Which is the better way to replace a missing tooth, dental implant or fixed bridge?

The Fixed Bridge

Fixed bridges (also called Fixed Partial Dentures) have been around for decades. They involve the removal of enamel along with an outer layer of dentin from the teeth on either side of the missing tooth. Crowns are then made to fit over the prepared teeth that are fused together usually using a metal substructure. In this way a false tooth can fill the missing-tooth space.

Benefits of the Fixed Bridge

  1. Treatment time from start to finish is usually shorter compared with the dental implant.
  2. No surgery is usually involved.
  3. Cost for this restoration is usually slightly less compared with the dental implant/crown. (If root canals are indicated, however, this may not be the case).
  4. A temporary fixed bridge can be worn while the final bridge is being made in the dental laboratory. This means that the individual will not have to wear a removable device with a false tooth in it.

Weaknesses of the Fixed Bridge 

  1. Bridges are more difficult to clean. Flossing around a bridge is more difficult.
  2. The longevity of the bridge is not as good as the implant/crown for a couple of reasons. Teeth under the bridge are still at risk of re-decaying (implants can’t decay) and bridges are more dependent on the dentist’s eye-hand skills. The dental implant is machine-made at high tolerances, so the fit is better.
  3. The cost to replace a failed bridge is much greater because three teeth are now involved – the two teeth that were prepared along with the space. The cost to replace or repair the implant/crown or the tooth on either side of the implant/crown is contained to managing the problems of one tooth, not three.

 

The Dental Implant/Crown

A dental implant is essentially a man-made root. It is made with a material (usually titanium) that bone likes. When a dental implant is surgically placed bone cells actually attach to it.  The chewing strength of a dental implant is greater than a healthy tooth. It is the most successful restoration in the history of dentistry and has longevity measured in decades rather than years. In fact it is expected that most dental implants will last for the rest of the patient’s life. The crowns placed over the dental implant will wear, but they can easily be repaired or replaced if and when this becomes necessary.

The Benefits of Dental Implants

  1. Unlike the fixed bridge, the replacement of a missing tooth does not involve more than the one tooth being replaced.
  2. The longevity of the dental implant, as mentioned above, is unsurpassed.
  3. Cleaning around a dental implant is as easy as cleaning around any other tooth. Even though the implant can’t decay, it still needs to be cleaned to keep the gums around it healthy. Also the teeth next to a dental implant are still at risk to decay.

Weaknesses of the Dental Implant

  1. There is a surgical element to having a dental implant and so some people are not candidates.
  2. The time from start to finish for the dental implant is longer compared with the fixed bridge.
  3. The dental implant/crown costs slightly more compared with the fixed bridge (when we do not take into account the replacement costs in the future).

Conclusions/Recommendations

If either procedure can be performed equally well then the best option is the dental implant/crown. It has been shown to last longer than the fixed bridge. Also replacement of crowns on dental implants is easier and less expensive compared with removal and replacement of bridges.

If for any reason the dental implant is not a good solution in a particular situation it is nice to know we have good proven alternatives that work extremely well.

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