Three options, one decision
When a tooth is lost, three main prosthetic options are available: the implant, the bridge and the denture. Each option has specific indications, advantages and disadvantages. There is no blanket “best” tooth replacement. There is the tooth replacement that fits best for your constellation, your anatomy and your life situation.
This article explains the three options, compares them against the key criteria and shows in which constellations which solution is medically sensible.
What a bridge is
A dental bridge replaces one or more missing teeth by anchoring to the neighboring teeth, the so-called abutment teeth. The most common form is the three-unit bridge: two abutment crowns on the neighboring teeth carry a middle pontic that closes the gap.
The abutment teeth are ground down before the bridge is placed, because the bridge construction is fitted over them. A previously healthy tooth thereby loses its original substance. With bridges over larger spans or with multiple pontics in a row, the mechanical load on the abutment teeth increases significantly.
A special form is the adhesive bridge (Maryland bridge), where a pontic is bonded via thin metal wings to the inside of the neighboring teeth. This is substance-saving but usually lasts less long than the classic bridge and is only suitable in certain constellations.
What an implant is
A dental implant is a screw made of pure titanium, anchored in the jawbone as a replacement for the tooth root. After a healing phase of three to four months, a crown, bridge or denture is attached to the implant.
In contrast to the bridge, the neighboring teeth are not ground down. The bone, which begins to shrink with every tooth loss, is stimulated by the chewing forces at the implant and remains stable long-term. An implant is substance-saving for the surrounding anatomy and biologically the replacement closest to a natural tooth.
More on treatment and materials is on our service overview for dental implants.
What a denture is
A denture replaces multiple teeth or the entire jaw. It is worn removably by patients.
The partial denture replaces a smaller number of teeth and either rests via clasps on the remaining teeth or via attachments or telescopic crowns. The full denture replaces the entire jaw and rests in the upper jaw via palatal suction, in the lower jaw usually reinforced with implants due to the missing suction surface.
The implant-supported hybrid denture is a special form: two to four implants hold the denture via locators or bars and remove its tendency to tip when speaking or eating. It combines the stability of implants with the flexibility of a removable solution.
Comparison by criteria
Bone preservation
The most important medical argument for an implant: the bone that begins to shrink after tooth loss is permanently stimulated by chewing forces at the implant. Bridges and dentures rest on the bone but do not transfer chewing forces into the depth. The bone shrinks measurably under bridges and dentures. With full dentures this leads long-term to a reduction of the jaw, making the denture unstable and requiring adjustments or new fittings every few years.
Neighboring teeth
The most important argument for an implant from the substance perspective: neighboring teeth are not ground down. With a bridge two previously healthy teeth are made crown-ready. If the abutment teeth have restorations or caries anyway, the bridge is acceptable because the substance there is reduced anyway. If the abutment teeth are healthy, the implant is more substance-saving.
Lifespan
Implants have survival rates in long-term studies above 95 percent after ten years and above 90 percent after twenty years, provided there is no peri-implantitis and no gross neglect of oral hygiene. More on preventing implant loss in the article on peri-implantitis.
Bridges typically last ten to fifteen years, with large variation depending on oral hygiene and load. The most common reason for failure is caries on the abutment teeth under the crown, where care is difficult.
Dentures last in construction usually five to ten years but often need to be relined or adjusted in between, because the jaw changes.
Care effort
Implants need at least the same care effort as natural teeth, often somewhat more. We recommend implant patients two dental hygiene sessions per year and an annual check-up.
Bridges are more difficult to care for because no direct cleaning under the pontic is possible. Special interdental brushes and superfloss are needed.
Dentures are removed daily, cleaned and stored overnight in a special solution. The effort is higher than with fixed solutions, but the cleaning itself is simple.
Treatment duration
Bridge: two to three sessions over two to four weeks.
Implant: from initial consultation to definitive crown four to six months, of which one hour of active surgery and three to four months of passive healing.
Denture: two to five sessions over four to eight weeks, depending on complexity.
Costs
Concrete prices depend on complexity, materials and effort. We do not name fixed amounts on the website because the Swiss dental tariff is standardized and treatments vary strongly per patient. An overview of cost ranges in Switzerland is in the separate articles on implant costs and generally on the insurance question at the dentist.
Rough order: A removable partial denture is the most cost-effective solution. A classic bridge is in the middle range. An implant with crown is most expensive at acquisition, but calculated over twenty or thirty years of durability often cost-neutral or cheaper than repeated bridges.
Decision matrix by constellation
Single tooth gap with healthy neighboring teeth
Recommendation: Implant. The neighboring teeth do not need to be ground down, the bone remains stable, lifespan is high. Exception: With medical contraindications for surgical treatment (see below), the adhesive bridge is a substance-saving alternative.
Multiple missing teeth side by side
Recommendation: Implant-supported bridge or multiple single implants. With three missing teeth, two implants supporting a bridge of three crowns are usually sufficient. Advantages: bone preservation, no load on neighboring teeth, long durability.
A conventional bridge is possible if the neighboring teeth need crowning anyway.
Terminal gap without distal abutment
Recommendation: Implant. A conventional bridge is not possible because an abutment tooth at the rear end is missing. The alternative would be a partial denture with clasp on the remaining tooth, which is often not ideal functionally and aesthetically.
Edentulous jaw
Options: Full denture, implant-supported hybrid denture, fixed bridge on four to six implants.
- Full denture: cost-effective, but often unstable in the lower jaw, acceptable in the upper jaw with palatal suction effect.
- Hybrid denture on two implants: significant improvement in stability at moderate cost. Often the best solution for patients with full denture who have stability problems.
- Fixed bridge on four to six implants (All-on-4 or All-on-6): the qualitatively highest solution but also the most expensive. Offers the feeling of natural teeth and maximum comfort.
Bone deficit
With receded bone after prolonged tooth loss, an implant without bone augmentation is often not possible. The options are:
- Bone augmentation plus implant: the bone is built up with own or synthetic material, then the implant is placed. Extends treatment duration by three to six months.
- Sinus lift in the upper jaw posterior area: the floor of the maxillary sinus is raised to create space for the implant.
- Bridge without bone augmentation: if bone augmentation is not desired or medically advisable.
- Hybrid denture without elaborate bone augmentation: as an alternative with strongly receded bone.
Complex bone augmentations and sinus lifts are treated at our Bellevue location by Dr. Dejan Dragisic, oral surgery specialist. More on the implant spoke Bellevue.
General medical contraindications for surgery
With certain pre-existing conditions an implant is difficult or not possible:
- Bisphosphonate therapy (e.g. after osteoporosis or cancer treatment): risk of jaw necrosis. Implants are examined case by case.
- Uncontrolled diabetes mellitus: elevated risk for wound healing disorders and peri-implantitis. Implants possible if the diabetes is well controlled.
- Heavy smoking: strongly elevated risk for implant loss. Implants possible, with clear explanation of elevated risk.
- Severe systemic diseases with sedation risk: plan procedure at location with experienced anesthesia.
In such constellations the conventional bridge or denture is often the safer choice.
Tight budget
Recommendation: Bridge or partial denture. If the budget for an implant is not sufficient and no supplementary insurance covers the costs, the conventional bridge is the more cost-effective fixed solution. The partial denture is the most cost-effective option if a removable solution is acceptable.
We discuss budget options openly in the appointment. A treatment that you cannot or do not want to afford, we do not recommend.
How Resident proceeds with the assessment
After initial consultation and clinical examination we take an X-ray or a 3D image (CBCT) if needed. Only then do we discuss the prosthetic options.
You receive a written treatment plan with detailed listing of all services and materials. If two options are sensible, we prepare two separate cost estimates for comparison on request. More on this in the article on the cost estimate.
We recommend the option that is medically and long-term most sensible for your constellation. You decide on this basis. With uncertainty a second opinion is always welcome; we share diagnostic documents on request with other practices.
Arrange an appointment at your location for an initial consultation. We take time for the assessment and discuss the options without pressure.