What is a Dental Bridge?
A dental bridge is a fixed (permanent) restoration that replaces one or more missing teeth in a patient’s dental arch. In more serious cases, a dentist positions multiple bridges to provide full mouth rehabilitation. Most bridges consist of porcelain that bond to a metal structure for support. Some are made of “all-ceramic,” which is a combination of porcelain and other materials that are similar in appearance.
All types of bridges mimic the look, shape, and function of natural teeth and are custom-made for every patient. The amount of tooth structure removal required for bridges is the same for both anterior and posterior teeth. All abutment teeth are prepared like a crown, removing all enamel and any additional tooth structure necessary to create a parallel path of insertion with the other abutment tooth.
Less tooth removal is possible for Maryland bridges because it attaches to the backside of the front teeth adjacent to a missing tooth space. All other bridges require a significant amount of tooth structure removal. The surrounding teeth support an entire structure, rather than just a single tooth restoration.
In a survey conducted by the American Academy of Cosmetic Dentistry (AACD), bridges were the sixth most common dental procedure patients received in 2013 (28 percent). Participants could select as many procedures as applicable:
“Almost 70 percent of adults between 35 and 44 years of age have lost at least one tooth from gum disease, an injury, tooth decay, or a failed root canal.”
Dental Bridge vs. Dental Implant
Implants and bridges are used to restore missing teeth. Although, the cost, look, and outcome of the procedures vary.
Advantages of Implants:
- Require less maintenance.
- Look more natural.
- Protect the jawbone.
- Do not strain or wear down teeth over time.
Disadvantages of Implants:
- They require more invasive surgery.
- A single tooth implant and restoration are slightly more expensive than a 3-unit bridge (which replaces a single missing tooth).
- The recovery time is longer.
- They can fracture or break.
Advantages of Bridges:
- The procedure is quicker and doesn’t require invasive surgery (unless the bridge is supported by implants).
- Recovery time is faster.
- They are more affordable.
Disadvantages of Bridges:
- Do not look as natural as implants.
- Must be replaced periodically.
- More prone to fractures and decay.
- Damage natural teeth (surrounding teeth).
When is a Bridge Needed?
Dentists only recommend bridges over implants when the patient already has existing dental crowns on the abutment teeth or when they are unable to have implants for medical reasons. Similar to implants, patients receive a bridge following a tooth extraction or tooth loss, typically due to:
Types of Bridges
There are four main types a dentist will recommend depending on needs, including:
Traditional bridges are the most common type of dental bridge. They consist of ceramic, PFM, or all-metal like gold. These bridges have one fake tooth, also called a pontic, that a dental crown holds in place on each side. A dentist shapes and files the two teeth adjacent to the fake tooth in order to successfully fit the two artificial crowns. Traditional bridges are durable, strong, and last a long time with proper care. They typically restore posterior (back) teeth, such as premolars and molars.
Cantilever bridges are similar to traditional bridges because they incorporate the same materials (porcelain fused to metal). Although, cantilevers require one natural tooth next to the gap. If a patient has one healthy tooth next to the fake tooth, a dentist rarely recommends a cantilever bridge because they have a high failure rate. The abutment tooth must be much larger with a much stronger root than the tooth being replaced. An artificial crown is placed over the unhealthy tooth on either side and requires shaping and contouring before bridge placement. They typically restore anterior teeth because they aren’t strong enough to support molars.
Maryland bridges, also called adhesive bridges, are less invasive than traditional options (traditional and cantilever). Although, instead of shaping adjacent teeth and placing crowns, a Maryland bridge consists of a pontic that is supported by a metal framework. Maryland bridges are also made with porcelain “wings” for improved aesthetic, which is more common than metal nowadays. This type of bridge is made of porcelain, porcelain fused to metal, and “wings” that bond to the adjacent teeth. They typically restore incisors and are rarely used to restore missing canines. This is because canines are too important to occlusion (the bite). Maryland bridges would dislodge and debond very easily.
Instead of being held up by a metal framework or crowns, this type of bridge is supported entirely by dental implants. Bridges must either sit on natural teeth at both ends or implants at both ends. Implant-supported bridges are ideal for patients who have at least three teeth missing in a row. They typically restore posterior (back teeth), such as premolars and molars.
Dental Bridge Procedure: Step-By-Step
First Visit — Teeth Preparation and Temporary Bridge Placement
During the first appointment, a dentist administers a local anesthetic to ensure the patient is comfortable and doesn’t feel any pain during the procedure. Then they shape and file the adjacent (supporting) teeth. After the teeth are shaped, impressions are made and sent to a dental laboratory to create the custom bridge. While the permanent bridge is being constructed, the dentist places a temporary bridge over the newly shaped teeth and gap. If the surrounding teeth are not strong enough to support a bridge, a dentist installs dental implants into the jawbone (implant-supported bridge).
Second Visit — Permanent Bridge Placement
Once the permanent bridge is ready, the patient will return for their second appointment. First, the dentist removes the temporary bridge and cleans the teeth. If the patient has sensitivity or pain, they will administer a local anesthetic before the temporary bridge is removed. Before cementing, the dentist takes x-rays of the bridge to confirm the proper fit. Then dental cement bonds the bridge and teeth together.
Oral Hygiene —Aftercare for bridges and crowns is relatively similar. Although, extra oral hygiene techniques are necessary following a permanent bridge placement. The area where the pontic (fake tooth) rests on the gums is difficult to clean, which may result in plaque and oral bacteria buildup. Patients are recommended to use mouthwash vigorously, brush at least twice a day, and floss underneath the bridge regularly to reduce gingival inflammation and prevent cavities at the edge of the bridge. This requires additional tools, such as floss threaders, superfloss, or water flossers.
Pain Maintenance — traditional, Maryland, and cantilever bridges are relatively painless procedures. Although, some patients may experience gum swelling or tenderness. Dentists recommend simple analgesic medications, such as ibuprofen, to manage the pain. Implant-supported bridges require minor surgery, which may result in tooth sensitivity, gum tenderness, and jaw swelling for the first few days after surgery.
Food — while a patient’s permanent bridge is being made, they will get a temporary bridge to protect the newly shaped teeth. During this transition period, avoid eating:
- Sticky or chewy foods, such as gum and candy.
- Hard foods, such as nuts and chips.
- Patients should also chew on the opposite side of their mouth with a temporary bridge in place.
A patient can typically return to normal eating habits after the permanent bridge is applied.
Although, dentists recommend avoiding sticky and hard foods for 24 hours after the procedure.
Treatment Costs for Bridges
Traditional or Cantilever Bridges
$2000-$5000 (includes one pontic and two crowns)
$1500-$2500 (includes one pontic and the framework)
$2500-$6500 (per implant)