Closing the gap - bridge or implant?

You have a gap in your teeth. Now you're wondering how you can smile brightly again. Which is better - a bridge or an implant? Both options have their advantages and disadvantages. Here you can find out what you need to know to make your decision.

A gap in the dentition is not only an aesthetic problem, but also a medical one. The neighboring teeth start to move and, in the worst case, tip into the gap. Without counterpressure, the opposite tooth grows out of the tooth bed (1). It is therefore important that you quickly restore a complete set of teeth.

It used to be simple - you either had a gap or a bridge! Implants are now becoming increasingly popular and over a million are inserted every year in Germany alone. Are bridges now obsolete? When should you consider a bridge and when does an implant make sense?

A bridge hangs from the cornerstones

A bridge in the mouth works in exactly the same way as in road construction: a structure is suspended from two pillars that spans a valley or a river (in this case a gap between teeth). Your teeth are ground down to the left and right of the gap. The amount of real tooth substance you lose depends on the bridge construction (2). They are then given a continuous crown so that the gap is closed.

Strong abutments are a prerequisite for the bridge to hold securely. If these are already wobbly or affected by periodontitis, they would not be suitable for a bridge.

This means that two teeth have to be ground down for a bridge. If your teeth are healthy and caries-free, you are "sacrificing" two healthy teeth. Many dentists are reluctant to do this. It's probably not a good idea for you either.

However, if the neighboring teeth themselves already have a large filling or you have already had root canal treatment on one of the teeth, a bridge may well be a good idea - then you will have restored three teeth at the same time without higher costs. Speaking of costs...

How much money you need to budget for a bridge or implant

Statutory health insurance covers half the cost of standard care for the bridge. Standard care means a bridge

• with the veneering of one side in the visible area or
• No veneering on the molars.

This costs around €700 to €900 - half of which will be reimbursed by your health insurance provider. Depending on the material and veneering of the bridge, your own contribution will be between €350 and €1500. For an implant, you will have to pay around €1500 to €2500 out of your own pocket.

The reason: statutory health insurance does not pay anything towards the actual implant, the artificial tooth root. You only receive the so-called fixed cost subsidy for the crown that is screwed onto the implant. An implant is therefore associated with higher costs.

What are the arguments against an implant or a bridge?

A bridge is only as good as its supporting pillars. This is just as true on a highway as it is in your mouth. If your teeth are already wobbly due to periodontitis or caries has already affected the abutment teeth, the bridge will only last a short time. In this case, a bridge would not be a good solution for you.

Another factor is the jawbone. The bone is not stressed under a bridge. The bridge abutments absorb all the forces that occur during chewing. The bone therefore slowly recedes due to the lack of load (3). A bridge can therefore mean that there is simply not enough bone material for an implant later on.

Implants preserve bone substance

This, in turn, is a major advantage of implants: Your jawbone is still loaded as if there was a tooth in place. This stresses the bone and protects it from deterioration. The implant is drilled directly into the bone. It is therefore important that there is no periodontitis or other bacterial infection on the bone. They could spread one level deeper into the bone after the implant has been inserted (4). In any case, you should first have your periodontitis thoroughly treated before the artificial root is implanted.

After the root has been inserted, it must grow into the tooth for a few weeks. Numerous diseases can lead to impaired wound healing. These include severe osteoporosis, leukemia and poorly controlled diabetes with impaired wound healing (5). However, heavy smoking, excessive alcohol consumption and night-time teeth grinding can also ruin the implant (6) (7).

The quality of your jawbone is also crucial for an implant (8). A gap between teeth that has existed for a long time or a tooth with severe periodontitis can significantly weaken the bone substance. If the bone is too thin, it cannot firmly anchor the artificial root. In this case, your dentist can try to build up the bone artificially or with the body's own substances. However, this is not always successful.

Risks with implants and bridges

An implant requires an operation in which the screw is inserted into the bone. There are the usual surgical risks, such as bleeding or infection. If you need an implant in the upper jaw, sinuses can be injured (9). Numerous nerves run through the lower jaw, which can be damaged when the implant is inserted (10). However, the vast majority of procedures are completely free of complications.

With a bridge, your adjacent teeth are ground down. This can lead to so-called grinding trauma (preparation trauma). This may require root canal treatment (11). In extreme cases, you may even lose the tooth. Such a grinding trauma is far from rare. Most sources assume 10 to 15 %.

Is the duration of treatment important to you?

Have you gathered enough information and made your decision? Then you can get started. However, the duration of treatment is quite different for the two options.

For a bridge, the adjacent teeth are ground down in the first appointment and an impression is taken. In a second appointment, your dentist checks the fit of the bridge before it is finalized by the laboratory. At the third appointment, the bridge is finally fitted. This procedure takes a total of ten days to three weeks.

With an implant, you need to be more patient. During the first session, your dentist cuts open the gums slightly, drills a hole in your jawbone and inserts the artificial tooth root. This then has to grow into the bone for a few weeks or even months.

After about a week, the stitches are removed and the dentist checks whether the wound is healing well. As soon as the implant is ready for the crown to be fitted, your dentist exposes the implant and takes the impressions. In one or more follow-up appointments, the crown is first fitted and then firmly anchored to the implant.

What about the shelf life?

Both bridges and implants are durable. A service life of over 20 years is possible with both variants.

For a bridge to last so long, the framework conditions have to be right. Your supporting pillars must be able to cope well with the "supporting role" over the years. You should prevent periodontitis from occurring in the first place with good oral hygiene and regular visits to the dentist. On average, 90% of bridges are still in place after ten years. However, if a supporting tooth has suffered grinding trauma and root canal treatment has become necessary, this will affect its lifespan. In this case, the risk of losing your bridge within ten years or even sooner is considerably higher.

Implants are also very durable. Here too, over 90 % still fulfill their full function after ten years. However, a study has shown that peri-implantitis occurs in 30 to 40 % of implants after a few years (12). But this does not have to be the case. Careful daily hygiene and individual dental hygiene at the dentist prevent peri-implantitis from occurring in the first place.

Friendship lasts a long time with the right hygiene

If you want to enjoy your radiant smile for a long time, oral hygiene plays an important role in your future life. In the blocked situation of the bridge, food debris can accumulate under the intermediate tooth and your gums. This causes bad breath and can even lead to inflammation. The transition from the abutment to the intermediate tooth is also a critical point where bacteria can accumulate. In the worst case scenario, this can lead to periodontitis or tooth loss. Only special toothbrushes and dental floss can help to ensure perfect hygiene!

You should pay even more attention to the care of your implant than a bridge. As the artificial tooth root protrudes through your gums and is directly connected to the bone, meticulous cleanliness should be your top priority. Daily care with brushes and dental floss as well as regular visits to the dentist and dental hygienist are essential with an implant.

Your doctor can use modern saliva tests to detect even mild inflammation. They also show whether collagen degradation is taking place in the supporting structures in your mouth. This allows you to take countermeasures in good time - before deep pockets form in your gums or your tooth starts to wobble. A personal hygiene plan tailored to you will ensure that you can enjoy your implant for a long time!