Skip to content
FR Access 01 42 67 05 04 Appointment

Managing a missing tooth: bonded bridge, bridge or implant?

A missing tooth is not always replaced the same way. Three fixed options exist; the choice depends first on the neighbouring teeth, on the available bone and on your situation.

Draft awaiting review

Book an appointment01 42 67 05 04

Why replace a missing tooth?

A missing tooth leaves a space that the mouth does not tolerate for long without change. The neighbouring teeth may tilt into the gap, the opposing tooth may drift down or up looking for a contact, and the bone that supported the root gradually resorbs. Chewing shifts to the other teeth, which wear faster.

Replacing the tooth is therefore not only a matter of appearance: it is also a way of protecting the remaining teeth and preserving bone.

Three fixed solutions

The bonded bridge

A bonded bridge replaces the missing tooth with a ceramic tooth attached to a thin wing, bonded to the inner surface of one neighbouring tooth (a single-wing “cantilever” bonded bridge). The neighbouring tooth is not prepared, or hardly at all: only what is needed for bonding is removed, within the enamel.

  • Strengths: no damage to the neighbouring teeth, no surgery, a reversible procedure, a good aesthetic result in the front of the mouth.
  • Limits: it needs healthy enamel and enough space; it is not suitable for molars or for people who clench or grind heavily; debonding remains possible and is usually repaired by rebonding.
  • Typical indications: a lateral incisor missing from birth (agenesis), an incisor lost after an injury, waiting for the end of growth in a teenager.

The conventional bridge

A conventional bridge rests on the two neighbouring teeth, which are prepared to receive crowns; the missing tooth is fixed between them. It is a well-established solution, but it requires reducing two teeth, sometimes healthy ones.

  • Strengths: fixed, no surgery, completed in few appointments; useful when the neighbouring teeth are already crowned or heavily restored.
  • Limits: two teeth are prepared, with a long-term risk for their nerve; cleaning under the middle tooth is more demanding; the bone under the gap keeps resorbing.

The implant

Illustration : implant dentaire et couronne
Implant, abutment and crown (illustration).

An implant is an artificial titanium root placed in the bone, on which a crown is fixed. It replaces the tooth independently: the neighbouring teeth are left untouched and the bone keeps being stimulated.

  • Strengths: neighbouring teeth intact, bone maintained, cleaned like a natural tooth, a durable solution when the conditions are met.
  • Conditions: enough bone volume (otherwise a graft is possible), healthy gums, completed growth, a compatible general health and any periodontal disease treated beforehand.
  • Limits: a surgical procedure, usually simple; a treatment in several stages; a higher initial cost.

How we decide at the practice

Planification 3D d'implants et de greffe
Three-dimensional planning: the bone volume is measured on the imaging before any decision.

There is no right solution in the abstract: there is the solution suited to one mouth and one person. Here is the order in which we examine the situation.

  • The neighbouring teeth: if they are healthy, we avoid preparing them; the choice is then between the implant and the bonded bridge. If they are already crowned or badly damaged, the conventional bridge becomes logical again.
  • Bone and gums: a clinical examination and three-dimensional imaging (cone beam) measure the available volume. Insufficient bone does not rule out an implant, but it requires a graft, which weighs in the decision.
  • Age: in teenagers and young adults, the implant waits for the end of growth; the bonded bridge is then the interim solution we prefer, because it preserves everything.
  • General health and habits: smoking, poorly controlled diabetes and some treatments (bisphosphonates, radiotherapy of the face) guide the decision and call for medical advice.
  • The bite: heavy clenching or grinding weakens a bonded bridge and points to another option.
  • Your expectations: aesthetics, timing, number of appointments and budget are discussed openly before deciding.

In practice, when the conditions are met, the implant is the solution we propose first for a single missing tooth, because it preserves the neighbouring teeth and the bone. The bonded bridge is our solution of choice for an incisor in a young patient, or when surgery is not wanted. The conventional bridge keeps its place when the neighbouring teeth already need crowns.

What if nothing is done?

Not replacing a tooth is sometimes a reasonable choice, for instance a wisdom tooth or a molar with no opposing tooth. In other cases, the sensible step is to talk about it: a consultation measures the real consequences in your mouth and sets, together, the right time to act.

At the practice

Implants are placed by Docteur Michaël Arroche and Docteur Victor Hazout; bonded bridges and crowns are made by the restorative and aesthetic team. Impressions are taken with an optical scanner, without impression paste. A written estimate and treatment plan are given to you before any procedure.

Related care

Implant dentaire dans l'os (animation)Implantology Intervention au bloc chirurgicalOral surgery Facettes en céramique et gencive, résultat d’un cas traité au cabinetAesthetics

Further reading

Empreinte optique : la praticienne montre à la patiente son modèle 3D sur l'écran du scanner intra-oralDigital impressions: the 3Shape TRIOS scanner in practiceAt the practice, impressions are taken with a 3Shape TRIOS intraoral scanner, without paste or trays. Here is how it works and what it brings to your care. Implant dentaire dans l'os (animation)Straumann and Dentsply Sirona implants: our choice explainedNot all implants are equal. The practice has chosen two long-established manufacturers, Straumann and Dentsply Sirona, for their clinical track record, the quality of their surfaces and the lasting availability of their components. Modélisation 3D d'une grille en titane au maxillaireCustom titanium mesh or titanium-reinforced PTFE membrane?When bone is lacking to place an implant, it has to be rebuilt. Two devices hold the grafted volume in place during healing: the custom-made titanium mesh and the titanium-reinforced PTFE membrane. The choice depends on the shape and extent of the defect. Aligneurs transparents (animation)Clear aligners: Invisalign and the other aligner systemsClear aligners move teeth with a series of custom-made trays. Several brands exist; at the practice, our orthodontists work with Invisalign, the original system, which has the longest clinical track record.