If you have a missing tooth or have a series of missing teeth, your dentist is likely to suggest you get a dental bridge done. A dental bridge is a prosthetic restoration wherein the crown of a missing tooth is replaced by taking the support of the existing ones or by taking the support of implants.
Traditional dental bridges are the most common type of dental bridges. The teeth adjacent to the edentulous or toothless space is used to take support to fabricate the missing teeth.
Cantilever bridges take support from only one side of the missing space. They have few restrictions as to where they can be used.
Maryland bridges are the most conservative variant of dental bridges. Implant supported bridges as the name suggest taking the support of implants rather than tooth to fabricate the prosthesis.
Let us understand in detail about dental bridges, which is the best option and what are the pros and cons of each variant.
Why do we require a dental bridge?
- After a tooth are extracted, or it falls off, the neighboring teeth are significantly affected as they have to levy the additional masticatory force. This causes premature wear of the teeth (1).
- The tooth lying opposite to the missing teeth starts drifting, which affects its anchorage. The tooth thus becomes more prone to root caries and proximal caries. This supraeruption of the opposing teeth leads to premature exfoliation (2).
- The tooth neighboring to the missing area starts rotating or migrating in an attempt to close the space. This pathologic migration of the teeth makes them periodontally weak and caries prone (3).
- People with multiple missing teeth are unable to chew food effectively, and hence their digestion is affected.
- Some people with unilateral missing teeth, start using the opposite side of the mouth to chew. When this happens, the saliva which cleans the surface of our tooth is inefficient in cleaning the affected side. This leads to deposition of plaque and tartar on the tooth surface, giving rise to periodontal complications. Not to forget, even the temporomandibular joint (TMJ) is affected (4).
- When a tooth is missing, the bone tends to shrink (5). If this happens, it may change the way the jawbone supports the lips and cheeks. Over time, your face starts to look older.
Tooth supported dental bridges
There are various types of dental bridges, and they are designed to replace one or more missing teeth, filling in gaps and restoring the function with natural-looking prosthetics.
Bridges are also called fixed partial dentures. The following are the varieties of tooth supported bridges.
Traditional dental bridge
These are the most common and most popular type of dental bridge system. This has proven effective to last and function optimally. In this system, the bridge comprises two components.
The supporting or the anchoring teeth of the bridge is called abutments and the missing tooth or teeth to be replaced are called pontic.
The dentist will shape the abutment teeth to receive the bridge. The amount of preparation of tooth required depends on the material of the bridge. For metal alloys the preparation or the shaving of the tooth is minimal.
For porcelain fused to metal it is intermediate, and for zirconia and porcelain, it is maximum (6).
The shaving involves removal of the outer enamel layer of the teeth. In some instances, it can cause dental sensitivity.
Depending on the condition of the abutment teeth and various other factors the dentist may or may not suggest an adjunct endodontic treatment.
Once the preparation of tooth is done, the dentist will make the impression of the teeth. This impression is sent to a dental laboratory for the fabrication of bridge.
Meanwhile, the dentist can give you a temporary bridge to avoid any changes and prevent the sensitivity of the prepared abutment teeth.
In traditional bridges, the pontic is positioned between the abutment teeth. However, in some clinical situations teeth may not be present on both sides of the toothless gap (7).
Cantilever bridges are dental bridges which are designed when abutment teeth are prepared on only one side of the missing toothless gap.
This can be done for aesthetic reasons in the front teeth of the mouth. When no teeth exist on one side of the gap, especially on the posterior aspect and the patient is unable to opt for implant a cantilever bridge can be given.
In situations where the required abutment teeth on one of the sides are already supporting another prosthetic restoration which cannot be replaced, a cantilever bridge is indicated.
The cantilever bridge is usually indicated in fewer instances, and the other options are preferred over it as it increases the axial force on the abutment teeth.
The success rate of cantilever bridge is higher when one than one abutment teeth are present and when they are fabricated in the anterior or the front region of the mouth.
The process of fabrication of cantilever bridges is the same as that of traditional bridges.
A Maryland bridge comprises a metal framework with a pontic tooth fabricated onto the front of this framework. These metal wings have a porous surface so that they can receive a bonding agent.
The wings of the Maryland bridge are bonded to the back side of the supporting teeth on either side of the missing tooth. The back side of the abutment teeth is slightly roughened, or grooves and boxes are created for supporting the Maryland bridge.
This is mostly indicated for single teeth replacement in the anterior region of the mouth (8). The strength of the Maryland bridge is less than that of the traditional bridges.
Implant-supported dental bridge
An implant-supported bridge provides ideal stability and requires no fit adjustments. The bridge is entirely supported by dental implants, which are titanium posts surgically placed in the jaw bone.
Implants are designed such that they provide support for the anchor for prosthetic teeth, and they work exceptionally well (9).
What materials are used for dental bridges?
There are several options from which your bridge can be made. Porcelain, porcelain-fused-to-metal, zirconia, gold, and metal alloys offer different pros and cons.
Discuss with your dentist your options and decide the material which suits your lifestyle, smile goals, and budget.
Caring for your dental bridge
- A bridge can fail if dental disease damages the supporting teeth or the jawbone (10). So maintaining optimal oral hygiene is a must.
- Brush your teeth twice daily. Use floss or another between-the-teeth cleaner once a day.
- Brushing and cleaning the teeth helps to remove plaque and prevents the development of tartar on or around the bridge.
- Visit your dentist regularly for professional cleaning.
- Eat a healthy diet, avoid any sticky, chewy items as they can lift or displace the bridge.
Replacing missing teeth is of critical importance. If you have single or multiple missing teeth, consult your dentist and get a dental bridge prosthesis at the earliest.
The dental professional will first evaluate the condition of the abutment or the supporting teeth and formulate a treatment accordingly.
Implant supported bridge is also an excellent option for the long span edentulous area.