The term dental bridge refers to a restoration which is used to replace missing teeth. Before dental implants were available, bridges were the only restoration which could replace a missing tooth and be fixed in the mouth. A bridge refers to a restoration which is attached in some way to a tooth either side of a missing tooth. It is fixed to these teeth in that it cannot be removed once it is placed.
It is an excellent way to replace missing teeth. A dental bridge is robust and if required very aesthetic. A dental bridge requires the preparation of the teeth either side of a space in a similar way to a preparation required for a crown. The main difference is that the teeth either side of a space need to be prepared parallel to each other so that a single Bridge can be made to be placed onto these teeth.
Bridges have a limited life span. In a Prosthodontic practice, a bridge would be expected to last for between 15 and 20 years. This would be discussed as part of the consultation process. Dental implants are now a common procedure for replacing missing teeth. In some cases dental implants are not suitable or possible. In these situations, bridges are the only other alternative for a fixed replacement of a missing tooth.
A bridge is an indirect restoration similar to a crown. It is made in a dental laboratory from either a ceramic or metal alloy. These are made using dental or digital impressions. While these are being made, a temporary bridge is made to restore the teeth and missing tooth.
Examination and Consultation
A Prosthodontic examination for a dental bridge would include an assessment of all the teeth, gums, and surrounding bone. A Prosthodontist would also assess the way your teeth fit together and how strongly the muscles in your jaws work. These observations would give us an idea of whether a bridge would work into the long-term. The forces placed on your teeth would give us an idea of what type of materials would be required.
Sometimes the teeth are either too small or do not have enough bone around them to support a bridge. We would need to assess all of these factors to allow a prediction for a bridge to last for at least 15 years. During the consultation process, we discuss alternatives available as well as advantages and disadvantages of bridges.
A bridge preparation appointment involves local anaesthetic, tooth preparation, a final bridge impression, bite recording, and construction and placement of a temporary bridge.
The tooth preparation appointment is similar in many ways to the preparations for crowns. The main differences being that care needs to be taken to make sure that the teeth are prepared parallel to each other. The appointment is normally twice as long as the appointment required for a crown. At the end of the appointment a temporary bridge is constructed and cemented with a temporary cement.
Construction of a temporary bridge is a more complex and time consuming procedure than required for a temporary single crown. The teeth are prepared so that the bridge will have enough thickness to withstand the biting forces into the long-term.
Placement of the bridge
The bridge is constructed in a dental laboratory in either ceramic, gold alloy, or a combination of both. The construction process is quite exacting. The bridge edges are polished using a microscope. The more precisely the bridge is made, the longer it will last. At the placement appointment, the temporary bridge is removed along with the temporary cement. The bridge fit, colour, and shape is checked and adjusted if necessary. Once this has been assessed to be correct, the bridge is usually placed initially with a temporary cement for 2 or 3 weeks. This will give you time to assess whether you are comfortable with the bridge.
The comfort of the bridge is assessed in the bite as well as the shape and colour. As bridges also replace missing teeth, it is important to know whether they work correctly when chewing and eating. Following this 2 or 3-week temporary stage, we will review the bridge and make changes if required. These changes normally take approximately 60 minutes and are carried out at our dental laboratory next door. If the changes we make our significant, we will sometimes replace the bridge temporarily for a another few weeks to make sure that it is perfect. Following this, it is placed with a permanent cement. Once this is done, the bridge is not able to be removed.
Normally mild analgesics including Panadol and Nurofen are taken following the tooth preparation appointment. We normally recommend taking these initially before the anaesthetic wears off. We then recommend a second analgesic prior to sleep. There is usually mild to moderate discomfort for approximately 24-48 hours following the initial procedure. Anything worse than this would be controlled with stronger pain killers or would require reassessment by us.
After bridge placement
There is usually little if any discomfort following placement of the bridge. It does take some time to get used to the new shapes inside the mouth. If the tooth being replaced has been missing for quite some time, it can feel a little unusual when it is first placed. The main disadvantage of a bridge is that the components are connected and it is necessary to use a floss threader. The most usual way to clean a bridge is with interproximal brushes which are small bristle brushes used to clean between the teeth at the gumline. This is important to be carried out on a daily basis.
Dental treatment needs to be checked on a regular basis. A normal long-term dental bridge would include regular check-ups with your dentist. A bridge should be x-rayed approximately every 2 years to make sure that decay does not start at the edges. A well-made dental bridge is usually fairly trouble free. Apart from yearly checking and a clean it should offer many years of use.