Dental Bridges

A dental bridge is an appliance that in its most common type consists of one or more artificial teeth (pontics) anchored by dental crowns on the adjacent teeth (abutment teeth) on either side of the missing tooth. The crowns that support the dental bridge can be placed on abutment teeth that are either natural teeth, dental implants, or a combination of natural teeth and dental implants.

Dental bridges are typically made of porcelain fused to metal or ceramic material to match the natural teeth color. They are an indirect type of dental restorations that are fabricated in the dental lab based on a mold of the patient’s teeth. A 3-unit dental bridge is the most common way used by dentists to replace a tooth lost by tooth decay, periodontal disease, trauma or other reason.

However today, the best option that modern dentistry has to offer is to replace missing teeth with dental implants.

Tooth loss has negative effects on both the appearance and functionality of the mouth.

• A missing front tooth can seriously affect the person’s appearance and self esteem.
• Speech is also compromised, and a lisp is a common consequence of the loss of a front tooth.
• When a tooth is lost, the adjacent teeth loose their lateral support and tend to rotate or/and shift towards the empty space, eventually becoming loose and increasing risk of loosing additional teeth in the future. Teeth can become crooked making oral hygiene more difficult and they get more susceptible to tooth decay and periodontal disease. The tooth on the other jaw opposite to the lost tooth may also become loose due to the loss of opposing force.
• If several teeth are missing the person’s chewing ability is reduced, affecting his diet, proper nutrition and quality of life.

All these problems can become more serious if many teeth are missing. Dental bridges can efficiently replace missing teeth, improving the chewing ability and speech, preventing facial collapse, and providing excellent aesthetic and functional results. Other possible options include partial dentures and dental implants.

Dental bridges can be distinguished in two main groups; fixed dental bridges and removable ones. Fixed dental bridges is what we usually refer to when talking about dental bridges. They are permanently bonded in the mouth and can be removed only by the dentist. Removable dental bridges are most often referred as partial dentures. They are held in place by metal clasps or precision attachments. Removable dental bridges are less expensive but they are not recommended unless fixed dental bridges can not be used.

Fixed dental bridges can be categorized in the following types:

• Traditional Fixed Dental Bridges – Traditional fixed dental bridges consist of one or more artificial teeth (pontics) fused to two crowns that are attached onto the teeth on each side of the false tooth/teeth (abutments) holding the bridge in place . They are the most commonly used type of dental bridges and they are usually made of either porcelain fused to metal or ceramics.
• Bonded Dental Bridges (also called a Maryland dental bridge because the first resin-bonded dental bridge was developed at the University of Maryland) – Bonded dental bridges make use of a metal framework on which the ‘pontic’ tooth is fused. The framework has two metal bands on its edges that are bonded with a resin directly on the back of existing abutment teeth on each side. This type of fixed dental bridge reduces the removal of healthy tooth enamel from the abutment teeth in order to prepare them for the placement of dental crowns as in traditional bridges. For this reason they are usually less expensive but they are not as strong. Maryland Bonded Bridges are more suitable for replacing missing teeth towards the front of the mouth where the biting pressures are not too high.
• Cantilever Dental Bridge – When there is an adjacent tooth on only one side of the missing tooth or teeth, the bridge can be attached to only one abutment. In this case the restoration is known as cantilever dental bridge. The other edge of the cantilever dental bridge is not anchored. It may be connected to dental crowns or attached by metal clasps or precision attachments. The use of a cantilever dental bridge is most common when back molars are missing. It can also be used in areas of little stress such as front teeth requiring only one crown and reducing the dental bridge cost.
• Implant-supported bridge – Dental Implant Bridge – When several adjacent teeth are missing, neither a traditional or a cantilever bridge can be used. If more than two pontics are needed, the abutment teeth that have to withstand all the forces get too much pressure increasing the risk of tooth fracture or bridge breakage. In these cases the dentist will recommend an implant-supported bridge or a removable partial denture. If the patient can afford the increased cost, a dental implant bridge is the best choice. The difference of a dental implant bridge from a traditional one is that instead of being supported by crowns on natural abutment teeth, the crowns are placed on artificial teeth using dental implants. The number of dental implants required depends on the number of missing teeth and they are must be enough to allow an even distribution of the biting forces. In another implementation of a dental implant bridge, two pontics are fused on either side of an implant supported crown.

The dental bridge type most suitable for each patient will be determined by the dentist depending on the number and position of missing teeth, the condition of remaining teeth, budget restrictions, and the aesthetic requirements of the patient.