Bridge or Denture: Replacing Teeth Without Implants

This cost is in tooth and gum, not money: a conventional bridge usually involves cutting down teeth, while a partial denture can increase plaque.

A conventional bridge usually means crowning the supporting (abutment) teeth. On resin model back teeth in a laboratory, complete crown preparations took about 67.5% to 75.6% of the part above the root, and adhesive or inlay designs about 5.5% to 27.2% (Edelhoff and Sorensen, 2002).

Over an average of about 14 to 16 years, one retrospective study found signs of a dead nerve in 25 of 77 crowned bridge-supporting teeth, and nerve-related failure in 19 of 122 single crowns (Cheung and colleagues, 2005).

For partial dentures, a 2011 narrative review (Preshaw and colleagues) found clear evidence of increased plaque and gum inflammation. They have not clearly been shown to raise the risk of periodontitis, deeper gum disease, while decay risk, particularly on roots, appears higher.

A 2025 review of 46 studies (Drummond and colleagues) found a higher risk of extraction after 5 years for teeth supporting the denture and teeth with dead nerves. Mobility and pocket depth did not change, gum inflammation scores rose, and the authors described few periodontal changes.

Direct comparisons are mixed. In a UK hospital trial of mostly older people missing lower back teeth, new decay at 2 years totalled 11 lesions with cantilever resin-bonded bridges and 51 with metal-framework partial dentures, a significant difference (Jepson and colleagues, 2001).

A German trial of 152 people missing molars in one jaw compared precision-attachment partial dentures with a shortened arch, its second premolar kept or replaced by a cantilever bridge. At 10 years, reached by 82 people, an estimated 44% and 52% respectively had lost no tooth, and 67% and 60% none in the study jaw. More teeth were lost than expected, and the authors suggested the prosthesis's influence has been overestimated (Walter and colleagues, 2018). Gum attachment loss, bleeding and plaque significantly favoured the shortened arch, pocket depth did not differ significantly, and they judged the overall differences of minor clinical relevance (2020 report).

A 2022 review of people with gum disease (Gotfredsen and colleagues) noted two retrospective studies linking partial dentures with more tooth loss than fixed bridges, but found no strong evidence that partial dentures themselves cause periodontal destruction, including tooth loss. The trials' bridges were resin-bonded or cantilever, so they say less about conventional ones.

Both can take some adjusting to. NHS guidance says getting used to dentures can take a few weeks, and Bristol Dental School says the bite might feel different after a resin-bonded bridge, adjusting over a number of weeks.

Quality-of-life trials differ, though both groups improved in each. In an Irish trial of 132 people aged 65 or over, 89 finishing, questionnaire scores at 24 months were significantly better with resin-bonded bridges than cobalt-chromium partial dentures in both its centres, particularly in its older, less well group, with fewer teeth replaced in the bridge group (McKenna and colleagues, 2018). A German trial of partial dentures against a shortened arch found no significant difference between them over 5 years (Wolfart and colleagues, 2014).

Dental implants are a third way to replace missing teeth, covered in the implants section. One page there starts from a bridge as the alternative and another from a denture as the alternative.

More treatment pairs are weighed in the options in this section. The wider service, repairing and rebuilding damaged teeth, centres on saving natural teeth, as distinct from implants.