Missing Tooth: Implant vs Bridge vs Denture, and What the Data Show

Missing Tooth: Implant vs Bridge vs Denture, and What the Data Show

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If you have lost a tooth, every page you open names a winner: implants are the gold standard, bridges are quicker, dentures are old-fashioned. The data are more modest. The Cochrane review that tried to compare ways of replacing missing teeth in randomised trials found 21 trials and not enough evidence to recommend any method. It was withdrawn in 2019 as out of date, and we found no long randomised head-to-head trial of implant crown against bridge against partial denture that has taken its place.

What exists instead are cohort studies that follow each option separately, a few trials on narrower questions and a great deal of marketing. This article puts the numbers side by side for one missing tooth, or a short span of up to three, explains why “still in the mouth” is not the same as “no problems”, and looks at what leaving the gap does. It will not tell you what to choose. That depends on your neighbouring teeth, gums, bone and habits, and only your dentist can examine them. It should help you ask better questions.

The Numbers Side by Side

The table gives the best pooled figures we found for each option. Read the notes under it before comparing rows.

Three cautions. First, the rows come from different groups of patients, not from one head-to-head test, and a systematic review that looked for a direct comparison of single implant crowns with tooth-supported bridges did not find one (Salinas 2007). Second, many pooled figures come from specialist and university settings, and everyday data can look worse: in NHS general dental service records for more than 80,000 adults in England and Wales (6,800 conventional bridge abutments), 72% of the abutments went ten years without further intervention other than re-cementation (Burke 2012). Third, “survival” only means the restoration is still in the mouth, with or without repairs, and the ten-year figures rest on fewer studies with wide confidence intervals (for the implant crown 89.4%, 95% CI 82.8–93.6; Jung 2012).

Count complications and the picture shifts. A 2012 review found screw loosening in 8.8% of implant crowns at five years, gum-tissue problems in 7.1% and loss of retention in 4.1% (Jung 2012). Newer studies found lower rates, 3.6%, 5.1% and 2.0% (Pjetursson 2018), and a 2018 international consensus summed complications up at 13–16% of implant crowns, about one in six (Morton 2018). For conventional bridges, 10-year survival was 89.2%, but only 71.1% were free of any complication in a separate review (Tan 2004).

Implant Crown: A Durable Implant and a Busier Crown

The implant is the sturdy part. In a pooled analysis of 46 studies it was still in place in 97.2% of cases at five years and 95.2% at ten. The crown on top is the weaker link, at 96.3% and 89.4%; the review counted crowns that were lost, removed or remade, and technical problems such as chipped porcelain and loose screws were frequent (Jung 2012). For a single crown, material made little difference to five-year survival: metal-ceramic and zirconia both stayed above 97%, with screw loosening more common in the first and core fractures in the second (Pjetursson 2018). For a bridge on several implants, veneered zirconia did worse than metal-ceramic (93.0% against 98.7% at five years) and chipped far more (Sailer 2018). Our pages on zirconia crowns and e.max against zirconia go into materials, and our complete guide to dental implants covers the procedure.

The other issue is the tissue around the implant. A 2025 review of 102 studies and 13,030 patients put peri-implant mucositis, reversible gum inflammation, at 46% of patients and peri-implantitis, inflammation with progressive bone loss, at 21%, with huge variation between studies and 12% of patients developing peri-implantitis within five years (Galarraga-Vinueza 2025). Our article on peri-implantitis covers symptoms and treatment. What the guideline stresses is upkeep. The European guideline recommends a supportive care programme once implants are in function, and in the studies behind it regular attenders had lower odds of peri-implant disease (OR 0.42), while irregular care went with a 3.76-fold higher risk of implant loss (Herrera 2023). Those are observational data: they show an association, not proof.

Do implants spare the neighbouring teeth? Not necessarily. One US university cohort found that 8.1% of teeth next to implants were lost, against 0.7% of other teeth (Chen 2024). A matched German study found a smaller difference, 10.4% against 6.0%, and once pre-existing root fillings (HR 2.08) and crowns (HR 2.02) were counted, the neighbouring implant itself showed only a limited association with tooth loss (Halstenbach 2026). Both are retrospective studies from single centres.

Bridges: Conventional, Cantilever and Maryland

A conventional bridge, with crowns on the teeth either side of the gap, was still in place in 93.8% of cases at five years and 89.2% at ten (Pjetursson 2007). That matches the implant crown at ten years, but the problems differ, and they sit in the supporting teeth. Pooled data from about fifty years of studies counted decay in 18% of those abutments and a need for root canal treatment in 11% (Goodacre 2003), and preparing a tooth for a full crown removed about two thirds of the crown in laboratory models, 63–72% in front teeth and 68–76% in back teeth (Edelhoff 2002). Against that, fewer than 5% of abutments had been removed at ten years in pooled data, although nearly a third of bridges were removed or needed replacing by fifteen (Scurria 1998).

A cantilever bridge, hanging from teeth on one side only, did worse: 80.3% at ten years in the pooled comparison (Pjetursson 2007) and 81.8% in a dedicated review, which also found loss of nerve vitality in 32.6% of supporting teeth (Pjetursson 2004).

A Maryland, or resin-bonded, bridge glues a wing to the back of the neighbouring tooth with little or no drilling, in laboratory models about 3–30% of tooth structure for front-tooth resin-bonded retainers and porcelain veneers combined (Edelhoff 2002). The price is debonding: 15% within five years, and 82.9% survival at ten (Thoma 2017). Evidence conflicts on the design. One review found one-wing bridges did better than two-wing ones (Thoma 2017), another found no difference (Alraheam 2019). A German group with long experience of one-wing zirconia bridges reports 98.2% survival at ten years (mean observation about 7.7 years), with debonded bridges re-bonded (Kern 2017), but those are single-centre series by the group that uses the technique. One review found front-tooth bridges survived better than back-tooth ones (Thoma 2017); an earlier review found only a non-significant tendency towards less debonding at the front (Pjetursson 2008).

Removable Partial Dentures: Reasonable Survival, Constant Upkeep

A 2025 meta-analysis of 46 studies found five-year survival of 95.1% for clasp-retained dentures and 91.7% for dentures held by telescopic crowns. The teeth that hold them were extracted more often after five years (OR 1.99), non-vital teeth most of all, but periodontal measures changed little (Drummond 2025). The definition of “survival” changes everything: in a Dutch cohort of 886 dentures only 40% of the conventionally designed ones survived five years if retreating an abutment counted as failure, against 75% if failure meant replacement or no longer wearing the denture (Vermeulen 1996). Dentures need looking after. They clearly increase plaque and gingivitis, root decay risk appears higher, and regular recall is essential (Preshaw 2011).

Quality of life is where dentures surprise. In a randomised trial in 14 German prosthodontic departments, patients aged 35 or older with all molars missing in one jaw were given either a shortened arch ending at the second premolar or a precision-attachment partial denture. Both groups improved by about 20 points on the OHIP-49 questionnaire, and the difference over ten years was −0.6 points (95% CI −7.1 to 5.9) (Reissmann 2019; Schierz 2021). That trial covers molar loss, not single-tooth gaps. A non-randomised study of 200 partially edentulous patients aged 30 to 50 found that every treatment improved quality of life, with the smallest gain for removable dentures (Swelem 2014). NHS.uk says dentures usually take a few weeks to make, may become loose as gums and jawbone change, and immediate dentures (made quickly, for example after extractions) often need adjusting or replacing up to a year later. See our page on removable partial dentures for the options.

Leaving the Gap: When Waiting Is Defensible

In 111 patients with one untreated back-tooth gap followed for a median of 6.9 years, most lost 1 mm or less of the space between the neighbours, the opposing tooth moved 1 mm or less in 99%, and bone loss next to the neighbours was 1 mm or less in 83%. The authors concluded that immediate treatment may not be critical and that monitoring may be warranted (Shugars 2000). That is one result. Another found that 83% of 155 unopposed back teeth had over-erupted, by up to 5.4 mm (Craddock 2004), and in a 12-year study of 292 women, unopposed molars were almost five times as likely to over-erupt by 2 mm or more (95% CI 1.5–15.3; Lindskog-Stokland 2012). Our reading of the two findings together: small movement in most people, a larger one in some.

Where the gap is matters. In a systematic review of 35 studies (10 of them pooled), tooth loss was linked to worse quality of life everywhere; four of five studies found a larger impact from front-tooth than back-tooth loss, and one pooled estimate put the odds of an impact on daily life about 1.8 times higher with at least one unrestored front-tooth space, although that estimate from two studies was imprecise (95% CI 0.68–4.87; Gerritsen 2010). Chewing depends on which teeth remain. In a Tanzanian survey of people with intact front teeth, 95–97% of those whose arch kept the premolars and at least one pair of molars had no chewing complaints, but 95–98% of those with two or fewer pairs of occluding premolars did (Sarita 2003). Drifting and bite collapse are described as consequences of stage IV (advanced) gum disease in the European guideline (Herrera 2022), which is a different situation.

What about the bone? In a review of 20 human studies, the ridge lost 3.79 mm of width on average within six months of an extraction, with the fastest change in the first three to six months (Tan 2012). Placing an implant straight away did not stop it in one small study of 18 patients: the outer bone wall still resorbed within four months (Botticelli 2004). A Cochrane review found that filling the socket with a xenograft bone substitute reduced loss of ridge width by about 1.2 mm compared with extraction alone, with very low certainty, and found no clear difference in later bone-grafting needs or implant failure (Atieh 2021). A 1998 narrative review concluded that an implant-supported fixed prosthesis “seems to be the best means” of preserving residual alveolar bone (Wyatt 1998), but we found no controlled human study comparing implant, bridge or denture with leaving the gap.

Which Option Fits Which Situation

The table links what we verified to common situations. It is a map of the evidence, not a recommendation, and your dentist’s examination comes first.

Imaging is part of the assessment. The American Academy of Oral and Maxillofacial Radiology recommends cross-sectional imaging for implant sites (Tyndall 2012), though a 2017 narrative review found no data showing fewer surgical complications or higher survival when a preoperative CBCT scan is used (Bornstein 2017). Our CBCT explainer covers what the scan shows. If more than a few teeth are missing, see full-arch options compared.

Our article on teeth grinding and dental work looks at the evidence on grinding in more detail.

Time, Visits and What the Money Studies Say

Timing depends on the protocol. In the consensus definitions, “immediate” placement is on the day of extraction, “early” placement waits 4–8 weeks for the soft tissue or 12–16 weeks for part of the bone to heal, and “late” placement means after more than six months; loading is immediate within a week, early up to two months and conventional after that (Morton 2018). A Cochrane review found no convincing evidence of a clinically important difference between loading times (Esposito 2013). The consensus says to plan placement before the tooth is extracted, and to reserve immediate placement with immediate loading for experienced clinicians and suitable conditions.

UK hospital leaflets, which are patient information and not evidence, describe typical steps. For an implant with early placement the tooth is extracted about 6–10 weeks beforehand, surgery takes about 90 minutes under local anaesthetic, the implant usually heals for 2–6 months before use (Leeds Dental Institute). Another hospital’s leaflet says a bone graft could prolong the overall treatment by 4 to 6 months (University Hospitals of North Midlands). The same leaflet describes a crown or bridge as a preparation appointment of one to two hours and a fitting appointment two to three weeks later (University Hospitals of North Midlands). Visits matter if you are travelling. In a Swiss practice comparison implant treatment needed more visits than a bridge (8.1 against 4.8) with similar total chair time (4.8 hours for implants against 5.1 hours for bridges) (Brägger 2005). That study is old, and no source we read compares visits for treatment abroad. Ask for the visit plan in writing.

Cost-effectiveness studies disagree, and prices vary by country and clinic, so we give no amounts. A 20-year simulation model called the implant the dominant strategy, with lower cost and higher success (Bouchard 2009), while a Korean decision model found the implant dearer, with a 10.4% higher survival rate (Kim 2014). A systematic review of 26 publications found similar long-term economics and noted that leaving healthy neighbours unprepared favoured the implant crown (Scheuber 2012). Ask for a written quote for the whole pathway, including maintenance and repairs.

What the weeks after implant surgery look like is covered in our implant healing timeline, and for the flight home see flying after dental surgery. If you have treatment abroad, who fixes dental work done abroad covers the aftercare questions.

Frequently Asked Questions

Do I have to replace a missing tooth?

Not always. In a study of 111 patients with a single untreated back-tooth gap, neighbours mostly moved 1 mm or less over a median of about seven years (Shugars 2000). Front-tooth gaps affected daily life more in four of five studies, and several missing premolars impair chewing. Have the gap and the bite examined before deciding.

Which lasts longer, an implant or a bridge?

Over ten years the implant crown (89.4%) and the conventional bridge (89.2%) were similar in pooled data, although the implant itself survived in 95.2%. The data come from separate cohorts, not a head-to-head trial, and complications differ.

Does a bridge damage the neighbouring teeth?

It requires preparing them. In laboratory models a full crown preparation removed about 63–72% of a front tooth’s crown. Decay was found in 18% of abutments and root canal treatment in 11% in pooled data, yet fewer than 5% of abutments were removed at ten years.

Does an implant protect the jawbone?

That is not shown. The ridge lost about 3.8 mm of width within six months of an extraction, and in one small study an immediate implant did not stop it. We found no controlled human study comparing implants, bridges, dentures and leaving the gap on bone.

Can I have an implant if I smoke or have gum disease?

These are risk indicators, not proven bans. Smoking was linked to about 2.25 times the odds of implant failure per implant, and a history of gum disease went with more peri-implantitis. Your dentist weighs them individually, usually after treating gum disease first.

When is a Maryland bridge a good option?

When the neighbouring teeth should be spared, typically for a front tooth (our reading). Ten-year survival was 82.9% and about 15% debonded within five years. One-wing designs may do better, but reviews disagree.

Is a partial denture still reasonable?

Five-year survival was 91.7–95.1% in pooled data, but 40–75% in one Dutch cohort depending on how failure was defined, and in molar loss a shortened arch and a partial denture gave equal quality-of-life gains. Expect repairs, relines and attention to plaque and root decay on the remaining teeth.

How long does treatment take?

It depends on the protocol. UK hospital leaflets and NHS.uk describe months from extraction to final crown for an implant, two visits about 2–3 weeks apart for a crown or bridge and a few weeks to make a denture. That is patient information, not trial data.

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This article is for general information only and does not replace an individual dental examination or the advice of your treating dentist. The figures are pooled estimates from different studies and populations, mostly from Europe, the USA and Asia, and many come from specialist centres; they are not a guarantee of any outcome for any individual patient or clinic.