Bridges to replace missing teeth


What are your options if you have a missing tooth or teeth are missing?

There is more than one option which includes having bridge-work carried out.

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 that one has to take dentures out at night time and for cleaning after meals. Conversely, a bridge is fixed and you are unable to take it out yourself.

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 but the natural tooth has been quite extensively modified or trimmed down in the same way a crown is placed over a tooth before the bridge can be attached on. A bridge has advantages but also can have disadvantages.

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Advantages & Disadvantages

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. An adhesive bridge is held in using a bonding agent to secure the bridge onto the tooth enamel.

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 also 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 its 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 20%. This means that if you are having a bridge made, you have a 20% chance that you will need a root canal treatment in future at extra cost and inconvenience.

How long will your bridge last? If you get 10 years out of it, you’re doing quite well. On average, you’ll need a replacement bridge every 10 years.

As stated above, root canal treatment may also be required. 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 complex and costly than an implant and can be done in far fewer visits. Dental implants cannot be placed in all situations so this is where a bridge comes in useful.  Quite often a dental implant cannot be placed due to lack of bone height and width so here is where a bridge is indicated.