Missing tooth: implant, bridge or partial denture?

Which replacement fits: an implant, a bridge or a partial denture?

Each option can replace a missing tooth. They differ in how they attach, how long they take, how long they last and what they ask of your other teeth. The table compares them using Cleveland Clinic and the ADA’s MouthHealthy site. Your dentist can tell you which fit your mouth.

The lifespans are averages from one source. They do not predict any one mouth.

Why replace a missing tooth at all?

You may not have to, but there are reasons. Cleveland Clinic says losing an adult tooth is like pushing over the first domino. It can lead to bone loss, shifting teeth and jaw pain. It lists other complications of untreated tooth loss: gaps in the smile, facial sagging from lack of support, extra pressure on remaining teeth, a bad bite, and speech changes.

Cleveland Clinic also says that unless you replace a lost tooth, you are more likely to lose another one in the future.

Why the tooth was lost matters too. Cleveland Clinic names gum disease as the main cause of tooth loss among adults. Cavities, injury and teeth grinding also play a part. A dentist will look for the cause before choosing a replacement, since a replacement does not fix gum disease or decay in the other teeth.

How does a dental implant replace a tooth?

An implant replaces the root, not just the visible tooth. A dentist or surgeon places a small post in the jawbone. The bone grows around it. Later a crown is attached. Because it does not rest on the neighbor teeth, they stay untouched.

Cleveland Clinic says an implant is “a one-tooth solution to a one-tooth problem.” Mayo Clinic says implant surgery can help when dentures or bridgework fit poorly. The process takes months, because the bone needs time to fuse with the post. Cleveland Clinic gives three to nine months for that step.

You need enough healthy bone and gums. Smoking, untreated gum disease and some illnesses can affect healing. Our dental implants guide covers the steps, recovery and risks in detail.

How does a dental bridge replace a tooth?

A bridge fills the gap with a false tooth that hangs between two crowns. The crowns go on the teeth next to the gap. The ADA’s MouthHealthy site says a bridge is also called a fixed partial denture. It is attached to the surrounding teeth for support, and only a dentist can take it out. Its success depends on the foundation, so it is important to keep the supporting teeth healthy and strong.

The glossary names the parts. The false tooth is a pontic. A dental bridge can be made of gold, alloys, porcelain or a mix.

Cleveland Clinic describes four types of bridge:

• Traditional. Crowns on both neighbor teeth hold the false tooth.
• Cantilever. A crown on one side only holds the false tooth.
• Maryland. Metal wings bonded to the backs of neighbor teeth hold the false tooth. Dentists typically use these for front teeth, because they are not strong enough for back teeth.
• Implant-supported. The bridge rests on implants, not natural teeth.

The dentist must shape the neighbor teeth to hold crowns, which means removing some enamel. Cleveland Clinic says a bridge helps keep other teeth from shifting into the gap. It also says that if decay or injury damages the supporting teeth, the bridge can be weakened. Cleaning under the bridge matters. Cleveland Clinic says a bridge is a good fit when one to four teeth in a row are missing.

How does a partial denture replace a tooth?

A partial denture is a removable appliance. Cleveland Clinic says partial dentures replace several missing teeth, and also one or more, in the upper or lower jaw. They rely on the gums and underlying bone for support, and special clasps hook around natural teeth for more stability. Partial dentures can also attach to dental implants in some cases.

You take a partial denture out to clean it, and you clean your natural teeth too. The ADA’s MouthHealthy site says to brush dentures daily with a soft brush and a non-abrasive cleanser, and to keep them in water when they are out. Our guide to denture care and repair covers daily care, relines and repairs.

A partial denture avoids surgery. It may feel odd at first. Cleveland Clinic says it can take weeks or months to get used to dentures, and several adjustments are common in the first few weeks.

How long does each option take?

Timing is one of the biggest differences. The steps below come from Cleveland Clinic and Mayo Clinic.

Some offices can make a bridge in one appointment with computer-aided design and milling. Cleveland Clinic suggests asking your dentist whether that is possible for you. Cleveland Clinic also says that reshaping the neighbor teeth for a traditional bridge removes some enamel and cannot be undone.

Does the tooth’s location or my age change the choice?

Yes. A front tooth and a back tooth carry different loads. Cleveland Clinic says Maryland bridges are typically used to replace front teeth, because they are not strong enough for the chewing forces on back teeth. A back tooth may suit a traditional bridge, an implant or a partial denture.

Age matters too. Cleveland Clinic says most dentists do not place bridges in people younger than 17 or 18, though there are exceptions. For a young person who loses an adult tooth, a Maryland bridge or a temporary partial denture sometimes called a flipper may work while the mouth finishes growing. Cleveland Clinic says the minimum age for an implant is typically 18, because you must be done growing. At the other end, the ADA’s MouthHealthy site says health matters more than age for implants.

How do I care for each option?

Each option needs daily cleaning. The details differ:

• Implant. Mayo Clinic says to keep the implant, the artificial tooth and the gums clean, and to use an interdental brush around the post.
• Bridge. Cleveland Clinic says to brush and floss daily and to clean underneath the bridge every day with floss threaders or tiny interproximal brushes.
• Partial denture. The ADA’s MouthHealthy site says to brush dentures daily with a soft brush, to rinse them first, and to store them in water when they are out of the mouth.

Regular checkups matter with all three. They let the dentist check the fit, the bite and the health of the gums and nearby teeth.

Which one fits my mouth?

Your dentist will weigh several things before recommending one:

• How many teeth are missing, and where. One tooth in the front differs from two in the back.
• The health of the neighbor teeth. A bridge needs healthy supporting teeth. A heavily filled neighbor tooth may already need a crown.
• Your bone. An implant needs enough bone, or a graft to build it.
• Gum health. Gum disease usually needs treatment first.
• Your health and habits. Smoking, diabetes and grinding can all affect the choice.
• Time. An implant takes months. A bridge or partial denture can often be made in a few visits.
• Your preferences. Some people want a fixed tooth. Others prefer removable.

What about cost and insurance?

Costs differ by option. Cleveland Clinic says bridges are typically more comfortable than partial dentures and more affordable than dental implants. It also says dental implants are typically more expensive than dentures. Those statements describe general patterns, not any office’s fees.

Town Center Dental does not publish prices. The office gives each patient their own estimate after an exam, so you can compare the options in writing. Ask what your insurance may cover for each. The office’s service pages describe dental implants, dental bridges and dentures.

What can I do while I wait?

You can protect the space and the teeth around it while you decide. Cleveland Clinic says to replace missing teeth as soon as possible to prevent other teeth from shifting into the gap. If you need an extraction first, you may wait a few months for the gums and bone to heal before a bridge. Mayo Clinic says a temporary partial denture can be worn after implant placement for appearance, and you can remove it to clean it and to sleep.

What should I ask my dentist?

These questions help you compare:

1. Which options suit my mouth, and which do you advise against?
2. What does each one need from my neighbor teeth?
3. How many visits and months should I plan for?
4. What is the estimate for each option, and what might insurance cover?
5. How long do you expect each one to last in my mouth?
6. What care will each one need?
7. What happens if I choose to wait?

Next step

If you have a gap, a loose tooth or a tooth that cannot be saved, an exam is the first step. Read about tooth replacement at Town Center Dental, then call (636) 273-5866 or request an appointment.