Dental bridges, like implants and partial dentures, are used to replace missing teeth.
Faced With Missing Teeth
are numerous reasons why someone may be missing
teeth. Perhaps a tooth was lost to injury or even
removed because of excessive decay - whatever the
reason; missing teeth are a common complaint at
the dental office.
should you get the missing tooth or teeth
replaced? There are several reasons - the most
popular being aesthetics. A smile that shows a
missing tooth often sends an uncomplimentary
message to others. From a dentist's standpoint
though, there are greater concerns than just
|Before and after
placement of a dental bridge for a
a tooth is missing, it is not uncommon for the
tooth above it to begin erupting (coming out of
its socket) into the empty space. Missing teeth
can alter speech sounds and adversely affect
childhood development or an adult's professional
life. A missing tooth can also result in nearby
teeth drifting, or tipping, into the open space.
Problems in occlusion (bite) can arise, making it
difficult to close the mouth. If left untreated,
temporomandibular joint disorder may even develop.
It is important to note that teeth can move at any
age, so replacing missing teeth is not just a
with such consequences, not all teeth require
replacement. Dentists never recommend
replacing a wisdom tooth for example. Also, in the
case of older patients, lost second molars rarely
affect function and often do not require
replacement. Always question your dentist's
reasons for wanting to replace a missing tooth
that is not affecting your lifestyle.
Options For Replacing Teeth/Tooth
have several options for replacing missing teeth -
not all options apply to every patient though. The
following are viable options for replacing one or
Partial or Full Dentures
Bridges (Fixed, Resin-bonded,
There are various
factors that dentists consider in choosing the
best option. Some include:
Cost: Dental implants are very costly, and are not covered by most dental insurance programs. Bridges are usually second in cost, followed by partial or full dentures.
Time: Bridges are usually completed by two appointments in the course of a week. Dentures are made as quickly, but need adjustments over a few weeks to fit the patient. Implants involve surgery, and require several months for healing. For all procedures though, temporary teeth will be placed in the open space while the final prosthesis is being manufactured.
Number of teeth missing: When only 1 or 2 teeth are missing, implants are the best option. Implants can also be placed to provide support for dentures in certain implant-supported-denture cases. Bridges are usually placed when no more than 2-3 teeth are missing since longer spanning bridges are prone to collapsing. Partial dentures are good for cases when more than 3-4 teeth are missing, and complete dentures are for when all teeth are missing.
Oral health: The biggest dental concern is the condition within the mouth. Bridges need to be supported by nearby teeth, so those teeth need to be of sound health. Nothing is more aggravating than paying for a costly bridge, only to have it fail because the supporting teeth could not handle the added stress. Similarly, few dentists will place implants in patients who are avid smokers, as they are prone to failure.
Comfort: Dental implants are the gold standard for replacing missing teeth, and many patients can hardly tell them apart from real teeth. Bridges are also highly aesthetic and fixed in the mouth, but keeping them clean can be difficult. Dentures can appear natural, but can slip out while eating certain foods, so most patients cannot function normally.
Always ask your
dentist why they chose a particular treatment in
replacing missing teeth. They should be more than
willing to explain their reasoning to you.
is a dental bridge?
bridges are a fixed solution for replacing
a missing tooth or teeth - unlike dentures, they
cannot be removed. An artificial tooth is held in
the open space at the gum line by attaching it to
teeth on either side of the missing tooth. If
several teeth are missing, artificial teeth are
strung together and attached to adjacent real
teeth. As one would expect, the supporting real
teeth need to be of good health, or else the
entire bridge will collapse. If done properly,
bridges are capable of with-standing normal daily
stresses and being made of porcelain makes them
indistinguishable from real teeth.
of dental bridges
most common type is the conventional fixed
dental bridge. For this bridge, the dentist
trims both teeth adjacent to the missing
tooth, and cements a porcelain crown on top of
each. Attached to the two crowns is an artificial
tooth (or pontic) in the middle. This
arrangement provides maximum support since any
force applied to the artificial tooth is spread to
the two nearby sound teeth.
form of a dental bridge is a cantilever bridge.
In a cantilever setup, only one adjacent
tooth is trimmed and fitted with a crown that is
attached to the artificial tooth. Trimming a tooth
involves removing large amounts of tooth structure
from healthy teeth, so a dentist might choose this
option to preserve tooth structure. The downside
for cantilever bridges is that support for the
artificial tooth is provided by only the one
tooth. This limits its use to areas of the mouth
which receive little stress during chewing.
the dentist may opt for a resin-bonded bridge
or Maryland bridge. These bridges require
minimal trimming of adjacent teeth, and rely on
plastic resin to hold the artificial tooth in
place. This makes them very weak, and should
therefore only be considered for replacing front
teeth, provided that the gums are healthy and the
surrounding teeth do not have extensive dental
should receive a bridge? Who should not?
are esthetic, permanently fixed in place, and
moderate in cost. These features make them ideal
for patients missing one or a few teeth.
Unfortunately, their success is largely tied to
the oral health of the patient. Patients who do
not brush and floss regularly have bridge failures
because bridges are highly susceptible to decay.
Once decay has begun, the dentist is forced to
remove the costly bridge.
dentists will look at the condition of the
patient's other teeth before recommending bridges.
Poor oral hygiene, heavy smoking, or supporting
teeth which are mobile, are reasons for why
bridges may be excluded for a patient.
dental bridge procedure outlined.
your dentist has determined that you are a
candidate for a dental bridge, the procedure will
begin with you receiving local anesthetic. The
anesthetic ensures that you will feel no pain
throughout the treatment.
your dentist will likely take an impression of
your mouth using a putty-like material. This
captures what your teeth looked like prior to the
treatment. Using dental drills, the teeth on
either side of the missing tooth (support teeth)
will then be trimmed. If these support teeth are
decayed, your dentist will likely first repair the
decay, then trim then down.
the neighboring teeth have been trimmed, another
impression will be taken using the putty-material.
This impression captures what your teeth look like
following the treatment. It will be sent to a
dental laboratory where over the course of a week,
they will fabricate the bridge that fits on this
impression. This bridge is then sent back to your
you leave your first appointment, your dentist
fits you with a temporary bridge so the teeth and
gums can be protected from damage until your
permanent bridge is ready. This temporary bridge
is made on the spot, so it is not made from
porcelain and therefore, is much weaker and less
aesthetic than the permanent bridge. It is held in
place by temporary cement so that it can be
removed at the next appointment.
your second appointment, your dentist will try on
the permanent bridge that was fabricated to ensure
it fits. You will have a chance to see how it
appears and feels before it is cemented in place
permanently. Your dentist may make some minor
adjustments to it to ensure your bite (occlusion)
is well following the cementation.
cost of a fixed dental bridge related to the
number of teeth missing. Resin-bonded bridges or
Maryland bridges are less expensive, but fracture
easily. Dental bridges are among the most
expensive treatments in dentistry, but patient
acceptance and satisfaction are very positive.
Nearly all patients say that treatment result
justifies the cost.
bridges, from start to finish, are roughly $1000
in cost, per missing tooth. Factors which alter
the cost include the material the bridge is made
from, whether your dental insurance covers any of
the charge, the abilities of the
dentist/laboratory technician, and whether any
other procedures are needed such as dental
fillings or root canals on the support teeth.
proper dental care, and regular dental checkups,
dental bridges can last from 10-20 years. Factors
that determine longevity include the dental
material, quality of dental work, and patient
maintenance. Every component is equally important
- so you need to play an active role in
maintaining good oral health.
Disadvantages & Risks
include that dental bridges appear and function
similar to natural teeth. They remain in the mouth
at all times. Disadvantages are that natural teeth
need to be trimmed down so that the bridge can be
attached, and these natural teeth may be
overloaded by stresses placed on them. Another
disadvantage is cost - dental bridges are
relatively costly compared to dentures.
Risks are that the extra load on the supporting teeth can weaken, break or cause pulp death in these teeth. The crowns (caps) that connect to the supporting teeth can become loose if not cemented or fitted well - making the natural teeth susceptible to decay.