Dental implant or bridge: which replaces a missing tooth better?

The neighboring teeth

A traditional bridge hangs a false tooth, the pontic, between abutment teeth, the natural teeth either side of the gap. Those teeth are shaved down to hold crowns, and the enamel removal is irreversible.

A dental implant is a titanium post in the jawbone that replaces the tooth without involving its neighbors. In a review of bridges followed five years or more, the most frequent problems were decay and loss of pulp vitality, meaning the nerve inside a supporting tooth died. An implant avoids both.

The bone under the gap

After an extraction, the ridge of jawbone shrinks. A review of human studies found it lost 29 to 63% of its width and 11 to 22% of its height within six months, fastest early and gradually after. A pontic rests on the gum with no root, so it does nothing to slow that loss.

An implant fuses with the bone, called osseointegration, and helps preserve what remains. The catch: it needs bone to start. If the gap has been empty for years, a graft may be needed first.

Who suits which, and how long it takes

An implant needs enough healthy jawbone. Untreated gum disease, unmanaged diabetes, or severe bone loss can rule it out or delay it, and smoking or vaping can disrupt healing. A bridge needs no surgery, but it needs strong, healthy teeth on both sides.

Osseointegration takes about three to nine months before the final crown. A bridge usually takes two to four weeks, over two visits with a temporary between. Choose the bridge when the neighbors already need crowns, surgery is off the table, or grafting isn’t acceptable. Choose the implant for a single gap between healthy teeth when you’re planning for decades. If neither fits, a removable partial denture needs no surgery or reshaping.

Longevity, cleaning, and cost

A bridge lasts 5 to 15 years on average. The implant post can often last a lifetime, though its crown may need replacing at around 15 years. At ten years the two are close: one review estimated 89.2% survival for conventional bridges and 89.4% for single implant crowns.

Floss can’t pass between a pontic and its crowns, so you clean under a bridge daily with a floss threader or interproximal brush. An implant crown stands alone, so you brush and floss around it like a natural tooth.

A bridge usually costs less up front. An implant’s price is driven by the surgery, any graft, and the crown on top; a bridge’s by its units, since one missing tooth means three linked pieces. Remaking a bridge every 5 to 15 years adds to its long-run total.