Dental Bridges
Dental bridges are used to fill the space left by one or more missing teeth. A dental bridge consists of one or more false teeth (called "pontics"), that are placed between two natural or implant teeth (called "abutment teeth"). The bridge is attached to the abutment teeth by crowns.
The world market for dental crowns and bridges amounts to approximately 110,000,000 teeth per year! Approximately 85 percent of dental crowns and bridges are metal-based and 15 percent ceramic-based.
Patients over 50 tend to have the most dental bridge procedures. As members of the baby-boom generation advance into middle age, more and more people will require bridge work. According to a survey by the American Academy of Cosmetic Dentistry (AACD), the most common procedures for patients over 50 are crowns and bridges.
The use of ceramics in bridges is quickly growing in popularity. Many patients prefer ceramic bridges because they offer a more natural and beautiful appearance.
Procedure
A mild anesthetic is administered to numb the gum area where the bridge will be installed. The cosmetic dentist then removes an area of each abutment tooth on either side of the missing tooth space to accommodate for the thickness of the crowns to be installed. If the abutment teeth already have fillings, part of the filling may be left in place to help as a foundation for the crown.
The dentist will make an impression of the open space, which will serve as the model for the dental laboratory to make the bridge, the false teeth, and the crowns. To protect the teeth and gums, a temporary bridge may be placed in the mouth until the next dental visit.
Some cosmetic dentists may require their patients to use a Flipper appliance (a false tooth) to temporarily take the place of a missing tooth before the permanent bridge is placed. A Flipper can be attached using a wire or a plastic piece that fits in the roof of the mouth.
During the next visit to the dentist, the temporary bridge is removed and the new permanent bridge is fitted. Before the bridge is cemented to the teeth, it is evaluated.
Types of Dental Bridges
Traditional Fixed Bridge: Fixed bridges are comprised of two crowns cemented to abutment teeth on either side of the missing tooth space. These porcelain crowns hold a pontic in place. The pontic is then fused between the crowns. Unlike partial dentures, fixed bridges cannot be taken out of the mouth. With good oral hygiene and maintenance, fixed bridges can last 10 years or more.
Resin Bonded Bridges ("Maryland" Bridge): The resin bonded bridge is used when the abutment teeth are healthy and do not have large fillings, thereby reducing the amount of preparation on the adjacent teeth. This bridge is used primarily for the front teeth. The pontic is fused to metal bands that have been bonded to the abutment teeth with resin.
Cantilever Bridges: When there are teeth on only one side of the open space, cantilever bridges are used. The cantilever bridge involves securing the pontic to one side over one or more adjacent teeth.
Costs of Dental Bridges
Depending on which type of dental bridge procedure you choose, the cost ranges from $200-$2,000 per tooth. Dental insurance will typically pay for about half the cost of a bridge procedure.
Pros: Bridges are natural in appearance and usually require only two visits to the dentist. Bridges can reduce the risk of gum disease, help correct bite issues, and improve speech.
Cons: Teeth may become sensitive to extreme temperatures for a few weeks after the treatment. The build-up of bacteria formed from food acids on teeth and gums can become infected if proper oral hygiene is not followed, which could possibly result in further treatment and the loss of the bridge.
Ask a Dentist, Dental Q & A - Crowns and Bridges
How long does it take for a procedure?
The first visit to the dentist will be about one hour. If all goes well with the fitting, the second visit is about 45 minutes, but this could be longer if adjustments to the fit need to be made.
How many dental visits does it require?
Two to three visits. If there are no complications experienced by the patient, the procedure is performed in two visits. The first visit is for a temporary crown and the 2nd visit is to fit the permanent crown and/or bridge.
What are the various things I should keep in mind to get prepared for the procedure?
On the day of the teeth whitening appointment, it is highly recommended that a patient cleans his/her teeth thoroughly. The dentist will also check and clean the teeth prior to the procedure, but it saves time to be prepared.
What does the dentist need to know about the patient?
The dentist should be informed of any and all medical conditions. This is necessary to avoid any complications that might occur during or after the procedure.
What should I expect during the procedure?
On the first visit, the patient will be given a local anesthetic. Depending upon the type of local anesthetic used, the patient can expect to be numb for one to four hours. The dentist will prepare your tooth in a specific way to retain the new porcelain to metal crown. A thin piece of retraction cord is placed around your tooth to get the impression material under the gum where the crown ends. The dentist, or dental assistant, will place a temporary crown (or bridge, if multiple teeth are involved) on the tooth. These plastic restorations are placed on teeth to protect the teeth and the gum tissues between dental visits.
On the second visit, the temporary crown is removed and any temporary cement is cleaned from the prepared tooth. The dentist will fit the final crown, check for accuracy, make adjustments for any bite discrepancies, and evaluate the esthetics. The crown is then cemented to your tooth.
What to do in between the first and the second visit to the dentist?
Home care is extremely important while your temporary crown is in place. The health of your gum tissue and the success of your final treatment depend upon it. Dentists recommend cleaning your teeth between visits.
Does the dentist use a laboratory for the procedure and is the cost of lab included in cost of the procedure?
The impressions of the teeth are sent to the lab to get custom-made bridges. The cost of the lab work is usually included in the procedure cost and should be discussed with the dentist.
What do most people experience after the procedure?
After the first visit, a patient can experience a slight degree of discomfort, but nothing that cannot be remedied with ordinary Aspirin or Tylenol. It is not uncommon to have sensitivity to heat, cold, or pressure, but if sensitivity persists beyond a few days, call your dentist. With bridges or crowns, recovery is quick, and teeth are back to normal within one or two days.
Are there any prescriptions provided after the procedure?
Take any antibiotics or other prescribed medications only as directed by your dentist.
What medical conditions would disqualify a person from getting a certain procedure?
It depends on each case that a dentist gets. Individuals with heart conditions should definitely inform the dentist.
How long do the results last?
With care, crowns and bridges can last five to 15 years, some significantly longer. The ultimate timeframe depends upon the oral health habits of the patient.
Post-Procedure recommendations
It is strongly recommend that patients avoid eating sticky foods like gum, caramels, and taffy. Avoid hard candy and definitely do not chew ice cubes!
If anesthetic was used during the procedure, avoid chewing until the numbness has completely worn off. Avoid chewing for at least 30 minutes to allow the temporary cement to set. To keep your temporary bridge in place, avoid eating hard or sticky foods, especially chewing gum. If possible, chew food only on the opposite side of your mouth that the bridge and/or crown is placed. Brush normally but floss very carefully. A dentist normally recommends special floss, brushes, or other cleaning aids to keep the area free of bacteria.
Use one teaspoon of salt in one cup of warm water to rinse your mouth three times a day. This will reduce any discomfort or swelling in the mouth. It is normal for gums to be sore for several days.
Call your dentist immediately if:
The temporary bridge comes off.
The temporary bridge does not fit properly, the bite feels uneven, or you have persistent sensitivity or discomfort.
Sources:
Christopher A. Jordan, DDS.
