Implant or Bridge for a Missing Tooth: How the Choice Is Made

Two Ways to Fill One Gap

A bridge is a false tooth fixed to one or more teeth either side of the gap. An implant is a titanium screw placed in the jawbone that carries the false tooth itself. The practical difference is where the support comes from: a bridge borrows support from your remaining teeth, an implant does not.

Leeds Teaching Hospitals names this as one of the specific advantages of an implant — there is no need to drill or cut down the neighbouring teeth to provide support.

What a Bridge Asks of the Neighbouring Teeth

There are two main types, and they ask for very different things.

For a conventional bridge, Leeds describes the adjacent tooth being drilled down to a peg, with a crown made to fit over it and the false tooth connected to that crown. It is direct about the cost: a conventional bridge can be destructive to the supporting teeth and can affect the nerve of the tooth. In up to 10–15% of cases the nerve of the supporting tooth is irreversibly damaged and the tooth may become infected, potentially needing root canal treatment.

For an adhesive bridge — also called resin-retained or Maryland — a small metal wing is stuck to the back of an adjacent tooth to support the false tooth. This requires very little or no drilling, though Leeds notes it can sometimes make the supporting tooth look slightly greyer.

Which is appropriate is not a free choice: Leeds notes a conventional bridge can be more secure and is usually advised if the supporting teeth are already crowned or have large fillings. If the neighbouring teeth are already heavily restored, the calculation changes.

How Long Each Lasts

Leeds publishes figures for bridges that are worth knowing before deciding. Around 80% of conventional bridges last 10 years or longer with relatively minor complications. Around 80% of adhesive bridges last 5 years or longer, though complications with them are relatively less complex and easier to manage — the most common being the cement failing so the bridge comes off, usually rectified by cleaning and re-sticking it.

It also notes that 10–15% of supporting teeth may eventually need root canal treatment as the nerve dies off, and a small proportion may develop decay along the bridge margin or gum disease around the supporting teeth.

For implants, no comparable single figure is quoted here. What can be said is what the FDA says: your overall health is an important factor in how long an implant may stay in place, complications can occur soon after placement or much later, and implant failure is usually defined as looseness or loss. Our article on how long implants last sets out what actually governs that.

Comparing a published bridge figure against an implant figure from a different study would not be a like-for-like comparison, which is why the decision is not made on survival percentages.

Cleaning Differs Too

A bridge is brushed as normal, but Leeds stresses that when you floss you must sweep the floss under the false tooth along the gum line — your dentist or hygienist will show you how — and calls this very important for keeping the gums and teeth healthy and helping the bridge last.

An implant needs its own cleaning routine, and the tissues around it can become inflamed and lose bone if that is neglected. See implant care and cleaning.

The Options That Are Not Either

Leeds lists the alternatives to a bridge, and they apply equally when considering an implant:

• Leaving the gap. If you are happy with the appearance and the gap does not affect eating or socialising, this is a legitimate choice. Leeds notes the small risk of teeth drifting into the space, which could make a bridge harder to fit later if you change your mind.

• A removable denture — a false tooth on a removable plate, taken out at night and for cleaning, usually recommended when several teeth are missing.

• An implant, which Leeds notes may give very good function and appearance in some cases, but adds this may not be possible for a number of reasons.

Frequently Asked Questions

Is an implant always better than a bridge?

No. If the neighbouring teeth already need crowns, a conventional bridge may make better use of work that has to happen anyway. If they are healthy and untouched, the case for not drilling them is stronger.

Is a bridge quicker?

Usually yes, since it does not require healing of bone around an implant. Speed is one factor among several rather than the deciding one.

What if the supporting tooth fails later?

That is the risk Leeds quantifies — up to 10–15% of supporting teeth needing root canal treatment with a conventional bridge. It is worth asking what the fallback plan would be before choosing.

Can I decide from an online comparison?

Not reliably. The state of the neighbouring teeth, the bone, your bite and what you can maintain all change the answer, and they need examining.

Questions and Appointments

Write to us on WhatsApp to discuss which option suits your own situation, directly with Dr. Aykut Gürel. International patient appointments are planned at Dentopol Ümraniye on Mondays, Wednesdays and Saturdays, 09:00–18:00 Istanbul time.

Dr. Gürel speaks English. Written messages in other languages can be supported by translation; please confirm the availability of a spoken-language interpreter before your appointment. Treatment, follow-up and any transfer or accommodation arrangements are confirmed individually before you book travel.

References

• Leeds Teaching Hospitals — Bridges

• Leeds Teaching Hospitals — Dental implants

• FDA — Dental implants: what you should know