When is a bridge better, when a dental implant?

Nowadays, dentists generally believe that a dental implant is the better treatment than a bridge to close a gap in a tooth, because an implant is an addition, i.e. you have one more abutment to damage instead of 2 abutments afterwards. Nevertheless, a general judgement on this question is not possible, since it depends on many individual factors, and implants have not only advantages but also risks. In addition, bridges represent an aesthetically and functionally very good fixed denture. Here we have put together the arguments for the decision “dental bridge or implant”. In the chapter “dental bridges” you can find out more about the technique and possibilities of bridges as dental prostheses.

What are the arguments for/against bridges or implants?

1. protection or strain of the own teeth?

The grinding of teeth is associated with damages and risks, which are complex.

Grinding trauma of the teeth for a bridge

The tooth is injured by the removal of the tooth hard substance, a grinding trauma develops, which can result in the death of the tooth nerve. This would result in the necessity of endodontic therapy (root canal treatment) with a worse prognosis than a healthy tooth and the risk of premature tooth loss.

Teeth with large fillings and/or root-filled teeth

If teeth have already been filled with large fillings, it may be advisable to crown them for long-term tooth preservation (need for crowning) for reasons of stability. In such cases, the grinding of the teeth can even be advantageous for a crown bridge restoration, especially for already root-treated, root-filled teeth. A grinding trauma to the detriment of the tooth nerve can no longer occur here. However, as bridge abutments, root-filled teeth must fulfil other attributes: they must be inflammation-free, and their stability must be sufficient for carrying a bridge (if necessary, additional measure: post build-up).

Overloading of the teeth by the dental bridge

Depending on the stability of the abutments, their bone preservation, the additional loading of the abutments with the function of the replaced tooth (short or long term) can lead to a reduction of the life span. A fixed bridge construction can have a very limited service life, especially in the case of existing periodontitis.

Secondary diseases: Caries and periodontitis

Due to the blocking, a bridge construction is fundamentally less maintainable than a single tooth. It is easier for plaque and food residues to settle because the use of dental floss is more difficult and the effectiveness of the toothbrush can be limited. With biologically healthy oral conditions, good oral hygiene and regular professional tooth cleaning, this may be unproblematic. This can be serious if there is a tendency to caries or periodontitis.

Conclusion: It depends on the teeth in question whether they are recommended as bridge abutments or not.

2. costs of treatment: Implant more expensive than dental bridge

In some cases, the decision for and against does not depend on the cost of the implant treatment, as there is private health insurance for implants or other financial freedom. In many cases, however, the investment consideration may play an important role: a large proportion of patients may choose implant treatment if it is the optimal solution, even if it involves financial sacrifice. For some patients, however, implant treatment may not be financially viable despite the fact that all possibilities for inexpensive implants have been exhausted. The costs for a bridge are lower and can also be reduced by cost-saving measures with a simple design (steel frameworks, unveneered) and imported dental prosthesis.

Conclusion: If the price of an implant cannot be financed with all the savings (foreign tooth replacement, cheap implants), then it will probably be nothing with an implant.

3. What lasts longer, a bridge or an implant?

There are few meaningful studies that compare the durability between implants and bridges. This is also due to the fact that there are different prognostic conditions for both restorations. It is important for an implant that the bone is good, for a bridge that the tooth abutments are good.

In an overview study of the University Hospital Bern it was statistically recorded that an implant had a slightly better 5-year success rate than a dental bridge. In the 10-year prognosis, however, the opposite was true. So it might not be correct to argue with a higher probability of success for one or the other type of tooth replacement.

Conclusion: It will depend on the conditions whether the dental implant or the dental bridge will last longer.

4. stress/loading: higher for implant treatments

One can still write so much that by modern anaesthesia possibilities, twilight sleep/sedation or general anaesthesia, the implant procedure objectively represents a consistently less stressful intervention. It is and will remain an operation, the idea of which should fill everyone with less or more discomfort. The more inevitable for the healing success or the more important the achievement of the desired goal is, the more one is

inclined to take on loads. With good, less exciting alternatives the willingness decreases accordingly. This is not only true for anxiety patients.

Conclusion: only if there is no real alternative to implants, an anxious patient will want to follow the path.

5. will the implant treatment be uncomplicated or difficult?

The protection of one’s own teeth is an important argument in favour of implants. But what about the risks of implant treatment? If the bone supply is good and the risk profile is otherwise favourable, the green light is quickly given. If, however, a large bone augmentation is necessary and important nerve tracts are endangered, it can look quite different. Implants are not about their end in themselves, but about their benefit in the treatment of a patient, carefully weighing the benefits, costs and risks.

Conclusion: The more difficult an implant treatment becomes, the more the bridge appears to be a good alternative.

6. age of the patient

If there are still no scientific studies for young patients regarding the question of implant prognosis and the “afterwards”, it seems that in this patient group a gap can only be adequately treated with an implant if the protection of one’s own teeth and the preservation of the jawbone are to be taken into account.

Since implants also function in old age, there is no age limit for the restoration of a tooth gap with an implant. Nevertheless, there are a number of biological differences (apart from the state of health) between young and old that may be relevant for the choice of dental prosthesis. As we get older, the life expectancy of our teeth decreases as well. The need for therapeutic foresight over a period of decades is therefore no longer necessary after a certain age. In addition, in older teeth the tooth nerve has generally receded, so that nerve damage due to grinding (a so-called grinding trauma, see above) is becoming increasingly unlikely.

All this does not argue against an implant restoration, but makes the grinding of teeth for a bridge seem less problematic from a medical point of view.

Conclusion: In high patient age dental bridges are less disadvantageous.

7. state of health

Conclusion: Although there are hardly any health reasons against an implant, this is all the more true for a bridge.

8. pro and contra dental bridge vs. implant:

What’s in favor of an implant?

  • healthy (fillingless, non-crowned) neighboring teeth
  • good bone supply
  • unsafe abutments (periodontitis, root diseases, unstable)

What limits the implant indication?

  • Difficult, riskier intervention
  • shortage of time
  • severe bone deficiency
  • insufficient funds
  • negative emotions towards surgical interventions

What’s the point of a bridge?

  • low financial resources
  • Neighboring teeth in need of crowning or already crowned
  • reduced physical capacity

What’s wrong with a bridge?

  • Healthy neighboring teeth
  • young patients
  • unsafe abutments (periodontitis, root diseases, unstable)

Hupfauf, L., Horch, H. H. (Herausg.), Festsitzender Zahnersatz, Bd 5, Urban & Schwarzenberg; Auflage: 3. Aufl. (1993)Zitzmann NU, Krastl G, Hecker H, Walter C, Waltimo T, Weiger R., Strategic considerations in treatment planning: deciding when to treat, extract, or replace a questionable tooth. J Periodontol. 2008 Jun;79(6):971-7. Avila G, Galindo-Moreno P, Soehren S, Misch CE, Morelli T, Wang HL., A novel decision-making process for tooth retention or extraction, J Periodontol. 2009 Mar;80(3):476-91.Pjetursson, Bjarni E., Brägger, Urs et al: Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs). Clin. Oral Impl. Res. 18 (Suppl. 3), 2007/97–113Zitzmann NU, Krastl G, Hecker H, Walter C, Weiger R., Endodontics or implants? A review of decisive criteria and guidelines for single tooth restorations and full arch reconstructions. Int Endod J. 2009 Sep;42(9):757-74. Epub 2009 Jun 22

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Christina Cherry
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