Dental Bridges

When a tooth or teeth are missing there are three options for its replacement

• A denture
• A bridge
• A dental implant

A bridge is so called because it behaves a little like a bridge across a river. It is usually connected to the two teeth either side of a gap and holds the false tooth or teeth in the middle. Occasionally if it’s a small tooth missing then the bridge may be held by a bigger tooth only on one end which is called a cantilever bridge.

There are two types of tooth supported bridges in common use otherwise- conventional or Maryland which is also known as acid etch. Bridges may also be retained by dental implants.

Conventional bridges require the supporting teeth to be trimmed down with a little bit taken off the height and the four sides. This allows the bridgework to entirely enclose the supporting teeth. Conventional bridges can be made from a variety of materials from gold to porcelain to a mixture of metals with porcelain over the top. They can also be made from acrylic. Conventional bridges tend to be made where the biting force may be relatively high and also where the teeth either side of the space are filled already and may benefit from being covered over. As long as the supporting teeth behave themselves a conventional bridge that is well looked after should last about fifteen years.

Maryland or acid etch bridges are held in place by metal or ceramic wings on the tongue or palate side of the supporting teeth. They are much more conservative than conventional bridgework and involve less tooth structure removal. This is their main advantage and they can be performed on teeth that already have veneers on the other side. However acid etch bridges aren’t as strong as conventional and aren’t suitable in every situation or bite type. They also don’t last as long with a lifespan of 6-8 years considered the norm.

We have examples of all bridge types in our practice.

Regardless of the type of bridge the bridge should fit snugly and be aesthetic. Its shade will be matched to the neighbouring teeth. The technicians are very skilled at crafting teeth that are lustrous, lifelike and a beautiful shape. Some bridge types have some metal showing on the tongue side of the teeth.

If that’s the case an example will be shown beforehand. There should be no interference in the bite and in general one should be unaware that it’s not your own tooth. Bridges are cemented on and shouldn’t in any way feel loose.

Bridges vary a lot in type, size and material and are usually priced per unit. What this means is a bridge replacing one tooth would be three units- one either end and the false tooth makes three. An acrylic or composite bridge might be 200euro per unit but porcelain fused to precious metal maybe 800 euro per unit for conventional bridgework. All-porcelain bridgework is now the most commonly used and is 700 per unit.  Maryland bridges generally cost from 1000-1200 euro.

As the false tooth is attached to the neighbouring teeth it is impossible to pass floss down in the normal way from the top of the tooth down to the gum. However, food will collect under the bridge and need to be removed. There are various tools for achieving this

• Floss threaders are almost exactly the same as the device used for passing thread through a needle. It is attached to a piece of floss and pushed gently between the supporting tooth and the false tooth. The floss is then wrapped around the supporting tooth and moved up and down. Following this then floss in gently moved under the false tooth over to the other supporting tooth and the process repeated.
• Superfloss has a rigid end and a thicker foam-like piece in the middle and is threaded through using the rigid bit until the thicker piece is in between the teeth. Otherwise, it is used in the same manner as above.
• If the space is large a small interdental brush could be used in a toothpick like action. This is however unlikely to fit under the false tooth—an area which is important to clean well.
• Various mechanical flossers now exist such as Waterpik which can be used under the false tooth gently and in between the teeth.

It should be remembered that the false tooth should be treated like a normal tooth otherwise and brushed well with a soft bristle toothbrush using the modified bass technique. Please click on the following link for a demonstration.

Occasionally a bridge may become loose and if the supporting teeth are in good condition may be recemented. If a bridge is broken perhaps one broken end can be removed and the bridge made a cantilever type hung off only one end. In general, however, it has to be said that a broken bridge usually means a bridge that is for the scrap heap.

If the tooth underneath is broken or decayed the bridge just will not fit as closely as it needs to once the tooth is repaired (if indeed it’s possible). It should be said that occasionally a fractured piece of porcelain can be repaired also. This would require careful consideration as to what caused the fracture.