Implant or bridge: how the decision is made

When a tooth is extracted or lost there are two established ways to fill the gap: a bridge resting on the neighbouring teeth, and an implant placed in the bone. Both have been used for decades; the question is not which is "better" but which suits your mouth.

What a bridge does

The teeth either side of the gap are reduced and a single three-unit crown is cemented over them; the middle unit fills the gap. The bone is untouched, there is no surgery, and it is finished in two or three weeks.

What an implant does

A titanium root is placed in the gap; once it has fused with the bone a single tooth is built on it. The neighbours are not cut. There is surgery, and a wait of 2–4 months for the bone to heal.

Four things that decide

The neighbouring teeth. If the teeth either side are already filled or crowned, a bridge costs them nothing more. If they are sound and untouched, an implant is considered rather than reducing two healthy teeth.

Bone. An implant needs enough height and width, measured on a CT scan. If bone is short, a graft or sinus lift is added — which adds time and stages.

Time. A bridge takes weeks, an implant months. For a patient coming from abroad or working to a date, this can be decisive.

General health. Uncontrolled diabetes, certain medicines and heavy smoking disturb implant healing; they change the plan, they do not always rule it out.

In the long run

An implant stimulates the bone beneath it and slows its loss; bone under a bridge recedes over time. On the other hand a bridge serves for years without trouble as long as the supporting teeth stay sound. Both need a check-up and interdental cleaning every six months.

In short

Both routes are legitimate. At the examination the neighbouring teeth are looked at first, then the CT scan, and both options are given in writing with their durations and stages. The decision is yours.