Implant or Bridge for One Missing Tooth?
The most common question at a consult for one missing tooth. The answer depends on four things, and one of them is the teeth next door.
Start with the Neighbors
A bridge needs the two teeth beside the gap to hold it, and to hold it they get ground down for crowns. If those teeth are healthy and untouched, that is a real cost: two good teeth become two crowned teeth carrying the load of three. If those teeth already have large fillings or need crowns anyway, a bridge costs them nothing they weren’t going to lose. That single question decides more cases than any other.
Then the Bone
An implant needs bone, and bone under a missing tooth shrinks over time. In a systematic review by Tan and colleagues in Clinical Oral Implants Research, sockets left to heal on their own lost roughly 29 to 63 percent of ridge width and 11 to 22 percent of ridge height within six months, most of it in the first three. If the tooth was lost recently, there is usually enough. If it was lost years ago, a graft may be needed first, which adds a step and a few months. A 3D scan answers this in seconds. A bridge doesn’t care about the bone, but the bone keeps shrinking under it, which is why a bridge over a long-missing tooth can develop a visible gap under the false tooth.
Time
A bridge is done in a few weeks. An implant takes three to six months from placement to final crown, longer with grafting. For most people that’s an inconvenience, not a reason. For someone with a wedding in six weeks, it may decide it.
Cost, Now and over a Lifetime
Up front, a bridge and a single implant with its crown are often closer than people expect. Over a lifetime, the implant usually costs less, because a bridge tends to need replacement in ten to fifteen years when one of the supporting teeth develops decay at the crown margin, and each replacement is a bigger job. A systematic review by Pjetursson and colleagues found about 89 percent of conventional tooth-supported bridges still in place at ten years, with decay and loss of pulp vitality in the supporting teeth the most frequent complications. A separate review by Jung and colleagues of single crowns on implants reported implant survival of 97.2 percent at five years and 95.2 percent at ten.
What We Usually Recommend
For one missing tooth with healthy neighbors and adequate bone: an implant. For one missing tooth with neighbors that need crowns anyway: a bridge is a perfectly good answer. For a tooth lost long ago with significant bone loss: an implant after grafting, if you’re willing to do the extra step; a bridge if you’re not.
A single tooth implant at Austin Periodontal Associates is performed by Dr. Andrew Verrett, a board-certified periodontist in North Austin.
And in every case: your dentist and Dr. Verrett decide this together, because your dentist makes the crown or the bridge and knows your mouth over time. The full comparison, or request a consult.
Frequently Asked Questions
Is an implant or a bridge better for one missing tooth?
It depends most on the teeth either side. If they are healthy and untouched, an implant replaces the missing tooth without cutting them down. If they already need crowns, a bridge does two jobs at once and is a perfectly good answer.
Why does a bridge involve the neighbouring teeth?
Because a bridge is carried by them. Both are reduced to hold crowns, which means removing healthy tooth structure from teeth that had nothing wrong with them. That is the main cost of a bridge and it is not reversible.
How do they compare over time?
Implant single crowns have been reported surviving at 97.2 percent at five years and 95.2 percent at ten, and conventional bridges at about 89 percent at ten. Those are population figures rather than a prediction for any one case.
Is a bridge faster?
Usually, yes. A bridge can be finished in a few weeks, where an implant typically runs three to six months because the bone has to grow onto it. If the timeline is the deciding factor, that is a legitimate reason to choose a bridge.
What about the bone under a bridge?
A bridge does not stop the jawbone under the missing tooth from shrinking, which is why a bridge over a long-missing tooth can develop a visible gap beneath the false tooth. An implant loads that bone and gives it a reason to stay.