Implant or bridge?

Implants and bridges close unsightly gaps between teeth when a tooth has to be extracted. But when is which solution better? What lasts longer: bridge or implant? What are the advantages and disadvantages of both methods? And what do they cost? Our expert, Dr. dr An interview with Manfred Nilius.

Implant: artificial tooth root

Dental implants are based on artificial tooth roots surgically attached to the jawbone so that a denture can be attached to them, such as a crown, bridge or removable dentures.

While the jawbone of wearers of partial and complete dentures often recedes due to incorrect loading, leading to instability, dental implants are firmly anchored in the bone like your own tooth. The small artificial roots of titanium or zirconium oxide provide the crowns or bridges attached to them with a secure hold and thus give the patient a perfect bite. “No method replaces missing teeth so naturally and inconspicuously,” emphasizes maxillofacial surgeon Dr. dr Manfred Nilius.

With the help of the latest computer technology, the implantologist calculates the position, angle and size of the optimal implant down to the millimetre and then plants it exactly where the root of the lost tooth was originally.

 

Bridge: bridging gaps between teeth

The fixed bridge is a tried and tested method of closing tooth gaps, and there are different types of bridges. The dental bridge is usually made of metal and veneered with tooth-coloured ceramic. Smaller versions are often made entirely of high-performance ceramics, which can also withstand high chewing forces in the area of ​​the posterior teeth. The bridge is so named because it bridges a tooth gap by being attached to the adjacent teeth.

In addition to a pontic that spans the gap, two anchor crowns are required, which are placed on the teeth to the left and right of the gap. Before that, however, the teeth have to be ground down like with a standard crown. Thanks to stable metal frameworks, several missing teeth can also be bridged. Bridges of the new generation are made of bioceramics and can be milled with computer assistance.

Both variants, bridge and implant, are often combined so rows of up to twelve teeth can be replaced on just four or six implants.

Implant or bridge? Expert Dr Interview with Nilius

What you always wanted to know about bridges and implants and what else you should know can be found below. The expert, Dr. Manfred Nilius, answers the most frequently asked questions on the subject.

 

When is an implant beneficial?

With the help of an implant, a firm anchorage is also possible where no natural one is available. The advantage: there is no need to grind down healthy teeth since the implants are fixed directly in the jaw and not on the tooth walls as with a bridge.

In which cases is a bridge still the better solution?

A bridge is the first choice if both neighbouring teeth are damaged. Because, in this case, they are optically supplied at no additional cost.

When should you generally do without an implant?

Implants can only be recommended to a limited extent in the case of diabetes, leukaemia, heart disease or severe disorders of the immune system. The same is true with certain medications or drug addiction. In these cases, it is essential to consult your family doctor beforehand.

 

What are the specific disadvantages of both methods?

Implants: Usually, the cost is higher than traditional bridges. In addition, the jawbone has to be drilled, even if it is only minimally invasive. Pay attention to the paranasal sinuses in the upper jaw. The lateral lower jaw area is essential to protect the sensory nerves.

Bridges: Patients often perceive these as foreign bodies. They can slip and wobble and do not provide as tight a fit as implants firmly anchored in the bone. Many tooth substances must be sacrificed to produce a beautiful new crown. In the case of bridges with a metal framework, the dark edge of the crown often shimmers through the mucous membrane.

Are there risks?

Implants: Wound healing disorders can occur. For smokers, the current success rate of around 98.8 per cent is significantly reduced. Serious risks are not known.

Bridge: There may be nerve damage to the tooth with subsequent nerve removal and discolouration. Losing the tooth and thus the loss of the entire bridge is possible. In addition, hygiene problems can arise under the pontics since cleaning is difficult.

Can implants cause allergies?

Instead of conventional materials such as gold and steel, “softer” materials such as “zirconium oxide” ceramics are increasingly used for implant construction. This means that the problem of metal intolerance, which often occurs, is off the table. Optically, some things speak in favour of implants as an alternative: the grey tinge that used to be familiar with implants is guaranteed to no longer be an issue.

 

How long do modern implants and bridges last?

Implants: With proper care, they last a lifetime.

Bridges: 15 years and longer.

How are dentures “anchored”?

Implants: A scalpel is unnecessary with modern methods. Instead of cutting open the mucous membranes, implantologists punch holes. The “corkscrew method” is relatively new. Unique laser technology and a corkscrew-like thread enable the implant to be anchored with a single hole that is only two millimetres tiny. The advantage for the patient: The wound heals more quickly, and swelling and pain are significantly reduced.

Bridges: Besides a bridge element that spans the gap, two anchor crowns are placed on the teeth to the left and right of the gap as a holder.

Is an implant possible even if there is little bone substance?

As a rule, the jawbone of a tooth gap provides sufficient substance for an implant with a ceramic structure. If not, the missing bone can be built using artificial replacement materials and the body’s tissue.

 

How much do the dentures cost?

Implants: The implant costs 1,500 to 2,500 euros, plus the structure and dental crown. 

Bridges: from 1,500 euros.

Does the health insurance company pay part of the costs?

Yes, the costs for the bridge are covered by health insurance. In the case of implants, statutory health insurance usually does not bear the costs. However, health insurance companies often pay a fixed subsidy for standard care. Talk to your dentist about the costs, treatment, and plan.

What should I consider when choosing a doctor?

If you decide to have an implant, the oral surgeon or dentist should be able to demonstrate further training as an implantologist.