Dental Bridges – Types, Risks and benefits

dental bridges

Also called: Removable Partial Dentures, Removable Bridges, Fixed Partial Dentures, Partial Dentures, Fixed Bridges

Reviewed By:
Andrew M. Sicklick, D.D.S.

Summary

A bridge is a device that replaces missing teeth with artificial teeth that are anchored to adjacent teeth or implants. Also called a partial denture, a bridge may be permanently attached (fixed) or removable and may last five to seven years or longer.

There are numerous types of bridges available, which can be made from various materials. In a traditional bridge, the artificial teeth, or pontics, are attached to natural abutment teeth located on either side of the gap. A cantilever bridge is attached to only one abutment and the other side is not anchored. In a Maryland bridge, the pontics are attached by a metal framework that is bonded directly to the abutment teeth along the back of the teeth. An implant-supported bridge is anchored to implants that are attached to the jaw.

Before a bridge can be created and placed, a patient needs to have an initial consultation and evaluation by a general dentist or a prosthodontist. This will include a dental examination and a medical and dental history.

A bridge is a type of indirect restoration. This means that it will require two or more visits to the dental office: one to prepare the abutment teeth and make impressions and another to fit and adjust the bridge and secure it into place. During the time between these visits, the impressions are sent to a dental laboratory, where the bridge is created.

Patients may need time to adjust to bridges. They may feel bulky and awkward at first. Patients may experience soreness, discomfort, or excessive production of saliva until they become accustomed to the bridges. Patients may also need to adjust their eating habits.

Natural changes in the mouth and jaw occur with age. Regular dental examinations are important to maintain a proper fit over time. Adjustments are made by the dentist in a dental office. Bridges can be damaged beyond repair by patients who attempt to fix or modify them. Because of this, it is important to see a dentist for any repairs or adjustments.

Bridges have disadvantages. They can break, chip or crack. In addition, healthy teeth must be prepared to serve as abutments by cutting away tooth enamel. This may weaken a healthy tooth. Poorly-fitting bridges can cause sores and irritations.

Bridges require special care. Different types of bridges may require different types of specific care. A dentist will explain how to care for a given bridge, including when to wear and when to remove a removable bridge.

About dental bridges

A bridge is a dental appliance that replaces missing teeth with artificial teeth that are anchored to adjacent teeth or implants. Also called a partial denture, a bridge may be permanently attached or removable and may last five to seven years or longer, depending on care and upkeep. Bridges may be used to replace teeth that are missing for any reason, including injury, tooth decay or periodontal disease.

A bridge is composed of pontics and abutments. The pontics are the artificial teeth that replace the missing teeth. The abutments are the structures that anchor the bridge in place. Abutments may be natural teeth that have been specially prepared to anchor the bridge or they may be special dental implants.

Bridges may be fixed or removable. Fixed bridges are permanently attached and can only be removed by a dentist. They may be attached to artificial crowns on the abutments or they may be bonded directly to the abutment teeth. Removable bridges can be taken out for cleaning. They may be held in place by metal clasps that attach to natural teeth or by precision attachments. Precision attachments are nearly invisible but are typically more expensive than metal clasps. Artificial crowns may be used on the abutment teeth to help secure the fit of a precision attachment.

The numerous types of bridges may be made of various materials. Only a dentist or dental specialist (e.g., prosthodontist) can determine what materials are most appropriate for a specific patient. Factors that influence this decision include the location of the bridge in the mouth (e.g., visible or not visible area) and patient preference and health. Materials frequently used in bridges include:

  • Gold alloys. Composed of a combination of gold, copper and other metals. These materials are tough and strong. They are highly resistant to tarnishing, corrosion, fracture and wear. These materials do not tend to require as much removal of healthy tooth material as other bridge materials. They are gentle to the nearby teeth and are well tolerated by patients. However, many patients do not like the metallic gold color.

  • Base metal alloys. Composed of a combination of base metals. These materials are also tough. They are highly resistant to fracture, wear, tarnishing and corrosion. However, they have a metallic silver color that many patients do not like. They may also cause an allergic reaction or initial discomfort with hot and cold in some patients.

  • Porcelain. May be composed of porcelain, ceramics or glasslike materials. These materials have a color and translucency that closely matches natural teeth. They are also highly resistant to wear. However, they may be prone to fracture and can wear down nearby teeth if the porcelain surface becomes rough.

  • Porcelain fused to metal (PFM). Composed of a porcelain crown bonded to a metal base. This combination is strong and durable and highly resistant to wear. However, it can wear down nearby teeth if the porcelain surface becomes rough. It may also cause an allergic sensitivity or initial discomfort with hot and cold in some patients.

  • Composite resin. Composed of a type of composite plastic. This material tends to be relatively inexpensive and looks like natural teeth. However, it may stain more readily than porcelain. This material is not as strong or durable as porcelain, but also does not excessively wear down nearby teeth. 

These materials or combinations of these materials can be used to produce many different types of bridges. Scientists are examining potential new materials for stronger, more natural looking bridges.

Types and differences of dental bridges

Only a dentist or dental specialist (e.g., prosthodontist) can determine what type of bridge is most appropriate for a specific patient. Different types of bridges include:

  • Traditional bridge. The artificial teeth (pontics) are attached to natural abutment teeth located on either side of the gap. The pontics are typically connected to artificial crowns on the abutments in a fixed (permanent) bridge. A removable bridge may be attached to the abutments by metal clasps or precision attachments. Traditional bridges are the most common type of bridge and are usually made of porcelain fused to metal.
  • Cantilever bridge. This bridge is attached to only one abutment. The other side is not anchored. This type is most common in the back molars, which are not flanked by a tooth on both sides. It may be connected to artificial crowns or attached by metal clasps or precision attachments.
  • Maryland bridge. Also called a Maryland bonded bridge or a resin-bonded bridge. This bridge has a metal framework across the back of the pontic teeth with “wings” to either side. The wings are bonded directly to the abutment teeth to hold the bridge in place. This tends to be less expensive, but it is not very strong. It is generally used in areas where biting and chewing forces are not high, such as the incisors.
  • Implant-supported bridge. The bridge is anchored to implants that are attached to the jaw. It is used when two or more teeth are missing. Each missing tooth is replaced with an implant, and a series of connected artificial crowns are placed over the implants. They are either screwed into the implants or cemented into place. The connected crowns help to reduce the stress that chewing can have on individual implants, dispersing the stress over the entire length of the bridge.

    An implant-supported bridge may also resemble a traditional bridge, with two implant-supported crowns on either side of a suspended crown. This may be done to avoid using an implant in certain areas (e.g., where it would be too close to a nerve or sinus cavity, or where there is not enough jawbone to support the implant).

Before and during the dental bridge procedure

Before a bridge can be created and placed, a patient needs to have an initial consultation and evaluation by a general dentist or a prosthodontist. This will include a comprehensive dental examination and a medical and dental history. X-rays and impressions of the teeth may be taken. In some cases, the dentist may order a computed axial tomography (CAT) scan. This may be important if an implant-supported bridge is planned. The CAT scan is used to determine how much bone is available in the jaw and the exact position of sinuses and nerves. If not enough bone is present to support the bridge, bone grafting or some other bone surgery may be recommended before further dental procedures can occur.

A bridge is a type of indirect restoration. This means that it will require two or more visits to the dental office: one to prepare the abutment teeth and make impressions and another to fit and adjust the bridge and secure it into place. During the time between these visits, the impressions are sent to a dental laboratory, where the bridge is created.

The preparation stage varies depending on what type of bridge will be used. If natural teeth are to serve as abutments, they may need artificial crowns, especially if a fixed bridge is planned. A root canal treatment is usually not necessary if the teeth are healthy and strong. However, part of the natural crowns will have to be removed to accommodate the artificial crowns. Some enamel is typically removed from natural abutment teeth with other types of bridges as well. The amount removed depends on how the bridge is connected. Typically, only enough enamel is removed to accommodate the size of the attachments.

If implants are to be used for the abutment teeth, they must first be surgically placed. This often takes two separate surgical procedures.

  • First, the implant is surgically placed within the jaw and covered with the gums. The jaw and gums are allowed time to heal so that the implant can fuse with the bone of the jaw. This may take three to six months.

  • Second, the head of the implant is exposed in a much more minor surgery. The permanent bridge is placed in the area after the gums have healed from this second surgery, which may take four to eight weeks.

Some dentists use a one-step process instead. This involves surgically placing implants into the jaw, while leaving the head of the implant exposed. Therefore, a second surgery is not needed.

After the abutments, either natural or implanted, have been prepared, an impression is made of the area to be restored. The impression is then sent to a dental laboratory, where it is used to make the permanent bridge. Meanwhile, a temporary bridge is placed over the prepared abutments. When the abutments consist of natural teeth with portions of their enamel removed to accommodate the crowns, the temporary bridge protects them and helps maintain their position in the mouth.

For surgically placed implants, a temporary bridge cushions the implant and allows the gum to continue to heal around the implant. Temporary bridges also provide cosmetic appeal while patients wait for their permanent bridge.

After the permanent bridge has been made and sent back to the dental office, the patient returns for another visit. The bridge is set in the mouth and checked for proper fit. It is adjusted as necessary. If the dentist cannot adjust the bridge to the extent needed to ensure a good fit, it may have to be sent back to the laboratory for more adjustment.

After the dentist determines that the bridge fits correctly, it is attached to the abutments. A fixed bridge is bonded into place either by cementing attached crowns to abutment teeth or by bonding directly to the teeth. If a removable bridge is used, the dentist will explain and demonstrate how to put in and remove the bridge. An implant-supported bridge may be either screwed or cemented to the implants. The screw-holes on the type that are screwed in are filled after a proper fit is verified on the permanent bridge. Typically, a composite resin material that matches the tooth color is used.

After the dental bridge procedure

Patients may need time to adjust to bridges. Inserting and removing removable bridges may take some practice. It is important to follow the dentist’s instruction closely. Do not force a bridge into position – it should fit relatively easily.

Bridges, especially removable or large fixed bridges, may feel bulky and awkward at first. Patients will eventually adjust to the feel of these dental appliances. Patients may feel some discomfort and soreness at first, but this will improve over time. The presence of the bridge may also cause more saliva to be produced until the mouth adapts to it.

Patients may need to make some changes in their eating habits while becoming accustomed to wearing a bridge. They may need to avoid certain foods, such as tough meats, raw vegetables and anything sticky. Soft foods that are cut into small pieces are typically recommended. After patients have become accustomed to their bridges, they may return to their previous diet, or at least something similar.

Patients who have difficulty making certain sounds after a bridge has been placed are encouraged to practice speaking. Speaking slowly, reading aloud and repeating troublesome words may help patients adapt to speaking with a bridge in their mouths. Regular dental examinations are important whether or not the patient wears a bridge. Dental examinations are also important to maintain a proper fit because natural changes in the mouth and jaw occur with age. The dentist can make many of these adjustments in the dental office. However, in some cases, a new bridge may be required. A dentist can recommend how often patients with bridges should have their fit examined.

Risks and benefits of dental bridges

The greatest benefit of bridges is the replacement of missing teeth. This is important for a number of reasons. The teeth are necessary to chew properly and are used to help form the sounds in words. They also help to establish and maintain the shape of the face. Missing teeth can place increased stress on the jaw that can lead to problems with the muscles and the temporomandibular joint (jaw joint). Finally, teeth preserve the positions of neighboring teeth. If a tooth is missing, the neighboring teeth may move into the open area.

However, bridges have some disadvantages. They require special care. They can break, chip or crack and an artificial tooth (pontic) may come loose. Bridges can also be damaged by patients who attempt to fix or modify them. Because of this, it is important to see a dentist for any repairs or adjustments.

For many types of bridges, especially fixed bridges, nearby teeth must be prepared to serve as abutments. This typically involves the irreversible removal of tooth enamel from otherwise healthy teeth to make room for artificial crowns.Poorly-fitting bridges can cause sores and irritations. Bridges that do not fit properly can also trap certain substances against the gums or natural teeth. This can greatly increase the risk of tooth decay. Furthermore, if cancer-causing substances (e.g., alcohol, tobacco) are trapped against the gum, the risk of oral cancer may be increased.

Lifestyle considerations with dental bridges

Different types of bridges may require different types of specific care. A dentist will explain how to care for a given bridge, including when to wear and when to remove a removable bridge.

Bridges may be fragile. They can break, chip or fracture if dropped or struck. Patients may want to insert or remove a removable bridge while standing over a folded towel or a sink filled with water to help protect the bridge if it falls.

It is important that remaining teeth are kept healthy with diligent dental hygiene. If the natural teeth that support the bridge are damaged, the bridge will not fit well and may need to be replaced.

The bridge itself needs to be cleaned daily to remove food particles and plaque and to prevent stains. A dentist may recommend a special brush designed for cleaning bridges and dentures. However, a regular soft-bristled toothbrush may also be appropriate. Toothbrushes with hard bristles can damage the bridge. Patients are generally advised to avoid abrasive toothpastes on the bridge, although a gentle toothpaste may be acceptable. A dentist may recommend a special denture cleanser. It is also important to clean the gum beneath a removable bridge. Patients with fixed bridges may use a device called a floss threader to floss under their bridge. These devices help patients to pass dental floss between the artificial (pontic) teeth in the bridge and their gums.

Patients with bridges may have to make some permanent adjustments to their eating habits. Certain foods (e.g., very sticky foods) may need to be avoided if they affect the fit of the bridge or cause other problems. Patients may also need to relearn how to eat. They are generally encouraged to use both sides of the mouth to chew and to use the canine teeth and those behind them to bite, avoiding the use of the incisors.

Depending on the location of the bridge, patients may experience difficulty speaking clearly. This occurs when the size or shape of the mouth has changed due to the presence of the bridge. Patients may have trouble pronouncing certain sounds (e.g., “s” and “f” sounds). It may feel as though there is not enough room for the tongue, or that a person is speaking with a mouth full of marbles. This is usually a temporary condition as patients adjust to speaking with a dental appliance in the mouth. This may take a few weeks, although it can differ from patient to patient. Tips for adjusting to speaking clearly with a new bridge include practice reading out loud, especially those sounds or words that are troublesome. Repetition can help a patient become accustomed to speaking with a bridge. If speech difficulties continue, patients should consult their dentist.

Questions for your doctor regarding dental bridges

Preparing questions in advance can help patients have more meaningful discussions regarding their conditions. Patients may wish to ask their dentist the following bridge-related questions:

  1. What type of bridge is right for me?
  2. What will my bridge be made of?
  3. Will my bridge be fixed or removable?
  4. How many visits will it take to prepare my teeth and attach my bridge?
  5. Will I need to have a root canal treatment before a bridge can be placed?
  6. Will I have to go without a bridge for a while? How long?
  7. How should I care for my bridge?
  8. How often should I schedule an appointment to check the fit of my bridge and make any necessary adjustments?
  9. How long is my bridge likely to last?
  10. Are there any alternatives to bridges that may be appropriate for me?
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