any history of radiotherapy.
- Bite and clenching: Chewing forces and the habit of clenching the teeth at night.
- Aesthetic zone: For the front teeth, the gum line and bone structure directly affect the result.
- Expected timeframe: How soon the treatment needs to be completed.
- Care habits: Both methods require regular cleaning and check-ups.
These criteria are assessed together after the examination and X-rays; the decision is made after discussing the pros and cons of each option with the patient.
A Common Claim: Bone Loss
After a tooth is extracted, the jawbone gradually becomes thinner; most of this loss occurs in the first 3-6 months (Tan et al., 2012). It is often said that an implant preserves bone better than a bridge. However, there is no strong study that directly compares the two methods in this respect, and placing an implant on the same day as the extraction does not prevent the dimensional changes that follow extraction either (Gallucci et al., 2018).
For this reason, the decision should not be made on the grounds of “bone”, but by looking at all of the criteria above together. If preserving bone is important, bone-preserving procedures carried out at the time of extraction can be planned separately.
What Can You Expect in the Long Term?
In a systematic review that directly compared the two methods, 10-year survival was 89.2% for conventional bridges and 89.4% for implant-supported single crowns. The types of problems differ, however: biological problems such as decay and loss of vitality in the supporting teeth are more common with bridges, while technical problems such as screw loosening and porcelain fracture are more common with implants (Pjetursson et al., 2007). For detailed figures, see our article on long-term results.
Bridge or Implant? Frequently Asked Questions
Which lasts longer, a bridge or an implant?
In systematic reviews, the 10-year survival rates of the two methods are close to each other (about 89%). What really determines how long they last are factors such as oral hygiene, regular check-ups, smoking and teeth clenching.
Are healthy teeth cut down for a bridge?
With a conventional bridge, the teeth on both sides of the gap are prepared for crowns. If these teeth are healthy, more conservative options such as an implant or, in suitable cases, a resin-bonded bridge are considered first.
If I do not have much bone, should I have a bridge?
Not always. In most cases the bone can be built up with a graft or a sinus lift. If bone augmentation is not wanted or not suitable, a bridge is a good option.
Can anyone have an implant?
Most adults can. Some uncontrolled diseases, a history of radiotherapy to the head and neck region and heavy smoking increase the risk; these situations are assessed separately during the examination.
What is a resin-bonded (Maryland) bridge?
It is a type of bridge held in place by wings bonded only to the back surfaces of the neighbouring teeth, and it requires very little reduction of the teeth. It is mostly used for single missing teeth at the front of the mouth.
Which one is completed sooner?
A bridge is usually completed sooner because it can be made without waiting for the bone to heal. With an implant, there is a wait of a few months for it to fuse with the bone; in suitable cases, temporary teeth can be fitted straight away.
Sources
- Edelhoff D, Sorensen JA. Tooth structure removal associated with various preparation designs for anterior teeth. J Prosthet Dent. 2002;87(5):503-509. doi:10.1067/mpr.2002.124094
- Pjetursson BE, Brägger U, Lang NP, Zwahlen M. Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs). Clin Oral Implants Res. 2007;18 Suppl 3:97-113. doi:10.1111/j.1600-0501.2007.01439.x
- Thoma DS, Sailer I, Ioannidis A, Zwahlen M, Makarov N, Pjetursson BE. A systematic review of the survival and complication rates of resin-bonded fixed dental prostheses after a mean observation period of at least 5 years. Clin Oral Implants Res. 2017;28(11):1421-1432. doi:10.1111/clr.13007
- Chen H, Liu N, Xu X, Qu X, Lu E. Smoking, radiotherapy, diabetes and osteoporosis as risk factors for dental implant failure: a meta-analysis. PLoS One. 2013;8(8):e71955. doi:10.1371/journal.pone.0071955
- Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res. 2012;23 Suppl 5:1-21. doi:10.1111/j.1600-0501.2011.02375.x
- Gallucci GO, Hamilton A, Zhou W, Buser D, Chen S. Implant placement and loading protocols in partially edentulous patients: a systematic review. Clin Oral Implants Res. 2018;29 Suppl 16:106-134. doi:10.1111/clr.13276
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