Implant, bridge or denture: choosing how to replace missing teeth

A dental implant is a small post, usually made of titanium, that is placed into the jawbone and acts as an artificial root. Once the bone has bonded with it, it can hold a single crown, a bridge or a denture. A bridge is a fixed replacement tooth (or teeth) held in place by the teeth or implants on either side of the gap. A denture is a removable plate with artificial teeth; a partial denture replaces some teeth, and a complete denture replaces all the teeth in one jaw.

These options can also be combined. For example, two or more implants can support a removable denture so that it clips into place, and implants can support a fixed bridge or a full arch of teeth. Implants are not automatically the best choice. Each option is a trade-off between surgery, time, effect on other teeth, cleaning and cost.

An implant replaces the root of a tooth without relying on the neighbouring teeth for support. Many people find that implant teeth feel stable and similar to natural teeth when eating and speaking. When a tooth is lost, the jawbone in that area tends to shrink over time; an implant may help to keep some of that bone, although this varies.

The trade-offs are that implants need minor surgery, a period of healing before the final teeth are fitted, and enough healthy bone in the right place. If there is not enough bone, bone grafting or a sinus lift may be needed first, which adds time. A dentist will also ask about your general health, smoking and gum health, because these can affect healing. For patients treated abroad, implants usually mean at least two trips.

A conventional bridge is usually held by crowns on the teeth on either side of the gap. To fit those crowns, the dentist needs to remove some of the outer surface of those teeth. If the neighbouring teeth already have large fillings or crowns, this may not be a disadvantage; if they are healthy and untouched, it is an important point to discuss.

A resin-bonded (adhesive) bridge has small wings that are bonded to the back of the neighbouring teeth. It needs very little drilling and is often used for front teeth, where biting forces are lighter. Bridges do not need surgery and can often be completed more quickly than implants. The neighbouring teeth must be strong, with good gum and bone support, and the area under the false tooth needs careful daily cleaning.

Dentures usually involve the least treatment and no surgery. They can replace many teeth at once and are often the simplest option to change or add to later. Some partial dentures clip onto the remaining natural teeth.

The trade-offs are that dentures are removable and may feel less stable, especially lower complete dentures. They need to be taken out for cleaning and are usually removed at night. Over time, the gums and jawbone change shape, so dentures can become loose and need adjusting, relining or replacing. Dentures fitted immediately after teeth are removed often need adjusting or replacing within about a year, as the mouth changes while it heals.

Implant-retained dentures (also called overdentures) clip onto a small number of implants. They are often more stable than conventional dentures, but they still need surgery and healing time, and the clips or attachments wear and need replacing from time to time.

No single option is best on every point. It can help to think about which of the following matter most to you, and to ask the dentist how each option compares for your mouth.

• Surgery: implants need it; bridges and dentures usually do not.
• Time: implants usually need several months of healing; bridges and dentures can often be finished sooner.
• Neighbouring teeth: conventional bridges involve preparing them; implants and most dentures do not.
• Bone: after tooth loss, bone tends to shrink; implants may help to keep some of it, while dentures do not.
• Cleaning: bridges and implants need careful cleaning around and under them; dentures are removed and cleaned separately.
• How long they last: every option can last many years with good care, but all of them may need repair, adjustment or replacement at some point.
• Trips abroad: implants usually need at least two trips; a bridge or denture may need fewer, but this depends on the plan.

As a general pattern, implants may suit people with enough healthy bone and good general and gum health who want a fixed result and can allow time for healing. Bridges may suit people with a short gap next to strong teeth, especially where those teeth already need crowns. Dentures may suit people who are missing many teeth, prefer to avoid surgery, or need a simpler or more flexible option, sometimes as a first step.

These are general patterns, not recommendations. Your bone, gums, bite, remaining teeth, medical history and habits such as smoking or teeth grinding can all change which option is sensible. Only a dentist who has examined you and seen your X-rays or scan can advise you.

Asking each clinic the same questions makes it easier to compare their advice.

• Which options are possible for me, and why do you recommend this one?
• What would happen to my neighbouring teeth and to the bone with each option?
• Will I need bone grafting or other treatment first?
• How many visits and trips would each option need, and how long would I be without fixed teeth?
• How would I clean it, and what maintenance would it need over the years?
• What parts are most likely to need repair or replacement in the future, and could a dentist at home do that?