I’m missing a tooth! Now what? – Part III (Bridges)
The second option to replacing missing teeth is what’s called a fixed partial denture; most commonly known as a “bridge”. Some people confuse the term and call partial dentures, bridges. There is a big difference. The main one being, bridges are permanently cemented in your mouth, whereas a partial denture is removable.
In order to get a bridge, the most important thing is there needs to be teeth on both sides of the empty space. A bridge is, basically, a crown (cap) on each tooth next to the empty space, with a “dummy” (false) tooth attached to them. This is then cemented into place; it does NOT come in or out. Like a real bridge, there is support on both ends and the bridge spanning between them. If there is only 1 tooth next to an empty space, USUALLY a bridge is not an option.
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Also important is the span of the empty space. If the empty space is too long, then either more teeth are going to be needed to help support the bridge, or a bridge may not be a good option to get. The longer that span is, the more the bridge can flex in the middle, which can compromise the integrity of the supporting teeth. Whether or not an area can be restored with a bridge will be determined by the dentist, who will evaluate the length of the empty space, the amount of vertical space available, any supererupted teeth on the opposing arch, any parafunctional habits (grinding, clenching), etc. All of these factors play an important part into the “restorability” of an empty space as well as the future prognosis of the fabricated bridge. For example, if a patient comes in with an empty space that is on the longer side (several teeth missing) with a grinding habit that is significant, then that patient may be a candidate for a bridge, but the prognosis may be guarded afterwards; meaning, there is a higher chance that that bridge may fail sooner than a bridge replacing a shorter span empty space on a non-grinder.
So, what are the pros and cons of bridges?
The pros are:
- They are a “permanent” restoration. This does not mean that they are meant to last forever, but rather, that they do not come in and out like a removable partial denture. There is no fear that this will accidentally pop out of your mouth as you’re speaking to someone.
- They are stronger than removable partial dentures. Porcelain is a much stronger material than acrylic used in dentures. Most people are able to chew and function as they had when they had natural teeth.
- There is no bulkiness or metal clasps as there are with removable partial dentures. There is no lisping or learning curve as there would be with a removable partial denture.
- If the adjacent teeth need crowns anyway, a bridge can solve 2 problems at once. It fills in the empty space and crowns the problematic adjacent tooth at the same time.
- Probably the most common method to restore a missing tooth.
- Success rates are pretty good, as long as hygiene is maintained.
- Can achieve very esthetic results, as compared to a denture.
The cons are:
- Bridges, like crowns, are supported by natural teeth. The problems you can have with natural teeth are the same type of problems you can have with teeth supporting a bridge. You can still get cavities on these teeth and you can still get bone loss around them. Having a bridge, or crown, on these teeth do not make them invincible to cavities and bone loss. If you get cavities, you will likely have to replace the whole bridge. If you get bone loss to the point where that tooth needs to be extracted, then you will need a new bridge that is longer.
- The teeth/crowns on a bridge are splinted together. You cannot floss “normally” in-between them. There is a special technique to floss under a bridge. This technique tends to be more cumbersome and, ultimately, a lot of people end up not flossing under bridges at all. However, hygiene with a bridge is very important since they are being held up with natural teeth (as mentioned earlier). Issues with supporting teeth could lead to the need for a new bridge or a longer bridge.
- The porcelain could chip on a bridge. This is the same risk you would have with a single crown. The risk increases if you have a parafunctional habit, such as grinding or clenching, and the type of diet you have (hard foods, like almonds, hard candy, etc). The only way to fix a chipped bridge is to get a new bridge.
- The preparation of the teeth for a bridge is determined by the angulation of these teeth. The more parallel they are to each other, the better. However, sometimes one of the supporting teeth may be angled/tilted too much. Preparing the teeth to get them parallel to each other may end up involving the nerve of the tooth. Therefore, in order to get a bridge, a root canal may have to be performed just to be able to get the preparations parallel to each other.
- The adjacent teeth may be perfectly fine teeth. I like to call these teeth “virgin” teeth, meaning there are no fillings or cavities or anything wrong with the adjacent teeth. If you want to get a bridge, you would have to prepare (or grind down) perfectly good teeth.
- The bone in our jaws pretty much has 1 purpose, and it’s to keep our teeth in place. When we lose a tooth, the bone that was once holding that tooth in place TENDS to resorb away. This resorption process differs in every person. For some, this process may be fast. In others, this process may be slow. It is not something that can be predetermined. So, although a bridge covers the empty space with a false tooth, there isn’t actually a tooth IN the bone. There is a possibility that that bone could resorb (shrink) over time. If this occurs, the space between the false tooth and the gums could become larger and larger. This becomes an area where food can get caught more easily. The more food that gets caught, the more flossing that needs to be done. If not, more bone loss could occur on the adjacent teeth, which in turn, could cause more bone resorption as well. It becomes this vicious cycle. Again, the only way to correct this would be to get a new bridge that closes up the space between the false tooth and the gums. This bone loss could be vertical, but it could also be horizontal; meaning, you could have a concavity on the bone (see photo below). So, if you move your finger along your gums, from the back of your mouth to the front, you will notice that, for the most part, it is pretty flat. If there are some “bumps”, that is usually the root of your tooth pushing the bone out. This is normal. However, if you’re missing a tooth, you may notice that as you move your finger across your gums, there may be a concavity or dimple in the area where you are missing a tooth. This is caused from bone loss or resorption. However, instead of lossing bone vertically, or away from your false tooth, you are losing bone horizontally. This can also lead to more food trapping under the bridge, if the bone loss is significant enough. This is a more difficult situation to correct, but one I will not get into just yet; mainly because getting a new bridge will not resolve the issue.
I, personally, feel the pros outweigh the cons, and find that this is a very common, successful restoration to obtain. However, it is still important to have all the facts available to make an informed decision for your future treatment.
NEXT: Part IV – Dental Implants