What is a dental bridge?
A dental bridge is a type of dental restoration that can replace one or more missing teeth. A dental bridge has 2 components; A pontic, which replaces the missing tooth/teeth and the adjacent abutment teeth. Dental bridges restore the function of the teeth and improve the smile. They can also help prevent the shifting of the remaining teeth and can help to maintain the proper bite relationship.
There are several types of dental bridges, including traditional bridges, cantilever bridges, Maryland bridges, and implant-supported bridges. The type of bridge that is best for a particular individual will depend on the specific needs and circumstances of that individual.
Dental bridges can be fabricated from various materials, including porcelain, ceramic, resin, or metal. The material used will depend on the location of the missing teeth, the colour of the surrounding teeth, and the individual’s preferences.
The types and options of dental bridges
Below are dental bridge options for patients:
Traditional bridges
Traditional bridges are the most common type of dental bridge. They consist of one or more pontics (artificial teeth) between two adjacent crowns. The crowns are placed on the abutment teeth (the teeth adjacent to the missing tooth) and anchor the pontic in place. Traditional bridges usually are made from porcelain, ceramic, or a combination of these materials.
Cantilever bridges
Cantilever bridges are supported by one abutment tooth and are typically utilized when only one or two teeth are missing. These bridges rely on the strength of the existing, healthy abutment tooth to hold in place the prosthetic replacement teeth that span across the gap left by extraction or decay.
Maryland bridges
Maryland bridges, also known as resin-bonded bridges, are made from porcelain or composite resin and are supported by a metal framework. The framework is bonded to the backs of the abutment teeth, with the pontic between the abutment. Usually, Maryland bridges are given in cases where the missing teeth are located in the front of the mouth and the abutment teeth are healthy.
Implant-supported bridges
Implant-supported bridges are supported by dental implants rather than by natural teeth. Dental implants are small titanium screws that are placed in the jawbone and act as a replacement for the roots of missing teeth. Implant-supported bridges are generally more stable and durable than traditional bridges, but they also require a surgical procedure to place the implants.
It is important to discuss the various options with a dental professional to determine which type of dental bridge is best for an individual’s specific needs and circumstances. Factors that might influence the decision include the location and number of missing teeth, the health of the abutment teeth, and the individual’s budget and preferences.
Which bridge treatment type is the quickest and least invasive?
Cantilever bridges are the quickest and least invasive type of dental bridges, requiring just one abutment tooth, as opposed to traditional bridges which require two. As a result, they are usually used when there are fewer than two missing teeth and when the abutment teeth are strong enough to support the bridge.
The process of getting a cantilever bridge involves the following steps:
- Consultation – The first step is a dental consultation to assess the individual’s oral health and determine the number and location of the missing teeth. The dentist will determine whether a cantilever bridge is a suitable treatment option.
- Preparation – If the individual is a candidate for a cantilever bridge, the next step is to prepare the abutment tooth. This may involve removing a small amount of enamel from the surface of the tooth to make room for the crown.
- Fabrication – The next step is to take an impression of the abutment tooth and the surrounding teeth and send it to a dental laboratory, where the cantilever bridge will be fabricated. This process can take several weeks.
- Placement – Once the cantilever bridge is ready, the individual will be called to the dental office for placement. The dental professional will remove any temporary crowns or fillings that were placed during the preparation process and will cement the cantilever bridge in place.
Getting a cantilever bridge is a relatively straightforward process that usually only requires two to three visits to the dental office. No surgery is necessary, making this procedure much less invasive than alternatives such as traditional bridges, Maryland bridges, and implant-supported bridges, which generally take longer to complete, as we will discover below.
Which bridge treatment type takes the longest and is most invasive?
Implant-supported bridges generally take the longest to complete and are the most invasive type of dental bridge as they require a surgical procedure to place the dental implants in the jawbone.
The implant-supported bridge process usually involves these steps:
- Consultation – The first step is to meet with a dental professional to determine whether implant-supported bridges are a suitable treatment option. The dental professional will assess the individual’s oral health and determine the number and location of the missing teeth.
- Implant placement – If the individual is a candidate for implant-supported bridges, the next step is to place the dental implants in the jawbone. This is typically done under local anaesthesia and may involve making an incision in the gum tissue to access the jawbone. The implants are then placed in the jawbone and allowed to heal for several months.
- Implant restoration – After the implants have had time to heal and integrate with the jawbone, the dental professional will attach a custom-made bridge to the implants. The bridge will consist of one or more pontics (artificial teeth) that are suspended between the implants.
Of these three types of bridge treatments (implant-supported, traditional, Maryland and cantilever bridges), the process of getting implant-supported bridges is the longest and most invasive. This treatment can take several months to a year to complete and involves surgery, unlike the other types of bridges which can typically be completed in two or three visits to the dental office and do not require surgery.
Difference in the mechanical functioning of natural teeth vs a dental bridge
The mechanical relationship of a natural tooth differs from a dental bridge. The periodontal ligament (PDL), a soft substance around the root, connects the natural tooth to the alveolar bone through the root. The stress distribution around the natural tooth and dental bridge are different under occlusal loading.
In my dental experience, I have come across patients where inappropriate dental bridge designs have caused stress concentration, resulting in the patient experiencing constant pain when biting, which will result in rapid bone loss amongst other issues.
Which bridge treatment type has the best success rates?
Implant-supported bridges generally have the best outcomes and last the longest of all types of dental bridge treatment. This is because they are supported by dental implants, which are small titanium screws that are placed in the jawbone and act as a replacement for the roots of missing teeth. Implant-supported bridges are generally more stable and durable than traditional bridges, which are supported by natural teeth.
Of all the types of bridge treatment available, implant-supported bridges have the highest success rate and longest life expectancy. This is because they are secured in place by titanium implants that are drilled into the jawbone, acting as a replacement for missing tooth roots, making them more secure and reliable than traditional bridges, which are supported by natural teeth.
The success rate for dental implants is generally high, with studies reporting success rates of 95% or higher. Implant-supported bridges can last for many years with proper care and maintenance and are often considered a permanent solution for replacing missing teeth.
The longevity of an implant-supported bridge will depend on several factors, including the individual’s oral hygiene, the quality of the implant and the bridge, and the individual’s overall health. Individuals with implant-supported bridges need to maintain good oral hygiene and have regular dental checkups and cleanings.
While implant-supported bridges generally have the best outcomes and longest lifespan, other types of dental bridges can also be effective and long-lasting. As we have seen above, traditional bridges, cantilever bridges, and Maryland bridges can all be good options for some patients, depending on their specific needs and circumstances.
What is the downside of a dental bridge?
Like any dental treatment, there are pros and cons to consider when deciding the right choice for a dental bridge.
One downside of a dental bridge is that it requires the preparation of the adjacent teeth, also known as abutment teeth. This means that a small amount of healthy tooth structure must be removed to place the bridge, which can lead to sensitivity or discomfort in the abutment teeth and can also weaken them over time.
Doesn’t address underlying issues
Another downside of a dental bridge is that it does not address the underlying problem that led to the missing tooth or teeth in the first place. For example, if a tooth was lost due to gum disease, a bridge will not treat the disease and may even exacerbate it if the problem is left untreated.
Dental bridges are not a permanent solution
A well-fabricated bridge can have a lifespan between 5-15 years and may require replacement or adjustments over time.
Bridges are not removable
Patients can’t remove a dental bridge, so proper oral hygiene habits and daily cleaning is required. Negligence of proper oral hygiene can result in decay or gum problems.
A dental bridge can be a good option for replacing missing teeth, but it is important to weigh the potential downsides against the benefits before making a decision. It’s always a good idea to talk to your dentist and get a second opinion from a dental professional to make sure you are choosing the best option for your individual needs and circumstance.
Can dental bridges become loose or fall out easily?
Dental bridges are designed to be a permanent solution for replacing missing teeth and are usually not prone to falling out easily. However, there are certain situations where a bridge may come loose or fall out, such as:
Poor oral hygiene: If plaque and tartar buildup accumulates around the abutment teeth, decay and gum disease can compromise the bridge and might make it weak or unsteady. Meticulous, consistent oral hygiene & regular dental checkups are necessary to prevent such problems.
Improper fitting: Poor fit of the bridge due to incorrect installation can cause it to loosen over time, rendering it ineffective, and failing.
Keep in mind that bridges have an average lifespan of 5-7 years. Regular dental check-ups for assessing the condition of bridge and any potential issues is necessary. Over time the bridge may need to be replaced or adjusted due to wear and tear.
In summary, dental bridges are designed as a permanent solution and should not fall out easily. However, due to poor oral hygiene or a lack of proper fit, a bridge may come loose or fall out. Maintaining good oral hygiene habits and regular dental check-ups should help to prevent a dental bridge from falling out.
While bridges are cemented to teeth with strong biocompatible cement, they can get loose or come out. In such cases, there is no need to panic, just keep your bridge with you and take it back to your dentist. Your dentist will clean it and cement it back.