A plan built around the future teeth
Several missing teeth do not always need one implant per tooth. Depending on the configuration, a bridge on implants or separate crowns may be proposed.
The number and position of the implants depend on the bone volume, the span of the bridge, the bite and how easily it can be cleaned. The prosthetic plan guides the choice of supports.
One implant per tooth? Not necessarily
The most common situation is two to four neighbouring missing teeth, often at the back of the mouth. Some example solutions, to be adapted to each case:
- Two neighbouring teeth: two crowns on two implants, or sometimes one implant carrying two teeth.
- Three neighbouring teeth: a three-unit bridge on two implants.
- Four or more teeth: a bridge on two or three implants, depending on the length and chewing forces.
- Several separate gaps: a combination of crowns and bridges, possibly with natural teeth kept in between.
Fewer implants often means less surgery and a lower cost, but each implant then carries more load. The balance is found using 3D imaging and with the dentist who will make the prosthesis.
Bridge on implants or separate crowns
| Option | Advantages | Points to consider |
|---|---|---|
| Separate crowns on implants | Each tooth is cleaned with floss or interdental brushes; a repair stays local. | One implant per tooth, so more bone and space are needed. |
| Bridge on implants | Fewer implants; useful when bone is limited in some places. | Cleaning under the bridge must be learned; a complication affects the whole bridge. |
| Bridge on natural teeth | No surgery if the supporting teeth are strong. | Supporting teeth are drilled down; limited span. |
| Removable partial denture | Simple and reversible solution. | Less stability and comfort. |
At the front of the mouth, two neighbouring implants make it harder to preserve the small point of gum between them. In the smile area, other set-ups are sometimes preferred for appearance.
What the research says
A 2014 review comparing older and newer publications reports, in recent studies, a 5-year survival of 96.4% for bridges on implants, and 96.1% for the implants supporting them. The authors note, however, that technical complications, such as chipped ceramic, and biological complications remain frequent.
Over the longer term, a 2019 meta-analysis estimates that about 96% of implants are still in place after 10 years. In the Swedish 9-year follow-up, 7.6% of patients had lost at least one implant: the survival of a single implant is therefore not the same as that of a whole treatment with several implants.
What affects the result
- Smoking : a 2021 meta-analysis estimates the risk of implant failure to be about 2.4 times higher in smokers, with more bone loss.
- A history of periodontitis : it is associated with a higher risk of peri-implantitis. Active gum disease is treated before placement.
- Diabetes : well-controlled diabetes does not rule out treatment, but it must be reported and monitored.
- Clenching or grinding : it increases the forces on implants and ceramic; a protective night guard may be advised.
- Maintenance : appropriate daily cleaning and regular check-ups are at the heart of the 2023 European guidelines.
The stages of treatment
- Assessment and 3D scanExamination, CBCT, digital impression and a tooth plan defined with your dentist.
- Preparation if neededGum treatment, extraction, bone graft or sinus lift if necessary.
- Implant placementUsually in a single procedure, under local anaesthesia; sedation can be discussed.
- OsseointegrationA few months of healing, with a temporary solution if possible.
- Bridge or crownsMade by your dentist if you were referred, followed by regular check-ups.
Frequently asked questions
Do I need one implant per missing tooth?
Not always. For three missing teeth side by side, a bridge on two implants is often possible. The number of implants depends on the available bone, the length of the gap, chewing forces and how easy the bridge is to clean.
Can two implants be placed side by side at the front?
It is possible, but the small point of gum between two neighbouring implants is harder to preserve than between an implant and a tooth. In the smile area, another set-up, such as one implant carrying an extension tooth, is sometimes preferable.
How long does a dental implant last?
In a meta-analysis of 18 studies, about 96% of implants were still in place after 10 years. The crown may need maintenance or replacement over time. Hygiene, not smoking and regular check-ups all matter for how long it lasts.
What is peri-implantitis?
It is inflammation of the tissues around the implant that leads to loss of the bone supporting it. It often starts as inflammation of the gum, which is reversible if treated early. Smoking, a history of periodontitis and insufficient cleaning increase the risk.
How often should my implants be checked?
It depends on your risk: often once or twice a year with your dentist or periodontist, sometimes more often if you have a history of periodontitis. European guidelines stress these regular check-ups to detect inflammation early.
Are implants a problem for an MRI scan or at the airport?
Titanium implants do not usually rule out an MRI scan, but they can cause artefacts on images of that area: tell the radiologist. They do not usually set off airport security scanners.
Sources
- Pjetursson et al. — Int J Oral Maxillofac Implants, 2014 — trends in survival and complication rates of crowns and bridges on implants.
- Howe, Keys, Richards — Journal of Dentistry, 2019 — meta-analysis of 18 studies on 10-year implant survival.
- Derks — Effectiveness of implant therapy in Sweden, University of Gothenburg, 2015 — 9-year follow-up of implant patients in Sweden (implant loss, peri-implantitis).
- Mustapha, Salame, Chrcanovic — Medicina, 2021 — meta-analysis on smoking and implant failure.
- Herrera et al. — EFP S3 guideline, J Clin Periodontol, 2023 — European guideline on preventing and treating peri-implant diseases.
Restoring a full arch · How long does an implant last? · Information and consent
This general information helps you prepare for your consultation. Treatment, its risks and aftercare instructions are adapted to your situation by the surgeon.