Replacing Missing Teeth: Options for One, Several or All Teeth

One missing tooth

• An implant with a crown. The implant, a small screw-shaped post, is placed in the jawbone and a crown is fitted on it after healing. The neighbouring teeth are usually not drilled or crowned. A review of 46 studies found that of every 100 implants carrying a single crown, about 97 were still in the mouth after five years and about 95 after ten¹. The crown is a separate part: about 96 in 100 were still in use after five years and about 89 after ten. Over five years the same review reported screw loosening in 8.8 per cent and soft-tissue problems in 7.1 per cent¹. Implant surgery has its own risks: bleeding, swelling and infection can occur, an implant can fail to fuse with the bone, and in the lower jaw the lip and chin can go numb, usually temporarily and rarely permanently.
• A conventional bridge. The teeth either side of the gap are usually reduced and crowned to carry a false tooth. No surgery is needed, but the tooth tissue removed does not grow back, and in long-term studies decay and the nerve dying in those supporting teeth² were the most common problems.
• A resin-bonded bridge. A false tooth with a thin wing bonded to the back of a neighbouring tooth. Little or no grinding, no surgery, but it can come loose.
• A removable partial denture. No surgery. It is taken out to clean, and it is often used as a temporary tooth while an implant heals.
• Leaving the gap. For a single back tooth this is reasonable for some people. Over time the neighbouring teeth can drift, the tooth opposite can move towards the gap and the bone shrinks, so have it checked.

The implant figures are averages from many studies, not a promise for one mouth. Conventional bridges were still in the mouth in about 9 in 10 cases after ten years³, but in separate studies: a 2007 review found no study comparing the two directly⁴, so the figures do not show that an implant is the better choice for you.

Several missing teeth in a row

• An implant for each tooth. Each implant carries its own crown.
• A bridge on implants. Fewer implants carry a bridge that spans the gap, for example three teeth on two implants. How many implants a gap needs is decided for your mouth; there is no fixed rule.
• A conventional bridge. Possible when there are strong teeth at both ends of the gap and the gap is not too long.
• A removable partial denture. One denture can replace teeth in several places in the same jaw.

With implants, the bone at each planned site is checked on a 3D scan. With a bridge or denture, the condition of the teeth that will carry it is checked.

All the teeth in a jaw

• A fixed bridge on four or six implants. The bridge is screwed to the implants and is not taken out at home. A 2026 review of 55 studies found that of every 100 implants, about 98 in All-on-4 and 97 to 98 in All-on-6⁵ were still in place after five years or more. The studies differed a great deal, and the authors ask for the results to be read with caution. Whether four or six is better has not been settled⁶. The bridge itself needs maintenance: in a 2012 review of bridges on four to six implants, about 97 in 100 upper and 98 in 100 lower bridges were in use after five years, and about 95 and 96 after ten⁷. Repairs are part of owning one: an umbrella review of full-arch bridges followed for 5 to 15 years reported screw loosening in 5 to 15 per cent, chipping of veneered zirconia in 15 to 35 per cent and peri-implantitis, inflammation around an implant with loss of the supporting bone, in 4 to 18 in 100 patients⁶, as far as the review summaries show; they do not make clear what the first two percentages were counted against. The All-on-4 and All-on-6 pages explain both.
• A denture held by implants. Implants hold a removable denture more firmly than the gums alone. You take it out to clean it. For a lower denture, a consensus report found that two implants gave better results than one, and more than two did not further improve what patients reported⁸. The upper jaw is planned separately: the evidence there is less clear⁹, and the number of implants depends on the bone and the design.
• A full denture. It rests on the gums and needs no surgery. Its fit changes as the gums and bone change, so it is checked and adjusted over the years.

When a few healthy teeth remain, keeping them is sometimes possible. Your dentist explains whether saving them or replacing them suits your mouth better.

When there is not enough bone

After a tooth is lost, the bone where it was can shrink. An implant then may need extra bone first.

• Bone grafting. Bone or a bone substitute is added where the implant will go. Building bone up in height is not a small step: a Cochrane review found complications common, especially with vertical grafting¹⁰. In a shrunken lower jaw, the review concluded that short implants appear to be a better alternative to vertical grafting. Both findings rest on few trials, most at high risk of bias.
• Sinus lift. In the back of the upper jaw, the sinus floor is raised and bone added. In a review of 11 studies of sinus lifts done through a window in the side of the sinus, in jaws with 6 mm of bone or less and followed for at least five years, implant loss was about 0.43 per cent a year per implant¹¹.
• Zygomatic implants. These are not a routine option. They are used when the upper jaw has too little bone for standard implants, and are anchored in the cheekbone. A Cochrane review calls the procedure technically demanding and says it may be associated with serious complications¹². Its randomised evidence comes from only two small trials.

The bone grafting page explains grafting and sinus lifts. If you would rather avoid more surgery, a bridge or denture may suit you better.

What decides the choice

The same questions come up for every option:

• Bone and gums. Is there enough bone for an implant, and are the gums healthy? Active gum disease and decay are treated first.
• The neighbouring teeth. Are they healthy and untouched, or do they already need crowns?
• Your health. Smoking, diabetes, gum disease, clenching and some medicines change the risk of implant treatment.
• Cleaning. Every option needs cleaning every day. Implants and bridges need small brushes or threaders; dentures come out to be cleaned.
• Time and surgery. Implants involve surgery and months of healing. Bridges and dentures usually do not.
• What bothers you. Chewing, appearance and speech matter differently to different people.

Ask for the plan in writing, with the steps, the reviews and maintenance you will need, and what happens if something fails.

When to see a dentist

See a dentist if you have lost a tooth or been told one has to come out, even if the gap does not bother you. An examination shows what is possible before the bone or the neighbouring teeth change.

Make an appointment sooner if you have pain, swelling, a loose tooth or bridge, or a denture that rocks or causes sores.

Emergencies. Difficulty breathing or swallowing, rapidly spreading swelling of the face or neck, or high fever are serious signs. Go to the nearest emergency department or call 112.

Frequently asked questions