Tooth Replacement: Bridge or Implant?

By Catherine M. Fascilla, D.D.S.

If you’ve lost or are about to lose a tooth, you have a couple of options for a fixed restoration. You may choose to replace your missing tooth with a bridge or with an implant. Some patients are not sure which option to go with. The goal of this article is to help understand the advantages and disadvantages of each form of treatment.

The simplest bridge involves the replacement of one tooth and is a three unit restoration. It replaces the tooth by having two crowns, also known as caps, attached to a false tooth. The false tooth is called a pontic and the two supporting teeth are called abutments. The abutment teeth must be reduced in size in order for the bridge to fit over them. The bridge is usually made with a metal substructure and porcelain fused over it. While it may look like three separate teeth, they are all connected. This is one of the disadvantages of the bridge. Flossing is more difficult to do as it requires special devices to be fed under the pontic. Another disadvantage is the need to cut down two teeth. If the teeth involved have large and old failing fillings in them, then covering them with crowns is a benefit. However, if the teeth involved are perfectly fine, cutting them down is not something that a dentist generally likes to do.

The main advantage to the bridge is that it can be completed fairly quickly, in as little as three visits. The temporary bridge can be fabricated in the dental office and can be placed the same day the tooth is extracted. It is both esthetic and functional. Patients usually feel good about having an immediate replacement. An implant is a surgically placed screw-like titanium fixture that fuses to bone. This process is called osseointegration. The implant becomes the artificial root for the tooth we will create. While implant placement has changed so much over the years and continues to improve, it generally takes longer to restore a missing tooth with an implant than with a bridge. We usually wait four months for the implant to osseointegrate before going on to complete treatment. Into the implant is screwed an abutment that has the shape of a tooth that has been prepared for a crown. The crown is fabricated and placed over the abutment and the final result is an individual tooth that looks and feels like your own tooth. It is easy to floss. Unlike your original tooth, it is not prone to tooth decay or root canal failure. In general, this makes the implant a much longer lasting restoration. Implants also keep the bone from shrinking which is typically what happens after a tooth is lost.

Generally speaking, an implant restoration is preferable to a bridge. While up front a single implant is a more expensive than a three unit bridge, the three unit bridge is likely to require replacement far more frequently than an implant and will cost much more in the long run.

It is very important to make an educated decision. Your dentist can help you. Ask questions and also talk to people you know who have had implants and bridges and see how they feel about their choice.

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