Dental Bridges – All Your Questions Answered

“What is a bridge?”

Are you missing a tooth?  A bridge is one of the dental treatments available to replace missing teeth.  Bridges are fixed into the mouth by attaching them to neighboring teeth. Therefore, unlike dentures (which are removable), these stay in your mouth.

The most common type is a conventional bridge where the teeth on either-side of the gap are crowned, with a “false” tooth stuck to those crowns, in order to fill the gap.

Bridgework may be placed on your own natural teeth, on implants or on a combination of the two.

 

Why Might you Want to Replace Missing Teeth?

Image of smile before and after bridge

Replacing a missing front tooth with a dental bridge

It is usually best to restore gaps for several reasons.  These include:

  • For aesthetic reasons, including your smile and maintaining the shape of your face.
  • To reduce the pressure on the other teeth (and any fillings, crowns etc. on them).
  • Reduce the chances of getting jaw problems (TMJ).
  • To prevent changes to the bite as the dentition can move when there is a gap.
  • To help keep the other teeth more cleansible and therefore reduce the potential for dental decay and gum problems.
  • For speech.
  • To help with chewing.

 

When is this procedure suitable?

Tooth bridges are one of the options to replace lost teeth. They can be used in the following cases:

  • A small number of teeth are missing, so the tooth bridge is a viable size.
  • The dentition either side of the gap are strong enough to hold the bridgework.
  • These anchors also need to have good gum health.
  • Your oral hygiene is of an acceptable standard.

 

Here is a nice video summary:

 

Types of Tooth Bridges

There are three main types:

Image of a metal-ceramic traditional dental bride

A ‘traditional’ fixed bridge, made of metal and porcelain

1. Traditional fixed bridge

This is the most common type to be placed. It is made up of one or more “false” units joined to two crowns, that are placed on to the adjacent teeth and/or implants.

 

2. Resin-bonded (‘Maryland’) bridges 

Instead of crowns being used to hold the bridge in place, metal ‘wings’ are made onto the false tooth. These wings are then bonded to the back of the anchoring teeth.

These have the advantage of being less destructive to the anchors than crowns are.  Therefore they are often chosen when those anchors are sound.  They are also less expensive than fixed bridgework.

This type is not as stable however, and is usually only used on frontal areas and when the patient’s bite is not excessive on the area.

 

3. Cantilever

Cantilever simply means that the bridge uses only one adjacent tooth to hold it in place. These can be of a fixed design or use resin-bonded wings.

 

What are they made from?

Like crowns, bridges may be made from:

  • Porcelain fused-to-metal.
  • Porcelain (or ceramic) only.
  • Metal only (usually gold).

 

What Does the Procedure Involve?

In order to decide if a bridge is appropriate and plan its design, the dentist will examine the area, take X-rays and make up casts of the arches.

Once it has been decided that bridgework is to be fitted and which type is to be constructed, an appointment is needed for “preparation” of the area.

  • Once the area is numbed, the anchors are filed down to the required size in order to make the space for the crowns/wings (which will be attached to anchor the bridge in place).  This can take up to 45 minutes per tooth.
  • A mold of the dental arch is then taken, using a rubber putty material.  It is this mold which is sent to the technician who makes prosthesis.
  • Lab construction can take around two weeks. In the interim, your dentist will fit a temporary unit which will protect the teeth and keep them in the correct position.
  • This temporary bridge is removed at the next visit and the newly made bridge is cemented into place, once you are both happy with how it looks and fits.

Read more on the procedure in this article.

 

“How long will it last?”

Just as with natural teeth, the health of a bridge will depend on how well you care for it.

With a healthy diet, good oral hygiene, regular check-ups with the dentist and sensible use of this treatment, one can expect a good bridge to last at least 5 years. Many will last well beyond this. The life expectancy of this work will also depend on the condition and position of the tooth/teeth in the first place.

 

“How much does a bridge cost?”

The price will vary greatly, depending on:

  • The skill and experience of the dentist.
  • The skill and experience of the dental technician.
  • The type of bridgework and the cost of its materials.
  • The price of any foundation work such as placing a post under the bridge.
  • Whether the unit is made by a machine in the dentist’s office or not.  Such modern machines are very expensive.
  • The number of teeth being replaced, i.e. the size of the bridge.

 

Recovery and Care After Placement

Once the bridge has been fitted into place, your dentist will instruct you on how to care for it.  In general these need even more attention than natural teeth, as they are harder to clean properly.

Oral hygiene routines must include proper cleaning under and completely around the bridgework (‘interdental’ cleaning e.g. flossing).  Your dentist will instruct you on how to do so adequately. This will involve the daily use of a floss ‘threader’ which is fed under the bridge to remove plaque build-up here.

These two teeth have been prepared, to make the necessary room for a bridge

These two teeth have been prepared, to make the necessary room for a bridge

Other points to note after this treatment is fitted:

  • No matter how strong a bridge is, it will not be as strong as healthy, sound teeth. Thus one will need to avoid particularly hard foods, and destructive habits such as biting ones fingernails or opening bottles with one’s mouth!
  • A major risk factor to bridges is clenching or grinding. If this is being done at night, the dentist may make a mouth guard to be worn at night-time.
  • There may be some sensitivity for a few days after both the preparation and fitting visit. If this is prolonged, or the area feels sore to bite on, you should contact your dentist.
  • Porcelain on the bridges may chip.  Is minor chipping occurs this can be left. Otherwise larger breaks can sometimes be repaired, but if not the treatment may need to be replaced.
  • If gaps occur between the supporting dentition and the bridge, decay may set in and the unit may loosen. This is more likely with ill-fitting bridges, but regardless it is important to get them checked often via regular dental visits.
  • A bridge may eventually fall out, in which case you should bring it to your dentist, as soon as possible. If everything appears healthy the dentist may be able to re-cement it.  If there is an obvious reason for the falling out, such decay or fracture, a replacement may need to be made.
  • On average, this treatment lasts five to seven years. A major reason bridgework fails is where new cavities develop on the supporting teeth. These cavities occur because of poor oral hygiene. With proper hygiene, which includes flossing your teeth under the bridge, they will last longer.

 

Summary

Bridges are one of the methods available to dentists to restore gaps in your smile. While they have waned in popularity somewhat due the emergence of implants, they are still an excellent choice when used in the correct circumstances.

Due to the damage incurred to adjacent teeth, getting bridgework done can carry some risks. The area needs to be kept very clean and well looked-after as the anchoring teeth under them are not immune to decay and gum disease.

For a great comparison of dental implants and bridges see here.

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