Dental Bridge

Dental bridge is a permanent prosthesis designed to replace missing tooth or teeth.

What is a Dental Bridge?

Dental bridge is a great fixed option for replacing missing teeth.  After a dental bridge is fabricated, it is cemented permanently in the mouth. It used to be the only fixed option to replace a missing tooth or teeth until dental implants appeared on the market.  A dental bridge consists of crowns that are attached to each other to make the entire prosthesis. Each crown in a bridge is referred to as a unit. If we wanted to replace one missing tooth, a three-unit bridge would be required. One of the units would replace the missing tooth and the adjacent crowns or units act as support. The crown that replaces the missing tooth is referred to as a pontic. Any unit of a bridge that is not cemented onto a natural tooth is a pontic. The supporting units of a dental bridge are referred to as abutments.  One of the main requirements for a dental bridge is that you have to have good supporting abutments on either side of the empty space so that the prosthesis can support the occlusal load (pressure exerted on the teeth during chewing).

Purpose Of A Dental Bridge

  • Replacing missing teeth with a fix prosthesis (not removable)
  • Provide a pleasing esthetic appearance
  • Improves the integrity of the dental arch (this will allow for improved chewing abilities)
  • Avoid that sunken cheek appearance caused by missing teeth usually present in the older population
  • Stabilizes that area of the dental arch to give you a more youthful appearance
  • A bridge is permanently cemented on to provide ideal esthetics and function

Dental Bridge and Oral Hygiene

Obtaining a restoration such as a crown or a bridge means maintaining excellent home care. Brushing twice a day and flossing at least once is essential in maintaining good oral health. Plaque and bacteria are more prone to collecting on a teeth that have a crown or a bridge than natural teeth. Flossing under the bridge can be a challenge, especially for individuals with poor manual dexterity.  It is very important to floss under the pontic or false tooth to prevent collection of plaque, which can lead to bone loss and decay.

Floss Threader and Superfloss:

Several floss aids are used for areas that cannot be reached with regular floss. These aids allow for thorough maintenance of a dental bridge in order to increase its functional life.  Superfloss and floss threaders are designed to make cleaning under the bridge easy.  It takes a few extra seconds to use them however, they  can make a big difference.  A floss threader is used to pass floss through tight areas under the bridge.  Superfloss is more effective in areas where there may be space between the pontic of a bridge and the gum tissue.

Threader for Floss
Floss threaders are used to help get the floss under a bridge

Superfloss
Superfloss is used for easier access to difficult to reach areas of teeth supporting a bridge

Types of Dental Bridges (Fixed Partial Dentures)

All metal bridge:

Metal Dental Bridge
Base metal fixed partial dentures are used when cost may be an issue for the patient
  • can either be yellow gold or base metal
  • rarely done today, unaesthetic, strong and durable
  • gold and some base metal bridges have great marginal integrity.  This means that they have an excellent fit.
  • bridge made up of yellow gold will be more expensive and is dependent on gold prices
  • cost of a base metal bridge is much less than the gold
  • gold is a soft, inert metal. Gold allergies are very rare. Gingiva or the gum tissue around the tooth stays healthy because of the great fit obtained with a gold restoration and the non-reactive nature of gold
  • base metal restorations are made from alloys, which can contain traces of metals that can elicit an allergic reaction

 

 

 

 

Porcelain Fused To Metal:

PFM Dental Bridge
PFM bridges are used in areas of high stress, with the benefit of esthetic appearance
  • commonly fabricated
  • provides an excellent fit like a metal crown with porcelain layer to provide with esthetic appearance
  • porcelain can fracture under certain conditions (usually insufficient thickness or excessive thickness)
  • the prosthesis can “black out”  discolored teeth with the metal portion while still providing an esthetic appearance
  • when the gum tissue recedes, a dark shadow can become apparent around the gum line. This usually leads to replacement because of compromised esthetics

 

All Porcelain Bridge:

  • all porcelain dental bridge can be fabricated thanks to improved materials and porcelain restoration fabrication techniques
  • made from very strong type of porcelain that can withstand the stress of chewing forces
  • masking discolored teeth is easier today with latest technique in an all porcelain prosthesis
  • very esthetic result

    All Porcelain Bridge
    Today most of the dental bridges are fabricated out of porcelain due to high strength of porcelain
  • In very severe cases of excessive biting pressure, or very long-span prosthesis, porcelain can fracture. Some of the more common reasons for fracture include:
    • grinding of teeth
    • chewing on things (pencil, pipe, ice)
    • microscopic defects in the structure of porcelain
    • incorrect thickness of porcelain during fabrication
    • interference during jaw movement

These problems were mostly seen with older porcelain and porcelain crown fabrication techniques.  Today porcelain crowns and bridges are milled from a block of porcelain, which minimizes internal defects and makes the final prosthesis much stronger.

Cost of Dental Bridge

The cost of a dental bridge is determined by adding up the number of abutments and pontics and multiplying it by the cost of an individual crown. The cost will vary upon the materials used to fabricate the bridge. A very esthetic, all porcelain dental bridge is usually more expensive.  On average, a cost of a 3-unit bridge will be 3000 to 3600 dollars.  The cost will increase if more units are added.   Just like the cost of a dental crown vary greatly across the country, the same is true for a dental bridge as well.

The cost of a 3-unit bridge is almost the same as a cost of an implant.  In these cases, an implant may be a better option.  The cost savings start adding up when you need a four or more unit bridge.  The cost of each unit that will replace a missing tooth will go up by the price of the crown.  For comparison, each implant that will replace a single tooth will cost you between 3000 and 3800 dollars.

Dental Bridge Insurance Coverage

Dental insurance coverage of a dental bridge is similar to a dental crown. Each bridge unit will count as a single crown. With most dental insurance plans, dental crowns are covered at 50 percent, although the coverage can range from 50 to 100 percent depending on the plan. This includes any pontics, or false teeth, that the bridge might have. Therefore a three-unit bridge will be charged out as three separate crowns. If you are considering a dental bridge, the limiting factor to how much the dental insurance company might cover would be your yearly dollar maximum. Ask the dental office representative to provide you with an estimate so that there are no surprises. If you would like to be absolutely sure that the insurance will cover the cost of the bridge you can request that your dental office sends a pre-estimate to the insurance company. In a response letter the insurance company will estimate total coverage for the bridge, and your financial responsibility, if you decide to get the work completed.

Dental Bridge Variation

Fixed dental bridge
An example of a cantilever bridge. There is no support on the back side of the bridge

A conventional bridge requires that we have healthy teeth on either side of the missing tooth area.  What happens in a situation where there is no back tooth to support the bridge?  In these situations, at least theoretically, a cantilever bridge could be placed.  A cantilever bridge consists of at least one abutment and one floating pontic, although it can contain more. The benefit of a cantilever bridge is that potentially only one tooth is prepared for a crown. It is rarely used because of potential issues which can occur. Since the cantilever bridge is only supported from one side there is potential for overstressing the supporting tooth or teeth. This could loosen up the tooth and cause local chronic inflammation and pain.  In severe cases it can lead to tooth loss.  Think about a real estate sign hanging from a pole. If you hang a heavy “For Sale” sign, the pole will tilt to the side where the sign is hanging and can come loose over time.  If the sign is supported by two poles, one on either side, the sign is going to be well supported over a long period of time.  The same thing can happen with  a natural tooth.  Too much pressure applied to the tooth that supports a cantilever bridge can cause long-term problems.

Maryland Bridge

Esthetic Dental Bridge
A bridge used to replace a missing tooth in younger individuals to preserve the health of pulp tissue

A Maryland bridge is usually a three-unit bridge designed to replace a missing tooth in younger individuals. One of the main advantages of this type of bridge is that only a small portion of the natural tooth is shaved down. This helps preserve the health of the pulp tissue (nerve of the tooth). This is crucial in younger individuals because the pulp chamber is large and the pulp tissue of the tooth is more prone to injury. If a conventional bridge was completed the prepared teeth might require root canal treatment. One of the disadvantages of a Maryland bridge is that it is only partially cemented in place making it less resistant to occlusal (biting) forces as well as lateral forces exerted during chewing or grinding of teeth.

A dental bridge is an excellent restorative option for replacing missing teeth. Even with dental implants being very popular, not all patients are good candidates for implant placement. See your dentist for an evaluation to determine which option would be better for you. Not convinced by your dentist’s recommendation?  It is easy to get a second opinion.