Crown or implant: which one does your tooth actually need?

These two are less like rivals than most patients assume. A crown (Krone) restores a tooth you still have; an implant (Implantat) replaces a tooth you no longer have. The real question is therefore not “crown or implant” but can this tooth still be saved, and is saving it worth what it takes? Where a stable collar of healthy tooth remains above the gum, a crown is usually the better and cheaper answer, and keeping your own root is worth a great deal. Where the root is fractured, the decay runs well below the bone, or the tooth is already gone, an implant becomes the option that preserves the neighbouring teeth. The money works completely differently for each: for a crown, your statutory fund pays a fixed subsidy (Festzuschuss) towards the whole treatment; for an implant, it pays nothing towards the implant and the surgery, but the same fixed subsidy towards the crown that goes on top.

Everything else follows from this. Before any comparison of materials, longevity or price, your dentist is answering one structural question — is there enough sound tooth above the gum line for a restoration to hold on to?

A crown needs a continuous collar of healthy tooth around the whole circumference to grip. Where that collar exists, a crown has something solid to sit on and the forces of chewing are carried down a root that is still attached to bone by its natural ligament. Where the tooth has crumbled to or below gum level on one side, that collar is broken, and a crown placed on top is working against the mechanics rather than with them.

Four findings typically move the answer away from a crown:

A vertical root fracture. A crack running down the root is the one finding that ends the discussion. It cannot be glued, and it lets bacteria into the bone alongside the root. This is usually diagnosed with a combination of clinical signs, a microscope and a 3D X-ray (DVT).

Decay running below bone level. If the sound margin sits under the bone, there is no clean way for a crown to seal against the tooth. Sometimes the gum and bone can be surgically reshaped to expose more tooth; sometimes the price of that in bone support is too high.

Too little root support. A tooth that has lost much of its surrounding bone through periodontitis (Parodontitis) may be mobile. Crowning a loose tooth does not make it firm.

A root canal that has failed more than once. Retreatment is often worthwhile, and success rates for a first well-performed treatment are good. But at some point, further attempts have poorer odds than starting again with an implant.

• A stable collar of sound tooth remains above the gum
• The root is intact and the surrounding bone is healthy
• The tooth is root-treated and needs protection rather than replacement
• A large old filling is failing but the walls are still sound
• You want the least invasive route — no surgery, no healing phase
• Cost matters and you want to avoid a private surgical bill
• You have a medical condition that makes surgery less attractive

There is a further argument that rarely appears on a price list: your own root keeps the bone. A natural tooth transmits chewing forces through its periodontal ligament, and it carries nerve endings that tell you precisely how hard you are biting. An implant fuses directly to bone; it works extremely well, but it does not have that ligament. Keeping a tooth that can be kept is almost always the better biology.

• The tooth is already missing
• The root is fractured, or the tooth has broken below the bone
• Decay has destroyed the tooth beyond restoration
• Repeated root canal treatment has not resolved the infection
• The neighbouring teeth are healthy and untouched — an implant avoids preparing them for a bridge
• A back tooth is missing and the gap needs a solution that does not rely on the neighbours

The strongest argument for an implant over a bridge is exactly that last point. A conventional bridge (Brücke) requires the two teeth on either side of the gap to be prepared. If those teeth are healthy and unrestored, an implant leaves them untouched.

Two lines in that table deserve a caveat. Longevity figures describe groups of patients, not your individual tooth — the survival of a crown depends mainly on the tooth beneath it, and the survival of an implant depends heavily on gum care and smoking. And the “no effect on neighbours” line assumes an implant rather than a bridge; that is the reason it is often preferred where the adjacent teeth are sound.

This is where German insurance surprises people who arrive from other systems, so it is worth reading slowly.

Your statutory fund does not pay a percentage of your dentist’s bill. It pays a fixed subsidy based on the cost of the standard care option (Regelversorgung) for your particular finding. Whatever you choose above that standard — a better material, a more elaborate technique — is added to your own share (Eigenanteil).

The size of the subsidy depends on your bonus booklet (Bonusheft):

Two practical consequences. First, a check-up every year is worth real money later — the stamps cannot be added retrospectively. Second, the treatment and cost plan (Heil- und Kostenplan, HKP) must reach your fund before treatment starts; if work begins first, the entitlement to the subsidy is lost. How long the fund takes to process it varies from fund to fund, so plan around it.

The statutory system treats the implant itself — the titanium screw and the surgery — as a private service and pays nothing towards it. But the crown on top of the implant is prosthetic work, and there the fund pays the same fixed subsidy it would have paid for standard care in that gap. Many patients do not know this and budget for the whole thing as if no help existed at all.

As general background — these are market ranges across Germany, not our prices — an implant with a crown, everything included, commonly falls between 2,100 and 4,000 €. That figure breaks down roughly into diagnostics 100–350 €, the surgical stage with the implant itself 1,000–2,000 €, and the crown on the implant 800–2,000 €. Where the bone has shrunk after a tooth has been missing for a long time, a bone graft (Knochenaufbau) adds a further 500–2,500 €.

Our own confirmed prices are these four and no others: the first consultation is free; a 3D X-ray (DVT) costs 178 €; implants start from 999 € for the surgical part, meaning the implant itself; and clear aligners are offered at 1,049 €, 2,800 € or 3,699 € depending on the variant. Everything else appears on your individual plan, because it depends on the finding — anyone quoting you a crown price over the phone, without seeing the tooth, is guessing.

Private insurance (PKV) and supplementary dental insurance (Zahnzusatzversicherung) reimburse a share set by the tariff, depending on the tariff. Two things are worth checking in your policy before you decide: whether implants are covered at all, and whether there is an annual cap in the early years of the contract. Send the plan to your insurer for a coverage statement before treatment starts.

Instalment payment (Ratenzahlung) is possible with us, subject to a credit decision. Ask when the plan is drawn up rather than after the invoice arrives.

A draft reform discussed during 2026 would reduce the statutory subsidy percentages for dentures in future while keeping the 100 % hardship provision. It is a proposal under discussion and has not completed the legislative process — nothing about it changes what applies to your treatment today. It is mentioned here only because patients weighing a larger plan sometimes ask whether the rules are stable.

If a tooth cannot be saved, an implant is not the only replacement. A bridge closes the gap by anchoring on the teeth on either side. It needs no surgery and no healing phase, it is usually quicker, and the statutory subsidy applies to it in the ordinary way.

The price is paid in tooth substance: the neighbouring teeth must be prepared, even if they are perfectly healthy. Where those teeth already carry large fillings or crowns, that argument loses much of its force, and a bridge can be an elegant answer. Where they are untouched, most dentists will point you towards the implant first. What a bridge treatment feels like is covered here: Does a dental bridge hurt? What you actually feel (EN).

A serious answer needs more than a glance. In our practice the sequence usually looks like this.

Examination and X-ray establish how much tooth is left, the state of the root and the level of the surrounding bone. A microscope shows cracks and margins that are invisible to the naked eye — often the finding that settles a borderline case. A 3D X-ray (DVT) is used where a specific question needs it: a suspected root fracture, the bone volume available for an implant, the position of a nerve. Primescan digital impressions capture the situation without impression trays.

Where an implant is the answer, we plan it three-dimensionally and place it with a surgical guide — navigated implantology, so that the position decided on screen is the position achieved in the mouth. Scans are reviewed with AI support alongside the dentist’s own assessment, never instead of it, and every finding is confirmed by a person.

Then you get the plan in writing, with the alternatives on it — not just the option we would choose. The first consultation is free, so getting a proper answer costs you nothing but the appointment.

Patients come to us from across NRW: from Düsseldorf, Cologne and Bonn, and from Essen, Dortmund and Bochum. Twenty to thirty minutes to a practice where a decision of this size is discussed entirely in English is a trade many expats make without hesitating. If you are still orienting yourself in the German system, start here: English-Speaking Dentist in NRW.

Some findings are worth deciding calmly. Others have a clock on them.

The reason for urgency is not drama but options. A tooth that fractures further, or a gap in which the neighbours have drifted and the opposing tooth has grown down, narrows what can be offered. Bone also shrinks after an extraction, and less bone means a longer, more expensive route to an implant later.