Bridges

You’ve undoubtedly crossed a bridge at least once in your life, but you might not have thought much about its purpose at the time. A bridge is a functional way to close the gap between one point and another. A dental bridge serves much the same purpose in your mouth: it literally “bridges” the gap created by one or more missing teeth.

That’s a good thing because missing teeth can cause surrounding teeth to shift, which may change your bite or make your jaw sore. Shifting teeth create new places for dental plaque to hide, increasing your chances of needing a tooth filling or gum disease treatment.

Dental bridges serve an aesthetic purpose, allowing you to show off your beautiful smile without shame or fear that your missing tooth is what people will remember. They help your wallet, too, because dental bridges cost less than other methods of tooth replacement.

How are they different from Dentures?

Unlike removable devices such as dentures, dental bridge work is cemented onto natural teeth or dental implants on either side of a missing tooth. These anchor teeth are called abutments. The replacement tooth — called a pontic — is attached to a dental crown on each abutment. There are three main types of dental bridges:

  • Traditional Bridge — This is the most common type of bridge and is made of porcelain or porcelain fused to metal.
  • Cantilever Bridge — The cantilever bridge supports the replacement tooth from just one side. It is most often used when abutment teeth are located on only one side of the missing tooth or in areas of the mouth that are under less stress.
  • Maryland Bonded Bridge — Also known as a resin-bonded bridge, this type is generally only used in the front of the mouth where the biting force is less strong. It consists of a false tooth fused to metal bands and bonded to abutment teeth with resin.

Replacement teeth for can be made of several materials, including gold, alloys, porcelain or a combination of these. Some types of dental bridges cost more than others. You and your dentist can decide which dental bridge work is best for you based on the placement, function, look and expense of the replacement tooth.

The Dental Bridge Procedure

A minimum of two dental visits are required to complete dental bridge work. During the first visit, your dentist may need to file down the abutment teeth so that the dental crown will fit over each leaving enough room in between for the replacement tooth. The second step in the dental bridge procedure is for your dentist to take an impression. This gives a laboratory an exact mold to use when creating your bridge. Your dentist will make a temporary bridge to protect the exposed teeth and gums while the permanent version is being made.

To complete the dental bridge procedure, you’ll need to return for a second appointment. Your dentist will remove your temporary and the new permanent bridge will be put in place. Placement usually involves some adjustments to get the fit just right.

Bridges, Crowns and Implants: Pros and Cons

Modern technology and varying treatment options may seem like a double-edged sword. We have many enticing alternatives available for dental care that were not feasible as recently as a decade ago. Of course, restorative choices may occasionally present both challenges and complex decisions for both patient and treating dentist. One thing is certain: One size fits all does not apply.

Suppose a patient is missing lateral incisors, a not uncommon congenital anomaly. These are the teeth between the central incisors, or front teeth and the canines, also known as eye teeth.

Historically, orthodontists have attempted remedies to accommodate the spaces by moving other teeth into the position of the missing lateral incisors, often requiring years of braces. The options were based on limited restorative treatment options. We now have other treatment modalities to consider.

Keep in mind that what I am about to offer are my personal and professional opinions, but the key word here is “opinion.” As with many things in life, there are many ways to solve a problem: You just have to find the one that best suits you. Each person and each situation is unique.

Below are four common solutions to restore the missing teeth, after stabilization of the orthodontic treatment. There are variations for each approach, complicating the options. Most important is to make an informed decision — the treatment that best suits your individual needs and desires. To accomplish this, an open two-way dialogue between patient and dentist is essential. The list below will offer a start on what to consider.

Conventional, Porcelain Fused to Metal Bridges

Pros:

  • Restores gaps reliably and predictably.
  • Might be most economical approach if the adjacent teeth already need fillings and crowns.
  • Durable and least likely to pop off or fracture.

Cons:

  • Requires removal of significant tooth structure on adjacent teeth, which is undesirable if the supporting teeth are free of decay.
  • Complicates use of dental floss with a potential for periodontal disease.
  • Least aesthetically pleasing.
  • Decay or damage may require replacement of the entire bridge.

Maryland Bridges

Pros: :

  • All porcelain restorations yield ideal aesthetics.
  • Less invasive than conventional bridge.
  • Dentist needs to roughen or remove minimal tooth structure on the adjacent teeth for bonding.
  • Less likely to develop periodontal disease with proper hygiene.

Cons:

  • Costs comparable to a conventional bridge.
  • Can sometimes snap off if the bridge is torqued at the wrong angle.
  • Susceptible to fracture.
  • Like any fixed stationary bridge, flossing is difficult and will typically require the use of floss-threaders.
  • Decay or damage may require replacement of the entire bridge.
  • Requires an ideal bite relationship.

All Porcelain Bridges

Pros: :

  • Excellent aesthetics.
  • More durable than Maryland Bridges, but not as predictably sound as porcelain fused to metal bridges.
  • Requires more tooth reduction than Maryland Bridge, but less than a conventional bridge.
  • Like the Maryland bridge less likely to cause periodontal disease with proper hygiene.

Cons:

  • Costs generally higher than either conventional or Maryland bridges.
  • Susceptible to fracture.
  • As with any fixed stationary bridge, flossing is difficult and will typically require the use of floss-threaders.
  • Like any fixed stationary bridge, flossing is difficult and will typically require the use of floss-threaders.
  • Decay or damage may require replacement of the entire bridge.
  • Requires an ideal bite relationship.

Dental Implants with Single Crowns

Pros:

  • Single restoration using no involvement of the adjacent teeth.
  • Easy to floss between the teeth.
  • Can be very aesthetic, assuming a proper shade match and characterization by the lab.
  • Like the Maryland bridge less likely to cause periodontal disease with proper hygiene.
  • Lasts for many years.
  • If something happens to the crown, or if decay develops on adjacent teeth, the implant tooth won’t be affected.
  • Least likely to cause periodontal disease with proper hygiene.

Cons:

  • Expensive and time consuming.
  • Susceptible to fracture.
  • Most insurance won’t cover any of the cost.
  • Has a very low, but possible chance of failure, which usually occurs within the first year of placement.
  • Does not address the condition of the adjacent teeth.

In most cases, dental implants should be the first choice for ideal aesthetics, predictability, ease of maintenance and longevity. In all cases, a healthy periodontal condition and a stable bite relationship are prerequisites to success. Other mitigating factors such as parafunctional habits, like night grinding or clenching, susceptibility to decay, periodontal status, aesthetics and financial considerations will affect the decision-making process. Once again, an informed patient will make the best choice. Ask questions before treatment rather than encounter surprises later.

I encourage you, as I do all my patients, to take the information I’ve presented and schedule an office visit to thoroughly explore the many options. As with any decision, evaluate the benefits and weigh the costs and risks of each treatment. Decide whats best for you.

How long does it last?

A bridge can last more than 10 years, especially if you practice good oral hygiene. Remember: Dental bridge work requires healthy surrounding teeth and gums to stay in place. To keep your teeth healthy, brush twice a day and floss daily. Regular dental visits and dental cleanings are recommended twice a year.

When should Bridges be replaced?

What you need to know is why a bridge should be replaced and how long a bridge should last. Some of the main problems that may require a bridge to be replaced include: deep cavities that get under the crown margins (the area where the crown ends and tooth begins), severe gum disease that weakens a tooth or teeth that support the bridge, and breakage of the porcelain or metal that gives the bridge its structural support. Some patients may also want a bridge replaced to improve its appearance, as when the gum recedes to expose the dark and unattractive crown margins.

If your dentist suggests that your bridge should be replaced, you should ask him or her why. If you are not satisfied with the answer, ask if he or she would mind if you took the X-rays to another dentist or to a dental school for a second opinion (X-rays are one great way for a dentist to evaluate if a bridge is still in good shape). If your dentist is resistant and unwilling, that might be a red flag, and you should consider getting that second or third opinion before making any treatment decisions.

Finally, it is important to know how long a bridge should last. Although every case is different, it is reasonable to expect that your bridge should last at least 8-10 years. I have seen some bridges that have lasted for as long as 40 years or more — believe me, theyre out there.

So heres what you can do to increase the longevity of your bridge: First, it is very important to maintain good oral hygiene. Next, I would also suggest that you avoid hard and sticky foods (pretzels, hard candy, caramels, chewing gum, etc.), and also use a custom athletic mouthguard if you are involved in contact sports. Lastly, make an effort to see your dentist for a regular dental exam and a professional cleaning at least twice a year.

Before & After: Porcelain Bridges

Utilizing the attributes of metal-free adhesion dental technology, a missing tooth may be replaced with minimum reduction of the supporting teeth, and without a surgical implant, utilizing porcelain or composite resin materials.

Anterior Bridges

State-of-the-art bonded ceramics, combined with augmentive periodontal procedures, offer the clinician a strong and aesthetic alternative that can produce magnificent results. Adhesion dentistry, using metal-free porcelain, is natural and lifelike. The “missing” tooth is undetectable.

Posterior Bridges

Offering the many advantages of composite resins, this 3-unit belleGlass bridge is undetectable, kind to opposing natural teeth and durable. Utilizing adhesion dentistry, the missing tooth may be replaced with a minimally invasive procedure.