Guides · Implants
A single missing tooth: implant or bridge?
The differences between the two options: effect on the neighbouring teeth, time, durability, care and when each comes out ahead.
For a single missing tooth, an implant is recommended if the neighbouring teeth are sound and there is enough bone: the neighbours are not cut, bone is preserved and it lasts long. If the neighbours already have large fillings or crowns, bone is insufficient and grafting is not wanted, or a quick result is needed, a bridge is a reasonable option. The decision is made after an examination, X-ray and assessment of general health.
When a single tooth is lost there are two established options: a fixed bridge supported by the teeth on either side of the gap, and a crown on an implant placed in the bone. The decision depends on the condition of the neighbouring teeth, the amount of bone, general health and time.
Comparison
| Implant + crown | Fixed bridge | |
|---|---|---|
| Neighbouring teeth | Untouched | Cut down and crowned |
| Time | 3–6 months (osseointegration) | 1–2 weeks |
| Surgery | A minor surgical procedure | None |
| Bone | Preserves bone, slows resorption | Bone in the gap resorbs over time |
| Cleaning | Like a natural tooth; floss passes through | Under the bridge with special floss |
| Lifespan | Many years with care | 10–15 years on average; the abutment teeth suffer at each replacement |
| Not suitable when | Insufficient bone, uncontrolled systemic disease, heavy smoking | Weak neighbouring teeth, a very long gap |
When the implant comes out ahead
- Neighbouring teeth sound and unfilled
- Enough bone, or bone that can be prepared with a graft
- A long-term solution that protects the neighbours is wanted
When the bridge comes out ahead
- Neighbouring teeth already heavily filled, root-treated or in need of crowns
- Bone insufficient for an implant and grafting not wanted
- A medical condition that rules out surgery
- A fixed solution is needed quickly
How is the decision made?
Examination and a panoramic X-ray; CBCT to measure the bone if needed. The vitality of the neighbouring teeth, gum health and the bite are assessed. Both options serve for many years when correctly indicated; the question is not "which is good and which is bad" but "which suits this mouth".
What happens in the long run?
With a bridge: The cut abutment teeth can decay under the crowns or develop pulpitis; a bridge is replaced after 10–15 years on average, and the abutments weaken a little at each replacement. Bone in the edentulous area keeps resorbing and a space forms under the bridge.
With an implant: The neighbours are untouched; the implant stimulates the bone and slows resorption. The commonest problem is peri-implantitis (plaque, smoking); with regular care, use for 20 years and more is usual. The crown on top can be replaced if needed while the implant is kept.
Time and comfort compared
| Implant | Bridge | |
|---|---|---|
| Total time | 3–6 months (longer with grafting) | 1–2 weeks |
| Surgery | Yes (local anaesthesia, 30–60 min) | No |
| Neighbouring teeth | Preserved | Cut down |
| Cleaning | Like a natural tooth + interdental brush | Superfloss under the bridge |
| Bone | Preserved | Keeps resorbing |
| Not suitable when | Uncontrolled diabetes, heavy smoking, insufficient bone, adolescents still growing | Missing or weak neighbouring teeth |
The in-between option: the Maryland bridge
Especially for a single missing front tooth — a winged bridge bonded to the back of the neighbouring teeth with minimal preparation. Used as an interim solution in young people until implant age, or as a permanent option in areas with low biting load. It can debond.
How long to wait after extraction?
For an implant, 2–3 months after extraction (once the bone has filled in) or, in suitable cases, at the same visit as the extraction; for a bridge, 4–6 weeks once the gum has healed. Leaving a gap for a long time lets the neighbouring teeth tilt and the opposing tooth over-erupt, which makes both options harder.
Questions to ask before deciding
- Are my neighbouring teeth sound, or filled?
- Do I have enough bone, or will I need a graft?
- Do I smoke; is my diabetes controlled?
- Can I accept surgery and a waiting period?
- Thinking 10–20 years ahead, which will need less intervention?
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