The decision-making process for single-tooth replacement should include all therapeutic options, including tooth-supported FPDs and resin-bonded bridges. There is limited evidence that implant-supported single crowns perform better than tooth-supported FPDs on a long-term basis. However, taking into account the favorable cost/benefit ratio and the high ISR, dental implant therapy is the first-line strategy for single-tooth replacement.

Advantages/Disadvantages of Tooth-Supported FPDs

From a biological point of view, preservation of the integrity of the teeth adjacent to the edentulous area is the main advantage. From an economic point of view, it has been shown that dental implant therapy is less costly and more efficient over time than tooth-supported FPDs for the replacement of one missing tooth (Bouchard et al., 2009).

The major disadvantage of dental implant therapy is the need for a surgical procedure. Tissue abnormalities at the implant site may require additional complex surgical procedures. The morbidity of these procedures must be considered in the decision-making process. The risk/benefit ratio with a single implant should be carefully evaluated, and alternative treatment options should be considered.

Indications

Anterior Single-Tooth Replacement

In sites without tissue deficiencies, predictable treatment outcomes, including esthetics, can be achieved because support is provided by the neighboring teeth (Belser et al., 2008). However, esthetics in dental implant therapy remains a challenge. Depending on the status of adjacent teeth, tooth-supported FPDs should sometimes be preferred to achieve better esthetics.

Posterior Single-Tooth Replacement

Esthetic considerations are less important here than in the anterior area. Therefore, dental implant therapy is the first-line strategy when it is compared to the bridge strategy in the case of intact bordering teeth.

Contraindications

• Interdental space less than 6 mm and/or apical root convergence. This may lead to proximal attachment loss and/or root injury.
• Unpredictable esthetic achievement in sites with tissue deficiency in anterior areas.

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