Dental bridges, like implants and partial dentures, are used to replace missing teeth.

Problems Faced With Missing Teeth

There are numerous reasons why someone may be missing teeth. Perhaps a tooth was lost to injury or even removed because of excessive decay - whatever the reason; missing teeth are a common complaint at the dental office.

Why should you get the missing tooth or teeth replaced? There are several reasons - the most popular being aesthetics. A smile that shows a missing tooth often sends an uncomplimentary message to others. From a dentist's standpoint though, there are greater concerns than just appearance.  

Before and after placement of a dental bridge for a missing tooth.

When a tooth is missing, it is not uncommon for the tooth above it to begin erupting (coming out of its socket) into the empty space. Missing teeth can alter speech sounds and adversely affect childhood development or an adult's professional life. A missing tooth can also result in nearby teeth drifting, or tipping, into the open space. Problems in occlusion (bite) can arise, making it difficult to close the mouth. If left untreated, temporomandibular joint disorder may even develop. It is important to note that teeth can move at any age, so replacing missing teeth is not just a childhood concern.  

Even with such consequences, not all teeth require replacement. Dentists never recommend replacing a wisdom tooth for example. Also, in the case of older patients, lost second molars rarely affect function and often do not require replacement. Always question your dentist's reasons for wanting to replace a missing tooth that is not affecting your lifestyle.

Available Options For Replacing Teeth/Tooth

Dentists have several options for replacing missing teeth - not all options apply to every patient though. The following are viable options for replacing one or more teeth:
 

· Dental Implants

· Partial or Full Dentures

· Bridges (Fixed, Resin-bonded, or Cantilever)

There are various factors that dentists consider in choosing the best option. Some include:

Cost: Dental implants are very costly, and are not covered by most dental insurance programs. Bridges are usually second in cost, followed by partial or full dentures.

Time: Bridges are usually completed by two appointments in the course of a week. Dentures are made as quickly, but need adjustments over a few weeks to fit the patient. Implants involve surgery, and require several months for healing. For all procedures though, temporary teeth will be placed in the open space while the final prosthesis is being manufactured.

Number of teeth missing: When only 1 or 2 teeth are missing, implants are the best option. Implants can also be placed to provide support for dentures in certain implant-supported-denture cases. Bridges are usually placed when no more than 2-3 teeth are missing since longer spanning bridges are prone to collapsing. Partial dentures are good for cases when more than 3-4 teeth are missing, and complete dentures are for when all teeth are missing.

Oral health: The biggest dental concern is the condition within the mouth. Bridges need to be supported by nearby teeth, so those teeth need to be of sound health. Nothing is more aggravating than paying for a costly bridge, only to have it fail because the supporting teeth could not handle the added stress. Similarly, few dentists will place implants in patients who are avid smokers, as they are prone to failure.

Comfort: Dental implants are the gold standard for replacing missing teeth, and many patients can hardly tell them apart from real teeth. Bridges are also highly aesthetic and fixed in the mouth, but keeping them clean can be difficult. Dentures can appear natural, but can slip out while eating certain foods, so most patients cannot function normally.

Always ask your dentist why they chose a particular treatment in replacing missing teeth. They should be more than willing to explain their reasoning to you.

What is a dental bridge?

Dental bridges are a fixed solution for replacing a missing tooth or teeth - unlike dentures, they cannot be removed. An artificial tooth is held in the open space at the gum line by attaching it to teeth on either side of the missing tooth. If several teeth are missing, artificial teeth are strung together and attached to adjacent real teeth. As one would expect, the supporting real teeth need to be of good health, or else the entire bridge will collapse. If done properly, bridges are capable of with-standing normal daily stresses and being made of porcelain makes them indistinguishable from real teeth.

Types of dental bridges

The most common type is the conventional fixed dental bridge. For this bridge, the dentist trims both teeth adjacent to the missing tooth, and cements a porcelain crown on top of each. Attached to the two crowns is an artificial tooth (or pontic) in the middle. This arrangement provides maximum support since any force applied to the artificial tooth is spread to the two nearby sound teeth.

Another form of a dental bridge is a cantilever bridge. In a cantilever setup, only one adjacent tooth is trimmed and fitted with a crown that is attached to the artificial tooth. Trimming a tooth involves removing large amounts of tooth structure from healthy teeth, so a dentist might choose this option to preserve tooth structure. The downside for cantilever bridges is that support for the artificial tooth is provided by only the one tooth. This limits its use to areas of the mouth which receive little stress during chewing.

Finally, the dentist may opt for a resin-bonded bridge or Maryland bridge. These bridges require minimal trimming of adjacent teeth, and rely on plastic resin to hold the artificial tooth in place. This makes them very weak, and should therefore only be considered for replacing front teeth, provided that the gums are healthy and the surrounding teeth do not have extensive dental fillings.

Who should receive a bridge? Who should not?

Bridges are esthetic, permanently fixed in place, and moderate in cost. These features make them ideal for patients missing one or a few teeth. Unfortunately, their success is largely tied to the oral health of the patient. Patients who do not brush and floss regularly have bridge failures because bridges are highly susceptible to decay. Once decay has begun, the dentist is forced to remove the costly bridge.

Most dentists will look at the condition of the patient's other teeth before recommending bridges. Poor oral hygiene, heavy smoking, or supporting teeth which are mobile, are reasons for why bridges may be excluded for a patient.

Dental Bridge Procedure

Conventional fixed dental bridge procedure outlined.

If your dentist has determined that you are a candidate for a dental bridge, the procedure will begin with you receiving local anesthetic. The anesthetic ensures that you will feel no pain throughout the treatment.

Next, your dentist will likely take an impression of your mouth using a putty-like material. This captures what your teeth looked like prior to the treatment. Using dental drills, the teeth on either side of the missing tooth (support teeth) will then be trimmed. If these support teeth are decayed, your dentist will likely first repair the decay, then trim then down.

Once the neighboring teeth have been trimmed, another impression will be taken using the putty-material. This impression captures what your teeth look like following the treatment. It will be sent to a dental laboratory where over the course of a week, they will fabricate the bridge that fits on this impression. This bridge is then sent back to your dentist.

Before you leave your first appointment, your dentist fits you with a temporary bridge so the teeth and gums can be protected from damage until your permanent bridge is ready. This temporary bridge is made on the spot, so it is not made from porcelain and therefore, is much weaker and less aesthetic than the permanent bridge. It is held in place by temporary cement so that it can be removed at the next appointment.

During your second appointment, your dentist will try on the permanent bridge that was fabricated to ensure it fits. You will have a chance to see how it appears and feels before it is cemented in place permanently. Your dentist may make some minor adjustments to it to ensure your bite (occlusion) is well following the cementation.

Cost

The cost of a fixed dental bridge related to the number of teeth missing. Resin-bonded bridges or Maryland bridges are less expensive, but fracture easily. Dental bridges are among the most expensive treatments in dentistry, but patient acceptance and satisfaction are very positive. Nearly all patients say that treatment result justifies the cost.

Dental bridges, from start to finish, are roughly $1000 in cost, per missing tooth. Factors which alter the cost include the material the bridge is made from, whether your dental insurance covers any of the charge, the abilities of the dentist/laboratory technician, and whether any other procedures are needed such as dental fillings or root canals on the support teeth.

Longevity

With proper dental care, and regular dental checkups, dental bridges can last from 10-20 years. Factors that determine longevity include the dental material, quality of dental work, and patient maintenance. Every component is equally important - so you need to play an active role in maintaining good oral health.

Advantages, Disadvantages & Risks

Advantages include that dental bridges appear and function similar to natural teeth. They remain in the mouth at all times. Disadvantages are that natural teeth need to be trimmed down so that the bridge can be attached, and these natural teeth may be overloaded by stresses placed on them. Another disadvantage is cost - dental bridges are relatively costly compared to dentures.  

Risks are that the extra load on the supporting teeth can weaken, break or cause pulp death in these teeth. The crowns (caps) that connect to the supporting teeth can become loose if not cemented or fitted well - making the natural teeth susceptible to decay.