Dental Bridge
In this section, we will cover:
- What is a bridge?
- What are the different types?
- What are the pros and cons?
- What is the procedure?
- What should I expect after I get my bridge?
- How do I look after my bridge?
- What other options do I have?
What is a bridge?
A dental bridge is used to replace one or more missing teeth.
It is a false tooth which is attached to the neighbouring natural teeth to hold it in place. The false tooth is called a "pontic" and the neighbouring tooth/teeth are called "abutments".
It differs from a denture because it is "fixed" in the mouth. This means you cannot remove it yourself. Many people prefer a bridge as you do not have to remove it every evening before bed, it is not as bulky as a denture and it feels more natural.
Bridges can be used to:
- restore a healthy-looking, youthful smile
- improve your ability to speak and chew your food
- prevent other teeth from drifting into the gap which can make your teeth look crooked and interfere with your bite
What are the different types?
There are many types of bridges which can be used to replace a missing tooth:
- Conventional Bridge
- Resin Bonded Bridge (also known as a Maryland Bridge)
- Implant-supported Bridge
A dental bridge can be attached to a tooth on either side of it (fixed-fixed bridge) or just one neighbouring tooth (cantilever bridge).
The type of bridge which is right for you is usually determined by which tooth is missing.
As a general rule of thumb, dental bridges should be avoided on teeth which have a large filling or have been root canal treated as they are significantly weaker than healthy natural teeth. Using these teeth as abutments for a dental bridge could cause further damage to the tooth leading to a dental extraction.
What are the pros and cons?
1. Conventional Bridge
- Pros
Conventional bridges have been around for longer than resin retained bridges and implant-supported bridges. Their long term results are more predictable and they have the highest success rate after 10 years (92% of conventional bridges will last for 10 years or more).
They are also more versatile than resin bonded bridges and can reliably replace back teeth or larger gaps where there are multiple missing teeth. - Cons
To make space for the dental bridge to fit on the abutment teeth, healthy tooth tissue must be removed. Unfortunately, this means there is a higher risk of damage to the nerve of these teeth. If the nerve inside the tooth dies, it will need a root canal treatment to save it.
Another risk with a conventional bridge is the abutment tooth can fracture. In some cases, the tooth can still be saved with a dental crown. But in many cases, so much of the tooth has fractured, it will not be restorable and it will need to be removed (see dental extraction).
2. Resin Bonded Bridge
- Pros
For many patients, the best thing about the resin bonded bridge is it requires no reshaping or filing down of the natural teeth. This means no local anaesthetic, no drilling and the abutment teeth remain relatively unscathed.
When a resin bonded bridge fails, it is usually due to debonding (i.e. it falls off) as opposed to the tooth fracturing as with a conventional bridge. Whilst this might be a nuisance, it can be glued back on without too much fuss. If the bridge failed because it was interfering with the bite, some small adjustments may need to be made. These can usually be done by your dentist at the same appointment they bond the bridge back on.
Resin bonded bridges are also a great alternative to dentures for teenage patients who have missing teeth but are too young for dental implants. They provide a good interim replacement until patients are old enough for an implant. In some cases, patients are so happy with their existing bridge, they choose to keep it instead of having a dental implant. - Cons
One of the biggest drawbacks of a resin bonded bridge is it can give the abutment tooth a grey-ish appearance as the colour of the metal wing shines through. This can be slightly camouflaged using an opaque resin when gluing the bridge on. Another option is to have an all ceramic resin bonded bridge but these have a higher risk of failure and more healthy tooth needs to be removed to make space for the ceramic wing.
Another issue with the resin bonded bridge is it is not as versatile as the conventional bridge. It cannot be reliably used to replace back teeth, particularly those in the lower jaw.
3. Implant-supported Bridge
- Pros
- Cons
What is the procedure?
If you are having a conventional bridge or a resin bonded bridge, it will take two appointments at the dentist to replace your missing tooth.
If you are having an implant-supported bridge, the procedure is slightly more complex. Before the bridge is placed, you will need at least 2 extra appointments to place the implant and then reposition the gum around the implant 3-6 months later. After these stages are complete, the procedure to make and place the bridge can begin.
It is important to note that before any treatment takes place, your dentist will check your mouth is healthy and suitable for such complex treatment. They will also take an xray of the abutment teeth to ensure they are free from dental disease and able to withstand the extra force from supporting a false tooth.
Conventional Bridge
First appointment
At the first appointment, your dentist will give local anaesthetic to numb the tooth and gum. Once the area has become numb, the abutment tooth/teeth will be filed down to make space for the dental crown.
A dental impression (or dental mould) will be taken of your top and bottom teeth. This is sent to the dental lab where they can make the bridge. You will also need to choose a shade for your bridge so it matches closely to your natural teeth.
Your dentist will then make a temporary bridge to wear until the final bridge is back from the lab. This protects the teeth and gums and maintains the gap for the final bridge.
Second appointment
Your second appointment will usually be 2-3 weeks after the first one. At this appointment, your dentist will remove your temporary bridge and check to see if the new bridge fits. Some adjustments may need to be made for the bridge to fit your mouth snugly. Your dentist will also check you are happy with how it looks.
Once all these checks and adjustments are complete, the bridge can be cemented onto the abutment teeth.
This is often done under "rubber dam". A rubber dam is a plastic sheet which isolates the teeth your dentist is working on and helps to keep them dry. This makes sure the bond between your teeth and the bridge is as strong as possible.
After a few final checks to make sure you can clean the bridge and it isn't interfering with your bite too much, you're all done! You should be able to eat and speak as normal but it is wise not to eat anything too hard on your dental bridge.
Resin Bonded Bridge
First appointment
This is usually quite a simple process as your tooth does not need filing down and no local anaesthetic is needed. If your dentist does decide to file down the tooth, such a tiny amount of tooth tissue is removed, local anaesthetic still isn't typically required!
Your dentist will take a dental impression, or mould, of your top and bottom teeth. These impressions are then sent to the dental lab to make your bridge. You will also need to choose a shade for your bridge so it matches closely to your natural teeth.
Your dentist may then place a temporary bridge to wear until the final bridge is back. These are notoriously difficult to keep on the teeth as there is not much to hold them in place!
Second appointment
Your second appointment will usually be 2-3 weeks after the first one, At this appointment, your dentist will remove your temporary bridge and check to see if the new bridge fits. Some adjustments may need to be made for the bridge to fit snugly. Your dentist will also check you are happy with how it looks.
Once all these checks and adjustments are complete, the bridge can be glued onto the abutment tooth/teeth using a resin adhesive. To do this, both your tooth and the metal wing have to be prepared with some special chemicals to get the strongest bond between them. All of this is done under "rubber dam". A rubber dam is a plastic sheet which isolates the teeth your dentist is working on and helps to keep the area dry. This makes sure the bond between your teeth and the bridge is as strong as possible - so your bridge is less likely to fall off!
After cleaning the excess resin, you're all done! The bridge will feel very odd initially as it will stop you from biting together as normal. But don't worry, this is completely expected and normal! Over the next few weeks or months, your teeth will gradually adapt and settle into new positions, restoring your "bite".
Implant-supported Bridge
First appointment
Your first appointment to place the implant will involve minor surgery which is usually done under local anaesthetic. You can read more about placing an implant here. After the implant has been placed and covered by the gum, it will need 3-6 months to fully heal and fuse to the surrounding jawbone. This is a process called "osseointegration".
Second appointment
After 3-6 months, your dentist will take an xray to check the implant has osseointegrated as expected. If they are happy, they can continue with the next stage. This involves making a small incision in the gum around the implant under local anaesthetic. This gum is pushed down to expose the tip of the implant. A metal cap (called a "healing cap") is then screwed onto the implant. This will allow the gum to heal around the implant, whilst leaving the tip of the implant exposed in the mouth - this is the part the bridge will attach to.
Third appointment
After the gum has had some time to heal (usually 2-4 weeks), your dentist will remove the healing cap and take a dental impression (or mould) of your upper and lower teeth. This dental impression is sent to the lab where they will make the final bridge. You will also need to choose a shade for your bridge so it matches closely to your natural teeth.
Fourth appointment
This appointment will usually be 2-3 weeks after the dental impression has been sent to the lab. Your dentist will check the new bridge made in the lab is a good fit. Once they are happy and you are happy with the appearance, they will secure the bridge to the implant. This can either be done using a cement or it can be screwed on - this depends on the type of system your dentist uses for implants.
You should be able to eat and speak as normal but it is wise not to eat anything too hard on your dental bridge.