Implant, bridge, or denture: how to think about replacing a tooth
How dental implants, bridges, and dentures each replace a missing tooth, what each one asks of you, and the questions that help you choose between them.
Losing a tooth, or learning that one has to come out, leaves you with a decision. There are three main ways to replace a tooth: a dental implant, a bridge, or a denture. Each one can work well. The right choice depends on your mouth, your health, and what matters most to you: how long treatment takes, how it feels, or what it costs.
This lesson explains how each option works and what each one asks of you, so you can come to your exam with good questions.
Why replace a missing tooth?
Teeth help hold each other in place. When one is lost, the teeth on either side can slowly tip or drift into the gap. The tooth above or below it can also move into the space, because it has nothing to bite against. Over time, your bite can change, and food can get caught in new places.
The bone changes, too. Chewing puts pressure on the jawbone through the roots of your teeth, and that pressure helps keep the bone strong. Where a tooth is missing, the bone slowly shrinks. A gap near the front also affects how you look, and sometimes how you speak.
Leaving a space is sometimes a reasonable choice, especially at the back of the mouth. If you’re thinking about it, ask what’s likely to happen over time if you wait.
Dental implants
A dental implant replaces the root of a tooth. It’s a small post, usually made of titanium, placed in the jawbone. Over a few months, the bone grows tightly against it. Then a connector, called an abutment, is attached, and a crown goes on top.
Figure 1 shows an implant beside a natural tooth.
- Crown
- Root
- Ligament
- Bone
- Crown
- Abutment
- Implant
- Bone
What implants do well
An implant stands on its own, so the teeth next to it don’t need to be changed. Because it sits in the bone, it helps keep that bone from shrinking. You clean it like a natural tooth, with brushing and flossing. With good care, implants are designed to last many years.
What implants ask of you
Placing an implant is surgery, done with the area numbed. The whole process usually takes several months, and longer if a tooth must come out or bone must be added first. You need healthy gums and enough bone to hold the post. If you don’t have enough bone, a bone graft can sometimes build it up.
Smoking and some health conditions, such as diabetes that isn’t well controlled, can make healing harder. Implants usually cost more up front than the other options, and insurance coverage varies from plan to plan.
Bridges
A bridge fills a gap with a false tooth that’s held in place by the teeth on either side. Those neighboring teeth are shaped and covered with crowns, and the false tooth is joined to them in between, like the span of a bridge between two supports. Figure 2 shows a bridge spanning a gap.
- Crown
- False tooth
- Tooth
What bridges do well
A bridge is fixed in place, so you don’t take it out. There’s no surgery, and it’s usually finished in two or three visits over a few weeks. It can be a good fit when the neighboring teeth already have large fillings or need crowns anyway.
What bridges ask of you
For a standard bridge, the neighboring teeth have to be reshaped for their crowns. That means removing some of their enamel, even if they’re healthy. And because a bridge relies on those teeth, a problem with one of them can affect the whole bridge.
You’ll need to clean under the false tooth every day with a floss threader or a small brush, because food and plaque collect there. A bridge also doesn’t stop the bone under the gap from shrinking.
Dentures
A denture is a removable set of false teeth on a gum-colored base. A partial denture replaces some teeth and clips onto the natural teeth you still have. A complete denture replaces all the teeth in your upper or lower jaw.
An upper denture is held mostly by suction against the roof of your mouth. A lower one tends to move more, because the tongue and cheeks push on it.
What dentures do well
Dentures can replace many teeth at once, without surgery. They usually cost less than implants up front, and they can often be made fairly quickly. If you lose more teeth later, a partial denture can sometimes have teeth added to it.
What dentures ask of you
Dentures take a few weeks or more to get used to, for both eating and speaking. They can feel bulky at first, and sore spots are common until they’re adjusted. You’ll take them out every day to clean them, and usually at night.
Because dentures rest on the gums rather than in the bone, the bone underneath keeps slowly shrinking. Over time, dentures need to be relined (refitted) or remade.
A middle path: dentures held by implants
If you’re missing most or all of your teeth, implants can hold a denture in place. Two or more implants are placed in the jaw, and the denture snaps onto them or is fixed to them. Figure 3 shows a denture held by implants.
- Denture
- Attachment
- Implant
Many people find an implant-supported denture much steadier than a regular one, especially in the lower jaw, where as few as two implants can make a big difference. It still involves surgery and healing time, but it usually takes far fewer implants than replacing every tooth one by one.
How to weigh the choices
No one option is right for everyone. These questions can help you and your dentist think it through:
- How many teeth are missing, and where? One missing tooth, a few in a row, and a whole jaw call for different answers.
- How healthy are the teeth next to the gap? Healthy neighbors are a reason to avoid reshaping them for a bridge. Neighbors that already need crowns can make a bridge a better fit.
- How are your gums and bone? Implants need enough healthy bone. X-rays, and sometimes a 3D scan, show how much you have.
- How do you heal? Your health, your medicines, and smoking all affect healing after surgery.
- How much time do you have? A bridge or a denture can often be finished in weeks. An implant usually takes months.
- What do you want day to day? Think about whether you’d rather have something fixed or removable, and how you’ll clean it.
- What will it cost, and what will insurance cover? Ask for an estimate for each option you’re seriously considering.
If a tooth is coming out soon
Ask about replacing it before it’s removed. Some choices, such as an implant, may go more smoothly if the bone is protected when the tooth comes out. Ask, too, whether you’ll have a temporary tooth while you heal.
Finding out what’s right for you
Dr. Minici is a general dentist. If any part of your treatment would be done by another dentist, such as an oral surgeon, he’ll tell you before you decide.
For more detail, see dental implants, dental bridges, dentures, and implant-supported dentures. This lesson covers the general picture. An exam is how you find out which option is right for your mouth.
Questions about your own teeth?
An exam is how you find out what’s right for you. Tell us a little about what’s going on, and we’ll call you to find a time.