Bridges to replace missing teeth

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A dental bridge, a Fixed bridge or bridgework is one of the ways to replace a missing tooth or teeth. Although a denture is easily the most commonly used method due to its low cost, it is not fixed in and one has to take dentures out at night time and for cleaning after meals.

A bridge is the most common way to have a fixed tooth so unlike a denture, it does not need to come out for cleaning etc. It’s fixed and stays in. A bridge is a false tooth to replace the tooth that has been extracted and is missing. It is held in using one or more of the patient’s own neighbouring natural teeth. For the neighbouring tooth to provide this attachment, it must be of good stable condition and the natural tooth has be quite extensively modified or trimmed down in the same way a crown is placed over a tooth before the bridge can be attached on.

There is a sub-category in this type of fixed tooth replacement and it’s called an “adhesive bridge” or an “acid etch bridge.” The main advantage of this sub-category of bridge is that there is much less modification needed on the adjacent teeth to hold the fixed tooth in position. In some cases no tooth preparation is required at all. They are however less strong and are prone to dislodging much more than a conventional type of bridge. In general, adhesive bridges  are used only for the replacement of  one front tooth where the biting forces are less compared to the heavy pressures on the big molars at the back of the mouth.

The biggest disadvantages of a dental bridge is that once the adjacent teeth have been modified or trimmed, then they have been altered forever. There is no going back even if the anchor teeth were totally healthy beforehand. Decay can occur under bridge teeth and quite often when it does occur, the decay has gone so deep that further teeth end up being lost. Once this happens, the costs and inconvenience to put everything right again goes up hugely and sometimes when this scenario happens, another fixed bridge is not even possible again. You are then back to wearing a denture or to consider dental implants. The other issue with bridgework is one of aesthetics. It is not possible to produce an exact likeness of the replacement tooth or teeth to what it was like naturally. At the back of the mouth, this is not too much of a big deal but it can be a big issue at the front in the smile zone. Furthermore, a bridge gets it’s strength from a layer of metal underneath the covering porcelain. This metal can become apparent when over a passage of time, the gum around the neck of the tooth shrinks hence exposing a black line showing up of the metal.

If the metal is unsightly then the only option is to take off the old bridge and make a new bridge with margins under the gum line. This procedure does have risks because of the damage that can occur to  your tooth underneath. Patient’s also have to be aware that the pulp or nerve of a tooth can die or become infected. This is surprisingly common and studies put this at about 10%.

Should this happen, a root canal treatment has to be performed by drilling through the back of the bridge. Although the above disadvantages of having a bridge to replace a missing tooth seem bad, this is still a good method as a bridge can produce good results lasting many years. A bridge is also much less costly than an implant and can be done in far fewer visits. Quite often a dental implant cannot be placed due to lack of bone height and width so here is where a bridge is indicated.

 

REFERENCES

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1Department of Medical Biotechnologies, Division of Fixed Prosthodontics, University of Siena, Siena, Italy2Department of Restorative Dentistry, University of Leeds, Leeds, UK
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1Department of Medical Biotechnologies, Division of Fixed Prosthodontics, University of Siena, Siena, Italy3Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
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