What are the options for replacing a missing tooth?
A single missing tooth can look like a minor issue, but if the gap is left for a long time the neighbouring teeth may tilt into the space, the opposing tooth may over-erupt towards it and the way you chew can gradually change. That is why it is worth discussing your options in good time, even for one tooth. The main options used today are:
- Implant-supported crown: a single implant placed in the jawbone with one crown on top. The neighbouring teeth are not touched.
- Conventional fixed bridge: the teeth either side of the gap are prepared for crowns, and the missing tooth is replaced by a one-piece restoration joined to those two crowns.
- Resin-bonded (Maryland) bridge: a replacement tooth held by thin wings bonded to the inner surfaces of the neighbouring teeth, with very little or no drilling. It is mainly used at the front of the mouth when the bite allows.
- Removable partial denture: a plate that clips onto the remaining teeth and can be taken out. It needs little or no tooth preparation, but it feels and stays in place differently from fixed options.
What is a dental bridge and how is it fitted?
A dental bridge is a fixed restoration that uses the teeth on either side of the gap as supports (abutments). Crowns are made for these abutment teeth, and the replacement tooth in the middle (the pontic) is attached to them. Because the bridge is cemented in place, you cannot take it out yourself. Bridges today are often made from metal-free ceramics such as zirconia, or from porcelain fused to metal; the material options are explained on the crowns and bridges page.
Treatment usually takes a few appointments: the abutment teeth are prepared, an impression or intraoral scan is taken, you wear a temporary bridge while the dental laboratory makes the final one, and after a try-in the permanent bridge is cemented. There is no surgical stage, which makes a bridge a valuable option for people who would rather avoid surgery or who are not suitable for implants.
Do healthy teeth have to be filed down for a bridge?
With a conventional bridge, yes. The abutment teeth are reduced all the way round so they can take a crown. How much is removed depends on the material and the position of the tooth; typically around 1–2 mm of tooth structure is taken from each surface. Tooth preparation cannot be undone, living teeth can be sensitive for a while afterwards, and in a small number of cases root canal treatment may be needed later.
How much this matters depends on the condition of the neighbouring teeth. If they already have large fillings, cracks or old crowns, crowning them as part of a bridge can actually protect them. If they are healthy and unfilled, filing them down for a bridge is a bigger trade-off. How much tooth is removed for veneers and crowns, and why it matters, is also covered in our article on Turkey teeth, veneers and crowns.
Is a dental implant right for me?
A dental implant is a small screw-shaped post, usually made of titanium, placed in the jawbone to replace the root of the missing tooth. Once it has fused with the bone (osseointegration), a connecting piece (abutment) and a crown are fitted on top. Its main advantage is that the neighbouring teeth are left alone. An implant also transmits chewing forces to the bone, which may help preserve it, whereas the bone under a bridge pontic can gradually thin over time.
Implant placement is a surgical procedure and needs sufficient bone volume. In most patients the bone takes a few months to heal around the implant, and longer if bone grafting is needed. The following factors can affect planning and should be discussed in detail with your dentist:
- Poorly controlled diabetes and certain other medical conditions
- Heavy smoking
- Some medicines used for osteoporosis (antiresorptive drugs) and a history of radiotherapy to the head and neck
- Untreated gum disease
- Young age, before jaw growth is complete
None of these automatically rules out an implant, but each means the risks and healing time need to be assessed individually. Restorations on implants, from single crowns to full-arch solutions such as All-on-4, are explained on the implant-supported prosthetics page.
Implant or bridge: which is better for one missing tooth?
Many studies report long-term success for both options when they are used in the right situation and well maintained. So the real question is not which one is better in general, but which one suits a particular patient. The main points of comparison can be summarised as follows:
Dental bridge
Supported by the neighbouring teeth
- No surgery needed
- Usually completed within a few weeks
- Neighbouring teeth must be filed down
- Can make sense if those teeth already have large fillings or crowns
- Needs special aids to clean under the pontic
Implant-supported crown
Supported by an implant in the bone
- Neighbouring teeth are not touched
- Involves surgery and a healing period for the bone
- Needs enough bone; grafting may be required
- Can be cleaned on its own, like a natural tooth
- General health and smoking can affect healing
| Factor | Dental bridge | Implant-supported crown |
|---|---|---|
| Effect on neighbouring teeth | Abutment teeth are prepared for crowns | Neighbouring teeth are not touched |
| Treatment time | Usually a few appointments over a few weeks | Usually a few months, because the bone needs to heal |
| Surgery | None | Yes; implant placement under local anaesthetic |
| Bone | Bone volume is not decisive; bone under the pontic may thin over time | Enough bone is needed; grafting can be planned if it is lacking |
| Cleaning | Superfloss, interdental brushes or a water flosser under the pontic | Brushing and interdental cleaning like a natural tooth; gum checks around the implant |
| Possible problems | Decay, sensitivity or need for root canal treatment in the abutment teeth | Gum inflammation around the implant, screw loosening |
How long a bridge or an implant crown lasts is closely linked to oral hygiene, clenching or grinding, gum health and regular check-ups. Zirconia, the material often used for crowns and bridges, is compared with porcelain veneers in our veneers vs zirconia crowns guide.
How is the bridge or implant decision made at your consultation?
The decision is based on your whole mouth, not just the gap. A prosthodontist such as Dr. Maryam Fazeli also considers your bite, your gum health and whether other teeth are likely to need restoring in future. The assessment usually follows these steps:
- 1
Examination and medical history
Your mouth is examined, and your general health, medicines, smoking habits and expectations are discussed.
- 2
X-rays and, if needed, 3D imaging
Panoramic and periapical X-rays show the roots of the neighbouring teeth and the bone. If an implant is being considered, a cone beam CT (CBCT) scan shows the height and width of the bone in three dimensions.
- 3
Bone and gum assessment
Gum inflammation or pockets, bone loss and the strength of the neighbouring teeth are checked. Where needed, a joint assessment is carried out with a periodontist (gum specialist).
- 4
Explaining the options
The suitable options are explained clearly, with their advantages, limitations, timelines and maintenance needs. The likely consequences of leaving the gap untreated are also covered.
- 5
Shared decision and treatment plan
Once you have the information you need, the plan is agreed together. Intraoral scanning and digital planning can help visualise the result in advance.
You can read more about digital impressions and planning on the digital dentistry page. Consultations are available in English, Persian and Azerbaijani. If you are travelling to İzmir from abroad, our trip planning guide explains how to plan your visits, and the contact page has appointment details.
How do you look after a bridge or an implant?
With either option, daily cleaning and regular check-ups are among the most important factors in how long the restoration lasts. Plaque can build up under a bridge pontic and around the edges of the abutment teeth; this area is cleaned with superfloss, interdental brushes or a water flosser. With an implant, inflammation of the surrounding gum (peri-implant mucositis) can progress to bone loss (peri-implantitis) if it is not picked up early.
Clenching or grinding (bruxism) puts extra load on both bridges and implant crowns, and a night guard may be recommended; see the TMJ and teeth grinding page. Tips for the first weeks after a new crown or bridge are in our veneer and crown aftercare guide.
Frequently asked questions
Does a bridge or an implant last longer?
There is no single definitive answer. Studies report high long-term survival for both conventional bridges and implant-supported crowns. How long either lasts depends mostly on oral hygiene, gum health, clenching or grinding, smoking and how regularly you attend check-ups. With a bridge, the health of the abutment teeth is key; with an implant, the health of the tissues around it.
Will healthy teeth be filed down for a bridge?
With a conventional bridge, the abutment teeth are prepared for crowns even if they are healthy. So when the neighbouring teeth are sound and unfilled, more conservative options such as an implant or, in suitable cases, a resin-bonded (Maryland) bridge are also considered. If those teeth already have large fillings or old crowns, a bridge can be a sensible choice because it also protects them.
Do I have enough bone for a dental implant?
This can only be confirmed with imaging. A cone beam CT (CBCT) scan shows the height and width of the bone at the implant site and its distance from nearby anatomical structures. If bone is lacking, grafting can be planned in suitable cases, which extends the treatment time. For some patients, a bridge turns out to be the more suitable option.
What happens if I leave a missing tooth untreated?
You may not notice a problem straight away, but over time the neighbouring teeth can tilt into the gap, the opposing tooth can over-erupt and food can get trapped more easily. These changes can affect your bite and make later treatment more complex. The bone in the gap may also thin. Even if you decide to wait, an examination is still advisable.
Who is a Maryland bridge suitable for?
A resin-bonded (Maryland) bridge is mostly considered for a single missing front tooth when the neighbouring teeth are healthy and the bite is favourable. It can also serve young patients until their jaw has finished growing and an implant becomes possible. It needs very little tooth preparation, but it can debond and may not suit people who clench or grind heavily.
When is a removable partial denture chosen?
A removable partial denture may be considered when teeth are missing in several areas, when surgery is not wanted, or when a temporary solution is needed. It usually needs little or no tooth preparation. On the other hand, taking it in and out, getting used to it and the visibility of clasps differ from fixed options, and these points are discussed at the examination.
This page is for general information. The right treatment for you is decided after a clinical examination, radiographs and a personal assessment.
With any surgical or interventional procedure, results may vary from person to person.
